FEU – Institute of Nursing Health Assessment

Francis Obmerga, PhD, RN

Assessing
Musculoskeletal
System
Part 1 (Muscles & Bones)

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FEU – Institute of Nursing Health Assessment

Structure and Function

The musculoskeletal system encompasses the
muscles, bones, and joints.
The nurse usually assesses the musculoskeletal
system for muscle strength, tone, size, and symmetry
of muscle development, and for tremors.
A tremor is an involuntary trembling of a limb or
body part. Tremors may involve large groups of
muscle fibers or small bundles of muscle fibers.
An intention tremor becomes more apparent when
an individual attempts a voluntary movement, such
as holding a cup of coffee.

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A resting tremor is more apparent when the client is

at rest and diminishes with activity.
A fasciculation is 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.

Major bones of the

skeleton.
The axial skeleton is shown
in yellow;
the appendicular skeleton
is shown in blue.

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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
• Hyperextension: Joint bends greater than 180
degrees
• Flexion: Bending the extremity at the joint and
decreasing the angle of the joint

• Dorsiflexion: Toes draw upward to ankle

• Plantar flexion: Toes point away from ankle
• Pronation: Turning or facing downward
• Supination: Turning or facing upward
• Protraction: Moving forward
• Retraction: Moving backward
• Rotation: Turning of a bone on its own long axis
• Internal rotation: Turning of a bone toward the
center of the body
• External rotation: Turning of a bone away from
the center of the body

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Muscles of the body

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Understanding Major Joints

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Understanding Major Joints

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Understanding Major Joints

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Understanding Major Joints

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Understanding Major Joints

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Muscles
DEVIATION FROM
NORMAL FINDINGS
NORMAL
Inspect the muscles Equal size on both Atrophy (a decrease in
for size. sides of body size) or hypertrophy
Compare each muscle (an increased in size)
on one side of the body
to the same muscle on
the other side. For any
apparent
discrepancies, measure
the muscles with a
tape.

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Muscle Atrophy

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Muscle Hypertrophy

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Muscles
DEVIATION FROM
NORMAL FINDINGS
NORMAL
Inspect the muscles No contractures Malposition of body
and tendons for part (foot drop or foot
contractures. flexed forward)

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FEU – Institute of Nursing Health Assessment

Muscles
DEVIATION FROM
NORMAL FINDINGS
NORMAL
Inspect the muscles No fasciculation or Presence of
for tremors. tremors fasciculation or tremors
Inspect any tremors of
the hands and arms by
having the client hold
arms out in front of
body.

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Muscles
DEVIATION FROM
NORMAL FINDINGS
NORMAL
Palpate muscles at rest Normally firm Atonic (lacking tone)
to determine muscle
tonicity.
Palpate muscles while Smooth coordinated Flaccidity (weakness or
the client is active and movements laxness) or spasticity
passive for flaccidity, (sudden involuntary
spasticity, and muscle contraction)
smoothness of
movement.
Test muscle strength. Equal strength on each 25% or less muscle
Compare the right side body side strength
with left side.

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Grading Muscle Strength

GRADE DESCRIPTION
100% of normal muscle strength; normal full movement
5
against gravity and against full resistance.
75% of normal strength; normal full movement against
4
gravity and against minimal resistance.
50% of normal strength; normal movement against
3
gravity.
25% of normal strength; full muscle movement against
2
gravity, with support.
10% of normal strength; no movement, contraction of
1
muscle is palpable or visible.
0 0% of normal strength; complete paralysis
4/14/20 1:20 PM Lecturer: FRANCIS OBMERGA, 24
RN, MAN
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FEU – Institute of Nursing Health Assessment

Sternocleidomastoid
Client turns the head to one side against the resistance of
your hand. Repeat with the other side.

Trapezius
Client shrugs the shoulders against the resistance of your
hands.

Deltoid
Client holds arm up and resists while you try to push it
down.

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Biceps
Client fully extends each arm and tries to flex it while you
attempt to hold arm in extension.

Triceps
Client flexes each arm and then tries to extends it against
your attempt to keep in flexion

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Wrist and Finger Muscles

Client spreads the fingers and resists as you attempt to
push the fingers together.

Grip strength
Client grasps your index finger and middle fingers while
you try to pull the fingers out.

Hip Muscles
Client is supine, both legs extended; client raises one leg
at a time while you attempt to hold it down.

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Hip abduction
Client is supine, both legs extended. Place your hands on
the lateral surface of each knee; client spreads the legs
apart against your resistance.

Hip adduction
Client is in same position as in hip abduction. Place your
hands between the knees; client brings the legs together
against your resistance.

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Hamstrings
Client is supine, both knees bent. Client resists while you
attempt to straighten the legs.

Quadriceps
Client is supine, knee partially extended; client resists
while you attempt to flex the knee.

Muscles of the ankle and feet

Client resists while you attempt to dorsiflex the foot and
and again resists while you attempt to flex the foot.

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Bones
DEVIATION FROM
NORMAL FINDINGS
NORMAL
Inspect the skeleton No deformities Bones misaligned
for normal structure
and deformities.
Palpate the bones to No tenderness of Presence tenderness of
locate any areas of swelling swelling
edema or tenderness.

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