Document Code

ISABELA STATE UNIVERSITY

College of Nursing
Revision No. Page 00 of 00

EVALUATION TOOL Effectivity Date

Name: ___________________________________ Date performed: ______________

Year Level & Section: ______________________
ASSESSMENT OF THE MUSCULOSKELETAL SYSTEM RATING
ASSESSMENT SKILL
1. Perform hand-washing.
2. Gather equipment (tape measure, goniometer)
3. Explain the procedure to the client.
4. Ask the patient to wear a gown.
Gait
1. Observe gait for base, weight-bearing stability, feet position, stride,
arm swing and posture.
Temporomandibular Joint
1. Inspect, palpate, and test ROM
Sternoclavicular Joint
1. Inspect and palpate for midline location, color, swelling, and masses.
Spine
1. Inspect and palpate cervical, thoracic, lumbar spine for pain and
tenderness.
2. Test ROM of cervical spine.
3. Test ROM of thoracic and lumbar spine.
4. Test for leg and back pain
5. Measure leg length
Shoulders
1. Inspect and palpate shoulders for symmetry, color, swelling, and
masses.
2. Test ROM of shoulders.
Elbows
1. Inspect and palpate elbow for size, shape, deformities, redness, or
swelling.
2. Test ROM of elbows.
Wrist
1. Inspect and palpate wrist for size, shape, symmetry, color, swelling,
tenderness, and nodules.
2. Test ROM of wrist.
3. Test for carpal tunnel syndrome.
Hands and Fingers
1. Inspect and palpate hands and fingers for size, shape, symmetry,
swelling, color, tenderness, and nodules.
2. Test ROM of hand and fingers.
Hips
1. Inspect and palpate hips for shape and symmetry.
2. Test ROM of hips.
Knees
1. Inspect and palpate knees for size, shape, symmetry, deformities,
pain, and alignment.
2. Test knees for swelling. If small of fluid present, do “bulge test”. If
large amount of fluid is present, do “ballottement test”.
 Document Code
ISABELA STATE UNIVERSITY
College of Nursing
Revision No. Page 00 of 00

EVALUATION TOOL Effectivity Date

3. Test ROM of knees.

4. Perform McMurray test if client complaints of “clicking” in knee.
Ankle and Feet
1. Inspect and palpate ankles and feet for position, alignment, shape,
skin, tenderness, temperature, swelling, or nodules.
2. Test ROM of ankles and toes.
TOTAL

SCOR
EQUIVALENT DESCRIPTION SCORE EQUIVALENT
E
98 1.0 50-59 3.25 Rating Scale:
Very
95-98 1.25 50-54 3.5 0 – Not Observed
Satisfactory
90-94 1.5 45-49 3.75 1 – Needs Improvement
85-89 1.75 40-44 4.0 2 – Satisfactory
80-84 2.0 Good 35-39 4.25 3 – Very Satisfactory
References:
75-79 2.25 30-34 4.5
70-74 2.5 25-29 4.75 Weber, J et.al. (2018). Health
Needs
65-69 2.75 24 and Assessment in Nursing. 6th Edition.
Improvement 5.0
60-64 3.0 below Wolters Kluver Health/ Lippincott
Williams and Wilkins.
Clinical Instructor