examination of Musculoskeletal system

Examination of

Musculoskeletal System

Assess this system while bathing or positioning

Focus on range of joint motion, muscle strength, tone, joint & muscle condition

Muscular disorders may result from neurological disease

Simultaneous muscular & neurological examination

Visualize : Bone anatomy, muscle placement & joint structure

Assess the degree of mobilityProvide proper position while

examination

Nursing HistoryDetermine involvement in

competitive sportsH/o alcohol or caffeine use,

cigarette smoking, constant dieting

Menopause before age 45, estrogen deficiency

Family H/o osteoporosisChronic diseases

Cont…History of problems in bone,

muscle or joint functionNature and extent of painNormal activity patternHeight loss in women over age

50

Inspection Observe client’s gaitNote: how client walks, sits &

rises from a sitting positionNote foot dragging, limping,

shuffling & position of legs in relation to trunk

Observe client in standing position

Note common postural abnormalities

Cont…Check for kyphosis, lordosis &

scoliosisAssess for signs of osteoporosisExtremities: overall size, gross

deformity, bony enlargement, alignment & symmetry

Palpation Gentle palpation : bones, joints,

surrounding musclesNote heat, tenderness, edema or

resistance to pressureDuring palpation: no discomfort

to clientMuscles should be firm

Terminology FlexionExtensionHyperextension PronationSupinationAbductionAdduction

Internal rotationExternal rotationEversionInversionDorsiflexionPlantar flexion

Range of motionIncludes both active & passive

ROMPut each major joint through

active and passive full ROMDemonstrate and instruct the

client

Cont…Goniometer : measures precise

degree of motion in a particular joint

Muscle tone and strengthCheck for hypertonicity &

hypotonicityIn case of pain: support the

extremitySlight resistance can be thereCompare symmetrical muscle

pairs

Maneuvers to assess muscle strength

Neck (sternocleidomastoid muscle)

Place hand firmly against client’s upper jaw & ask the client to turn the head laterally against resistance

Cont..Shoulder (trapezius)Place hand over midline of client’s shoulder exerting firm pressure. Have the client to raise shoulder against resistance

Cont…Elbow

◦Biceps : pull down on forearm as client attempts to flex arm

◦Triceps : as you flex client’s arm, apply pressure against forearm. Ask client to straighten the arm

Cont..Hip

◦Quadriceps : when client is sitting, apply downward pressure to thigh. Ask client to raise leg up from table

◦Gastrocnemius : client sits, while examiner holds shin of flexed leg. Ask client to straighten leg against resistance

Muscle strength Muscle function level

Grade % Normal Lovett scale

No evidence of contractility

0 0 0(zero)

Slight contractility, no movement

1 10 T(trace)

Full range of motion, gravity eliminated

2 25 P(poor)

Full range of motion with gravity

3 50 F(fair)

Full range of motion against gravity, some resistance

4 75 G(good)

Full range of motion against gravity, full resistance

5 100 N(normal)

THANK YOU..!!