FINALS

• The musculoskeletal system encompasses the muscles, bones, and joints
• Nurse's assessment of the musculoskeletal system

  • Muscle strength, tone, size, and symmetry of muscle development, and for tremors
• Tremor


  An involuntary trembling of a limb or body part
• Intention tremor


  Becomes more apparent when an individual attempts a voluntary movement, such as holding a cup of coffee
• Resting tremor


  More apparent when the client is at rest and diminishes with activity
• Fasciculation


  An abnormal contraction of a bundle of muscle fibers that appears as a twitch
• Bones are assessed for normal form
• Joints are assessed for tenderness, swelling, thickening, crepitation (a crackling, grating sound), and range of motion
• Body posture is assessed for normal standing and sitting positions
• Skeletal regions


  • Axial skeleton (shown in yellow)
  • Appendicular skeleton (shown in blue)
• Skeletal muscle movements


  • Abduction
  • Adduction
  • Circumduction
  • Inversion
  • Eversion
  • Extension
  • Hyperextension
  • Flexion
  • Dorsiflexion
  • Plantar flexion
  • Pronation
  • Supination
  • Protraction
  • Retraction
  • Rotation
  • Internal rotation
  • External rotation
• Temporomandibular joint


  Articulation between the temporal bone and mandible
• Temporomandibular joint motions


  • Open and closes mouth
  • Projects and retracts jaw
  • Moves jaw from side to side
• Sternoclavicular joint


  Junction between the manubrium of the sternum and the clavicle; has no obvious movements
• Elbow joint


  Articulation between the ulna and radius of the lower arm and the humerus of the upper arm; contains a synovial membrane and several bursae
• Elbow joint motions


  • Flexion and extension of the forearm
  • Supination and pronation of the forearm
• Shoulder joint


  Articulation of the head of the humerus in the glenoid activity of the scapula. The acromioclavicular joint includes the clavicle and acromion process of the scapula. It contains the subacromial and subscapular bursae
• Shoulder joint motions


  • Flexion and extension
  • Abduction and adduction
  • Circumduction
  • Rotation (internal and external)
• Wrist, fingers, and thumb

  Articulation between the distal radius, ulnar bones, carpals, and metacarpals. Contains ligaments and is lined with synovial membrane
• Wrist, fingers, and thumb motions

  • Wrist: Flexion, extension, hyperextension, adduction, radial and ulnar deviation
  • Fingers: Flexion, extension, hyperextension, abduction, and circumduction
  • Thumb: Flexion, extension, and opposition
• Vertebrae


  Thirty-three bones: 7 concave-shaped cervical (C), 12 convex-shaped thoracic (T), 5 concave-shaped lumbar (L), 5 sacral (S), and 3-4 coccygeal, connected in a vertical column. Bones are cushioned by elastic fibrocartilaginous plates (intervertebral discs) that provide flexibility and posture to the spine. Paravertebral muscles are positioned on both sides of vertebrae
• Vertebral motions


  • Flexion
  • Hyperextension
  • Lateral bending
  • Rotation
• Hip joint


  Articulation between the head of the femur and the acetabulum. Contains a fibrous capsule
• Hip joint motions


  • Flexion with knee flexed and with knee extended
  • Extension and hyperextension
  • Circumduction
  • Rotation (internal and external)
  • Abduction
  • Adduction
• Knee joint


  Articulation of the femur, tibia, and patella; contains fibrocartilaginous discs (medial and lateral menisci) and many bursae
• Knee joint motions


  • Flexion and extension
• Ankle and foot


  Articulation between the talus (large posterior foot tarsal), tibia, and fibula. The talus also articulates with the navicular bones. The heel (calcaneus bone) is connected to the tibia and fibula by ligaments
• Ankle and foot motions

  • Ankle: Plantar flexion and dorsiflexion
  • Foot: Inversion and eversion
  • Toes: Flexion, extension, abduction, adduction
• Inspect the muscles and compare each muscle on one side of the body to the same muscle on the other side. Measure any apparent discrepancies with a tape
• Inspect the muscles and tendons for contracture
• Inspect the muscles for tremors and note the client's posture and ability to support weight while breathing comfortably
• Palpate the muscle at rest to determine muscle tonicity
• Palpate muscle while the client is active and passive for flaccidity, spasticity, and smoothness of movement
• Test muscle strength and compare the right side with left side
• Muscle strength tests


  • Sternocleidomastoid
  • Trapezius
  • Deltoid
  • Biceps
  • Triceps
  • Wrist and finger muscles
  • Grip strength
  • Hip muscles
  • Hip abduction
  • Hip adduction
  • Hamstrings
  • Quadriceps
  • Muscles of the ankle and feet
• Inspect the skeleton for normal structure and deformities
• Normal vs deviation from normal skeletal assessment

  • Equal size on both sides of body vs Atrophy (a decrease in size) or Hypertrophy (an increased in size)
  • No contractures vs Malposition of body part (foot drop or foot flexed forward)
  • No fasciculation or tremors vs Presence of fasciculation or tremors
  • Normally firm vs Atonic (lacking tone)
  • Smooth coordinated movements vs Flaccidity (weakness or laxness) or Spasticity (sudden involuntary muscle contraction)
  • Equal strength on each body side vs 25% or less muscle strength
  • No deformities vs Bones misaligned
• Inspect the joints for swelling and palpate each joint for tenderness, smoothness of movement, swelling, crepitation, and presence of nodules
• Assess joint range of motion by asking the client to move selected body parts and using a goniometer to measure the angle of the joint in degrees
• Normal range of motion for neck (pivot joint)

  • Flexion: 45° from the midline
  • Extension: 45° from the midline
  • Hyperextension: 45° from the midline
  • Lateral flexion: 40° from the midline
  • Rotation: 70° from the midline