The human musculoskeletal system (also known as the locomotor

system, and previously the activity system) is an organ system that gives
humans the ability to move using their muscular and skeletal systems. The
musculoskeletal system provides form, support, stability, and movement to
the body.
It is made up of the bones of the skeleton, muscles, cartilage,
tendons, ligaments, joints, and other connective tissue that supports and
binds tissues and organs together. The musculoskeletal system's primary
functions include supporting the body, allowing motion, and protecting vital
organs. The skeletal portion of the system serves as the main storage
system for calcium andphosphorus and contains critical components of
the hematopoietic system.[4]
INSPECTI

This system describes how bones are connected to other bones

and muscle fibers via connective tissue such as tendons andligaments. The
bones provide stability to the body. Muscles keep bones in place and also

ON
Have the patient stand with his heels together, with his hands hanging

play a role in the movement of bones. To allow motion,

different bones are connected by joints. Cartilage prevents
the bone ends from rubbing directly onto each other. Muscles contract to
move the bone attached at the joint.

normally at his sides. Encourage the patient to stand normally and not try to
assume "good posture" or the "military stance". Note body type and then the
following checkpoints relative to a lateral plumb line falling just anterior to the
external malleolus (See Figure 4.1) and an anterior or posterior vertical line
bisecting the heels.
Head and Neck. From the side, forward or backward shifting of body
weight (not normal sway) can be judged by the position of the line from the
ear. From the rear, note the position of the patient's head by comparative ear
level. If the head is tilted to the right, the chin will tilt to the left. Note the
bilateral development of the sternocleidomastoideus and suboccipital
muscles. Asymmetrical fullness of the suboccipital musculature indicates
upper cervical rotation.
Shoulder Girdle. From the side, note the prominence, rotation, or tilting of
the inferior angles of the scapulae. From the rear, observe the comparative
height of the scapulae, comparing one to the other. The cervicobrachial spine
is always scoliotic toward the side of the high shoulder. Check for winged
scapulae or for scapulae failing to lie smoothly on the chest wall. Note the
distance of the scapulae vertebral borders from the spine. The midthoracic
spine is always scoliotic toward the side on which the vertebral margin of the
scapula is more prominent and flaring. If the shoulder is high on the right and
the scapula flares on the right, the entire cervicobrachial and thoracic spine
is scoliotic toward the right. If the shoulder is high on the right yet the left
scapula flares, the cervicobrachial spine is scoliotic to the right and the
midthoracic spine is scoliotic to the left.
Thorax. From the front, observe any signs of hollow chest, sternal or rib
depression, or pathologic signs such as Harrison's groove, funnel chest,
barrel chest, or pigeon chest. From the rear, note the contours of the
trapezius muscles for normal development or for abnormal tightness or
tenderness. Note the angles of the ribs. A difference in the height of the
scapulae and the iliac crests usually indicates a scoliosis. Lateral positions of
the spinous processes and anterior or posterior positions of the transverse
processes together with an elevation of the angles of the ribs indicates a
rotation of vertebrae.

Abdomen. From the side, check the degree of abdominal muscle

relaxation. Keep in mind that children normally have a prominent abdomen
and adult women have a deposit of superficial fat lying transversely below
the umbilicus.
Spine. From the side, check the curvatures of the spine. Evaluate as
normal or abnormal; lordotic or kyphotic. Note the degree of sacral tilt and
lumbosacral angle. From the rear, compare the line of the spinous
processes. Bear in mind the possibility of a spinous process being
asymmetrical, deviated to the right or left, without the body of the vertebra
being involved. Evaluate any degree of scoliosis.
Pelvis. In pelvic mechanical pathologies on the side of involvement, there is
a reduction in the height and depth of the body angle as observed from the
posterior. A low and less prominent iliac crest will be best observed from the
front. Note the comparative height of the iliac crests and greater trochanters.
Check the comparative height and depth of the sacral dimples, the position
of the gluteal cleft, and the bilateral buttock height. If chronic sciatic neuralgia
is on the high iliac crest side, degenerative disc weakening with
posterolateral protrusion should be suspected. If it occurs on the side of the
low iliac crest, one must consider the possibility of a sacroiliac slip and
lumbosacral torsion as being the causative factor.
Legs. From the side, note the degree of knee hyperextension. From the
front, check for any degree of genu valgum or genu varum by the space
between the knees. Seek possible tibial torsion or lateral rotation of the tibia
(usually unilateral) by noting the position of the patellae.
Developmental Progress
Skill

Average Age

Head up, prone

3.2 mo.

Puts hands
together

3.7 mo.

Grasps small
objects

4.1 mo.

Sits, head steady

4.2 mo.

Arm support

4.3 mo.

Rolls over

4.7 mo.

Reaches for
objects

5.0 mo.

Bears some weight

on legs

6.3 mo.

Accepts objects in
hands

7.5 mo.

Pulls to sitting
position

7.7 mo.

Sits without
support

7.8 mo.

Resists toy pull

10.0 mo.

Pulls to standing
position

10.1 mo.

Thumb-finger
grasp

10.6 mo.

Stands briefly, no
support

13.0 mo.

Walks forward

13.3 mo.

Kicks ball

2.0 yr.

Throws ball

2.6 yr.

Rides tricycle

3.0 yr.

Hops on one foot

4.9 yr.

Catches ball

5.5 yr.

Activities of Daily Living

DEFINITION of 'Activities of Daily Living - ADL' Routine activities that
people tend do every day without needing assistance. There are six basic
ADLs: eating, bathing, dressing, toileting, transferring (walking) and
continence.

Posture is the way you position your body or arrange your limbs. So stand up
straight, put your shoulders back, and lift that chin up.

Gait is the pattern of movement of the limbs of animals, including humans,

during locomotion over a solid substrate. Most animals use a variety of gaits,
selecting gait based on speed, terrain, the need to maneuver, and energetic
efficiency.Human gait refers to locomotion achieved through the movement

of human limbs. Human gait is defined as bipedal, biphasic forward

propulsion of center of gravity of the human body, in which there are
alternate sinuous movements of different segments of the body with least
expenditure of energy. Different gait patterns are characterized by
differences in limb movement patterns, overall velocity, forces, kinetic and
potential energy cycles, and changes in the contact with the surface.

Atrophy is the partial or complete wasting away of a part of the body.

Causes of atrophy include mutations (which can destroy the gene to build up
the organ), poor nourishment, poor circulation, loss of hormonal support, loss
of nerve supply to the target organ, excessive amount of apoptosis of cells,
and disuse or lack of exercise or disease intrinsic to the tissue itself.
Hormonal and nerve inputs that maintain an organ or body part are referred
to as trophic [noun] in medical practice ('trophic" is an adjective that can be
paired with various nouns). Trophic describes the trophic condition of tissue.
A diminished muscular trophic is designated as atrophy.
Atrophy is the general physiological process of reabsorption and breakdown
of tissues, involving apoptosis. When it occurs as a result of disease or loss

swelling, turgescence or tumefaction is a transient abnormal enlargement

of a body part or area not caused by proliferation of cells.[1] It is caused by
accumulation of fluid in tissues.[2] It can occur throughout the body

of trophic support due to other disease, it is termed pathological atrophy,

although it can be a part of normal body development and homeostasis as
well.

(generalized), or a specific part or organ can be affected (localized).[2]

Swelling is considered one of the five characteristics of inflammation; along
with pain, heat, redness, and loss of function.
In a general sense, the suffix "-megaly" is used to indicate a growth, as
in hepatomegaly, acromegaly, and splenomegaly.
A body part may swell in response to injury, infection, or disease. Swelling,
especially of the ankle, can occur if the body is not circulating fluid well.
Generalized swelling, or massive edema (also called anasarca), is a
common sign in severely ill people. Although slight edema may be difficult to
detect to the untrained eye, especially in an overweight person, massive
edema is very obvious.

A deformity, dysmorphism, or dysmorphic feature is a major abnormality

in the shape of a body part or organ compared to the normal shape of that
part.

Non Invasive:

An electromyogram is a diagnostic test involving the placement of small

needles into the muscles to assess the electrical activity of muscle and nerve
function.
Turgor
An electromyogram (EMG) is a test that is used to record the electrical
the state of turgidity and resulting rigidity of cells (or tissues), typically due to

activity of muscles. When muscles are active, they produce an electrical

the absorption of fluid.

current. This current is usually proportional to the level of the muscle activity.
An EMG is also referred to as a myogram.

An EMG is often performed when patients have unexplained

muscle weakness. The EMG helps to distinguish between muscle conditions
in which the problem begins in the muscle and muscle weakness due to
nerve disorders. The EMG can also be used to detect true weakness, as
opposed to weakness from reduced use because of painor lack of
motivation. EMGs can also be used to isolate the level of nerve irritation or
injury.

A nodule is a growth that forms under your skin. A nodule may be filled with
inflamed tissue or a mixture of tissue and fluid. The collection of colored fluid
within a nodule may indicate an infection.

Nodules are usually wider than pimples, harmless, and easily treatable.
However, they are considered abnormal growths and should be checked by
a doctor. Small cysts, tumors, boils, and abscesses can easily be mistaken
for nodules.

A biopsy is a sample of tissue taken from the body in order to examine it

more closely. A doctor should recommend a biopsy when an initial test

suggests an area of tissue in the body isn't normal. Doctors may call an area

of abnormal tissue a lesion, a tumor, or a mass.

Prostate biopsy. Multiple needle biopsies are taken at one time

from the prostate gland. To reach the prostate, a probe is inserted into the
rectum.

A biopsy might be recommended whenever there is an important medical

question the biopsy could help answer. Here are just a few examples:

A mammogram shows a lump or mass, indicating the possibility

ofbreast cancer.

A mole on the skin has changed shape recently and melanoma is

Skin biopsy. A punch biopsy is the main biopsy method. It uses a

circular blade to get a cylindrical sample of skin tissue.

Surgical biopsy. Either open or laparoscopic surgery may be

necessary to obtain a biopsy of hard-to-reach tissue. Either a piece of tissue
or the whole lump of tissue may be removed.

possible.

A person has chronic hepatitis and it's important to know

if cirrhosisis present.

Types of Biopsies
There are many different kinds of biopsies. Nearly all of them involve using a
sharp tool to remove a small amount of tissue. If the biopsy will be on the
skin or other sensitive area, numbing medicine is applied first.
Here are some types of biopsies:

Needle biopsy. Most biopsies are needle biopsies, meaning a

needle is used to access the suspicious tissue.

CT-guided biopsy. A person rests in a CT-scanner; the scanner's

targeted tissue.

Infectious diseases those caused by bacteria, fungi, or viruses. They may

Ultrasound-guided biopsy. An ultrasound scanner helps a

Bone biopsy. A bone biopsy is used to look for cancer of the

orthopedic surgeon.
Bone marrow biopsy. A large needle is used to enter the pelvis
bone to collect bone marrow. This detects blood diseases such
asleukemia or lymphoma.

Liver biopsy. A needle is injected into the liver through the skin
on the belly, capturing liver tissue.

Kidney biopsy . Similar to a liver biopsy, a needle is injected

through the skin on the back, into the kidney.

conditions affecting one or more joints and the synovial fluid can be divided
into four main categories:

bones. This may be performed via the CT scan technique or by an

of joint inflammation, pain, swelling, and fluid accumulation. Diseases and

images help doctors determine the exact position of the needle in the

doctor direct the needle into the lesion.

Synovial fluid analysis may be ordered to help diagnose the cause

Aspiration biopsy. A needle withdraws material out of a mass.

This simple procedure is also called fine-needle aspiration.

originate in the joint or spread there from other places in the body. These
conditions include acute and chronic septic arthritis.
Bleeding bleeding disorders and/or joint injury can lead to blood in the
synovial fluid. Commonly present in people with untreated blood clotting
disorders such as hemophilia or von Willebrand Disease.

Phosphorus is an important element that is vital to several of your bodys

physiologic processes. It helps with bone growth, energy storage, and nerve
and muscle production. Many foods especially meat and dairy products
contain phosphorus, so its usually easy to get enough of this mineral in your
diet.

What Is a Serum Phosphorous Test?

Phosphorus is an important element that is vital to several of your bodys

physiologic processes. It helps with bone growth, energy storage, and nerve
and muscle production. Many foods especially meat and dairy products
contain phosphorus, so its usually easy to get enough of this mineral in your
diet.
Calcium concentration, both total and free, is characterized by a high
physiological variation, depending on age, sex, physiological state (eg,
pregnancy), and even season (owing to the seasonal variation of vitamin D,
which is directly involved in the regulation of calcium concentration).
Therefore, separate reference intervals have been established according to
the age and sex of the individual being tested.

Your bones and teeth contain most of your bodys phosphorus. However,
some phosphorous is in your blood. Your doctor can assess your blood
phosphorus level using a serum phosphorus test.

Total calcium reference ranges in males are as follows:

Younger than 12 months: Not established

Age 1-14 years: 9.6-10.6 mg/dL
Age 15-16 years: 9.5-10.5 mg/dL
Age 17-18 years: 9.5-10.4 mg/dL
Age 19-21 years: 9.3-10.3 mg/dL
Age 22 years and older: 8.9-10.1 mg/dL
Total calcium reference ranges in females are as follows:

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Hyperphosphatemia is when you have too much phosphorus in your

blood. Hypophosphatemia is the opposite: having too little phosphorus.
Various conditions, including liver disease and vitamin D deficiency, can

Younger than 12 months: Not established

Age 1-11 years: 9.6-10.6 mg/dL
Age 12-14 years: 9.5-10.4 mg/dL
Age 15-18 years: 9.1-10.3 mg/dL
Age 19 years and older: 8.9-10.1 mg/dL
Free (ionized) calciumreference ranges in males are as follows:

cause your blood phosphorus level to become too high or too low.

Younger than 12 months: Not established

1-19 years: 5.1-5.9 mg/dL
Age 20 years and older: 4.8-5.7 mg/dL
Free (ionized) calciumreference ranges in females are as follows:

condition. Your doctor will need to perform more tests to determine whats

Younger than 12 months: Not established

1-17 years: 5.1-5.9 mg/dL
Age 18 years and older: 4.8-5.7 mg/dL
Calcium (urine) reference ranges are as follows*:

The alkaline phosphatase test (ALP) is used to help detect liver disease or

Males: 25-300 mg/24-hour urine collection

Females: 20-275 mg/24-hour urine collection
Hypercalciuria: >350 mg/specimen
*Values are for persons with average calcium intake (ie, 600-800
mg/day)

A serum phosphorus test can determine whether you have high or low
phosphorus levels, but it cant help your doctor diagnose the cause of your

causing abnormal serum phosphorus test results.

bone disorders.

In conditions affecting the liver, damaged liver cells release

increased amounts of ALP into the blood. This test is often used to
detect blocked bile ducts because ALP is especially high in the edges
of cells that join to form bile ducts. If one or more of them are

obstructed, for example by a tumor, then blood levels of ALP will often
be high.

Any condition that affects bone growth or causes increased

activity of bone cells can affect ALP levels in the blood. An ALP test
may be used, for example, to detect cancers that have spread to the
bones or to help diagnose Paget's disease, a condition that causes
malformed bones. This test may also sometimes be used to monitor
treatment of Paget's disease or other bone conditions, such as vitamin
D deficiency.

If ALP results are increased but it is not clear whether this is due to liver or
bone disease, tests for ALP isoenzyme may be done to determine the cause.
A GGT test and/or a test for 5'-nucleotidase may also be done to differentiate
between liver and bone disease. GGT and 5'-nucleotidase levels are
increased in liver disease but not in bone disorders.