Musculoskeletal System

• ROM


  Moving major joint through active and passive ROM
• When assessing ROM


  • DO NOT force joint beyond it's normal ROM, or into a painful position
  • Always compare symmetry/ equality in movement
  • ROM is equal between contralateral joints
  • Check muscle strength- may use opposing force
  • Pt may require rest periods
• Body mechanics


  Coordinated efforts of the musculoskeletal and nervous systems
• Proper body mechanics


  Applied in the lifting techniques prevents injuries
• Nurses use evidence-based information about body alignment, balance, gravity, and friction; and safe use of equipment when transferring patients, assisting with ambulation, determining the risk of patient falls, and selecting the safest way to move or transfer patients
• History


  • Involvement in sports
  • Risk for osteoporosis- female, over 50, smoking, inactive lifestyle
  • History of bone, muscle and joint issues- fall, trauma, lifting heavy objects (work, others), h/o related diagnoses if any
  • Issues with mobility- difficulty to move around , walk, going up or down stairs, stability
  • Pain that relates to mobility, ADLs
• Inspection


  • General inspection- gait, balance, posture, observe for foot dragging, limping, shuffling, and the position of the trunk in relation to the legs
  • Inspection extremities for overall size, gross deformity, bony enlargement, alignment, and symmetry. Normally there is bilateral symmetry in length, circumference, alignment, and position and in the number of skinfolds
• Palpation


  • Note any heat, tenderness, edema, or resistance to pressure. The patient should not feel any discomfort. Muscles should be firm.
• Muscle tone and strength


  Assess during ROM
• Active ROM


  Demonstrate movement and ask patient to actively move each joint
• Passive ROM


  Ask the patient to relax and then passively move the extremities through their ROM
• Compare the same body parts for equality in movement
• Functional Ability


  Dependent on Musculoskeletal function and Neurological System Function
• Mobility


  • Do you have trouble moving? feel steady when you walk? use anything to help you walk? trouble getting out of bed? difficulty sitting down or standing up?
• Observe movement, limitation
• Fall Risk Assessment tools


  • Include risk categories on age, fall history, elimination habits, high-risk medications, mobility, and cognition
• Joints


  Point where 2 or more bones meet
• Types of Joints


  • Fibrous- Bones joined by fibrous tissue- skull
  • Cartilaginous- bones joined by cartilage tissue- vertebrae
  • Synovial- bones joined by fluid-filled joint cavity (allows extreme freedom of movement, reinforced by ligaments &tendons – limb joints
• Range of Motion


  • Abduction- Movement of limb away from midline
  • Adduction- Movement of limb toward midline
  • Eversion- Turning outward- Sole face laterally
  • Inversion- Turning inward- Sole face medially
  • Flexion- Bending movement that decreases the angle of joint
  • Extension- Increases the angle of joint
  • Circumduction- Moving arm or leg in full circle
  • Hyperextension- Bending a joint beyond 180 degrees
  • Internal Rotation- Shoulders, knee, Hip
  • External Rotation- shoulders, knee, Hip
  • Pronation- hand and forearm- palm downward
  • Supination- hand and forearm- ventral (palm) surface upward
  • Dorsiflexion- foot
  • Plantar flexion- foot
• Muscle Tone and strength


  • Assess during ROM
  • Patient to assume stable position
  • Perform maneuvers demonstrating strength of major muscle groups
  • Note symmetry and quality of muscle development, tone, and strength
  • A muscle that has atrophied (reduced in size) feels soft and boggy(spongy) when palpated
• Muscle Group Maneuvers


  • Neck (sternocleidomastoid)
  • Shoulder (trapezius)
  • Elbow Biceps
  • Elbow Triceps
  • Hip Quadriceps
  • Gastrocnemius
• Muscle Function Level Grade

  • No evidence of contractility 0 0 0 (zero)
  • Slight contractility, no movement 1 10 T (trace)
  • Full range of motion, gravity eliminated* 2 25 P (poor)
  • Full range of motion with gravity 3 50 F (fair)
  • Full range of motion against gravity, some resistance 4 75 G (good)
  • Full range of motion against gravity, full resistance 5 100 N (normal
• Temporomandibular Joint (TMJ)


  • Inspect for symmetry- no swelling noted
  • Palpate as it opens and closes mouth
  • Should be smooth motion of mandible
  • Audible and palpable clicking may be normal
  • Palpate as patient clenches teeth
  • Masseter & temporalis muscles should be symmetric, firm and non-tender
  • Muscle Strength (cranial nerve V) Pt to open and close mouth against resistance
• Clavicles & Scapula


  • Inspect for symmetry- no deformities
  • Palpate from sternoclavicular joint laterally to acromioclavicular joint, then downward toward greater tubercle of humerus
• Shoulder ROM


  • Forward flexion
  • Backward Extension
  • Abduction
  • Adduction
  • Circumduction
  • External Rotation
  • Internal Rotation
• Elbows


  • Inspect lateral & medial aspects
  • Symmetrical –no swelling or deformities
  • Palpate lateral & aspects of Olecranon process with thumb & middle finger
  • No pain
• Elbow ROM


  • Flexion
  • Extension
  • Hyperextended (may not be for all people)
  • Supination
  • Pronation
• Wrists & Hands


  • Inspect wrists & dorsum of hand
  • Symmetric, no swelling or deformity
  • Inspect palms of hands
  • Symmetric, no swelling or deformity
  • Rounded protuberance over thenar eminence
  • Palpate wrists & hands (note temperature & texture)
  • Each finger & interphalangeal joint should be done separately with your thumb & index finger
  • Symmetric, warm, smooth (rougher on knuckles)
  • Joints are firm, non-tender
• Wrist ROM


  • Hyperextension
  • Flexion
  • Radial deviation
  • Ulnar Deviation
• Finger ROM


  • Abduction, Adduction, Extension (straight), Hyperextension, Flexion (fist), Circumduction, Opposition of thumb
• Hips & Legs


  • Inspect- Symmetrical with no deformities
  • Legs slightly apart and toes facing ceiling
  • Palpate- Firm and non-tender
• Hip ROM


  • Extension (straight)
  • Hyperextension
  • Flexion
  • Internal rotation
  • External rotation
  • Abduction
  • Adduction
  • Circumduction
• Knees


  • Inspect while standing and sitting
  • Patella centrally located
  • Symmetrical with no deformities
  • Palpate- begin 10 cm above patella and move downward to 5 cm below- no pain, swelling or heat
• Knee ROM


  • Extension
  • Flexion
• Ankles & Feet


  • Inspect while sitting, standing & walking
  • Symmetrical, no swelling or deformities, even color with rest of body, toes properly aligned
  • Palpate the ankles, the achilles tendon, metatarsophalangeal joints, interphalangeal joints- firm, non-tender, free of nodules
• Ankle & Foot ROM


  • Dorsiflexion
  • Plantar flexion
  • Inversion
  • Eversion
• Spine


  • Inspect while pt standing
  • Cervical and lumbar curves are concave
  • Thoracic curve convex
  • Palpate each vertebral process- aligned, uniform in size, firm, stable & non-tender
• Neck ROM


  • Flexion
  • Extension
  • Hyperextension
  • Lateral Flexion
  • Rotation
• Spine ROM


  • Lateral flexion
  • Extension
  • Flexion
  • Rotation
• Passive ROM


  Supporting patient's limb and moving their joint through ROM smoothly & slowly