Musculoskeletal System

• Musculoskeletal system


  The bones, muscles and joints that make up the system
• Musculoskeletal system


  • Controlled and innervated by the nervous system
• Bones


  • Provide structure, protection, serve as storage of calcium and produced blood cells
  • 206 bones: axial and appendicular skeleton
  • Composed of compact (hard and dense, outer layer) and spongy (contains numerous spaces, inner layer) osseous tissue
  • Osteoblasts (bone formers)
  • Osteoclasts (bone destroyers)
  • Red marrow (produces blood cells)
  • Yellow marrow (composed mostly of fats)
• Skeletal muscles


  • 650 skeletal (voluntary) muscles, which are under conscious control
  • Assist with posture, produces body heat and allow body to move
• Skeletal muscle movements


  • Abduction (moving away from midline of the body)
  • Adduction (moving toward midline of the body)
  • Circumduction (circular motion)
  • Inversion (moving inward)
  • Eversion (moving outward)
  • Extension (straightening the extremity at the joint and increasing the angle of the joint)
  • Flexion (bending the extremity at the joint and decreasing the angle of the joint)
  • Pronation (turning or facing downward)
  • Supination (turning or facing upward)
  • Protraction (moving toward)
  • Retraction (moving backward)
  • Rotation (turning head to the right shoulder then back to the midline, next turning the head to left shoulder then back to midline)
• Joints (Articulation)


  • Fibrous (are joined by fibrous connective tissue and are immovable)
  • Cartilaginous (are joined by cartilage)
  • Synovial (contain a space between the bones that is filled with synovial fluid, a lubricant that promotes a sliding movement of the ends of the bones)
  • Temporomandibular (open and closes the mouth, projects and retracts the jaw, moves jaw from side to side)
  • Sternoclavicular (has no obvious movements, junction between the manubrium of the sternum and the clavicle)
  • Shoulder (Flexion and extension, Abduction and adduction, Circumduction, Rotation (internal and external))
  • Hip (Flexion with knee flexed and with knee extended, Extension and hyperextension, Circumduction, Rotation (internal and external), Abduction and adduction)
  • Wrists, Fingers & Thumb (Wrists: flexion, extension, hyperextension, adduction (radial and ulnar deviation); Fingers: flexion, extension, hyperextension, abduction, circumduction; Thumb: flexion, extension, opposition)
  • Elbow (flexion and extension of the forearm, supination and pronation of the forearm)
  • Knee (flexion and extension)
  • Ankle And Foot (Ankle: plantar flexion and dorsiflexion; Foot: inversion and eversion; Toes: flexion, extension, abduction, adduction)
  • Vertebrae (Lateral View) (C-7 concave-shaped, T-12 convex-shaped, L-5 concave-shaped, S-5, Cx-3-4; flexion, hyperextension, lateral bending, rotation)
• Assessment of the musculoskeletal system

  • Inspection (Inspect muscles for size, Inspect muscles and tendons for contractures, Inspect muscles for tremors)
  • Palpation (Palpate muscles at rest to determine muscle tonicity, Palpate muscles while the client is active and passive for flaccidity, spasticity, and smoothness of movement, Test muscle strength, Grade muscle strength)
  • Palpation & Inspection (Bones, Joints)
  • Range of Motion (ROM)
• Client


  • Resists while you attempt to dorsiflex the foot
  • Resists while you attempt to flex the foot
• Palpation & Inspection


  • Bones
  • Joints
• Bones


  • Inspect the skeleton for normal structure and deformities
  • Palpate the bones to locate any areas of edema or tenderness
• Normal bone findings


  • No deformities
  • No tenderness or swelling
• Deviation from normal bone findings

  • Bones misaligned
  • Presence of tenderness or swelling
• Joints


  • Inspect the joint for swelling
  • Palpate each joint for tenderness, smoothness of movement, swelling, crepitation, and presence of nodules
• Normal joint findings


  • No swelling
  • No tenderness, swelling, crepitation, or nodules
• Deviation from normal joint findings

  • One or more swollen joints
  • Presence of tenderness, swelling, crepitation, or nodules
• Range of Motion (ROM)


  1. Ask the client to move selected body parts

  2. Use a goniometer to measure the angle of the joint in degrees
• Normal ROM


  • Varies to some degree in accordance with person's genetic makeup and degree of physical activity
• Deviations from normal ROM

  • Presence of tenderness, swelling, crepitation, or nodules
• Head ROM


  • Flexion
  • Extension
  • Hyperextension
  • Lateral Flexion
  • Rotation
• Shoulder ROM


  • Flexion
  • Extension
  • Hyperextension
  • Abduction
  • Adduction (Anterior)
  • Circumduction
• Elbow ROM


  • Flexion
  • Extension
• Forearm ROM


  • External Rotation
  • Internal Rotation
  • Rotation for supination
  • Rotation for pronation
• Wrist ROM


  • Flexion
  • Extension
  • Hyperextension
  • Radial Flexion (Abduction)
  • Ulnar Flexion (Adduction)
• Hand ROM


  • Flexion
  • Extension
  • Hyperextension
  • Abduction
  • Adduction
• Thumb ROM


  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Opposition
• Hip ROM


  • Flexion
  • Extension
  • Hyperextension
  • Abduction
  • Adduction
  • Circumduction
• Knee ROM


  • Flexion
  • Extension
• Ankle ROM


  • Flexion (dorsiflexion)
  • Extension (plantar flexion)
  • Eversion
  • Inversion
• Toe ROM


  • Flexion
  • Extension
• Trunk ROM


  • Flexion
  • Extension
  • Hyperextension
  • Lateral Flexion
  • Rotation
• Abnormalities Affecting the Wrist, Hands and Fingers

  • Acute Rheumatoid Arthritis
  • Chronic Rheumatoid Arthritis
  • Boutonniere and Swan-neck Deformities
  • Thenar Atrophy
  • Ganglion
  • Osteoarthritis
  • Tenosynovitis
• Abnormalities of Feet and Toes

  • Acute – Gouty Arthritis
  • Callus
  • Corn
  • Plantar Wart
  • Hallux Valgus