Musculo Skeletal Power Point

7/31/2019 Musculo Skeletal Power Point

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Chief complaints:Pain: - Bone/ muscle/joints.Bone pain - Deep/ Dull/ and Throbbing.Muscle pain -- Cramping/ Soreness.Rheumatoid arthritis -- Joint pain / Stiffness.Weakness -- Myopathy/ Neuropathy.Proximal weakness -Difficulty in lifting

objects/ combing hairUpper extremitiesLower extremities -- Difficulty in walking/

crossing the knees


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Distal weakness -- Difficulty in dressing/turning a door knobUpper extremitiesMyasthenia gravis -- Diplopia/ swallowing/

chewing/ Generalizedmuscle weakness.

Stiffness --Worse at any particular

time of the day(arising)Balance and co ordination -- Falling/ lossing

balance ataxia/irregularUn co ordinate voluntary movements.


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PAST HEALTH HISTORY:Child hood illness -- Juvenile Rheumatoidarthritis/ cerebralPalsy/musculardystrophy.

Surgery -- Surgery involving bones/muscles/ joints

Other supportingstructures.


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Diagnostic procedures:Post menopausal women -- Dexa scanSerious injuries -- In joints/

muscles / bones.Chronic illness -- Medical problem/

SLE/Arthritis/Synovitis

Myositis/HIV/TB/Diabetes/Charcots

joints.


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Immunization -- TT/Polio.Allergies -- Diary products/

Lactose intolerance.

MedicationsMiddle aged women -- Estrogen replacement

therapy.

(Menopausal)Recent travel -- Exposure to

chemicals /Lymedisease.


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PERSONAL HISTORY -- Smoking/ alcohol/drug abuse.FAMILY HISTORY:Familial musculoskeletal problems Gout/

arthritis/osteoporosis.LIFE STYLE AND HEALTH PRACTICESSmoking - How many/ How often/ How for.

Alcohol -quantity/ amount/How for/Howoften

Exercise - Timing/Daily/ weekly.

Stress - Kind of stress


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PSYCHO SOCIAL HISTORYOccupation history -- Travel to foreigncountry

Geographical location -- Recent travel.Environment - Living conditionNutrition -- Vegetarian/ non vegetarianHabit -- Life style


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ALCOHOL CAGE QUESTIONNAIRE:C ---- Have you ever felt, you should cut downon your alcohol intake.

A ------ Have people annoyed you bycriticizing your alcohol intake.

G ----- Have you ever felt guilty about youralcohol intake.

E ------ Have you ever needed alcohol for aneye opener.


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ASSESSING READINESS TO QUITE SMOKING 5 ASAsk about tobacco use.Advise to quite through clear personalized

messagesAssess willingness to quiteAssess to quiteArrange follow up and support.


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EXERCIZE -FITTF ------- Frequency of exerciseI -------Intensity

T --------Time/ durationT --------Type of exercise.


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HEAD TO TOE PHYSICAL ASSESSMENT.General appearance Thin/ moderately built/obese

Height - LossWeight - Gain / LossHeadFace - Symmetrical/

Asymmetrical Oedema - Present/ Absent


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Eye - Dry red eyesEye brow - Equal distribution of hair/sparingly distributed/Absent

Eye lashes - Equal distribution of hair/sparingly distributed/

Absent

Conjunctiva -Pale/red yellow / pink.Eye lids - Able to open and close/

ptosis

Pupils - PERLA


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EarPosition - Above the level of the outercantus/at the level ofThe outer cantus /below thelevel of the outer Can thus.

Drainage - Present/ AbsentNostrils - Patent/ obstructed

Septum - Centre / deviatedDischarge - Present / Absent.


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MouthLips -Dry/moistGums - Healthy/SwollenOdour - present/Absent

Throat - Normal / Inflamed/ulcer/nodules /swellingDiscoloration/ Inflammation.

Neck - Swollen glandsTrachea - Mid line/ deviated.Neck muscle retraction - Present/ Absent


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ChestInspectionChest movement Symmetrical/AsymmetricalAuscultation - S1 S2 heard / lung sound

heardPercussion - Hyper resonant/ resonant/ dullPalpation - Mass/ tenderness

Abdomen -Nausea/ vomiting/ DiarrhoeaGenitalia - STD /Menopause/HRT/LesionsExternal - Drainage/ edema/ inflammation/

odour.


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Lower extremitiesROM - Full/ LimitedChanges in sensation - Numbness/ tinglingSYSTEMIC ASSESSMENTCENTRAL NERVOUS SYSTEMLevel of consciousness - Alert/ awake/

Lethargy/ obtunded/

stupor/comaDress and grooming -Neat/ meticulous

grooming


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Facial expression -- Good eye contact/ pooreye contactHead ache -- Present/ absent.Loss of sensation - Numbness/ Tingling

CARDIOVASCULAR SYSTEMRheumatoid heart disease/pericarditis/ Myocarditis/

Raynauds disease.RESPIRATORY SYSTEM

-Interstitial fibrosis/ pleuritis / pneu

monitis pleural effusion


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Gastrointertinal system : GI Pain / diarrhoea

nausea /vomiting/

difficulty inswallowing

Genito urinary system : HaematuriaReproductive system :Menstrual

Irregularities back pain

Neurological : Loss of sensation /

numbness tinglingEndocrine system : Muscle wasting

/weakness muscle

ache /pain


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Assessing Joints and Muscles :

Upper and lower ExtremitiesInspect / palpate : Muscle mass / toneTempromandibular jointInspect / Palpate : ROM / Muscle strengthSterno clavicular JointInspect / Palpate : Location to midline / color

swelling / pain / massesCervical, thoracic and lumbar spine :Inspect / Palpate

cervical spine Tenderness /

Pain / test room musclestrength neck

Cervical Spine ROM :Hyper extension / HexionRt lateral bending /

Lt lateral Bending


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Left Rotation / Rt rotation

Thoracic and lumbarspine: Hyper extension /

flexion RtLateral bending /Lt lateral Bending

Left rotation / Rt rotationShouldersInspect : Symmetry / Swelling

Palpate : color / masses

ROM : tenderness / test ROMMusclestrengthForwardflexion /

Backward extensionAbduction /

Adduction External rotation

Internal rotation


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Upper Arm & elbowInspect : Symmetry / Swelling / color andmesses

Palpate : Tenderness / Test ROM muscle

strengthWristInspect / Palpate: Tenderness / Nodules /

test ROM muscle strengthROM : Extension / Hyper

extension flexionRadial deviation / ulnar

deviation


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Hands and Fingers

Inspect : Size / Shape / Symmetry

swelling and colorPalpate : nodules and tenderness test

ROM /Muscle strengthROM : Hyperextension / dorsiflexionflexionHerberdens nodes /

Rheumatoid arthritis

Hand and FingersInspect : Symmetry / Shape

Palpate : Stability / tenderness / Creptitis

test for ROM Extension / Flexion


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Ankles and feet

Inspect :Position / Alignment / Shape skinPalpate : Beat / Swelling / tenderness or

nodules / ROMROM : Hyper extension / dorsiflexionAdditional Test : Phalens test / tinels test

straights leg raisingThomas test / Pronatos

drift / Bulge test patellarballottement lachmantest / memorys test /

Apleys test


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Musculo Skeletal Power Point

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