Chapter 24

Assessing Musculoskeletal
System
Structure of the Bones #1
❖ 206 bones
❖ Axial (head and trunk) and appendicular (extremities,
shoulders, and hips) skeleton
❖ Compact and spongy bones
❖ Osteoblasts, osteoclasts

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Structure of the Bones #2

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Structure of the Skeletal Muscles #1
❖ Three types:
o Skeletal voluntary (650), smooth, cardiac
❖ Movements: abduction, adduction, circumduction,
inversion, eversion, extension (hyperextension), flexion
(dorsi and plantar), pronation, supination, protraction,
retraction, rotation (internal and external)

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Structure of the Skeletal Muscles #2

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Question #1
Which skeletal muscle movement means “to move
forward”?
A. Abduction
B. Flexion
C. Protraction
D. Eversion

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Answer to Question #1
C. Protraction.
Protraction means moving forward. Abduction is moving
away from the midline of the body. Bending the extremity
at the joint and decreasing the angle of the joint is known
as flexion. Moving outward is known as eversion.

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Structure of the Joints
❖ Fibrous, cartilaginous, and synovial
❖ Ligaments
❖ Bursae

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Osteoporosis #1
❖ One in three women and one in five men will have a
fractured bone, with hip, forearm, and vertebral
fractures predominating.
❖ Europeans and Americans accounted for 51% of
osteoporosis-related fractures in the year 2000, followed
by people from the Western Pacific and Southeast Asia.
❖ Osteoporosis is lowest in black males and highest in
white females.

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Osteoporosis #2

❖ Uncontrollable risk factors:

o Age, gender, family history, previous fracture,
ethnicity, menopause/hysterectomy, long-term
glucocorticoid therapy, rheumatoid arthritis,
primary/secondary hypogonadism in men
❖ Modifiable risk factors:
o Alcohol, smoking, low body mass index, poor
nutrition, vitamin D deficiency, eating disorders, low
dietary calcium intake, insufficient exercise
(sedentary lifestyle), frequent falls

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Risk Reduction: Osteoporosis

❖ Ensure a nutritious diet with adequate calcium intake.

❖ Avoid protein malnutrition and undernutrition.
❖ Maintain an adequate supply of vitamin D.
❖ Participate in regular physical activity.
❖ Avoid the effects of second-hand smoke.

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Question #2
Is the following statement true or false?
Decreased estrogen levels after menopause increase the
risk of osteoporosis.

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Answer to Question #2
True.
Decreased estrogen levels in postmenopausal women
decrease bone mass density, making them prone to
osteoporosis.

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Collection of Subjective Data
❖ History of present health concern
❖ Past health history
❖ Family history
❖ Lifestyle and health practices

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Collection of Objective Data #1
❖ Preparing the client
❖ Equipments required:
o Tape measure
o Goniometer
o Skin marking pencil

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Collection of Objective Data #2

❖ Gait: observe gait; assess for risk of falling

❖ Temporomandibular joint:
o Inspect and palpate the TMJ
o Test range of motion
❖ Sternoclavicular joint

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Collection of Objective Data #3

❖ Cervical, thoracic, and lumbar spine:

o Observe the cervical, thoracic, lumbar curves.
o Palpate the spinous processes and paravertebral
muscles for tenderness or pain.

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Collection of Objective Data #4

❖ Cervical, thoracic, and lumbar spine (cont.):

o Test ROM of the cervical, thoracic, lumbar spine.
o Test for back and leg pain.
o Measure leg length.

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Collection of Objective Data #5

❖ Shoulders, arms, and elbows; inspection, palpation, ROM

❖ Elbows:
o Inspect for size, shape, deformities, redness, or
swelling.
o Test ROM.

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Collection of Objective Data #6

❖ Wrists: inspection, palpation, test ROM, test for carpel

tunnel syndrome
❖ Hands and fingers: inspection, palpation, test ROM
❖ Hips: inspection, palpation, test ROM

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Collection of Objective Data #7
❖ Knees: inspection, palpation
o Test for swelling.
o Perform ballottement test.
o Test for ROM.
o Test for pain and injury.

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Collection of Objective Data #8

❖ Ankles and feet:

o Inspect position, alignment, shape, and skin.
o Palpate ankles and feet for tenderness, heat,
swelling, or nodules.
o Test ROM.

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Abnormal Spinal Curvatures
❖ Flattening of the lumbar curve
❖ Kyphosis
❖ Lumbar lordosis
❖ Scoliosis

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Wrist Abnormalities
❖ Acute rheumatoid arthritis
❖ Chronic rheumatoid arthritis
❖ Boutonnière and swan neck deformities
❖ Ganglion
❖ Osteoarthritis
❖ Tenosynovitis
❖ Thenar atrophy

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Feet and Toes Abnormalities
❖ Acute gouty arthritis
❖ Flat feet
❖ Callus
❖ Hallux valgus
❖ Corn
❖ Hammer toe
❖ Plantar wart

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Question #3
Is the following statement true or false?
Calluses are painful thickenings of the skin that occur over
bony prominences and at pressure points.

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Answer to Question #3
False.
Calluses are nonpainful areas of thickened skin that occur
at pressure points. Corns are painful thickenings of the skin
that occur over bony prominences and at pressure points.

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Older Clients
o Older clients usually have slower movements,
reduced flexibility, and decreased muscle strength
because of age-related muscle fiber and joint
degeneration, reduced elasticity of the tendons, and
joint capsule calcification.
o An exaggerated thoracic curve (kyphosis) is common
with aging.

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Older Client Frequent Findings

❖ Bones lose their density with age, putting the older client
at risk for bone fractures, especially of the wrists, hips,
and vertebrae. Older clients who have osteomalacia or
osteoporosis are at an even greater risk for fractures.
❖ Joint-stiffening conditions may be misdiagnosed as
arthritis, especially in the older adult.
❖ Osteoporosis is more common as a person ages because
bone resorption increases, calcium absorption decreases,
and production of osteoblasts decreases as well.
❖ Some older clients have an impaired sense of position in
space, which may contribute to the risks of falling.

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Analysis of Data #1
❖ Selected nursing diagnoses:
o Wellness diagnoses
o Risk diagnoses
o Actual diagnoses

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Analysis of Data #2
❖ Selected collaborative problems:
o Osteoporosis
o Joint dislocation
o Compartmental syndrome
o Pathologic fractures

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