Assessment of muscle loss

• Temporal region (well nourished)

  • well defined muscle
  • muscle firm and taut
  • has significant resistance when palpate
• Temporal region (moderate wasting)

  • slightly depression on temporal muscle
• Temporal muscle (severe wasting)

  • hollowing, scooping depression
  • notable separation of skin from muscle
• Temporal region (special consideration)

  • in elderly, there's likely natural muscle loss and increase depression of temporal region
  • masked by adipose tissue, fluid overload
• Clavicle region (well nourished)

  • not visible in man, slightly visible in female
  • muscle behind clavicle and trapezius feel firm
• Clavicle region (moderate wasting)

  • visible in male and prominent in female
  • muscle around clavicle less taut
• Clavicle region (severe wasting)

  • significant protrude, prominent bone
  • notable separation of skin from muscle
• Clavicle region (special consideration)

  • prominent in elderly (normal loss of skin turgor)
  • masked by adipose tissue
  • some people has natural prominent clavicle
• Acromion

  • posterior head of deltoid muscle firm and taut
  • has rounded shoulder that curve from arm to shoulder to neck
• Acromion (moderate wasting)

  • loss roundness of shoulder
  • slightly protrude acromion
• acromion region (severe wasting)

  • shoulder to arm joint look square with prominent bone
  • significantly protrude acromion
  • deltoid less taut
• Acromion (special consideration)

  • elderly has looser skin tone -> give false sense of flaccid muscle
  • need to palpate enough wether it loosing skin or muscle
  • important to assess rigidity
  • masked by adipose tissue
• Pattelar region:

  well nourished

  • protruding quads with non prominent bone in knee

  moderate wasting

  • have some roundness on knee, but somewhat prominent patella
  • muscle around patella less taut

  severe wasting

  • have prominent bone in knee with significant depression
• Anterior thigh region :

  well nourished

  • well develop quad
  • no notable depression along inner thigh

  moderate wasting

  • mild depression on inner thigh
  • quad appear thin
  • easily compress and loose skin when grasp quad

  severe wasting

  • significant depression along inner thigh
  • quad obviously thin
  • thigh extremely compressable
• posterior calf region

  well nourished

  • well develop bulbous gastrocnemius muscle
  • significant resistance when palpate

  moderate wasting

  • less well develop gastrocnemius
  • less resistance when squeeze

  severe wasting

  • very thin gastrocnemius with minimal to no muscle
• Special consideration anterior thigh

  • some people have naturally thin quad
  • to differentiate between naturally thin and malnutrition, look at looseness of skin
  • bed bound may have thin quad due to disuse, not malnutrition (assess upper body more accurate)
  • wasting masked by adiposity, fluid overload
• Scapular region

  well nourished

  • visible but not prominent

  moderate wasting

  • mild depression
  • bone slightly protrude
  • trapezius less firm

  severe wasting

  • visible and prominent
  • depression between rib, scapula and around shoulder
• Dorsal region

  well nourished

  • bulging interosseous muscle (may be flat)

  moderate wasting

  • slightly depress interosseous muscle

  severe wasting

  • significant depress between thumb and forefinger
• Special consideration dorsal region

  • interosseous muscle of female more flat
  • increase in aging, more flat interosseous muscle
  • interosseous muscle more pronounced in dominant hand