Physical Assessment of Musculoskeletal System

musculoskeletal system assessment

BY,Ashwini K N Lecturer in Pediatric NursingPadmashree college of nursingBangalore , Karnataka

TYPES OF BONE

There are 206 bones in the human body, divided into four categories:

Long bones (e.g, femur)

Short bones (e.g., metacarpals)

Flat bones (e.g., sternum)

Irregular bones (e.g., vertebrae)

STRUCTURE OF LONG BONE AND HAVERSION SYSTEM

TYPES OF JOINTS

Ball-and-socket joints,

Hinge joints

Saddle joints

Pivot joints

Gliding joints

STRUCTURE OF SYNOVIAL JOINT

TYPES OF MUSCLE CONTRACTIONS

Isometric Contraction

Isotonic Contraction

COLLECTING SUBJECTIVE DATA

Current symptoms

Have you had any recent weight gain?

Describe any difficulty chewing you have.

Is it associated with tenderness or pain?

Describe any joint, muscle, or bone pain you have.

CON….

Past History

Describe any past problems or injuries you have had to your joints, muscles, or

bones. What treatment was given? Do you have any after effects from the

injury or problem? When were your last tetanus and polio immunizations?

Have you ever been diagnosed with diabetes mellitus, sickle cell anemia,

systemic lupus erythematous(SLE), or osteoporosis?

For middle aged and female clients:

Have you started menopause? Are you receiving estrogen replacement therapy?

CON

Family History

Do you have a family history of rheumatoid arthritis, gout, or osteoporosis?

Life-style and health practices

What activities do you engage in to promote the health of your

musculoskeletal system (e.g., exercise, diet, weight reduction)?

Do you smoke tobacco? How much and how often?

Do you drink alcohol or caffeinated beverages? How much and how often?

Describe your typical 24- hours diet. Are you able to consume milk or milk-

containing products? Do you take any calcium supplements?

Describe your activities during a typical day. How much time do you spend in

the sunlight?

CON….

Describe any routine exercise in which you engage.

Describe your occupation.

Describe your posture at work and at leisure. What type of shoes do you usually

wear?

Do you have difficulty performing normal activities of daily living? Do you use

assistive devices (e.g., walker, cane, braces) to promote your mobility?

How have your musculoskeletal problems interfered with your ability to interact

or socialize with others? Have they interfered with your usual sexual activity?

How did you view yourself before you had this musculoskeletal problem, and

how do you view yourself now?

Has your musculoskeletal problems added stress to your life? Describe.

COLLECTING OBJECTIVE DATA

Physical Assessment Guidelines

Inspection

Palpation

Test the range of motion

Test muscle strength

RATING SCALE

Movement Classification Score

Active motion against full

resistance

Normal 5

Active motion against some

resistance

Slight weakness 4

Active motion against gravity Average weakness 3

Passive range of motion Poor ROM 2

Slighter flicker of contraction Severe weakness 1

No muscular contraction Paralysis 0

GAIT

Observe Gait

Observe the client’s gait as the client enters and walks around the room.

Note:

Base of support

Weight bearing stability

Feet position

Stride

Stride length

Cadence

Arm swing

Posture

“nudge test.”

TEMPOROMANDIBULAR JOINT(TMJ)

Inspect, palpate, and test ROM

STERNOCLAVICULAR JOINT

Inspect and palpate

With client sitting, inspect the sternoclavicular joint for location in

midline, color, swelling, and masses. Then palpate for tenderness or

pain.

CERVICAL,THORASIC,AND LUMBAR SPINE

Inspect and palpate

TEST ROM OF THE CERVICAL SPINE

Test ROM by asking the client to:

Touch chin to chest(flexion).

Look up at ceiling(hyperextension).

Touch each ear to the shoulder on that side (lateral bending).

CERVICAL ROM

TEST ROM OF THE THORACIC AND LUMBER SPINE

LATERAL BENDING

TEST FOR BACK AND LEG PAIN

Lasegue’s test

MEASURE LEG LENGTH

SHOULDERS

INSPECT AND PALPATE

With the client standing or sitting, inspect for symmetry, color,

swelling, and masses.

Palpate for tenderness, swelling, or heat.

TEST ROM OF SHOULDER

ELBOWS

INSPECT AND PALPATE

Inspect for size, shape, deformities, redness, or swelling.

With the elbow relaxed and flexed about 70o, use your thumb and

middle fingers to palpate the olecranon process and epicondyles.

TEST ROM OF ELBOW

SUPINATION AND PRONATION

WRISTS

INSPECT AND PALPATE

Inspect for size, shape, symmetry, color, and swelling.

Palpate for tenderness and nodules.

TEST ROM OF WRIST

TEST FOR CARPAL TUNNEL SYNDROME(PHALEN’S TEST)

TINEL’S SIGN

HANDS AND FINGERS

INSPECT AND PALPATE

Inspect for size, shape, symmetry, swelling, and color.

Palpate for tenderness and nodules.

TEST ROM

Ask the client to: Spread the fingers apart.

ROM OF FINGERS

HIPS

INSPECT AND PALPATE

With the client standing inspect for symmetry and shape.

Palpate for stability, tenderness, and crepitus.

TEST ROM

ABDUCTION AND ADDUCTION

INTERNAL ROTATION

EXTERNAL ROTATION

THOMAS’S TEST.

TRENDELENBERG TEST.

KNEES

INSPECT AND PALPATE

TEST FOR SWELLING

BULGE TEST.

BALLOTTMENT TEST.

FLEXION AND EXTENSION

TEST FOR PAIN

McMurry’s test.

ANKLES AND FEET

Inspect and palpate

With the client sitting, standing, and walking, inspect

position, alignment, shape, and skin.

Palpate for tenderness, heat, swelling, or nodules.

TEST ROM

ABNORMAL SPINAL CURVATURE

ABNORMAL WRISTS, HANDS, AND FINGERS

Boutonniere and swan-neck deformities

Ganglion.

Osteoarthritis.

Tenosynovitis.

Acute rheumatoid arthritis.

Chronic rheumatoid arthritis

Thenar atrophy

ABNORMAL ANKLES, FEET, AND TOES

Acute gouty arthritis.

Callus.

Corn.

Flat feet.

Hallux valgus

Hammer toe.

Thank you……