Musculoskeletal

• Aim of musculoskeletal assessment


  To differentiate between inflammatory and degenerative/mechanical problems. To identify patterns that may help with diagnosis, and assess the impact of any problem on a patient.
• When should we assess?

  When patient reports pain or loss of function in a joint or muscle. After injury and part of mobility or falls risk assessment.
• Some relevant information needed:

  Calcium intake <500mg daily. Thin and light body frame. Exposure to environmental or occupation hazards.
• Musculoskeletal Assessment: Inspection


  Observe patients ability to safely stand, transfer and mobilise. (Note how much assistance is required). Observe gait and look for symmetry.
• Gait: The way a person walks or runs, especially when moving from one place to another.
• Musculoskeletal Assessment: Palpation


  Inspect and gently palpate major joints for range of motion in arms, legs and (when possible) spine. (Note any pain, swelling, warmth or crepitus).
• Crepitus: A crepitant sound heard when the joints are moved.
• Musculoskeletal Assessment: Assess muscle strength, compare right and left sides. (Note involuntary movements). Assess pain, measurement, walking assistive device, range of motion and Gait analysis.
• Skeletal growth is most rapid during infancy and adolescents. Assessing growth and development is an integral part of the physical examination for children.
• The bones of children are more resilient, tend to bend, and may deform before breaking.
• Pregnancy produces major changes in the musculoskeletal system, from the straining of ligaments and the decrease in range of motion to an increase in muscle tension, causing pain.
• Musculoskeletal assessment changes when ageing


  Tendons shrink & harden, Reduction in bone mineral & mass, Loss of height, Joint activity & motion and Increased risk fractures.
• Arthritis: inflammation of the joints, caused by the breakdown of cartilage
• Osteoporosis: A disease in which bone density is reduced, leading to an increased risk of fractures
• What are some risk factors for falling in hospital?

  Mental status, Urinary issues, Mobility issues, medications, environmental factors, Socioeconomic factors.
• Risk factors for falling in residential aged care


  Number of medications, Sedatives, Antidepressants, Walking aids Disability, History of falls, Vision impairment, Incontinence, Parkinson’s disease.
• Common diagnostic tests: Laboratory Tests, Imaging Tests, X-rays, Arthrography, Bone Scanning, Computed tomography (CT) and magnetic resonance imaging (MRI), Dual-energy x-ray absorptiometry (DXA) and Ultrasonography.
• Arthroscopy: A surgical procedure that uses an arthroscope to examine the inside of a joint.
• Joint aspiration (arthrocentesis): aspiration of synovial fluid from a joint.
• Nerve and muscle tests: tests that assess the function of the nervous system