MUSCO

• Bones


  • Provide protection & structure, serve as levers, store calcium and produce blood cells
  • 206 bones
  • Osseous tissue (compact bone & spongy bone)
• Types of muscles


  • Skeletal (voluntary)
  • Smooth
  • Cardiac
• Skeletal muscles


  • 650 skeletal muscles
• Joints


  • Where 2 or more bones meet
  • Provide variety of range of motion
  • Fibrous, cartilaginous, synovial
• Common musculoskeletal symptoms


  • Pain or discomfort
  • Deformity
  • Weakness
  • Stiffness or limited
  • Lack of balance and coordination
• Key topics & questions for health promotion


  • Demographic data (age, gender, race)
  • Family history
  • Past medical history
  • Nutrition & medication
  • Occupation, lifestyle & behaviors
• Some musculoskeletal diseases are age-related or more prevalent by gender or ethnic group
• Musculoskeletal problems with a familial tendency include osteoporosis, bone cancer, and rheumatoid arthritis
• Calcium and vitamin D are essential for bone health
• Some occupations increase risk of injury through repetitive movement
• Health promotion teaching


  • Psychosocial screening
  • Scoliosis screening
  • Nutrition and weight management
  • Safety measures
  • Bone density preservation
• If a patient has a musculoskeletal injury, ask how it will affect ability to work, participate in hobbies, or perform routine activities of daily living (ADLs)
• People of all ages need to learn to maintain a healthy weight and perform weight-bearing exercise at least three times per week
• Exercises to increase strength and flexibility and improve posture decrease the risk of falls
• Bone density preservation is a major age-related concern that lifestyle modification can help control
• Preparing the client

  • Make sure that the room is at a comfortable temperature
  • Provide adequate draping to avoid unnecessary exposure of client
  • Older adult consideration - be sensitive to client's needs and adapt your technique as necessary
• Equipment


  • Tape measure
  • Skin marking pen
  • Goniometer
• Physical assessment


  1. Observe gait & posture

  2. Inspect for size, symmetry & color

  3. Palpate for tenderness, edema, heat, nodules & crepitus

  4. Test muscle strength & ROM of joints

  5. Compare bilateral finding of joints & muscles

  6. Perform special test for CTS

  7. Perform the "bulge, ballottement" & McMurray knee test
• Posture


  Erect & comfortable for age
• Gait


  • Base of support
  • Weight-bearing stability
  • Foot position
  • Stride length & cadence
  • Arm swing
• Perform "nudge test"


  1. Evenly distributed weight

  2. Able to stand on heels & toes

  3. Client does not fall back

  4. Uneven weight bearing is evident

  5. Client limps, shuffles, propels forward, or had wide-based gait

  6. Falling backward easily is seen with cervical spondylosis & Parkinson disease
• Temporomandibular joint

  1. Inspection & palpation of TMJ

  2. Test ROM

  3. Snapping & clicking may be felt and heard in the normal client

  4. Mouth opens 1-2in

  5. Jaw moves laterally 1-2cm

  6. Jaw protrudes and retracts easily

  7. Jaw has full ROM against resistance

  8. Contraction palpated with no pain or spasms

  9. Decreased ROM, swelling, tenderness or crepitus may be seen in arthritis

  10. Decrease muscle strength with muscle & joint disease

  11. Decrease ROM & clicking, pooping or grating sound may be noted with TMJ dysfunction

  12. Lack of full contraction with cranial nerve V lesion

  13. Pain or spasms occur with myofascial pain syndrome
• Sternoclavicular joint


  1. Inspection & palpation

  2. With client sitting, inspect the sternoclavicular joint for location in midline, color, swelling, and masses

  3. Then palpate for tenderness or pain

  4. There is no visible bony overgrowth, swelling or redness

  5. Joint is nontender

  6. Swollen, red or enlarged joint or tender, painful joint is seen with inflammation of joint
• Cervical, thoracic & lumbar spine

  1. Inspection & palpation

  2. Palpate the spinous processes and the paravertebral muscles on both sides of spine for tenderness or pain

  3. Cervical & lumbar spines are concave; thoracic spine is convex

  4. Spine is straight

  5. Nontender spinous processes; well-developed, firm & smooth, nontender paravertebral muscles

  6. No muscle spasm

  7. A flattened lumbar curvature may be seen with a herniated lumbar disk or ankylosing spondylitis

  8. Compression fractures and lumbosacral muscle strain can cause pain & tenderness of the spinal processes & paravertebral muscles
• Test ROM of the cervical spine


  1. Ask the client to touch the chin to the chest (flexion) & to look up at the ceiling (hyperextension)

  2. Flexion & extension of cervical spine is 45 degrees

  3. Cervical strain is the most common cause of neck pain

  4. Cervical disk degenerative disease & spinal cord tumors are associated with impaired ROM & pain that radiates to the back, shoulder or arms

  5. Neck pain with a loss of sensation in the legs may occur with cervical spinal cord compression

  6. Impaired ROM & neck pain associated with fever, chills and headache could be indicative of a serious infection such as meningitis
• Test lateral bending

  1. Ask the client to touch each ear to the shoulder on that side

  2. Normally the client can bend 40 degrees on both sides
• Test rotation


  1. Ask the client to repeat the cervical ROM movement against resistance

  2. About 70 degrees of rotation is normal
• Test ROM of the lumbar spine


  1. Ask client to bend forward and touch the toes

  2. Observe for symmetry of shoulder, scapula & hips

  3. Flexion of 75-90 degrees, smooth movement, lumbar concavity flattens out & the spinal processes are in alignment

  4. Limited ROM is seen with neck injuries, osteoarthritis, spondylosis or disk degeneration

  5. Decrease ROM against resistance is seen with joint or muscle disease
• Sit down behind the client, stabilize the client's pelvis with your hands & ask to bend sideways, bend backward toward you & twist shoulders one way, then the other


  1. Lateral bending capacity of the thoracic & lumbar spines should be about 35 degrees

  2. Hyperextension & rotation about 30 degrees
• Measure leg length


  1. Measurements are equal or within 1cm

  2. Unequal leg lengths are associated with scoliosis

  3. Also seen with abnormalities in the structure or position of hips & pelvis
• Inspect & palpate shoulder & arms


  1. Shoulders are symmetry round; no redness, swelling, deformity or heat

  2. Muscles are fully developed

  3. Clavicles & scapulae are even & symmetric

  4. No tenderness

  5. Flat, hallow or less rounded shoulders are sees with dislocation

  6. Muscle atrophy is seen with nerve or muscle damage or lack of use

  7. Tenderness, swelling & heat may be noted with shoulder strains, sprains, arthritis, bursitis & degenerative joint disease
• Test ROM of the shoulder


  1. Extend of forward flexion should be 180 degrees; hyperextension, 50 degrees; adduction, 50 degrees; & abduction 180 degrees

  2. Extent of external & internal rotation should be about 90 degrees, respectively

  3. The client can flex, extend, adduct, abduct, rotate & shrug shoulder against resistance

  4. Painful & limited abduction accompanied by muscle weakness & atrophy are seen with a rotator cuff tear

  5. Chronic pain & severe limitation of all shoulder motions are seen with calcified tendinitis

  6. Inability to shrug shoulders against resistance is seen with a lesion of cranial nerve XI (spinal accessory)

  7. Decreased muscle strength is seen with muscle or joint disease
• Inspect the elbows


  Elbows are symmetric, without deformities, redness or swelling
• Palpate the elbows


  Nontender; without nodules
• Test ROM of the elbows

  1. Normal ROMs are 160 degrees of flexion, 180 degrees of extension, 90 degrees of pronation & 90 degrees of supination

  2. Some clients may lack 5-10degrees or have hyperextension

  3. Redness, heat and swelling may be seen with bursitis of the olecranon process due to trauma or arthritis

  4. Firm, nontender, subcutaneous nodules may be palpated in rheumatoid arthritis or rheumatic fever

  5. Tenderness or pain over the epicondyles may be palpated in epicondylitis (tennis elbow) due to repetitive movements of the forearm or wrists

  6. Decrease ROM against resistance is seen with joint or muscle disease or injury
• Inspect the wrists


  1. Wrists are symmetric without redness or swelling

  2. They are nontender & free of nodules
• Perform the squeeze test


  Client tolerates test without extreme pain
• Palpate the anatomic snuffbox


  No tenderness palpated
• Wrist swelling


  Seen with rheumatoid arthritis
• Wrist tenderness & nodules

  May be seen with rheumatoid arthritis