Musculoskeletal System
Nursing 330
Governors State University
Shirley Comer
Relevant History
Joint pain, swelling, stiffness, heat, ROM Muscles pain, cramps weakness Bone pain, deformity, trauma Functional assessment Self care habits, lifting repetitive motions Exercise program Recent weight gain or loss
Movements
Inspection/Palpation
Observe posture and spinal alignment– Kyphosis
Normal convex curvature of cervical spine
– Lordosis Normal concave curvature of the lumbar spine
– Scoliosis Abnormal side to side curvature of the spine
Assess spinal alignment– Bend at waist and touch toes
Hips, scapulas and shoulders should be symmetrical in height
– Stand against wall to assess Lordosis Observe Gait
Cervical Spine
Inspect – heal alignment and spine straightness
Palpate – spinous processes and stenomastoid, trapezious and paravertebral muscles
Ask pt touch chin to chest, lift chin to ceiling, touch chin to opposite shoulders (do not attempt is neck trauma suspected)
Inspection/palpation cont
Compare joints on both limbs– Length– Symmetry– Function-ROM– Size and contour– Skin for color, edema, masses or deformity
Palpate– Note temperature– Swelling– masses– Crepitus– Tone
Range of Motion
Active – Ask Pt to move each joint through it’s appropriate range of motion
Passive – done by assessor. – Do not force a joint to move beyond it’s capability– If pt is contractured, gently try to extend the joint but
do not force– Estimate the angle of the extension of impaired joint
Pix ROM shoulder
JOINT ANGLE
Muscle Testing
Test each muscle group Ask pt to flex and hold Attempt to extend the joint Pt should resist your attempts to extend joint If pt’s resistance is easily overcome then
muscle strength is weakened
Rating Muscle Strength
5- Normal- Active motion against full resistance 4 – Sl Weakness – active motion against some
resistance 3 – Average weakness – Active motion against
gravity 2 – Poor ROM – Passive ROM 1 – Severe Weakness - Slight flicker of
contraction 0 – paralysis – no muscular contraction
Normal Spinal Curvatures
Upper Extremities
Inspect and palpate – shoulders and arms Ask pt to rotate arms internally and externally, lift
above head and move arm in circle Test shoulder strength by asking pt to shrug
against your hands (CN XII) Bend elbow and have pt try to flex against your
resistance Inspect and Palpate wrist joint and hands Perform active and passive ROM of fingers and
hand
Lower Extremities
Inspect and palpate Hip –raise leg then bend to chest, swing leg outward and inward, and front to back
– Crepitation– Pain– Decreased ROM
Knee – Bend and extend– Crepitation– Moveable patella
Foot – point toes up and then to floor, rotate foot, move laterally- flex and extend toes
– Deformities– Swelling, inflammation– Decreased ROM
Tests for Common Joints Abnormalities
Pronator Drift- Used to detect weakness in arms– Extend supinated arms and close eyes. Should be
able to hold position for 20-30 sec
Straight Leg Raising- Used to assess for herniated disk when pt c/o LBP with radiation down leg– Raise affected leg to the point of pain and dorsiflex
the foot. Pain is positive for herniated disk
Tests for Common Joints Abnormalities cont
Thomas Test – Assess hip flexure contractures hidden by increased lordosis– Flex knee to chest- other knee should stay on table
Trendelenburg test – Assess dislocated hip and gluteus medius muscle strength– Shifting weight from 1 foot to another should not
result in movement of iliac crest
Test for Knee complaints
Bulge Test – Small amt of fluid– Stroke upward medial side of knee then press
lateral side and look for bulge on medial side
Patellar Ballottement – Large amount of fluid– Press firmly on each side of patella then tap patella.
If fluid present, will bounce back
Lachmean test – instability– Flex knee to 30 degrees. Try to move the lower leg
from side to side
Test for Knee complaints
Drawer test- ACL and PCL – Flex knee to 90 degrees and apply pressure to
anterior and posterior to tibia. Movement = tear
McMurray’s test – tears in meniscus– Positive if clicking with internal and external rotation
Apley’s Test – Damage to meniscus– Knee in 90 degrees, put pressure on knee and heel
and rotate foot. Clicks = damage
Age Specific Consideration
Infants – lift to observe back, passive ROM, observe
spontaneous movements Children
– shoulders and scapula should be level– 1 to 2 yrs old have broad gait and use arms for
balance and place weight on inside of foot– Weight shifts to outside of foot through childhood /c
arms closer to body
Age Specific Continued
Adolescents– Screen for scoliosis beginning at age 10 to 12– Have child bend over and look for hump on one side
of spine– Differentiate from poor adolescent posture
Pregnant Female– Waddling gait – pronounced Lordosis
Age Specific Continued
Aging Adult– Decreased height– Shortened trunk makes arms look longer– Kyphosis common /c backward head tilt to
compensate- makes shape of “3”– Decreased fat to limbs and increased to trunk– Bony prominences more pronounced– Shuffling gait– Decreased sense of balance
Practice Exam Question
Mr. Jones is 70 years old and just suffered a mild CVA. He appears to be functionally safe but you want to be sure before you let him ambulate alone. While assisting him to ambulate he begins to sway. What piece of equipment should you have placed on Mr. Jones before ambulation?
A. Walker B. Gait belt C. Wheel chair D. heart Monitor
Rationale
B is the correct answer. A gait belt will assist you in preventing the pt from falling. It lets you maneuver him at his center of gravity no matter your respective sizes.