Physical Assessment Of Musculoskeletal System

1. musculoskeletal system assessment
BY,
Ashwini K N
Lecturer in Pediatric Nursing
Padmashree college of nursing
Bangalore , Karnataka

2. TYPES OF BONE
There are 206 bones in the human body, divided into four categories:
 Long bones (e.g, femur)
 Short bones (e.g., metacarpals)
 Flat bones (e.g., sternum)
 Irregular bones (e.g., vertebrae)

3. STRUCTURE OF LONG BONE AND HAVERSION SYSTEM

4. TYPES OF JOINTS
 Ball-and-socket joints,
 Hinge joints
 Saddle joints
 Pivot joints
 Gliding joints

5. STRUCTURE OF SYNOVIAL JOINT

6. TYPES OF MUSCLE CONTRACTIONS
 Isometric Contraction
 Isotonic Contraction

7. COLLECTING SUBJECTIVE DATA
Current symptoms
 Have you had any recent weight gain?
 Describe any difficulty chewing you have.
 Is it associated with tenderness or pain?
 Describe any joint, muscle, or bone pain you have.

8. CON….
Past History
 Describe any past problems or injuries you have had to your joints, muscles, or
bones. What treatment was given? Do you have any after effects from the injury
or problem? When were your last tetanus and polio immunizations?
 Have you ever been diagnosed with diabetes mellitus, sickle cell anemia,
systemic lupus erythematous(SLE), or osteoporosis?
 For middle aged and female clients:
 Have you started menopause? Are you receiving estrogen replacement therapy?

9. CON
Family History
 Do you have a family history of rheumatoid arthritis, gout, or osteoporosis?
 Life-style and health practices
 What activities do you engage in to promote the health of your
musculoskeletal system (e.g., exercise, diet, weight reduction)?
 Do you smoke tobacco? How much and how often?
 Do you drink alcohol or caffeinated beverages? How much and how often?
 Describe your typical 24- hours diet. Are you able to consume milk or milk-
containing products? Do you take any calcium supplements?
 Describe your activities during a typical day. How much time do you spend in
the sunlight?

10. CON….
 Describe any routine exercise in which you engage.
 Describe your occupation.
 Describe your posture at work and at leisure. What type of shoes do you usually
wear?
 Do you have difficulty performing normal activities of daily living? Do you use
assistive devices (e.g., walker, cane, braces) to promote your mobility?
 How have your musculoskeletal problems interfered with your ability to interact
or socialize with others? Have they interfered with your usual sexual activity?
 How did you view yourself before you had this musculoskeletal problem, and
how do you view yourself now?
 Has your musculoskeletal problems added stress to your life? Describe.

11. COLLECTING OBJECTIVE DATA
Physical Assessment Guidelines
 Inspection
 Palpation
 Test the range of motion
 Test muscle strength

12. RATING SCALE
Movement Classification Score
Active motion against full
resistance
Normal 5
Active motion against some
resistance
Slight weakness 4
Active motion against gravity Average weakness 3
Passive range of motion Poor ROM 2
Slighter flicker of contraction Severe weakness 1
No muscular contraction Paralysis 0

13. GAIT
Observe Gait
Observe the client’s gait as the client enters and walks around the room.
Note:
 Base of support
 Weight bearing stability
 Feet position
 Stride
 Stride length
 Cadence
 Arm swing
 Posture
 “nudge test.”

14. TEMPOROMANDIBULAR JOINT(TMJ)
 Inspect, palpate, and test ROM

15. STERNOCLAVICULAR JOINT
 Inspect and palpate
 With client sitting, inspect the sternoclavicular joint for location in
midline, color, swelling, and masses. Then palpate for tenderness or
pain.

16. CERVICAL,THORASIC,AND LUMBAR SPINE
 Inspect and palpate

19. TEST ROM OF THE CERVICAL SPINE
Test ROM by asking the client to:
 Touch chin to chest(flexion).
 Look up at ceiling(hyperextension).
 Touch each ear to the shoulder on that side (lateral bending).

20. CERVICAL ROM

21. TEST ROM OF THE THORACIC AND LUMBER
SPINE

22. LATERAL BENDING

23. TEST FOR BACK AND LEG PAIN
 Lasegue’s test

24. MEASURE LEG LENGTH

25. SHOULDERS
INSPECT AND PALPATE
 With the client standing or sitting, inspect for symmetry, color,
swelling, and masses.
 Palpate for tenderness, swelling, or heat.

26. TEST ROM OF SHOULDER

27. ELBOWS
INSPECT AND PALPATE
 Inspect for size, shape, deformities, redness, or swelling.
 With the elbow relaxed and flexed about 70o, use your thumb and
middle fingers to palpate the olecranon process and epicondyles.

28. TEST ROM OF ELBOW

29. SUPINATION AND PRONATION

30. WRISTS
INSPECT AND PALPATE
 Inspect for size, shape, symmetry, color, and swelling.
 Palpate for tenderness and nodules.

31. TEST ROM OF WRIST

32. TEST FOR CARPAL TUNNEL SYNDROME(PHALEN’S TEST)

33. TINEL’S SIGN

34. HANDS AND FINGERS
INSPECT AND PALPATE
 Inspect for size, shape, symmetry, swelling, and
color.
 Palpate for tenderness and nodules.

35. TEST ROM
Ask the client to:
 Spread the fingers apart.

36. ROM OF FINGERS

37. HIPS
INSPECT AND PALPATE
 With the client standing inspect for symmetry and shape.
 Palpate for stability, tenderness, and crepitus.

38. TEST ROM

39. ABDUCTION AND ADDUCTION

40. INTERNAL ROTATION

41. EXTERNAL ROTATION

42. THOMAS’S TEST.

43. TRENDELENBERG TEST.

44. KNEES
 INSPECT AND PALPATE

45. TEST FOR SWELLING
BULGE TEST.

46. BALLOTTMENT TEST.

47. FLEXION AND EXTENSION

48. TEST FOR PAIN
 McMurry’s test.

49. ANKLES AND FEET
Inspect and palpate
 With the client sitting, standing, and walking, inspect position,
alignment, shape, and skin.
 Palpate for tenderness, heat, swelling, or nodules.

50. TEST ROM

51. ABNORMAL SPINAL CURVATURE

52. ABNORMAL WRISTS, HANDS, AND FINGERS
 Boutonniere and swan-neck deformities

53.  Ganglion.

54.  Osteoarthritis.

55.  Tenosynovitis.

56.  Acute rheumatoid arthritis.

57.  Chronic rheumatoid arthritis

58.  Thenar atrophy

59. ABNORMAL ANKLES, FEET, AND TOES
 Acute gouty arthritis.

60.  Callus.

61.  Corn.

62.  Flat feet.

63.  Hallux valgus

64.  Hammer toe.