muskoskeletal

• Musculoskeletal assessment


  Assessment of musculoskeletal function focusing on determining range of joint motion, muscle strength and tone, and joint and muscle condition
• Musculoskeletal assessment


  • Can be performed as a separate examination or integrated with other parts of the total physical examination
  • Nurses can assess the patient's movements while performing other nursing care measures such as bathing or positioning
• Key components of musculoskeletal assessment

  • General inspection
  • Palpation (joints, bones & muscles)
  • Muscle tone and strength
  • Range of motion
• General inspection


  1. Ensure that the areas to be examined are fully exposed and the patient is resting comfortably

  2. Observe from side when standing

  3. Observe gait

  4. Inspect joint for swellings

  5. Inspect for skin changes in color, scars, previous surgery, rashes

  6. Inspect adjacent structures like wasting of muscles above and below a joint

  7. Always compare to opposite side
• Inspection of the hand and wrist joints

  1. Inspect both hands and wrists as one

  2. Inspect the front, back and sides of all joints

  3. Compare sides
• Inspection of the spine

  1. Ask patient to undress while providing privacy

  2. Inspect from the front, sides and behind ideally with patient sitting and standing

  3. Pay special attention on pigmentations, abnormal hair growth or unusual skin creases, alignment of the neck and shoulder symmetry
• Lordosis


  Excessive inward curvature of the lumbar spine
• Kyphosis


  Thoracic spine curves giving a round shouldered or hunched appearance
• Scoliosis


  Thoracic and/or lumbar spine curve laterally forming a S or C shaped
• Inspection of the lower limbs

  Observe position of the joints, pelvic tilting
• Movement of the hip joint

  • Flexion, extension, abduction, adduction, internal and external rotation
• Inspection of the knees


  1. Inspect, comparing knees with patient supine

  2. Detect swellings by loss of medial and lateral dimples suggestive of an effusion
• Bow-legs (genu varum)


  Common condition where the knees angle outward
• Knock-knees (genu valgum)


  Common condition where the knees angle inward
• Prepatellar bursitis (housemaid's knee)


  Swelling over the patella
• Infrapatellar or anserine bursitis

  Swelling over the tibial tubercle
• Inspection of the ankle and foot

  1. Inspect foot and ankles ideally with patient standing and more carefully with the patient supine

  2. Look at the shoes for abnormal wear or stretching

  3. Assess movement of the ankle (dorsiflexion, plantar flexion, inversion, eversion) and toes (extension, flexion, abduction and adduction)
• Musculoskeletal Assessment


  Assessment of the musculoskeletal system
• Palpation of joints, bones & muscles

  • Note any heat, tenderness, edema, or resistance to pressure
  • The patient should not feel any discomfort when you palpate
  • Muscles should be firm
• Palpation of Joints


  1. Feel for any swelling and its nature

  2. Tenderness

  3. Temperature

  4. Joint crepitus

  5. Tendon crepitus
• Hard swelling


  Suggests bone
• Spongy or boggy swelling

  Suggests synovial thickening
• Fluctuant swelling


  Suggests an effusion or fluid filled
• Tenderness


  Ask client for pain or discomfort when an affected area is touched
• Joint crepitus


  A palpable grating sound or sensation produced by friction
• Tendon crepitus


  A dry, friction rub palpable when tendons move
• Palpation of Bones (Spine)

  1. Palpate the shoulder and neck muscles for tenderness

  2. Palpate each of the spinal processes noting any prominence or steps

  3. Palpate the paraspinal muscles for tenderness or spasm

  4. Palpate the sacroiliac joints
• Muscle tone


  The muscle's resistance to passive stretch
• Hypotonia


  Flaccidity
• Hypertonia


  Spasticity
• Muscle strength


  The amount of force a muscle can produce with a single maximal effort
• Muscle strength grading scale

  • Grade 0 - Complete paralysis
  • Grade 1 - Trace strength
  • Grade 2 - Poor strength
  • Grade 3 - Fair strength
  • Grade 4 - Good strength
  • Grade 5 - Normal strength
• Muscle atrophy


  Loss of muscle tissue, muscles appear smaller than normal
• Range of Motion


  • Passive form
  • Active form