Assessment of Musculoskeletal System

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Assessment ofMusculoskeletal System

• By
• Dr. Hanan Said Ali

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Learning Objectives

• Explain how to assess musculoskeletal system

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MusculoskeletalAnatomy and Physiology

• Anatomy and physiology
• The musculoskeletal system comprises
• bones, muscles and joints, and makes up most of
  the bodys mass. It performs a number of
  essential functions including
• Maintenance of body shape.
• Support and protection of soft tissues structures
  such as the brain, heart and lungs.

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• Movement.
• Breathing.
• Storage of calcium and phosphate in bone.
• The manufacture of red blood cells, white
• blood cells and platelets in the bone marrow
• (haematopoiesis)

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Bones

• Bone is a rigid structure ideally suited for its
  supportive and protective function. Bones contain
  sites for muscle attachment, the mechanical basis
  for movement.
• Muscles
• Muscle tissue is made up of contractile cells
  which have the ability to shorten in length or
  contract. It is this characteristic that is
  responsible for movement, maintenance of posture
  and heat production

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• Joints
• A joint is the site at which two or more bones
  are united, providing the allows movement.
• Fibrous joints unite bones by fibrous connective
  tissue and allow very little movement.

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MusculoskeletalAssessment

• Health History
• Subjective Data -Chief Complaints pain, altered
  sensation, limited motion
• Family history, personal history, dietary
  history, socioeconomic status
• Medications (steroids) Current health problems -
  obesity
• Objective Data - Physical Exam
• Objective Data - Diagnostic Tests

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If there is alterationDetermine how alteration
influences ability to perform activities of daily
living (e.g., bathing, feeding, dressing,
toileting, and ambulating)Social functions
(e.g., household chores , work , recreation,
sexual activities).
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Physical Exam

• Mental Status
• General inspection
• Looks at the extremities for overall size , gross
  deformity , bony enlargement, ,and symmetry.
• Head and neck crepitus
• Height, weight, nutritional status, skin,
• spine lordosis (is an increased lumbar
  curvature), scoliosis ( Lateral spinal
  curvature),
• Kyphosis ( is an exaggeration of the
  posterior curvature of the thoracic spine).

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Posture, gait, ROM ex., muscle strength and tone,
size symmetry of muscle development
.PalpationThe nurse applies gentle palpation to
all bones, joint, and surrounding muscles to
Heat, tenderness, edema, or resistance to
pressure. Normal The client should feel no
discomfort when palpation is applied. Muscles
should be firm.
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Physical Exam (cont.)

• A Tremor is an involuntary trembling of a limb
  or body part.
• Tremor may involve large groups of muscle
  fibers or small part.
• An intention tremor when an individual attempts
  a voluntary movement, such as holding a cup of
  coffee.
• A resting tremor is more apparent when the
  client is at rest and diminishes with activity.
• Body posture is assessed for normal standing and
  sitting position.

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Physical Exam (cont.)

• Bones
• are assessed for normal form.
• Joints are assessed for
• tenderness
• swelling ,
• thickening,
• crepitation (the sound of bone grating on
  bone),
• presence of nodules,
• range of motion

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• Muscle Assessment
• Inspection of the muscles
• For the size. Compare the muscles on one side of
  the body to the same muscle to the other side.
  For any
• discrepancies, measure the muscle with a tap.
• Normal finding
• Equal size on both sides of body
• Deviations from normal
• Atrophy (a decrease in size) or hypertrophy (an
  increase in size) asymmetry

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• Muscle Assessment (cont.)
• Inspect the muscle and tendons for contractures (
  shortening ).
• Normal finding
• No contractures
• Deviations from normal
• Malposition of body part ,e.g., foot drop
  (foot flexed downward.
• Inspect the muscles for tremors , for example by
  having the client hold the arm out in front of
  the body
• Normal finding No
  tremors
• Deviations from normal Presence of
  tremors

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• Palpate the muscles for
• Palpate the muscles at rest to determine the
  muscle tonicity ( the normal condition of
  tension, or tone, of a muscle at rest).
• Normal finding
• Normally firm
• Deviations from normal
• A tonic (lacking tone).

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• Palpate muscle while the client is active and
  passive for
• flaccidity.
• spasticity.
• smoothness of movement.
• Normal finding
• Smooth coordinated movement
• Deviations from normal
• Flaccidity (weakness of laxness) or spasticity
• (sudden involuntary muscle contraction).

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• Muscle Assessment (cont.)
• Test muscle strength
• Compare the right side with left side.
• Sternocleidomastoid
• Client turns the head to one side against the
  resistance of your hand.
• Repeat with the other side.
• Normal finding
• Equal strength on each side
• Deviations from normal
• 25 or less of normal strength.

Applied for all muscles
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• Trapezius
• Client shrugs the shoulders against the
  resistance of your hands
• .
• Deltoid
• Client holds arm up and resists while you try to
  push it down.
• Biceps
• Client fully extends each arm and tries to flex
  it while you attempt to hold arm in extension

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TricepsClient flexes each arm and then tries
to extend it against your attempt to keep arm in
flexion.Wrist and finger muscles Client
spreads the fingers and resists as you attempt
to push the fingers together.Grip
strengthClient grasp your index and middle
fingers while you try to pull the fingers out.
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Hip musclesClient is supine, both legs
extended client raises one leg at a time while
you attempt to hold it down.Hip
abduction.Client is supine, both legs extended.
Place your hands on the lateral surface of each
knee client spreads the legs apart against your
resistance.Hip adductionClient is in same
position as for hip abduction. place your hands
between the knee client brings the legs together
against your resistance
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Grading Muscle Strength
Comments Percentage of muscle strength
Complete paralysis 00 of normal strength
No movement , contraction of muscle is palpable or visible 110 of normal strength
Full muscle movement against gravity , with support . 225 of normal strength
Normal movement against gravity 350 of normal strength
Normal full movement against gravity and against minimal resistance 475 of normal strength
Normal full movement against gravity and against full resistance 5100 of normal strength
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Bone AssessmentInspect the skeleton for
normal structure and deformities.Palpate the
bones to locate any areas of edema or
tenderness.Normal findings No deformities.No
tenderness or swelling.Abnormal findingsBones
misaligned.Presence of tenderness or
swelling(may indicate fracture, neoplasm, or
osteoporosis
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. Assessment of jointsInspect the joint for
swelling.Palpate each joint for tenderness,
smoothness of movement ,swelling, crepitation,
and presence of nodulesNormal findingsNo
swelling.No tenderness, swelling , crepitating
or nodules.Joints move smoothly.Abnormal
findingsOne or more swollen joints.Presence of
tenderness, swelling, crepitating , nodules.
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Assess joint range of motion. Ask the client to
move selected body parts. The amount of joint
movement can be measured by a goniometer, a
device that measure the angle of the joint in
degrees. Goniometers are the measuring
devicesGoniometer pin is placed over the joint
and two arms are aligned with the limbs connected
to the joint
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Assess joint range of motion. (cont.)A
proficiency anatomical landmark location aids in
more accurate measurements. Best results are
obtained if the joints are ranged slowly and
smoothly.Two people should perform the
test.One will range the joint and the other will
hold and read the goniometer
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Assess joint range of motion. (cont.)
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Assess joint range of motion. (cont.)
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Assess joint range of motion. (cont.)
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• Assess joint range of motion. (cont.)

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Assess joint range of motion. (cont.)Normal
FindingVaries to some degree in accordance with
person genetic makeup and degree of physical
activity.Deviation From NormalLimited range of
motion in one or more joints
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Diagnostic Evaluation

• Imaging Procedures CT, Bone Scan, MRI
• Nuclear Studies - radioisotope bone density,
• Endoscopic Studies arthrocentesis, arthroscopy
• Other Studies biopsy, synovial fluid,
  Arthrogram, venogram,
• Electromyography
• Myelography
• Laboratory Studies

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• Thank You