Assessment of the MusculoSkeletal System

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Assessment of the Musculo-Skeletal System
Dr Essmat Gemaey 230 NUR
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Outlines

• Review of Anatomy and physiology of
  musculoskeletal system
• Physical Exam
• Inspection
• Palpation
• ROM (Rang of motion)

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Objectives

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

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What do muscles do ?

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

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

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Physical Exam

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

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

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

heels
tiptoes
tandem
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Upper Extremity Muscles

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

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Determine muscle power by

• Gently trying to overpower contraction of each
  group of muscles.
• Shoulder Abduction (Deltoid)
• , Adduction
• , Shrug (Trapezius)

Abduction
Adduction
Trapezius)
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• Elbow flexion (Biceps)
• Elbow extension (Triceps)
• Wrist Flexion ( )and extension().

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

Grip
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• 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,
  increased or decreased

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Normal findings

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

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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 
• Feel for crepitus during passive motion
• Para spinal muscles
• Range of motion
• Active
• Touch chin for flexion
• Throw head back for extension

Touch chin
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, able to touch chest with
  chin, 55 degree extension and 40 degree lateral
  bend.
• No resistance during the range of motion.

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Muscles of Lower Extremity

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

Hip flexion
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The Knee Exam

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

varus Knee deormity, more marked on the left leg
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• 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.

While both legs have well developed musculature,
the left calf and hamstring are bulkier than the
right
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• Knee Flexion (Hamstrings), Extension
  (Quadriceps)
• Ankle Dorsiflexion (Tibialis anterior), Plantar
  flexion (Gastronemius).
• Determine limb tone resistance to passive
  stretch. With the patient relaxed, gently move
  the limb at the hip, knee and ankle and note
  whether tone is normal, increased or dicreased.
  Flex the hip and knee.
• Support the knee, dorsiflex the ankle sharply and
  hold the foot in this position checking for
  clonus.

Knee extension
Knee flexion
Dorsiflexion
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Spine (Bone)

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

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• 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

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Thank you