Chap 24 Assessing Musculoskeletal System Flexion – bending the extremity at the joint and

decreasing the angle of the joint

Musculoskeletal System  Dorsiflexion - toes draw upward to ankle
- Composed of bones, muscles and joints  Plantar Flexion – toes point away from the
- Controlled and innervated by the nervous ankle
system Pronation – turning or facing downward
- Its primary purpose is to provide structure Supination – turning or facing upward
and enable movement Protraction – moving forward
Retraction – moving backward
Bones Rotation – turning of a bone on its own long axis
- Provides structure and protection, serves  Internal rotation – turning of a bone
as levers store calcium and produce blood toward the center of the body
cells  External rotation – turning of a bone away
- 206 bones (axial and appendicular) from the center of the body
- Composed of osseous bones which has
two types the compact and spongy Joints
 Compact bone – hard and dense and - Or articulation, is the place where two or more
makes us the shaft and outer layers bones meet
 Spongy bones- contains numerous - Provide a variety of ranges of motion (ROM) for
spaces and makes up the ends and the body parts and may be classified as fibrous,
centers of the bones cartilaginous, or synovial
- Bone tissues is formed by active cells Fibrous joints (ex. Sutures between skull bones)
called osteoblasts and degraded by cells are joined by fibrous connective tissue and are
referred to as osteoclasts. immovable.
- Bones contains red marrow that produces
blood cells and yellow marrow composed Cartilaginous joints (ex. Joints between vertebrae)
mostly of fat are joined by cartilage
- Periosteum covers the bones; it contains
osteoblasts and blood vessels that Synovial joints (ex. Shoulders, wrists, hips, knees,
promote nourishment and formation of ankles;) contain a space between the bones that is
new bone tissues filled with synovial fluid, a lubricant that promotes
- Bone shapes vary and include short a sliding movement of the ends of the bones.
bones, long bones, flat bones, and bones Bones in synovial joints are joined by ligaments,
with an irregular shapes which are strong, dense bands of fibrous
connective tissue. Some synovial joints contain
Skeletal Muscles bursae, which are small sacs filled with synovial
- The body consists of three types of fluid that serve to cushion the joint.
muscles: smooth, cardiac and skeletal
- Made up of 650 skeletal (voluntary)
muscles, which are under conscious Nursing Assessment
control and are made up of long muscle - Helps to evaluate the client’s level of
fibers (fasiculi) arranged together in functioning with activities of daily living (ADLs).
bundles and joined by connective tissue It will also provide the information about the
called tendons client’s daily activity and exercise patterns that
- Tendons: assist with posture, produce promote either healthy or unhealthy
body heat, and allow the body to move. functioning of musculoskeletal.
- Musculoskeletal system affects the entire
Skeletal Muscle Movements body and greatly influences what physical
Abduction – away from the midline of the activities a client can and cannot do.
body - ONLY THE CLIENT can give you the data
Adduction – towards the midline of the body regarding the pain, stiffness and levels of
Circumduction – circular motions movement and how ADLs are affected.
Inversion – moving inward - Client’s nutrition, activities, and exercise is a
Eversion – moving outward significant part of the musculoskeletal
Extension- straightening the extremity at the joint assessment
and increasing the angle of the joint - Pain or stiffness is often a chief concern
 Hyperextension – joint bend greater than with musculoskeletal problems. Therefore
180 degrees pain is also included in the assessment
 - It is important to remember to investigate Osteoporosis is more common as a person ages
signs and symptoms reported by the client because that is when bone resorption increases,
- Neurologic system is responsible for calcium absorption decreases, and production of
coordinating the functions of the skeleton osteoblasts decreases.
and muscles. It is important to understand
how these systems relate to each other and Having diabetes mellitus, sickle cell anemia, or SLE
to ask questions accordingly (Systemic Lupus Erythematosus) places the client
- Client teaching regarding exercise, diet, at risk for development of musculoskeletal
positioning, posture, and safety habits to problems such as osteoporosis and osteolyelitis.
promote health thus becomes an essential  Type 1 Diabetes – increases risk of low bone
part of this examination density, and may increase fracture risk
 Type 2 Diabetes – often increase body weight
From ppt (Mam Sibayan) and thereby increased bone density and may
 Reason for seeking health care increase fracture
 Hx of present concern
 Personal health hx Women who begin menarche late or begin
 Family hx menopause early are at greater risk for
 Lifestyle and health practices development of osteoporosis because of
 Physical examination decreased estrogen levels, which tend to decrease
the density of bone mass.
Collecting Subjective Data (p.534-536)
 Evaluate level of function with activities of Collecting Objective Data
daily living (ADLs) - Observe gait and posture
 Note for pain or stiffness - Inspect joints, muscles, and extremities for
 Exercise patterns size, symmetry and color
 Weight (increase physical stress and strain) - Palpate joints, muscle, and extremities for
 Injuries and health conditions (can affect tenderness, edema, heat(inflammation),
the level of function of joints and the nodules, or crepitus
client’s current ROM) - Test muscle strengths and ROM of joints
 Polio immunizations and tetanus shots - Compare bilateral findings of joints and
(Joint stiffening) muscles
 Menopause - Perform special test: Carpal tunnel syndrome,
 Medications bulge, balotement, Mc Murray.
 Smoking, Alcohol, Caffeinated drinks
 Occupation
Common Concerning Symptoms
Bone pain – dull, deep and throbbing - Low back pain neck pain
Joint or muscle pain – aching - Moroarticular or Polyarticular Joint Pain
Sharp,knife like pain – fractures and increases - Inflammatory or Infectious Joint Pain
with motion of the affected body part - Joint Pain with Systemic Features (Such as
Osteoarthritis pain – usually begins in one set of fever, chills, rash, anorexia, weight loss,
joints and on one side of the body, with a feeling of weakness)
pain deep in the joint, improving with rest but - Joint pain with symptoms from other organ
worsening with rainy weather, perhaps a systems
sensation of bones grating together with stiffen
early in the morning improving with movement. Deformities in Arthritis
Rheumatoid arthritis pain – varied and may feel  Ulnar Deviation
burning, throbbing, occurs on both sides of the  Synovitis
body, worsens after sitting for a long periods, has  Boutonniere and Swan Neck Deformities
inconsistent pattern of worse and less pain, and  Heberden node
with a feeling of heat and soreness in joints,
caused by genetics or from trigger factors such as Musculoskeletal Deviations
infections or physical or emotional trauma.  Bulging Acromio-clavicular Joint
 Closed Fracture
Bone loses their density with age. Older clients  Olecranon Bursitis
who have osteomalacia or osteoporosis are at an  Sprengel Deformity
even greater risk for fractures.  Talipes cavus ,equines, calcaneus, valgus,
equinovalgus and calcaneovalgus
  Knock Knees and Bow Legged -open and close your mouth
 Gunstock Deformity -push your jaw outward then inward (Protrusion
 Lordosis and retraction)
 Kyphosis -side to side move of your jaws (Lateral)”
 Scoliosis
Arthritis -Decreased ROM, swelling, tenderness, or
------------------------------------------------------------------- crepitus, may be seen in this disease
--- TMJ Dysfunction – decreased muscle strength with
Checklist!! muscle and joint disease, decreased ROM, and a
Before I enter the room, I need to make sure that I clicking, popping or grating sound
have already washed my hands and gathered all Lack of full contraction with cranial nerve V lesion
the equipments that I will need pain or spasms occur with myofascial pain
syndrome
Introduce self, verify client’s identity and check if  Jaw protrudes and retracts easily and moves
there is any health condition that the patient has laterally without difficulty. Client’s mouth open
and closes smoothly
“Today, I am assigned to do your musculoskeletal
assessment this is for us to have a baseline for NECK
assessing your health condition. I will need your  Inspect for deformities, abnormal posture,
cooperation in doing the assessment, is that okay and symmetry
with you? Rest assured that all of the information “Now I’ll be inspecting for deformities or
that I will be gathering will be held confidential abnormalities on your neck and check if it is
between us and the health care team.” symmetrical while also inspecting your posture”
 The neck is located at the midline, symmetrical
I will make sure that the room is private with and it with no deformities noted
is quiet with appropriate lighted environment
 Palpate spinous process of the cervical spine,
“Mam/sir, can you please change into your gown trapezius muscle and muscle between the
and we will begin after you have changed” scapulae take note of tenderness
“I’ll be palpating the spinous process, the trapezius
TEMPOROMANDIBULAR JOINT (TMJ) muscle, and the muscle between your scapulae,
 Inspect for facial symmetry and for please tell me if there is any pain”
deformities and swelling  The spinous process of the cervical spine is
“First we will be checking for your facial symmetry, palpable at the level of C7 and there are no
and if there are any deformities or swelling” tenderness noted.
 The face is symmetrical, there is no swelling or
redness, and there are no deformities  Range of Motion
“Next I will be assessing your range of motion,
 Locate the TMJ and ask the patient to open - Move your chin to your chest (Flexion)
their mouth and observe the movement - Turn your head left and right (Rotation)
“Now I’ll be locating your temporomandibular - Ear to shoulders both sides (Lateral )
joint, Mam/Sir can you please open your mouth” - Tilt head to back (extension)”

 Check for crepitus, snapping or clicking sound Lateral (ears to shoulders) – 40 degrees
and take note of tenderness Rotation – 70 degrees
Crepitus – a grating sound or sensation produced  Client has full range of motion and reported no
by friction pain and difficulty
“I’ll be checking if there is any crepitus, snapping
or clicking sound of this joint (TMJ) and if there is SHOULDERS
any tenderness”  Observe the shoulder. Note symmetry,
Snapping and Clicking of may be felt and heard in deformity and muscle atrophy
the normal client. Mouth open 1-2in. (between “Now I will observe the symmetry of your
upper and lower teeth) moves laterally 1-2cm. shoulders, and also checking if there are any
 Contraction palpated with no pain or spasm. deformities or muscle atrophy.”
No crepitus noted. “And I will also check the clavicles and scapulae if
they are symmetric”
 Range of Motion
“Next I will be assessing your range of motion,
 Shoulders are symmetrically rounded, no  Note any displacement, tenderness, or
redness, swelling or deformity. The clavicles thickening
and scapulae are even and symmetric. “Next, I will palpate the medial and lateral
epicondyles and olecranon process of your elbows
 Palpate the sternoclavicular joint, acromial please tell me if u feel any pain while I am
clavicular joint, and sub acromial area palpating”
“Mam/sir, I will now palpate the sternoclavicular Firm,non tender, subcutaneous nodules may be
joint, acromial clavicular joint and subacromial palpated in rheumatoid arthritis or rheumatic
area please tell me if you feel any pain” fever
Tenderness of pain over the epicondyles may be
Swollen, red, or enlarged joint or tender, painful palpated in epicondylitis (tennis elbow) due to
joint is seen with inflammation of the joint repetitive movements of the forearm or wrists
 No swelling, no tenderness, no crepitus.  No tenderness, no crepitus noted upon
palpation
 Range of Motion
“Next I will be assessing your range of motion,  Range of Motion and Maneuvers
- Raise your arms in front of you and “Next I will be assessing your range of motion,
overhead (Flexion) - Bend your elbow (Elbow flexion)
- Raise your arms behind you (Extension) - Straighten your elbow (Elbow Extension)
- Raise your arms out to the side - Turn your palms up (Forearm supination)
(Abduction) - Turn your palms down (Forearm
- Cross your arm in from of your body pronation)
(Adduction)  Client has full range of motion and reported no
- Place one hand behind your back and pain and difficulty. Client can flex and extend
touch the shoulder blade (Internal elbows, pronate and supinate the forearms
Rotation)
- Place one hand behind the head with WRIST AND HANDS
elbows flexed and touch the opposite  Observe the position of the hands in motion
scapula (External rotation) to see if movements are smooth and natural
 Inspect the palmar and dorsal surfaces of the
Flat, hollow, or less rounded shoulders are seen wrist. Note deformities and angulation from
with dislocation radial or ulnar deviation
 Inspect the palm for contours. Note thickening
Muscle atrophy is seen with nerve or muscle and contractures of fingers
damage or lack of use “Now we will be assessing your wrist and hands, I
will now inspect the palmar and dorsal surface of
Tenderness, swelling, and heat may be noted with your wrist if there any deformities. And I will also
shoulder strains, sprains, arthritis, bursitis, and check the contour of the palm”
degenerative joint disease
 Client has full range of motion and reported no Wrist
pain and difficulty. Client can flex, extend, Swelling is seen with rheumatoid arthritis.
adduct, abduct, rotate, and shrug shoulders.
Tenderness and nodules may be seen with
ELBOWS rheumatoid arthritis. A nontender, round,
 Inspect the contours of the elbow. Note any enlarged, swollen, fluid filled cyst (ganglion) may
nodules or swelling be noted on the wrist.
“Now I will inspect the contours of the elbow and Signs of wrist fracture include pain, tenderness,
check if there are nodules or swelling” swelling, and inability to hold a grip; as well as
Redness, heat, and swelling may be seen with pain that goes away and then returns as a deep,
bursitis of the olecranon process due to trauma or dull ache.
arthritis
 The elbows are symmetric, no redness, swelling  The wrist are symmetrical, no redness, swelling
or deformity. No nodules. or deformity. No nodules.

 Palpate the elbow : medial and lateral Hands

epicondyles and olecranon process (use your Hands and fingers are symmetric, non tender, and
thumb and middle finger) without nodules. Fingers lie in straight line. No
swelling or deformities.
 - Make a tight fist with each hand, thumb
Pain, tenderness, swelling, shortened finger, across the knuckles (Flexion)
depressed knuckle, finger crossing over adjacent - Spread the fingers apart (Abduction)
finger when making a fist, or inability to move the - Bring back the fingers together
finger may be seen with finger fractures (Adduction)
- Evaluate muscle strength by testing wrist
Swollen, stiff, tender finger joints are seen in acute flexion, hyperextension and hand grip
rheumatoid arthritis. Boutonniere deformity is Unable to extend the ring and little fingers us seen
seen in long term rheumatoid arthritis. Atrophy of in Dupuytren contracture. Painful extension of a
the thenar prominence may be evident in carpal finger may be seen in tenosynovitis.
tunnel syndrome.  Client has full range of motion and reported no
pain and difficulty. Client can flex, abduct and
In osteoarthritis, hard, painless nodules may be adduct the wrist
seen over the distal interphalangeal joints  Client has full range of motion and reported no
(Meberden nodes) and over the proximal pain and difficulty. Client can flex, extend,
interphalangeal joints (Bouchard nodes) abduct and adduct the fingers
 No tremors noted
 The hands and fingers are symmetrical. Fingers  Both hands have equal strength
lie in a straight line. No nodules and swelling
noted. SPINE
 Expose the entire back and observe the
 At the wrist, palpate the distal radius and ulna patient’s spinal profile observing the cervical,
on the lateral and medial surfaces thoracic, and lumbar curvatures from the side
“Next, I will palpate the distal radius and ulna” “Now we will now assess your spine, can you
*Unequal lengths of the ulna and radius have been please turn around and I will expose your back is
found in some ethnic groups (ex. Swedes and that okay with you? We will know assess the
Chinese) cervical, thoracic and lumbar curvature”
 Palpate the groove at each wrist joint with
your thumb. Note for swelling, bogginess, or Cervical and lumbar spines are concave
tenderness Thoracic spine is convex
 Palpate for carpal bones, metacarpals, and Spine is straight
phalanges
 Palpate the medial and lateral aspects of each Kyphosis – exaggerated thoracic curve; common
joint between the fingers with aging
“Now I’ll be palpating the groove of your wrist Scoliosis – lateral curvature of the thoracic spine
joints, carpal bones, metacarpals, and the medial with an increase in the convexity of the curved
and lateral joints between the fingers please tell side
me if there are any pain” Lordosis- exaggerated lumbar curve; often seen in
 No tenderness, no crepitus noted upon pregnancy or obesity
palpation
 Rounded protuberance noted next to the A flattened lumbar curvature may be seen with
thumb over the thenar prominence. Smaller herniated lumbar disc or ankylosing spondylitis
protuberance seen adjacent to the smaller
finger. Unequal size of the hips suggest unequal leg
lengths
 Range of Motion and Maneuvers Some findings that appear to be abnormalities are,
“Next I will be assessing your range of motion, in fact, variations related to culture or sex
Wrist
- With palms down, point your fingers  Inspect the patient lateral curvature from the
toward the floor (Flexion) back. Then ask the patient to bend forward.
- With palms down, point your fingers Observe for deviations and symmetry.
toward the ceiling (Extension) “ Now I will inspect for the lateral curvature from
- With palms down bring your fingers the back, can you please bend forward Mam/sir?”
towards the midline (Adduction)  The spine is located at the midline. There are
- With palms down bring your fingers away no lateral deviations noted when inspecting
from the midline (Abduction posteriorly The cervical and lumbar spines are
Fingers concave while thoracic spine is convex from the
lateral view. No deformities noted.
 Strains, a stretch or tear of muscle or tendon,
 From a sitting or standing position, palpate often occur in the lower back and the hamstring
the : muscle
(a) Spinous process of each vertebra with your
thumb (assess for tenderness)  The buttocks are equally sized. The iliac crest
(b) Paravertebral muscles for tenderness and are symmetrical. The hips are stable, non
spasms tender, with no crepitus noted.
“I’ll be now palpating the spinous process of each  Inspect the anterior and posterior aspect of
of your vertebra and please tell me if there are any the hips for areas of muscle atrophy and
pain and also I will palpate the paravertebral bruising
muscles for any tenderness or spasm” “I will be now assessing the anterior and posterior
 The paravertebral muscles and spinous process aspects of your hips if there are any areas of
are firm and non tender muscle antrophy or bruising”
 Range of Motion for Spinal Column  Palpate for the anterior and posterior aspect
“Mam/sir can you please, of the hips
- Bend forward and try to touch your toes “I will now palpate the anterior and posterior
(flexion) aspect of your hips”
- Bend back as far as possible (extension)  Ask the patient to lie down
- Rotate from side to side (Rotation)  Range of Motion and Maneuvers
- Bend to the side from the waist (Lateral “Mam/sir can you please,
Bending) - Bend your knee to your chest and pull it
against your abdomen (Flexion)
Cervical strain is the most common cause of neck - Lie face down, then bend your knee and lift it
pain. Characterized by impaired ROM and neck up (Extension)
pain from abnormalities of the soft tissue, caused - Lying flat, move your lower leg away from
by sleeping in the wrong position, carrying a heavy the midline (Abduction)
suitcase, or being in an automobile crash - Lying flat, bend your knee and move your
lower leg toward the midline (Adduction)
Cervical disc degenerative disease and spinal cord - Lying flat, bend your knee and turn your
tumors are associated with impaired ROM and lower leg and foot across the midine
pain that radiates to the back. (External Rotation)
- Lying flat, bend your knee and turn your
 Client has full range of motion and reported no lower leg and foot away from the midline
pain and difficulty (internal rotation)

HIPS Inability to abduct the hip is a common sign of hip

 Assess the leg length for symmetry disease
“I will now assess your leg length and check if it is Pain and a decrease in internal hip rotation may be
symmetrical” a sign of osteoarthritis or femoral neck stress
fracture. Pain on palpation of the greater
Measurements are equal or within 1 cm, if the legs trochanter and pain as the client moves from
are unequal, assess the apparent leg length by standing to lying down may indicate bursitis of the
measuring from a non fixed point (the umbilicus) hip.
to a fixed point (medical malleolus)
If the client has had a total hip replacement, do
Unequal leg lengths are associated with scoliosis not test ROM unless the physician gives
permission to do so, due to the risk of dislocating
Instability, inability to stand, and/or a deformed the hip prosthesis.
hip area are indicative of a fractured hip.
Tenderness, edema, decreased ROM, and crepitus  Client has full range of motion and reported no
are seen in hip inflammation and DJD. pain and difficulty. The client can flex, extend,
abduct, adduct, rotate internally and externally
The most common injuries of the hip and groin the hip joint
region in athletes are groin pulls and hamstring
strains KNEES
 Check the alignment and contours of the
knees. Look normal hallows around the
 patella. Observe for atrophy, thickening or ANKLES AND FOOT
swelling, and warmth  Observe all surfaces of the ankles and feet,
“Next will be the assessment of your knees, I will noting any deformities, nodules, swelling,
check the alignment and the contours of your calluses or corns
knees and check also the hallows around the “I will now assess your ankles and feet, if there are
patella. I will also check if there are any any deformities, nodules, swelling, calluses or
atrophy, thickening or swelling, and warmth” corns”

Knock knees (genu valgum) – knees turn in Toes usually point forward and lie flat
Bowed lega (genuvarum) – knees turn out Pes varus – point in toes
Pes valgus – point out toes
Swelling above or next to the patella may indicate
fluid in the knee joint or thickening of the Toes and feet are in alignment with lower leg.
synovial membrane Smooth, rounded medial melleolar prominences
with prominent heels and metatarsophalangeal
Tenderness and warmth with a boggy consistency joints
may be symptoms of synovitis. Asymmetric Longitudinal arch- most of the weight bearing is
muscular development in the quadriceps may on the foot midline
indicate atrophy
A laterally deviated great toe with possible
 The knees are symmetrical. Hollow is present in overlapping of the second toe and possible
both sides of the patella. No bulging, swelling, formation of an enlarged, painful, inflamed bursa
or deformities are noted. The lower leg is in (bunion) on the medial side is seen with hallux
alignment with the upper leg vagus

 Palpate for bony landmarks (a) tobiofemoral Pes planus – flat feet; feet with no arches
joint and (b) patella using your thumb. Note Pes cavus – feet with high arches
swelling, pain and irregular bony ridges along Cons – painful thickening of the skin over bony
joint margins. prominences and at pressure points
”I will now palpate the bony landmarks starting Calluses – non painful thickening skin that occurs
with your tobiofemoral joint and next your patella at pressure points
using my thumb. Please tell me if u feel any pain” Verruca vulgaris – painful warts
Plantar warts
 The knee joint non-tender No swelling, no
redness, no crepitus and warmth upon  The ankles are equal bilaterally. No redness,
palpation swelling, or crepitus. There is no pain upon
palpation
 Range of Motion and Maneuvers  Toes usually point forward and lie flat. Toes
“Mam/sir can you please, and feet are in alignment with the lower leg.
- Bend or flex your knee/squat down to the Smooth, rounded medial malleolar
floor (Flexion) prominences with prominent heels and
- Straighten your leg/after you squat down metatarsophalangeal joints
to stand up (Extension)  Skin is smooth and free of corns and calluses.
- Whille sitting, swing your lower leg No pain, heat, swelling or nodules are noted on
toward the midline (Internal Rotation) the phalangeal joints.
- While sitting, swing your lower leg toward
the midline (internal Rotation)  Palpate for the,
- While sitting, swing your lower leg away (a) Anterior aspect of the ankle joing using the
from the midline (External Rotation) thumb
(b) Achilles tendon
Osteoarthritis is characterized by a decreased (c) Metatarsophalangeal joints. Compress the
ROM with synovial thickening and crepitation. forefoot between the thumb and fingers
Flexion contractures of the knee are characterized (d) The heads of the five metatarsals and grooves
by an inability to extend the knee fully between them
“I will now palpate for the anterior aspect of your
 Client has full range of motion and reported no ankle using my thumb, then the Achilles tendon,
pain and difficulty next will be the metatarasophalangeal joints and
lastly the head of the five metatarsal and the Fibromyalgia – a disorder characterized by
grooves between them” widespread musculoskeletal pain accompanied by
fatigue, sleep, memory, and mood changes, or
Ankles are the most common site of sprains, which cognitive disorders, is hard to diagnose.
occur with stretched or torn ligaments (tough
bands of fibrous tissue connecting bones in a joint) Osteomalacia – soft bones; a disease
characterized by softening of the bones caused by
Tender, painful, reddened, hot, and swollen impaired bone metabolism due to inadequate
metatarsophalangeal joint of the great toe is seen levels of available phosphate, calcium and vitamin
in gouty arthritis. D or because of resorption of calcium
Nodules of the posterior ankle may be palpated
with rheumatoid arthritis Osteomyelitis- infection of the bone, a rare but
serious condition
Pain and tenderness of the metatarsophalangeal
joints are seen in inflammation of the joints, Osteoporosis- brittle bones; disease in which
rheumatoid arthritis, and DJD. density of bone are reduced, leading cause of
Tenderness of the calcaneus of the bottom of the osteoporosis is a lack of certain hormone
foot may indicate plantar fasciitis particularly estrogen in women and androgen in
men
Plantar Fasciitis is the most common cause of heel
pain, which occurs when the strong supportive Lactose Intolerance – inability to break down a
band of tissue in the arch of the foot becomes type of natural sugar called lactose.
irritated and inflamed
Osteopenia/osteoporosis – progressive loss of
 Range of Motion and Maneuvers total bone mass
“Mam/sir can you please,
- Point your foot toward the floor (Ankle/plantar Sarcopenia – degeneration of skeletal muscle
flexion) fibers that occur with aging
- Point your foot toward the ceiling (Ankle
Extension) Myofascial pain syndrome is a chronic pain
- Bend your heel inward (inversion) disorder. In this condition, pressure on sensitive
- Bend your heel outward (eversion) points in your muscles (trigger points) causes pain
in the muscle
Decreased strength against resistance is seen in
muscle and joint disease Degenerative joint disease or osteoarthritis a
Hyperextension of the metatarsophalangeal joint common “wear and tear” disease that occurs
and flexion of the proximal interphalangeal joint is when the cartilage that serves as a cushion in the
apparent in hammer toe joints deteriorates

 Client has full range of motion and reported no Arthritis inflammation of the joints
pain and difficulty in both the ankle joint and
joints of the toes Bursitis painful condition that affects the small,
fluid filled sacs called bursae
CLOSING PHASE
“thank you mam/sir for cooperating with me, for Rheumatic fever a disease that can affect the
the summary of the findings, ……… heart, joints, brain and skin. Occur after a throat
infection
After the assessment I will now wash my hands
and document the findings. Rheumatic arthritis autoimmune condition, its
caused by the immune system attacking healthy
body tissue
DISEASES:
Epicondylitis painful inflammation of tendons
Temporomandibular joint (TMI) dysfunction may surrounding an epicondyle
have difficulty chewing and may describe their
jaws as “getting locked or stuck”