examination of Musculoskeletal system

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Information about examination of Musculoskeletal system
Health & Medicine

Published on March 11, 2014

Author: ciplashine

Source: slideshare.net


this power point includes the details of examination of musculoskeletal system (inspection, palpation, range of motion, muscle tone & strength)

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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