MUSCULOSKELETAL ASSESSMENT

• Abduction - away from the midline
• Adduction - toward the midline
• Circumduction - distal part of the bone in circle while the proximal end remain fixed
• Inversion - Turning the sole of the foot inward
• Eversion - Turning the sole of the foot outward
• Extension - Increasing the angle of the joint
• Flexion - Decreasing the angle of the joint
• Pronation - The palm of the hand faces downward
• Supination - The palm of the hand faces upward
• Rotation - Movement of the bone around its central axis
• Equipments to be used in musculoskeletal assessment

  Measuring Tape

  Goniometer (Movement in degrees)

  Pencil (Skin Marking Pencil)
• Assessing muscles

  → Test muscle strength

  → Document muscle strength by using a standard scale

  → If the client can’t move the parts against resistance, ask the

  client to move the part against gravity
• Normal muscle strength (5 rating)

  active motion against full resistance
• Slight weakness muscle strength (4 rating)

  Active motion against some resistance
• Average weakness muscle strength (3 rating)

  Active motion against gravity
• Poor ROM muscle strength (2 RATING)

  Passive ROM (gravity removed and assisted by examiner)
• Severe weakness muscle strength (1 rating)

  Slight flicker of contraction
• Paralysis muscle strength (0 rating)

  No muscular contraction
• Musculoskeletal assessment outline

  → GAIT

  → TEMPOROMANDIBULAR JOINT (TMJ)

  → STERNOCLAVICULAR JOINT

  → CERVICAL, THORACIC, AND LUMBAR SPINE

  → SHOULDERS, ARMS, AND ELBOWS

  → ELBOWS

  → WRISTS

  → HANDS AND FINGERS

  → HIPS

  → KNEES

  → ANKLES AND FEET
• How do we inspect the gait of the client

  Walk across the room and return; heal to toe
• Test for gait we perform for elderly and the handicapped

  Nudge test
• Test wherein the patient moves forward, backward, sideways

  nudge test
• Abnormal finding in test for gait wherein the patient falls backward easily

  cervical spondylosis; Parkinson’s disease
• Changes in gait occurs due to

  • drug or alcohol intoxication
  • motor neuron weakness
  • muscle weakness
• SCISSORS GAIT

  • Spastic lower limbs, and movement on stiff, jerky movements
  • Knees are together and the legs cross in front of one another
  • One arm flexed
  • Toe of leg dragged
• Parkinsonian Gait

  • Shuffling gait, very stiff manner
  • Stooped over posture with flexed hips and knees
• Steppage gait

  • Foot drop walk
  • Flexes and raises the knee higher than usual
• Spastic hemiparesis

  • Flexed arm held close to body while client drags toe of leg
  • Constant state of contraction in one side
• Propulsive Gait

  • Head and neck bent forward
• Waddling Gait

  - Duck-like
• decreased ROM, swelling, tenderness, crepitus in TMJ

  arthritis
• decreased muscle strength & ROM, clicking, popping, or grating sound

  TMJ dysfunction
• Lack of full contraction of TMJ

  CN 5 lesion (trigeminal nerve)
• STERNOCLAVICULAR JOINT → Junction between manubrium and clavicle
• Assessment of CERVICAL, THORACIC, & LUMBAR SPINE

  Observe the cervical, thoracic, and lumbar curves from the side then from behind.

  Palpate the spinous processes and the paravertrebral muscles on both sides of the spine for tenderness or pain

  C, L – Concave

  T- Convex
• abnormal findings of CERVICAL, THORACIC, & LUMBAR SPINE

  • Flattened lumbar curvature;
  • Lateral curvature of thoracic spine (scoliosis);
  • Exaggerated lumbar curvature/lordosis (pregnancy, obesity);
  • Unequal hip height (unequal leg length)
  • Pain and tenderness (compression fractures, lumbosacral muscle strain)
• Kyphosis - Kuba
• Lumbar Lordosis - Common in pregnant women and obese
• Assessment for cervical spine ROM

  • HYPEREXTENSION
  • FLEXION
  • LATERAL BENDING ROTATION
• Assessment of THORACIC AND LUMBAR SPINE ROM

  • FLEXION
  • LATERAL BENDING
  • ROTATION