MUSCULOSKELETAL ASSESSMENT

• Inspection and palpation of joints are integrated with each body system
• When inspecting note the size and contour of the joint.
• Inspect the skin and tissues over the joints for color, and any masses or deformity
• There should be no swelling, redness, masses, or deformities in the joints.
• Swelling in the joints which may be caused by excess joint fluid (effusion), thickening of the synovial lining, and inflammation of surrounding soft tissue (bursae, tendons) or bony enlargement.
• Dislocation – complete displacement of a joint.
• Subluxation – partial displacement of a joint.
• Contracture – shortening of a muscle leading to limited range of motion (ROM) of joint.
• Ankylosis – stiffness or fixation of a joint.
• Palpate each joint, including its skin for temperature, its muscles, bony articulation, and area of joint capsule.
• When palpating note any heat, tenderness, swelling, or masses.
• Joints normally are not tender to palpate.
• The synovial membrane normally is not palpable.
• TRUE OR FALSE?

  TRUE: A small amount of fluid is present in the normal joint.
• NORMAL OR ABNORMAL?

  ABNORMAL: Palpable fluid.
• Pushing on one side of the sac causes shifting of fluid and a visible bulging on another side.
• Recognize limitations of ROM of joints.
• If a ROM limitation is recognized, gently attempt passive motion.
• Joints motion should cause no tenderness, pain or crepitation.
• Crepitation is an audible and palpable crunching or grating that accompanies movement.
• Crepitation occurs when the cartilage of joints is worn off and the articular surfaces in the joint are roughened (e g., osteoarthritis)
• Test the strength of muscle groups for each joint.
• Muscle strength is equal bilaterally and fully resists opposing force
• GRADE 5 (NORMAL): Full ROM against gravity, maximal resistance
• GRADE 4 (GOOD): Full ROM against, moderate resistance
• GRADE 3+ (FAIR PLUS): Full ROM against gravity, slight resistance
• GRADE 3 (FAIR): Full ROM against gravity
• GRADE 2 (POOR): Full ROM, gravity eliminated
• GRADE 2- (POOR MINUS): At least 50% ROM, gravity eliminated
• GRADE 1 (TRACE): Visible or palpable contraction
• GRADE 0 (ZERO): No muscle contraction
• GRADE 2+ (POOR PLUS): At least 50% ROM against gravity, slight resistance
• TEMPOROMANDIBULAR JOINT (JAWS)

  While the patient is in sitting position inspect the area just anterior to the ear.
• TEMPOROMANDIBULAR JOINT (JAWS)

  Place the tips of 2 fingers in front of each ear and ask the patient to open and close the mouth.
• TEMPOROMANDIBULAR JOINT (JAWS)

  Place the fingers into the depressed area over the joint and feel smooth movement of the mandible.
• An audible and palpable snap or click usually occurs as the mouth opens.
• Crepitus and pain occur with temporomandibular joint dysfunction,
• NORMAL OR ABNORMAL?

  ABNORMAL: Swelling (round bulge) over the joint.
• There is vertical motion of the jaw.
• The measurement of the space between the upper and lower incisors is 3 to 6 cm., or 3 fingers inserted sideways.