Health Assessment, part 39: Spinal Curvatures & Joint Movements

Hi. I'm Meris. And in this video, I'm going to be talking to you about the normal curvatures of the spine, abnormal curvatures of the spine, and joint movements. I'm going to be following along using our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you are somebody who prefers digital products, I would invite you to check out Flashables, the digital version of all of our flashcards. All right. Let's go ahead and get started.

So up first, I'm going to talk to you about the normal curvatures of the spine. And there are four normal and expected curves of the spine. Remember, the spine is not straight. It does have these curves in it. And this is due to the effects of gravity. This is due to the anatomical position of our other organs and things of that nature. This is also due to the fact that we walk upright on two legs, that our spine looks a certain way. Now, when I talk to you about concave and convex, I want you to understand that we are facing the patient's back when we are thinking about these things as being concave or convex. So concave means it caves in. Convex means it's going to come out towards you, okay? These also are in alphabetical order. Concave comes before convex, and we're going to talk about that in a minute.

So I have four normal curvatures of my spine. I expect my cervical spine here in my neck to be concave. My thoracic spine, I should expect to see a convex curvature here. In my lumbar spine, I expect to see concave. And in my sacrum, in my sacral spine, I expect to see a convex curvature. The reason I told you about alphabetical nature of this is that it goes in alphabetical order. Concave comes first, and then convex, and then it repeats. So concave, convex, concave, convex, okay? So I know that's confusing. I know it's a lot of words that sound very similar, but it is important to understand that there are normal curves. And if I have exaggerated curves-- I expect that my patient has a curvature of their spine, right? I don't expect that it looks like this. This would be an exaggerated curve of the cervical spine. I also don't expect that their spine looks like this, right? That would be a loss of that curve. So it's important that we are looking for these things so that we can note any abnormalities.

I'm now going to talk to you about some abnormal curvatures of the spine. And we have three here that we're going to talk about. They're very important. And you see them with frequency in your clinical practice. The first I want to talk to you is about a condition known as kyphosis. Kyphosis is an exaggerated curve of the thoracic spine. This is sometimes referred to as being a hunchback. It gives this hunched back appearance because my thoracic spine is more curved than is expected. This can be due to different types of anomalies and different types of pathophysiological processes. However, it is also common in elderly patients. This can be something that we see developing over time, but it is an important thing for you to assess because if I am chronically kyphotic like this, do you think I have good lung expansion and lung volume? No. So I need to be concerned about somebody with kyphosis in terms of, what's their respiratory status?

Another unexpected curvature of the spine is known as lordosis, and this is sometimes referred to as the condition of being swayback. And this is an abnormal and exaggerated curvature of the lumbar spine. So this is going to cause that lumbar portion of my abdomen to protrude forwards. There are two patient populations where this is a common and benign finding, meaning that this is present for a short period of time, it's going to go away, and it is benign. There is not a malignant or a pathophysiological process at play. Nothing nefarious is going on. And these two groups would be toddlers and pregnant patients. So for a very good reason, toddlers, first of all, we're just learning to walk, right? We're developing these normal curves, and we have a lot of things going on with our posture. I'm trying to get my balance. And they're going to have that exaggerated stance and that big pot belly coming forward that's going to give them that lordosis. I love seeing toddlers with lordosis. I think it is just the cutest thing in the world. They always have that little swagger to their walk. They're adorable.

And then pregnant patients, why do you think that when I was pregnant, I had some mild lordosis? Because I have a massive watermelon on my belly, right? We're talking about changing my center of gravity, so it's going to change how I need to carry myself. So when I think about a patient with lordosis, I think about a heavily pregnant patient who's got that kind of funny walk, and they've got that swayback to them. That is lordosis. But keep in mind, there are people who may have lordosis who are not pregnant and are not toddlers, right? And that requires further investigation.

The last abnormal curvature that I would like to talk to you about today is scoliosis. And scoliosis is going to be an abnormal C-shape or S-shape curvature of the spine. So this is talking about a lateral curvature. We're not talking about these curves in and out. We are talking about side to side. Now, sometimes this can be something that is very mild and benign and does not require a lot of treatment or any treatment whatsoever. However, think about if you have somebody with severe scoliosis, my same concerns apply. What is going on with their respiratory status, with their cardiovascular status? How are their organs doing inside when we have this chronic malformation of the thoracic cage or of the lumbar spine, whatever it may be? Remember that you may see other forward effects in a patient with scoliosis, such as uneven gluteal cleft or uneven hips. If you try to put your hands on them, you will see that they are uneven. And we may even have a leg length discrepancy.

All right. So now we're going to move on, and I'm going to talk to you about different movements of the joints. And there are a bunch. There's a bunch here on this card, and we do have some cool chicken hints for you. So I just want you to know, really pay attention to this card because there is a lot going on. Flexion. Flexion is a joint movement where the angle of the joint is decreased. So for instance, I think of flexing my arm, right? So here, the angle of my joint right now is 180 degrees. But as I flex it, now we are at 90 degrees, right, or I can make it 45 or even smaller of an angle. But I have taken the angle, and I have made it smaller. That is flexion, where extension is the opposite. It is where I am making the angle of a joint larger. So for instance, this would be me extending my arm. They are two opposite motions.

We also have abduction, like abduction. And this means you are moving the extremity away from the body, specifically away from the midline of the body. I always think of this because our cool chicken hint here is when someone is abducted, they are taken away, right? If we say somebody was abducted, that means they were taken away from the place where they belong, right? So they were abducted. Where adducted, a deduction, is the opposite. It is when I am moving an extremity closer to the midline. We also have a cool chicken hint for. It is adduction is adding a part to the body, right? My arm is all the way out here, and then I add it to my body. Adduction.

Then our last two here, circumduction. Circum meaning in a circle. So this means moving a joint in a circle. Not all joints are able to circumduct. I cannot really circumduct this joint right here, right? I can't really move that in a circle. But what can I circumduct things like ball and socket joints such as my arm, right, or even my leg, I can circumduct my leg as well. This is that circular motion. And last but not least, rotation. Now, rotation, this is confusing because you said, "But you just rotated your arm." No, no, no. I circumducted my arm, right? Rotation has to do with how a limb rotates around its own longitudinal axis, is the best way to describe it. So when I rotate my arm outwards away from my midline, that is external rotation. When I do this, that is internal rotation.

The patients that I think of, as an ER nurse, that this matters a lot is hip fractures. Very commonly, my patient will have a dislocated or a fractured hip. And one of the things that I will be able to notice on my assessment is that their one leg is internally or externally rotated. So the toes are either pointing outward too much or inward too much. And that's a big sign to me that we've got something wrong here. Now, yes, can I just externally and internally rotate my leg? Absolutely, I can. But what I want you to understand is that it could also be a sign of some sort of a finding. Why is this leg externally rotated right now when they're not trying to do it, right? So those are the joint motions to be familiar with for the health assessment flashcards.

All right. I'm so happy you stayed until the end because I've got lots of quiz questions to test your knowledge of key facts provided in this video. The nurse expects a patient to exhibit concave curvatures of which portions of the spine? Cervical and lumbar. What term should the nurse use to describe excess convex curvature of the thoracic spine? Kyphosis. In which two patient populations is lordosis a common, benign finding? Toddlers and pregnant patients. How should the nurse describe the motion of the joint when a patient goes from standing to bending forward at the hips? Flexion.

All right. That is it for this video. I hope you found it helpful. I would love it if you would leave me a comment. Let me know what you liked about this or found especially memorable. Or if you have a good way of remembering something that I didn't mention, I would love to hear that, and I know it would be beneficial to other learners as well. Thanks so much for watching, and happy studying.