MUSCULOSKELETAL ASSESSMENT

Musculoskeletal assessment can be conducted as a separate examination or integrated

appropriately with other parts of the total physical examination. The nurse can also integrate
this assessment with other nursing care as the client moves about or performs any type of
physical activity.
Physical assessment of the musculoskeletal system provides data regarding the client’s
posture, gait, bone structure, muscle strength, and joint mobility, as well as the client’s ability
to perform activities of the daily living. The assessment, furthermore, includes inspecting and
palpating the joints, muscles, and bones, testing ROM, and assessing muscle strength.

EQUIPMENT TO BE USED:
 Tape measure
 Goniometer (optional) – a device that measures movement in degrees
 Skin marking pencil (optional)

CLIENT PREPARATION:
 Because the examination is lengthy, be sure that the room is at a comfortable
temperature and provide rest periods as necessary.
 Provide adequate draping to avoid unnecessary exposure of the client yet adequate
visualization of the part being examined.
 Explain that you will ask the client frequently to change positions and to move various
body parts against resistance and gravity.
 Demonstrate to the client how to move the various body parts and provide verbal
directions.

GUIDING PRINCIPLES FOR ASSESSMENT:

1. Observe gait and posture
2. Inspect joints, muscles, and extremities for size, symmetry, and color

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 3. Palpate joints, muscles, and extremities for tenderness, edema, heat, nodules, or
crepitus
4. Test muscle strength and ROM of joints
5. Compare bilateral findings of joints and muscles
6. Perform special tests for carpal tunnel syndrome
7. Perform the “bulge,” “ballottement,” and McMurray’s knee tests

GUIDELINES FOR ASSESSING JOINT AND MUSCLE STRENGTH:

**These guidelines may either be presented as they are or as part of the
techniques.
1. JOINTS
a. Inspect size, shape, color, and symmetry. Note any masses, deformities, or
muscle atrophy. Compare bilateral joint findings
b. Palpate for edema, heat, tenderness, pain, nodules, or crepitus. Compare
bilateral joint findings
c. Test each joint’s ROM. Demonstrate how to move each joint through it’s normal
ROM, then ask the client actively to move the joint through the same motions.
Compare bilateral joint findings.

*** If you identify a limitation in the ROM, measure ROM with a goniometer. To do so,
move the arms of the goniometer to match the angle of the joint being assessed. Then
describe the limited motion of the joint in degrees: for example, “elbow flexes from 45
degrees to 90 degrees.”

2. MUSLCLES
a. Test muscle strength by asking the client to move each extremity through it’s full
ROM against resistance. Do this by applying some resistance against the part
being moved.
b. Document muscle strength by using a standard scale

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 c. If the client can’t move the parts against your resistance, ask the client to move
the part against gravity. If this is not possible, then attempt passively to move
the part through it’s full ROM. If this is not possible, then inspect and feel for
palpable contraction of the muscle while the client attempts to move it.
d. Rate the muscle strength in accord with the strength table below.

STRENGTH
RATING EXPLANATION
CLASSIFICATION
5 Active motion against full resistance Normal
4 Active motion against some resistance Slight weakness
3 Active motion against gravity Average weakness
2 Passive ROM (gravity removed and assisted by examiner) Poor ROM
1 Slight flicker of contraction Severe weakness
0 No muscular contraction Paralysis

ASSESSMENT TECHNIQUES, NORMAL AND ABNORMAL FINDINGS (tabular

presentation – see musculoskeletal assessment techniques file)
These abnormal findings are also incorporated in the tabular presentation

1. Abnormal Spinal Curvatures

a. Flattening of the Lumbar Curve
 May be seen with a herniated lumbar disck or ankylosing spondylitis
b. Kyphosis
 A rounded thoracic convexity is commonly seen in older adults
c. Lumbar Lordosis
 An exaggerated lumbar curve is often seen in pregnancy or obesity
d. Scoliosis
 Lateral curvature of the spine with an increase in convexity on the side
that is curved
2. Abnormalities affecting the Wrists, Hands, and Fingers
a. Acute Rheumatoid Arthritis
 Tender, painful, swollen, stiff joints
b. Chronic Rheumatoid Arthritis
 Chronic swelling and thickening of the metacarpophalangeal and
proximal interphalangeal joints, limited ROM, and finger deviation
toward the ulnar side
c. Boutonniere Deformity
 Flexion of the proximal interphalangeal joint and hyperextension of the
distal interphalangeal joint
 Common in chronic rheumatoid arthritis

d. Swan-Neck Deformity
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  Hyperextension of the proximal interphalangeal joint with flexion of the
distal interphalangeal joint
 Common in chronic rheumatoid arthritis

e. Ganglion
 Nontender, round, enlarged, swollen, fluid-filled cyst commonly seen at
the dorsum of the wrist
f. Heberden’s Nodes
 Hard, painless nodules over the distal interphalangeal joints
 Seen in osteoarthritis
g. Bouchard’s Nodes
 Hard, painless nodules over the proximal interphalangeal joints
 Seen in osteoarthritis
h. Tensosynovitis
 Painful extension of a finger due to infection of the flexor tendon sheath
i. Thenar Atrophy
 Atrophy of the thenar prominence due to pressure on the median nerve
commonly seen in carpal tunnel syndrome

3. Abnormalities of the Feet and Toes

a. Acute Gouty Arthritis
 Tender, painful, reddened, hot and swollen metatarsophalangeal joint of
the great toe
b. Flat Feet
 Also known as “Pes Planus”
 No prominent arch that may cause pain and swelling of the foot surface
c. Callus
 Non-painful, thickened skin that occur at pressure points
d. Hallux Valgus
 Abnormality in which the great toe is deviated laterally and may overlap
the second toe. An enlarged, painful, inflamed bursa (bunion) may form
on the medial side
e. Corn
 Painful thickenings of the skin that occur over bony prominences and at
pressure points
f. Hammer Toe
 Hyperextension at the metatarsophalangeal joint with flexion at the
proximal interphalangeal joint commonly occurring with the second toe
g. Plantar Wart
 Also known as “Verruca Vulgaris”
 Painful warts that often occur under a callus, appearing as tiny dark
spots