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Assessment of the Musculo-Skeletal System

Wilfredo A. Dela Cerna, RN

Outlines
1. Review of Anatomy and physiology of musculoskeletal system 2. Physical Exam 3. Inspection 4. Palpation 5. ROM (Rang of motion)

Objectives
• Apply knowledge of Anatomy and physiology of musculoskeletal system • Differentiate between normal and abnormal • Implement physical assessment

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The parts of the skeleton The human skeleton is divided into two distinct parts: Axial Appendicular .

The The The The Skull Sternum Ribs Vertebral Column . neck. and trunk.Axial Skeleton The axial skeleton consists of • bones that form the axis of the body and support and protect the organs of the head.

The Upper Extremities – The Lower Extremities – The Shoulder Girdle – The Pelvic Girdle--(the sacrum and – coccyx are considered part of the vertebral column) .Appendicular Skeleton The appendicular skeleton is • composed of bones that anchor the appendages to the axial skeleton.

• There would be no exploring. speak. walk. you wouldn't be alive for very long . without muscles. talk. The fact is. blinking. breathing. or move your food through your digestive system. shake hands. smiling. climbing. running. You couldn't move anything inside or outside you.What do muscles do ? • Muscles simply move you! • Without muscles you couldn't open your mouth.

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It does three major jobs.The skeleton is the name given to the collection of bones that holds our body up. 2. the heart. 3. It allows us to move. Because our muscles are attached to our bones. It protects our vital organs such as the brain. and we move . 1. when our muscles move. Our skeleton is very important to us. Without our skeleton we would just be a blob of blood and tissue on the floor. and the lungs. It gives us the shape that we have. they move the bones.

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Inspection • Observe any lack of symmetry and any evidence of trauma or disease. . • Inspect the joint contour (shape) and observe any evidence of swelling. • Look for muscle wasting.Physical Exam 1. deformity or inflammation.

or otherwise identify. Screening questions for musculoskeletal disorders 1. Can you walk up and down stairs without difficulty? 3.• Ask the client to point to. any painful areas. legs or back? 2. including sites of radiation of pain. Can you dress yourself in everyday clothes without any difficulty? . Do you have any pain or stiffness in your arms.

)Reassure patient that you will support him. Person should be able to stand with feet together without falling with eyes open or closed. • Next. • Observe for equality of arm swing . • Ask the patient to tandem walk . balance and rapidity and ease of turning .• Assessment of Gait • Ask the patient to walk back and forth across the room .then on heels . in case he becomes unsteady . • Normal :Person can walk in balance with the arms swinging at sides and can turn smoothly. ask the patient to walk on his tiptoes . (Romberg's test . heels tiptoes tandem . • Test patient's ability to stand with feet together with eyes open and then closed.

• Look for asymmetry. • Note muscle size (bulk).Upper Extremity Muscles • Inspect the muscles of the shoulder. • Look for tremor and other abnormal movement at rest and with arms outstretched. . arm. forearm and hand. atrophy and fasciculation.

Determine muscle power by • Gently trying to overpower contraction of each group of muscles. – Shoulder: Abduction Abduction (Deltoid) – . Adduction – . Shrug (Trapezius) Adduction Trapezius) .

– Elbow: flexion (Biceps) – Elbow extension (Triceps) – Wrist: Flexion ( )and extension(). .

– Hand: Grip Grip – opposition of thumb and index finger – opposition of thumb and little finger and – finger abduction and adduction. .

increased or decreased .• Determine limb tone (resistance to passive stretch). • With the patient relaxed • Gently move the limb at the shoulder. elbow and wrist joints and note whether tone is normal.

• You have to learn to appreciate the normal tone from practice. • Muscle power obviously varies. You should not be able to overpower with reasonable resistance.Normal findings • Muscles are symmetrical in size with no involuntary movements. • In some. muscles may be slightly larger on the dominant side. .

Neck: Range of Motion of • Fix the head with one hand while you examine neck • Inspection – Note the normal concavity of cervical spine – Identify Transverse process of C7 – Observe Trapezius and Sternomastoid muscles • Palpation – Feel each spinous process looking for focal areas of tenderness – Joint – Para spinal muscles – Active • Feel for crepitus during passive motion Touch chin • Range of motion • Touch chin for flexion • Throw head back for extension Throw head back .

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• Touch each shoulder with ears for lateral flexion • Touch each shoulder with chin for lateral rotation – Passive • Feel for crepitus during passive motion • Normal: – 30 degree rotation. . – No resistance during the range of motion. able to touch chest with chin. 55 degree extension and 40 degree lateral bend.

atrophy and fasciculation . Note muscle size( bulk . Extension (Gluteus maximus). – Hip :Flexion( Iliopsoas). knee and ankle . • • • • Hip flexion . Adduction .) Look for asymmetry.Muscles of Lower Extremity Inspect the muscles of the hip. Look for abnormal movement . Determine muscle power by gently trying to overpower contraction of each group of muscles . Abduction.

deormity marked on the left leg . is there evidence of bowing (varus) or knockkneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee. • Do they limp or appear to be in pain? • When standing.The Knee Exam • Inspection • Make sure that both knees are fully exposed. The patient should be in either a gown or shorts. varus Knee more . a common cause of bowing . Rolled up pant legs do not provide good exposure ! • Watch the patient walk.

While both legs have well developed musculature. the left calf and hamstring are bulkier than the right .• Is there evidence of atrophy of the quadriceps. hamstring. or calf muscle groups? Knee problems/pain can limit the use of the affected leg. leading to wasting of the muscles .

• Support the knee. increased or dicreased. gently move the limb at the hip. dorsiflex the ankle sharply and hold the foot in this position checking for clonus . With the patient relaxed. Flex the hip and knee. knee and ankle and note whether tone is normal.) Extension( Quadriceps ) – Ankle : Dorsiflexion( Tibialis anterior). – Knee : Flexion( Hamstrings .• Determine limb tone resistance to passive stretch. Plantar flexion (Gastronemius .) Knee extension Knee flexion Dorsiflexion .

Spine (Bone) • The examiner should stand behind the patient and observe the alignment of the spine in the flexed position to determine scoliosis .Percuss one vertebra at a time. . • View the spine from the side to determine kyphosis . • Ask the patient if he is aware of sore spots. starting from head . • . Palpate the spinous process and be gentle with the sore spots .

• Assess range of motion of spine by having patient bend down to pick up an object without bending his legs while you hold his hips . • Normal : • Gentle concavities in cervical and lumbar regions and a convexity in the thorax . • Vertebral line and gluteal cleft align .