Assessment of The Musclo-Skletal System
Assessment of The Musclo-Skletal System
Assessment of The Musclo-Skletal System
Musculo-Skeletal System
Dr Essmat Gemaey
NUR 230
Outlines
1. Review of Anatomy and physiology
of musculoskeletal system
2. Physical Exam
3. Inspection
4. Palpation
5. ROM (Rang of motion)
Objectives
Apply knowledge of Anatomy and
physiology of musculoskeletal system
Differentiate between normal and
abnormal
Implement physical assessment
What do muscles do ?
Muscles simply move you!
Without muscles you couldn't open your
mouth, speak, shake hands, walk, talk, or
move your food through your digestive
system.
There would be no exploring, running,
climbing, smiling, blinking, breathing. You
couldn't move anything inside or outside
you. The fact is, without muscles, you
wouldn't be alive for very long
Physical Exam
1. Inspection
Observe any lack of symmetry and
any evidence of trauma or disease.
Look for muscle wasting;
Inspect the joint contour (shape)
and observe any evidence of
swelling, deformity or inflammation.
Assessment of Gait
Ask the patient to walk back and forth
across the room.
Observe for equality of arm swing ,
balance and rapidity and ease of
turning.
Next, ask the patient to walk on his
tiptoes, then on heels.
Ask the patient to tandem walk.
Test patient's ability to stand with feet
together with eyes open and then
closed. (Romberg's test). Reassure
patient that you will support him, in
case he becomes unsteady.
Normal: Person can walk in balance
with the arms swinging at sides and can
turn smoothly. Person should be able to
stand with feet together without falling
with eyes open or closed.
heels
tiptoes
tandem
Abduction
Shoulder:
Abduction
(Deltoid)
, Adduction
, Shrug
(Trapezius)
Adduction
( Trapezius
Elbow extension
(Triceps)
Hand: Grip
Grip
opposition of
thumb and index finge
r
opposition of
thumb and little finger
and
Normal findings
Muscles are symmetrical in size with
no involuntary movements.
In some, muscles may be slightly
larger on the dominant side.
Muscle power obviously varies. You
should not be able to overpower with
reasonable resistance.
You have to learn to appreciate the
normal tone from practice.
Palpation
Touch chin
Range of motion
Active
Passive
Feel for crepitus during passive
motion
Normal:
30 degree rotation, able to
touch chest with chin, 55
degree extension and 40
degree lateral bend.
No resistance during the range
of motion.
Hip flexion
varus Knee
deormity, more
marked on the left
leg
Is there evidence of
atrophy of the
quadriceps, hamstring,
or calf muscle groups?
Knee problems/pain can
limit the use of the
affected leg, leading to
wasting of the muscles.
Knee extension
Knee flexion
Dorsiflexion
Spine (Bone)
The examiner should stand behind the
patient and observe the alignment of the
spine in the flexed position to determine
scoliosis.
View the spine from the side to determine
kyphosis.