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Adventist University of the Philippines

College of Nursing
MNHA 510 – Advanced Health Assessment

Musculoskeletal System
Equipment: skin marking pencil, tape measure, and reflex hammer.

Physiological Examination Findings

Basic Guidelines
Begin by observing posture and gait. Also inspect the Can stand still, walk straight and stay
skeleton and extremities when the patient stands, sits, balanced. No abnormal curvatures or
and walks. Compare sides for alignment. postures.

When examining each region, observe the following

guidelines.

- Inspect the skin and subcutaneous tissues over - No swelling, discoloration or masses
the muscles and joints, noting the skin color on the skin surface. With good skin
and number of skinfolds. Observe for any color.
discoloration, swelling, or masses.

- Inspect the muscles and compare contralateral - Symmetrical muscles noted. No

sides for size and symmetry. Stay alert for fasciculation observed.
fasciculation.

- Palpate the bones, joints, and surrounding -No heat, tenderness, swelling, joint
muscles to evaluate muscle tone and detect any fluctuation, crepitus, pain, or resistance
heat, tenderness, swelling, joint fluctuation, to pressure upon assessment.
crepitus, pain, or resistance to pressure.

- Examine each major joint for active and - Upon joint motion, no tenderness,
passive range of motion. If the range of motion pain, or crepitation noted.
seems increased or decreased, use a
goniometer to measure the angle of the joint.
- Muscle strength 5, equal strength
- Test muscle strength by applying resistance as bilaterally and fully resist when
the patient moves. Grade muscle strength from applying opposing force.
zero to five.
Head

Physiological Examination Findings

Assess the temporomandibular joint in three ways.

- Palpate the joint space for clicking, pain, - Upon palpating, no clicking, pain,
crepitus, locking, or popping crepitus, locking, or popping, noted.

- Assess range of motion by having the patient - Can open and close mouth with no
open and close the mouth, move the lower jaw pain or any abnormalities. Can move
to each side, and protrude and retract the jaw. the lower jaw to each side and can
protrude or retract jaw.

- Test the strength of the temporalis and
masseter muscles with patient’s teeth clenched.
Shoulder
Evaluate the shoulder using four techniques.
- Inspect the contour of the shoulders, shoulder
girdle, clavicles, scapulae, and surrounding
muscles.
- Palpate the joint spaces, bones, and muscle
insertions of the shoulders.
- Examine range of motion. The patient should
be able to shrug the shoulders, perform
forward flexion to 180 degrees and
hyperextension to 50 degrees, complete
abduction to 180 degrees and adduction to 50
degrees, and do internal and external rotation
of 90 degrees.
- Test the muscle strength as the patient shrugs
the shoulders.
Upper Extremities
Physiological Examination
Examine the hands and wrists in four ways
- Inspect the dorsum and palm of the hands.
Note their contour, position, and shape, and the
number and completeness of fingers.
- Palpate each joint in the hand and wrist.
- Test the range of motion Metacarpophalangeal
flexion should be 90 degrees.
Metacarpophalangeal hyperextension should
be 30 degrees. The patient should be able to
demonstrate thumb opposition, from a first,
and adduct the fingers. You should see wrist
flexion of 90 degrees and wrist hyperextension
of 70 degrees. Expect radial motion to be 20
degrees, and ulnar motion to be 55 degrees.
- Evaluate muscle strength by testing wrist
flexion and hyperextension and hand grip.
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- Firm and bulk muscles. Can bite well
with the teeth clenched.
- No redness, muscular atrophy,
deformity, or swelling on both
shoulders.
- No muscular spasm or atrophy,
swelling, heat, or tenderness when
palpated.
- No crepitation noted. Can perform
well the range of motion on both
shoulders.
- Can shrug both shoulders against my
resistance.
Findings
- The position of the hand shows the
wrist in slight extension. The fingers lie
straight in the same axis as the forearm.
There is no swelling or redness,
deformity, or nodules.
- Joint surfaces feel smooth, with no
swelling, bogginess, nodules, or
tenderness
- Have done this. The patient was able
to demonstrate thumb opposition, from
a first, and adduct the fingers. There
was a wrist flexion of 90 degrees and
wrist hyperextension of 70 degrees.
Radial motion was also noted by 20
degrees, and ulnar motion with 55
degrees.
- Can flex and hyperextend wrists. With
firm and strong hand grip. Muscle
strength 5.

- If you need to evaluate the median nerve in the - No pain, numbness, or tingling felt in
hand , have the patient mark the locations of
pain, numbness, and tingling on the Katz hand
diagram. Also test for Tinel sign and perform
the thumb abduction and Phalen test.
Physiological Examination
Asses the elbows with four methods
- Inspect the elbows in the flexed and extended
positions. Note their contour and carrying
angle, which should be 5 to 15 degrees
laterally.
- Palpate the extensor surface of the ulna, the
olecranon process, and the medial and lateral
epicondyles of the humerus.
- Check the range motion. With elbow flexion,
range of motion should be 160 degrees. With
extension, it should be 180 degrees. With
pronation and supination, it should be 90
degrees.
- Asses muscle strength during elbow flexion
and extension.
Spine
Examine the cervical spine using four techniques.
- Inspect the neck for alignment as well as
symmetry of the skinfolds and muscles.
- Palpate the posterior neck, cervical spine, and
paravertebral, trapezius, and
sternocleidomastoid muscles.
- Evaluate range of motion by forward flexion
(which should be about 45 degrees), extension
(about 45 degrees), lateral bending (about 40
degrees), and rotation (about 70 degrees).
- Test the strength of the sternocleidomastoid
and trapezius muscles.
Physiological Examination
Asses the thoracic and lumbar spine with four
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the hands.
Findings
- No deformity, redness, or swelling
noted. Have a carrying angle of 5-15
degrees laterally.
- No unusualities noted upon palpation.
- With good range of motion. Upon
elbow flexion, range of motion is
around160 degrees. With extension, it
was 180 degrees. With pronation and
supination, it was 90 degrees.
- Muscles strength 5. Able to elbow
flex and extend.
- The spine is straight, and the head
erect.
- They are firm, with no muscle spasm
or tenderness.
- Can do this. The patient can also
normally maintain flexion against my
full resistance.
- They are firm, with muscle strength at
5.
Findings
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maneuvers.

- Inspect the landmarks of the back for - No deviation or curvatures noted.

alignment. Note the curve of the spine.

- Palpate along the spinal processes and - No bulges, or swelling noted.

paravertebral muscles.

- Percuss for spinal tenderness. - No tenderness noted.

- Examine range motion. Expect forward flexion - Range of motion present and within
of 75 to 90 degrees, hyperextensions of 30 normal ranges.
degrees, and lateral bending of 35 degrees.

Hips

Evaluate the hips in three ways.

- Inspect the hips, checking for symmetry, the - Smooth, even gait reflects equal leg
size of the buttocks, and the numbers and level lengths and functional hip motion.
of the gluteal folds. Joints feel stable and symmetric, with
no tenderness or crepitation.

- Check the hip range of motion, hip flexion - No limit in motion as observed.
with the knee extended should be 90 degrees; Absence of pain upon movement.
with the flexed, it should be 120 degrees. Hip
hyperextensions with the knee 30 degrees. Hip
abduction should be 45 degrees, while
abduction should be 30 degrees. Internal
rotation should be 40 degrees, and external
rotation should be 45 degrees.
- Muscle strength 5. With full strength.
- Test the muscle strength during hip flexion
Can flex and extend without any pain
with the knee flexed and then extended, during
or limited movement.
abduction and adduction, and when the seated
patient uncrosses the legs.

Physiological Examination Findings

Lower Extremities

Examine the legs and knees using four techniques.

- Inspect the knees, their popliteal spaces, and - Within expected angle, lesss than 15
lower leg alignment. The expected angle degrees. There are distinct concavities,
between the femur and tibia is less than 15 or hollows, on either side of the patella.
degrees.

- Palpate the popliteal space and tibiofemoral - No fullness or swelling noted.

joint space, particularly noting tenderness, Negative bogginess, nodules, or

swelling, bogginess, nodules, or crepitus.
- Evaluate knee range of motion. Expect 130
degrees of flexion, full extension, and up to 15
degrees of hyperextensions
- Test the strength of the knee muscles while the
patient maintains flexion and extension.
Physiological Examination
Examine the feet and ankles with four methods.
- Inspect the feet and ankles while the patient is
bearing weight and while sitting. Observe
landmarks; contour; arches; foot alignment
with tibia; toe alignment with the other toes;
and position, size, and number of toes.
- Palpate the Achilles tendon, anterior surface of
the ankle, medial and lateral malleoli, and each
metatarsophalangeal joint.
- Check the range of motion with the patient
seated. Dorsiflexion should be 20 degrees.
Plantar flexion should be 45 degrees. Expect
inversion of 30 degrees and eversion of 20
degrees. Expect abduction of 10 degrees and
adduction of 20 degrees. Expert flexion and
extension of the toes, especially the great toes.
- Test the muscles strength during dorsiflexion
and plantar flexion and during ankle abduction
and adduction and great to flexion and
extension.
Adapted from Seidel, H.; Ball, J.; Dains, J.; Flynn, J; Solomon, B.; & Stewart, R. (2011)Mosby’s
Guide to Physical Examination (7th edition). St. Louis: Mosby/Elsevier
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crepitus.
- Can bend each knee, 130-150 degree
flexion. Can extend each knee, 15
degrees hyperextension.
- No limping noted, no sudden locking
of knees. No sudden buckling, or
giving away of lower extremities. With
full strength. Can rise from lower chair
without using hands for support.
Findings
- The toes point straightforward and lie
flat on the surface. The foot is aligned
with the long axis of the lower leg.
Complete toes on both feet. No lesions
noted.
- The ankles are smooth, and has bony
prominences. No abnormal swelling,
tenderness or nodules noted on each
area.
- Can perform all these instructions
without any limitation or pain (degrees
are within the expected range of
motion):
Point toes toward the floor.
Point toes toward your nose.
Turn soles of feet out and then in.
(Stabilize ankle with one hand and hold
heel with the other to test the subtalar
joint.)
Flex and straighten toes.
- When doing this, patient can hold
flexion strongly and firmly.