Chapter 18

Chapter 18
The Musculoskeletal System
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Copyright
© 2012
© 2022
Wolters
Wolters
Kluwer
Kluwer
Health• All
| Lippincott
Rights Reserved
Williams & Wilkins
Assessing the Musculoskeletal System
❖Overview
o Musculoskeletal complaints and disorders are the
leading causes of health care visits
o The musculoskeletal system can be examined at
the same time as the neurologic system
o In this chapter, the anatomy and physiology and
the examination for each joint are combined
Copyright © 2022 Wolters Kluwer • All Rights Reserved

Joint Structure and Function #1
❖Articular structures: joint capsule, articular cartilage,

synovium, synovial fluid, intra-articular ligaments,
juxta-articular bone
❖Extra-articular structures: periarticular ligaments,
tendons, bursae, muscle, fascia, bone, nerve,
overlying skin
❖Ligaments: rope-like bundles of collagen fibrils;
connect bone to bone

Joint Structure and Function #2
❖Tendons: collagen fibers connecting muscle to bone

❖Cartilage: another type of collagen matrix;
facilitates smooth painless movement of the joint
❖Bursae: pouches of synovial fluid; cushion
movement of tendons and muscles over bone/other
joint structures

Types of Joint Articulation #1
❖Synovial joints
o Freely movable
o Covered by articular
cartilage
o Synovial cavity
o Joint capsule
o Example:
▪ Knee
▪ Shoulder

❖Cartilaginous Joints
o Slightly movable
o Fibrocartilaginous
discs
o Nucleus pulposus
o Example:
▪ Vertebral column

❖Fibrous joints
o Intervening layers
of fibrous tissue or
cartilage hold bones
together
o Almost in direct
contact
o No appreciable
movements
o Example:
▪ Sutures of skull

Structure of Synovial Joints #1


❖Bursae
o Disc-shaped synovial sacs
o Allow adjacent muscles, or muscles and tendons,
to glide over each other
o Lie between skin and convex surface of bone or
joint
o Lie in areas where tendons or muscles run
against bone, ligaments, or other tendons or
muscles

Question #1
The leading cause of complaints in health care visits

are related to:
A. Cardiovascular complaints
B. Musculoskeletal complaints
C. Reproductive complaints
D. Neurologic complaints

Answer to Question #1
B. Musculoskeletal complaints
Musculoskeletal complaints and disorders are leading
causes of health care visits in clinical practice.

The Health History #1
❖Common or concerning symptoms

o Joint pain
o Joint pain associated with systemic symptoms,
such as fever, chills, rash, weakness, and weight
loss
o Low back pain
o Neck pain
o Bone pain
o Muscle pain or cramps
o Muscle weakness

❖Joint pain
o Myalgias?
o Arthralgias?
❖Low back pain
o Midline?
o Off the midline?
o Radiation?
o Associated bladder or bowel dysfunction?

❖Neck Pain
o Usually self-limited
o Ask about radiation into arm; arm or leg
weakness or paresthesias; change in bowel or
bladder function
o Persisting pain after blunt trauma or motor
vehicle accident warrants further evaluation

Examination of the Joints #1
❖Important areas of examination for each of the

major joints
o Inspect joint symmetry, alignment, bony
deformities
o Inspect and palpate surrounding tissues for skin
changes, nodules, muscle atrophy, crepitus
o Range of motion maneuvers to test joint function
and stability,
o Assess for signs of inflammation, swelling,
warmth, tenderness, redness
o Assess muscle strength

❖Systematic examination
o Inspection and palpation of bones and joints
o Assessment of range of motion and muscle
strength
▪ Passive ROM
▪ Active ROM

❖Equipment
o Tape measure
o Goniometer
o Skin marking pen

❖Tips for a successful

examination
o Look for symmetry
o Use inspection and
palpation to assess
surrounding tissues
o Test range of motion
and maneuvers
o Test muscle
strength

❖Signs of inflammation
o Swelling
o Warmth
o Tenderness
o Redness

❖Muscle bulk
o Inspect size and
contour
o Atrophy?
o Hypertrophy?
o Fasciculations?

❖Muscle tone
o Slight residual tension that remains when
normal muscle with intact nerve supply is
relaxed voluntarily
o Assess with passive stretch
o Hypotonia? Flaccidity?
o Spasticity? Rigidity?

❖Muscle strength
o Allow for variables: age, sex, muscular training
o Dominant side usually slightly stronger
o Active resistance testing
o Paresis, paralysis, or plegia?
▪ Hemiparesis, hemiplegia, paraplegia,
quadriplegia


❖Documenting muscle strength

o Indicate scale used
o If joints are painful, move person gently
o Patient may move more comfortably by
themselves
o If joint trauma is present, ask about an x-ray
before attempting movement

Question #2
Trauma that results in stretching or tearing of

ligaments is referred to as:
A. Sprain
B. Strain
C. Bursitis
D. Tendinitis

A. Sprain
The stretching and/or tearing of a ligament is called a
sprain. A strain is the tearing of a tendon.

Examination of Joints:
Anatomy and Physiology and
Physical Examination
by Individual Joint

Temporomandibular Joint #1

Temporomandibular Joint #2

Temporomandibular Joint Physical
Examination #1
❖ Inspection and
palpation
o Symmetry?
o Swelling?
o Redness?
o Snapping/
clicking?
o Pain?
o Tenderness?

Temporomandibular Joint Physical
Examination #2
o Range of motion and maneuvers

▪ Threefold
⮚Opening and closing
⮚Protrusion and retracting
⮚Lateral
o Muscle strength
▪ Difficulty chewing?
▪ Jaw weakness?

The Shoulder #1
❖Overview
o Glenohumeral joint
o Wide-ranging movement
o Mobility from complex interconnected structure
of four joints, three large bones, three principal
muscle groups
▪ Referred to as shoulder girdle

The Shoulder #2

The Shoulder #3
❖Joints
o Glenohumeral joint
o Sternoclavicular joint
o Acromioclavicular joint

The Shoulder #4
❖Muscle groups
o Scapulohumeral
group
o Axioscapular group

The Shoulder #5
❖Muscle groups—(cont.)
o Axiohumeral group

The Shoulder #6
❖Additional structures
o Articular capsule
o Long head of the
biceps tendon
o Subacromial bursa

The Shoulder: Physical Examination #1
❖Inspection
o Anteriorly: shoulder and shoulder girdle
o Posteriorly: scapulae and related muscles
o Swelling, deformity, atrophy, fasciculations,
abnormal positioning
o Color change, skin alteration, unusual bony
contours


❖Shoulder movement
o Flexion
❖Patient instructions
o “Raise your arms in
front of you and
overhead”
❖Principle muscles:
Anterior deltoid,
pectoralis major,
coracobrachialis, biceps
brachii

o Hyperextension
o “Raise your arms
behind you.”
Latissimus dorsi, teres
major, posterior deltoid,
triceps brachii

o Abduction
o Raise your arms out
to the side and
overhead.”
Supraspinatus, middle
deltoid, serratus
anterior

o Adduction
o “Lower your arms to
your sides, then
bring them across
your body.”
pectoralis major,
coracobrachialis,
latissimus dorsi, teres
major, subscapularis
o Internal rotation
o “Place one hand
behind your back
and touch your
shoulder blade.”
subscapularis, anterior
deltoid, pectoralis
major, teres major,
latissimus dorsi

❖ Shoulder movement
o External rotation
❖ Patient instructions
o “Raise your arm to
shoulder level, bend
your elbow and rotate
your forearm toward
the ceiling.”
❖ Principle muscles:
infraspinatus, teres minor,
posterior deltoid


Special Maneuvers for Examining the Shoulder—

(cont.)


(cont.)


(cont.)


(cont.)

Painful Shoulders #1



Question #3
Which muscles form the rotator cuff? (Choose all that

apply.)
A. Supraspinatus
B. Infraspinatus
C. Teres major
D. Subscapularis

A. Supraspinatus
B. Infraspinatus
D. Subscapularis
The SITS muscles form the rotator cuff:
supraspinatus, infraspinatus, teres minor, and
subscapularis.

The Elbow #1
❖Overview, bony structures, and joints

o Helps position hand in space
o Stabilizes lever action of forearm
o Three articulations
▪ Humeroulnar joint
▪ Radiohumeral joint
▪ Radioulnar joint
▪ Common articular cavity and extensive
synovial lining

The Elbow #2

The Elbow: Physical Examination #1

❖Palpation
o Olecranon process
o Epicondyles
o Grooves
❖Tenderness?
❖Swelling?
❖Thickening?
❖Displacement?

Range of Motion and Maneuvers

Elbow Movement Patient Primary Muscles
Instructions Affecting Movement
Flexion “Bend your elbow” Biceps brachii,
brachialis,
brachioradialis
Extension “Straighten your elbow” Triceps brachii,
anconeus
Supination “Turn your palms up, as Biceps brachii, supinator
if carrying a bowl of
soup”
Pronation “Turn your palms down” Pronator teres, pronator
quadratus

Range of Motion and Maneuvers—(cont.)


Question #4
Lateral epicondylitis is commonly referred to as:

A. Tennis elbow
B. Pitcher’s elbow
C. Golfer’s elbow

A. Tennis elbow
Pitcher’s or golfer’s elbow are the common names for
medial epicondylitis.

The Wrist and Hands #1
❖Overview
o Complex unit of small highly active joints
o Used almost continuously during waking hours
o Little protection
o Increased vulnerability to trauma and disability

Bony
Structures


❖Muscle groups
o Wrist flexion: two carpal muscles (radial and
ulnar)
o Wrist extension: two radial, one ulnar
o Supination and pronation: contraction of forearm
o Thumb: three muscles for flexion, abduction,
and opposition
o Digits: flexor and extensor tendons of muscles in
the forearm and wrist
o Intrinsic muscles

o Carpal tunnel
o Median nerve
o Flexor retinaculum

The Wrist and Hands: Physical
Examination #1
❖Inspection
o Observe position in motion
o Palmar and dorsal surfaces for swelling over
joints
o Deformities
o Angulation
o Contours of palm
o Thickening of flexor tendons
o Flexion contractures in fingers

Examination #2

Examination #3
Palpation—(cont.)

Examination #4
Wrists: Range of Motion
Wrist Movement Patient Instructions Primary Muscles

Affecting Movement
Flexion “With palms down, point Flexor carpi radialis, flexor
your fingers toward the carpi ulnaris
floor.”
Extension “With palms down, point Extensor carpi ulnaris,
your fingers toward the extensor carpi radialis
ceiling” longus, extensor carpi
radialis brevis

Examination #5
Wrists: Range of Motion—(cont.)
Wrist Movement Patient Instructions Primary Muscles

Affecting Movement
Adduction (radial “With palms down, bring Flexor carpi ulnaris
deviation) your fingers toward the
midline.”
Abduction (ulnar “With palms down, bring Flexor carpi radialis
deviation) your fingers away from
the midline”

Examination #6
Range of Motion—(cont.)

Examination #7

Examination #8

Examination #9
Maneuvers to Test for Carpal Tunnel Syndrome—

(cont.)

Examination #10
❖Fingers and thumbs:

range of motion
o Flexion and
extension
o Abduction and
adduction

Examination #11

Examination #12
❖Finger muscle strength tests

o Finger abduction

Examination #13
❖Finger muscle strength tests

o Opposition of thumb

Arthritis in the Hands #1

Arthritis in the Hands #2

Swellings and Deformities of the Hands
#1

Swellings and Deformities of the Hands
#2

Question #5
Match the following types of arthritis with their

etiologies:
1. Osteoarthritis
2. Rheumatoid
3. Gouty arthritis
A. Metabolic Copyright © 2022 Wolters Kluwer • All Rights Reserved

1. Osteoarthritis—B. Degenerative
2. Rheumatoid—C. Autoimmune
3. Gouty arthritis—A. Metabolic

The Spine #1
❖Overview
o Central supporting structure of trunk and back
o Concave curves: cervical, lumbar spine
o Convex curves: thoracic, sacrococcygeal spine
o Complex mechanisms to coordinate action of:
▪ Vertebrae and intervertebral discs
▪ Ligaments between anterior and posterior
vertebrae, spinous processes, and lamina
▪ Large superficial muscles, deeper intrinsic
muscles, and muscles of abdominal wall

The Spine #2
❖ Bony structures
o 24 vertebrae stacked on sacrum and coccyx
o Sites for joint articulations, weight bearing, and
muscle attachments
o Vertebral processes and foramina:
▪ Spinous process
▪ Articular processes
▪ Vertebral foramen
▪ Intervertebral foramen
▪ Transverse foramen

The Spine #3

The Spine #4

The Spine #5

The Spine #6

The Spine #7

The Spine #8

The Spine #9

The Spine #10

The Spine #11

The Spine: Physical Examination #1
❖Inspection
o Posture
o Position of neck and trunk when entering the
room
o Position of the head; smooth, coordinated neck
movement; ease of gait
o Drape or gown the patient
o Should be standing upright in natural position
o Identify landmarks
o Inspect from the side and behind

❖Inspection—(cont.)
o Lateral deviation
o Kyphosis, scoliosis, lordosis
o Unequal heights
o Sciatic nerve tenderness
o Limitations in ROM

Inspection—(cont.)



❖Palpation
o Spinous processes
o Vertebral slippage
o Sacroiliac joint
o Paravertebral
muscles
o Sciatic nerve

❖Palpation—(cont.)
o Areas of tenderness

❖ Range of motion and maneuvers

o Neck:
▪ Most mobile portion of spine
⮚ ROM limitations from arthritis, trauma, muscle
spasm
▪ Skull and C1: flexion/extension
▪ C1 to C2: rotation
▪ C2 to C7: lateral bending
▪ For tenderness, loss of sensation, muscle
weakness, or impaired movement, perform
neurologic testing

Muscle strength test
Neck Movement Patient Instructions Primary Muscles

Affecting Movement
Flexion “Bring your chin to your Sternocleidomastoid,
chest.” scalene, prevertebral
muscles
Extension “Look up at the ceiling.” Splenius capitis and
cervicis, small intrinsic
neck muscles
Rotation “Look over one shoulder, Sternocleidomastoid,
and then the other.” small intrinsic neck
muscles
Lateral Flexion “Bring your ear to your Scalene and small
shoulder.” intrinsic neck muscles

❖Range of motion
o Spinal column
▪ Flexion

❖Range of motion—
(cont.)
o Spinal column—
(cont.)
▪ Extension

(cont.)
o Spinal column—
(cont.)
▪ Rotation

(cont.)
o Spinal column—
(cont.)
▪ Lateral flexion

❖Muscle strength test

o Performed during range-of-motion assessment
o Pain?
o Tenderness?
o Radiation of pain into leg?
o Low back pain? (see Table 18-1)

Question #6
Scoliosis is a ________ curvature of the spine.

A. Kyphotic
B. Lordotic
C. Lateral

C. Lateral
Scoliosis is a lateral curvature of the spine, usually in
the thoracic vertebral column.

The Hip #1
❖Overview
o Deeply embedded in pelvis
o Notable for strength, stability, wide range of
motion
o Stability of hip joint essential for weight bearing

The Hip #2

The Hip #3
Bony Structures and Joints—(cont.)

The Hip #4

The Hip #5
o Strong, dense articular capsule
o Three principal bursae:
▪ Psoas bursa (a.k.a. iliopectineal or iliopsoas)
▪ Trochanteric bursa
▪ Ischial bursa (a.k.a. ischiogluteal)
o Sciatic nerve

The Hip: Physical Examination #1
❖Inspection
o Stance and gait
▪ Width of base, shift of pelvis, knee flexion
▪ Difficulty/pain during weight bearing?
▪ Waddling gait?
▪ Leg swings out to side (circumduction)?
▪ Lack of dorsiflexion?
o Lumbar spine for lordosis
o Symmetry of leg length

Inspection

❖Inspection
o Swing

❖Palpation
o Bony landmarks
o Inguinal structures

Hip Movement Patient Instruction Primary Muscles

Affecting Movement
Flexion “Bend your knee to your Iliopsoas
chest and pull it against
your abdomen.”
Hyperextension “Lie face down, and then Gluteus maximus

bend your knee and lift it
up” or “Lying flat, move
your lower leg away from
the midline and down over
the side of the table.”


Affecting Movement
Abduction “Lying flat, move your Gluteus medius and
lower leg away from the minimus
midline.”
Adduction “Lying flat, bend your knee Adductor brevis, adductor
and move your lower leg longus, adductor magnus,
toward the midline.” pectineus, gracilis


Affecting Movement
External rotation “Lying flat on your back, Internal and external
bend your knee and hip obturators, quadratus
90 degrees, and turn your femoris, superior and
ankle and foot across your inferior gemelli
opposite leg.”
Internal rotation “Lying flat on your back, Gluteus medius and
bend your knee and hip minimus
90 degrees and turn your
lower ankle and foot away
from your body.”

❖Maneuvers
o Hip flexion and
flattening of lumbar
lordosis

❖Muscle strength test—

(cont.)
o Extension of the hip
o Abduction of the hip


(cont.)
o Adduction


(cont.)
o External and
internal rotation


(cont.)
o Flexion at the hip

The Knee #1
❖Overview
o Largest joint in body
o Hinge joint
o Three bones: femur, tibia, patella
o Two rounded condyles of femur rest on tibial
plateau
o No inherent stability
o Depends on ligaments to hold in place

The Knee #2

The Knee #3
❖Joints
o Tibiofemoral joints (2)
o Patellofemoral joint (1)
o Trochlear groove

The Knee #4

The Knee #5
o Menisci
o Ligaments
▪ Collaterals
▪ Cruciates

The Knee: Physical Examination #1
❖Inspection
o Gait
▪ Smooth, rhythmic?
o Alignment?
o Contours?
o Muscle atrophy?
o Swelling?

❖Palpation
o Tibiofemoral joint

o Suprapatellar
pouch, prepatellar
bursa, and anserine
bursa

o Gastrocnemius and soleus muscles, Achilles
tendon
▪ Posterior surface of lower leg
▪ Common tendon: Achilles
⮚Palpable from about lower third of calf to
insertion on calcaneus

Knee Movement Patient Instructions Primary Muscles

Affecting Movement
Flexion “Bend or flex your knee” or “Squat Hamstring group: biceps

down to the floor” femoris, semitendinosus,
semimembranosus
Extension “Straighten your leg” or “After you Quadriceps, rectus

squat down to the floor, stand up” femoris, vastus medialis,
lateralis, intermedius
Internal rotation “While sitting, swing your lower leg Sartorius, gracilis,
toward the midline” semitendinosus,
semimembranosus
External rotation “While sitting, swing your lower leg Biceps femoris
away from midline”


o Extension at the
knee


o Flexion at the knee

Question #7
The hamstrings consist of which of the following?

(Choose all that apply.)
A. Rectus femoris
B. Gracilis
C. Sartorius
D. Semitendinosus

B. Gracilis
C. Sartorius
D. Semitendinosus
The rectus femoris is located anterior to the femur.
The hamstrings are all posterior to the femur. The
fourth muscle is the semimembranosus.

The Ankle and Foot #1
❖Overview
o Total weight of body transmitted through ankle
to foot
o Must balance body
o Absorb impact of heel strike and gait
o Frequent sites of sprain and bony injury



The Ankle and Foot: Physical Examination
#1
❖Inspection
o All surfaces
▪ Deformities?
▪ Nodules?
▪ Swelling?
▪ Calluses?
▪ Corns?

#2

#3
Ankle and Foot Patient Instructions Primary Muscle

Movement Affecting Movement
Plantar flexion “Point your foot toward the Gastrocnemius, soleus,
door.” plantaris, tibialis posterior
Dorsiflexion “Point your foot toward the Tibialis anterior, extensor

ceiling.” digitorum longus, extensor
hallucis longus
Inversion “Bend your heel inward.” Tibialis posterior and

anterior
Eversion “Bend your heel outward.” Peroneus longus and
brevis

#4

o Dorsiflexion at ankle

#5

(cont.)
o Subtalar joint

#6

(cont.)
o Metatarsophalangeal
joint

#7

Abnormalities of the Feet #1

Abnormalities of the Feet #2

Abnormalities of the Toes and Soles #1



Question #8
A hammer toe deformity most often involves the:

A. Great toe
B. Second toe
C. Third toe
D. Fourth toe
E. Fifth toe

B. Second toe
A hammer toe deformity most often involves the
second toe. A bunion (hallux valgus) or gout usually
involves the great toe.

Special Techniques

Recording Your Findings
❖Correct anatomical terms

❖Correct abbreviations
❖Structure
❖Movement
❖Restrictions
❖Deformities
❖Range of motion
❖Strength

Health Promotion #1
❖Topics
o Nutrition, exercise, and weight
o Low back pain
o Fall prevention
o Osteoporosis screening and prevention

Health Promotion #2
❖Nutrition, exercise, and

weight
o Proper calcium
intake
o Increase bone mass
o Reduce excess
mechanical wear
and tear
o Physical activity

Health Promotion #3
❖Physical Activity Guidelines for Americans (2nd ed.)

o At least 2 hours and 30 minutes to 5 hours/week
of moderate-intensity, or 1 hour and 15 minutes
to 2 hours and 30 minutes/week of vigorous-
intensity, aerobic physical activity or an
equivalent combination
o Moderate or greater intensity muscle-
strengthening activity that involve all major
muscle groups on 2 or more days a week

Health Promotion #4
❖Low back pain prevention

o One of the most vulnerable parts of skeleton
o Most patients with acute LBP better in 6 weeks
o Diet to maintain healthy weight
o Exercise to strengthen lower back
o Maintaining good posture and avoiding heavy
lifting

Health Promotion #5
❖Preventing falls
o Leading cause of nonfatal injuries
o Account for dramatic rise in death rates after 65
years
o Most common cause of traumatic brain injury
o 95% of hip fractures due to falls
o 15% to 25% will remain in long-term care
facilities after hip fracture

Health Promotion #6
❖Preventing falls—(cont.)
o Risk factors are both cognitive and physiologic
▪ Unstable gait
▪ Imbalanced posture
▪ Reduced strength
▪ Previous fall
▪ Impaired mobility
▪ Medications

Health Promotion #7
❖ Preventing falls—(cont.)
o Risk factors are both cognitive and physiologic (cont.)
▪ Incontinence
▪ Hypertension
▪ Cognitive loss as in dementia
▪ Altered mental status
▪ Deficits in vision and proprioception
▪ Osteoporosis
o Environmental hazards

Health Promotion #8
❖Osteoporosis: Screening and prevention

o Common U.S. health problem
o Bone strength reflects both bone density and
bone quality
▪ Bone density: interaction of bone mass, new
bone formation, and bone resorption or loss
▪ Bone quality: architecture, turnover, damage
accumulation from microfractures, and
mineralization

Health Promotion #9
❖Measuring bone density

o No direct measurement of bone strength
o World Health Organization uses bone density to
define osteopenia and osteoporosis
▪ Osteopenia: bone density T score between
−2.5 and − 1.0 (1.0 to 2.5 standard
deviations below the young adult mean)
▪ Osteoporosis: T score less than −2.5 (bone
density 2.5 or more standard deviations below
the young adult mean)

Health Promotion #10
❖Measuring bone density—(cont.)

o Measured at hip, femoral neck, Ward triangle at
the femoral neck, greater trochanter, and total
hip
o 10% drop in bone density, equivalent to 1.0
standard deviation, associated with 20%
increase in risk for fracture

❖Risk factors for osteoporosis

o Postmenopausal status in women
o Age ≥50 years
o Low body mass index
o Low dietary calcium intake
o Vitamin D deficiency
o Prior fragility fracture

❖Risk factors for osteoporosis—(cont.)

o Osteoporosis in first-degree relative
o Sedentary lifestyle or extended bed rest
o Tobacco and excessive alcohol use
o Inflammatory disorders of musculoskeletal,
pulmonary, or gastrointestinal systems
o Medications: oral and high-dose inhaled
corticosteroids, anticoagulants (long-term),
aromatase inhibitors, methotrexate, antiseizure
medications, immunosuppressive agents,
proton-pump inhibitors (long-term), antigonadal
therapy
❖USPSTF recommendations
o Use WHO Fracture Risk Assessment (FRAX)
calculator
o Generates 10-year osteoporotic fracture risk and
hip fracture risk
o Based on: age; gender; weight; height; parental
fracture history; use of glucocorticoids; presence
of RA or conditions associated with secondary
osteoporosis; tobacco and heavy alcohol use;
femoral neck bone mass density

❖Prevention and treatment

o Adequate calcium intake
o Increased calcium intake for older person
o Adequate vitamin D intake
o Antiresorptive agents
o Anabolic agents
o Regular exercise
o Limit alcohol and caffeine

Question #9
Because of the benefits of estrogen on bone density,

hormone replacement therapy is useful in preventing
osteoporosis.
A. True
B. False

B. False
Despite the benefits of estrogen on bone density,
three recent trials have shown increased risk of stroke
for women taking HRT and failure to reduce risk of
coronary heart disease; two of the trials found an
increased risk of breast cancer. The U.S. Preventive
Services Task Force now recommends against routine
use of estrogen and progestin for the prevention of
chronic conditions in postmenopausal women.

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Chapter 18

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Chapter 18

The Musculoskeletal System

Copyright © 2022 Wolters Kluwer • All Rights Reserved

❖Articular structures: joint capsule, articular cartilage,

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❖Tendons: collagen fibers connecting muscle to bone

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The leading cause of complaints in health care visits

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❖Common or concerning symptoms

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❖Important areas of examination for each of the

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❖Tips for a successful

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❖Documenting muscle strength

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Trauma that results in stretching or tearing of

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o Range of motion and maneuvers

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Special Maneuvers for Examining the Shoulder—

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Special Maneuvers for Examining the Shoulder—

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Special Maneuvers for Examining the Shoulder—

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Special Maneuvers for Examining the Shoulder—