Musculoskeletal assessment

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Musculoskeletal assessment

• Joints are the functional unit of the MS system
  because they permit mobility needed for ADLs
• Nonsynovial joints are fibrous tissue or
  cartilage are immovable or slightly movable
• Synovial- freely movable enclosed in joint cavity
  which is filled with synovial fluid which is a
  lubricant
• Cartilage- covers the surface of opposing bone
• Musculoskeletal (MS) system composed of 206 bones
  which are rigid very dense.
• Ligaments-are fibrous bands running directly

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• directly from one bone to another to
• strengthen the joint helps prevent
  movement
• in undesirable direction
• Muscles-when contract produce movement
• Skeletal muscle composed of muscle fibers
• Tendon a strong fibrous cord which is attaches
  skeletal muscle to bone
• Movement of Skeletal Muscles
• Flexion-bending of limb at a joint
• Extension- straightening the limb at a joint
• Abduction- moving a limb away from the midline of
  the body

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• Adduction- moving a limb toward the midline of
  the body
• Pronation- turning the forearm so that the palm
  is down
• Supination- turning the forearm so that the palm
  is up
• Circumduction- moving arm in a circle around the
  shoulder
• Inversion- moving the sole of foot inward at the
  ankle
• Eversion- moving the sole of the foot outward at
  the ankle

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• Rotation- moving the head around a central axis
• Protraction-moving a body part forward and
  parallel to the ground
• Retraction- moving body part backward and
  parallel to the ground
• Elevation- raising a body part
• Depression- lowering a body part
• Assessing the Musculoskeletal System-
• Assess the function of the ADLs to see if
  there is any abnormalities.
• Assess the gait, posture, how client sits in
  chair, raises from chair, takes off jacket, man-
• ipulates small objects as pen

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• Equipment-
• Tape measurer
• Goniometer ( measure joint angles)
• Procedure- exam from head to toe, proximal to
  distal
• Joint to be examined should be supported at rest
  is area inflamed be careful can cause pain
• Inspection- note size, contour of joint, color,
  swelling, any masses or deformity
• Palpation- palpate each joint not heat,
  tenderness, swelling or masses,

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• Range of Motion ( ROM)- become familiar with ROM
  of each joint, so you can recognize limitation.
  If limitation, gently attempt passive motion (one
  hand anchor joint while other hand slowly moves
  it to its limit). Both ROM and passive motion
  should be done at same time
• Crepitation- audible and palpable crunching or
  grating that accompanies movement
• Muscle increase with use and decrease with
  disuse
• Increase in the skeletons size and increase in
  fat and muscle

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• Inspection
• Note size and contour of joint
• Inspect skin and tissues for color,
  swelling,
• masses or deformity
• Palpation
• Palpate joint note skin temperature, heat,
• tenderness, swelling or masses.
• Normally joints not tender, if occurs try to
• locate specific anatomic structure
• Synovial membrane not palpable. Feels
• doughy or boggy

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• Muscle testing
• Test strength of prime muscle movers for
  each
• join
• Muscle strength should be equal bilaterally
• Wide variety among people
• Please read pages 616-636 for adult explanation
• Musculoskeletal Tests
• Phalens test- hold both hands back to back
• while flexing wrists 900 for 60 seconds- no
  pain
• for in normal hands. With carpal tunnel
• syndrome have burning and numbness

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• Tinel Sign-percussion of the location of
• median nerve at wrist no symptoms. In
• carpal tunnel syndrome causes a burning
• and tingling
• Bulge Sign- suprapatellar pouch, confirms
• presence of small amt. of fluid. Fluid
• displaced ( pg 629)
• Ballottement of Patella-large amount of
  fluid
• in suprapatella pouch moves to knee joint.
• Check for crepitus, if pronounced is
• significant and maybe degenerative disease
• of knee. Pg 629
• McMurrays test- client supine, hold heel and
  
• flex knees and hip rotate leg in out to

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• loosen joint normally no pain if hear or
  fell
• click positive torn meniscus
• Vocabulary
• Osteoarthritis-noninflammatory, progressive
• disorder involving deterioration of
  articular
• cartilages and subchondral bone, and
• formation of new bone
• Osteoporosis- decrease of skeletal bone mass
• when rate of bone resorption is greater
  than
• that of bone formation decrease in bone
• density
• Rheumatoid Arthritis-(RA) systemic inflamma-
• disease of joint and surrounding connective
  

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tissue, Has inflamed joints, limited ROM,
worse in the AM when getting up, movement
decreases client is up. Children Childr
en- by 3 months gestation form scale model-
made up of cartilage, which becomes true bone
during the gestational period. -- Long bones
grow after birth in width and diameter until
age 20 --As skeleton contributes to linear
growth, muscles and fat increase in persons
weight
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• Note any positional deformities
• check for congenital hip dislocation Ortolanis
  maneuver or Allis Test
• Ortolanis Test-Infant supine, flex knees holding
  thumb on inner mid-thigh, your fingers outside on
  hips touching greater trochanter gently lift up
  and abduct moving knees apart should be smooth
  if hip unstable ,feels like a clunk is positive
  need to be referred for dislocated hip
• Allis Test-test for dislocated hip comparing leg
  length. Baby supine, feet flat on table bend
  knees up, both knees at same elevation

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• Moro Reflex- startle infant by jarring crib, make
  loud noise or, support head and back of infant
  in semi-sitting position quickly lowering infant
  300 will look like hugging tree (see 696) if
  absent indicates severe CNS injury
• Preschool and School Age Children-
• Check for Knock Knees or lateral bowling of tibia
• Flat feet
• Adolescents- check for Kyphosis and
• and Scoliosis ( lateral curvature of spine)

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At Birth

• Skeletal System- at birth contains larger amount
  of cartilage than ossified bone, though
  ossification is rapid during the first year
• 6 Skull bones relative soft and have not joined
  at birth.
• Muscular system almost completely formed at birth
• Check 10 toes, 10 fingers, full ROM, creases on
  anterior 2/3 of sole, symmetry of extremities

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• Babinski sign- dorsiflexion of big toe and
  fanning of other toes normal in infancy abnormal
• Children fine motor skills
• Grasping-2-3 months
• Hand closed- 1 month
• Hand open-3 month
• Voluntary grasping at things 5 months
• Princer grasp- ( using thumb index finger)8 to
  10 months
• Children Gross motor skills
• Head Control- 3 moths hold head up

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• 4 months lifts head
• 4-6 months head control established
• Rolling over- from abdomen to back- 5 months
• Sitting- begins to sit up with help 4 months
• Sit alone- 7 months
• From prone to sitting position- 10 months
• Locomotion- propels themselves forward on all 4
  extremities
• Propels backward -4 to 6 months

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• Crawling to creeping with belly off floor- 9
  months
• Walking holding on to furniture-11 months
• In Children note
• muscle-
• Note symmetry and quality of muscle and quality
  of development ( shape and contour) tone
  (firmness when contracted and relax) and strength
  ( push and pull)
• Joints-
• evaluate ROM, palpate joints for heat,
  tenderness, swelling

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• Bone- assess shape of bone
• Maybe bowleg (lateral bowing of the tibia)
• Maybe knock Knee (knees close together but
  feet spread apart)
• Feet- for arch development
• Flat feet
• Assess gait
• Estimate angle of gait outward less than
• 30 degree and inward less that 10degree
• Check for pigeon toe or toeing in

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• Extremities-
• symmetry of length, size, count fingers and
  toes, inspect arms and legs for temperature,
  color, tenderness, and masses. May see some
  trauma
• Accidental fractures in children main
• criteria
• pain
• pulse
• paresthesia (abnormal sensation as
• numbness)
• pallor
• paralysis

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• Pregnancy
• Pregnancy-changes occur to compensate for the
  enlarging fetus called Lordosis, which shifts
  center of balance forward. As pregnancy increase
  there is a shift of weight further back on lower
  extremities sometimes felt as low back pain
  during late pregnancy

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• Older Adults
• Aging-as this occurs there is a loss of bone
  matrix and therefore decrease in bone density
  (osteoporosis). Results in posture changes
• Decrease in height (shortening of vertebral
  column) beginning at age 40 for males and 43 in
  females
• Kyphosis- backward head tilt
• Slight flexion of hips and knees.
• Loss of subcutaneous fat leaves bony
• prominences
• Loss in muscle mass

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• Some muscle decrease in size
• Subcutaneous fat increases weight in 40s and
  50s. losses it in face and gains in abdomen and
  hip in 80s and 90s decrease in the forearm