Published on March 11, 2014
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 mobility Provide proper position while examination
Nursing History Determine involvement in competitive sports H/o alcohol or caffeine use, cigarette smoking, constant dieting Menopause before age 45, estrogen deficiency Family H/o osteoporosis Chronic diseases
Cont… History of problems in bone, muscle or joint function Nature and extent of pain Normal activity pattern Height loss in women over age 50
Inspection Observe client’s gait Note: how client walks, sits & rises from a sitting position Note 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 & scoliosis Assess for signs of osteoporosis Extremities: overall size, gross deformity, bony enlargement, alignment & symmetry
Palpation Gentle palpation : bones, joints, surrounding muscles Note heat, tenderness, edema or resistance to pressure During palpation: no discomfort to client Muscles should be firm
Terminology Flexion Extension Hyperextension Pronation Supination Abduction Adduction Internal rotation External rotation Eversion Inversion Dorsiflexion Plantar flexion
Range of motion Includes both active & passive ROM Put each major joint through active and passive full ROM Demonstrate and instruct the client
Cont… Goniometer : measures precise degree of motion in a particular joint
Muscle tone and strength Check for hypertonicity & hypotonicity In case of pain: support the extremity Slight resistance can be there Compare 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)
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