Musculoskeletal Assessment

N326

Musculoskeletal Assessment

Components: bones, joints, muscles

Bones Joints

Types

Synovial Cartilaginous Fibrous

Ligaments Muscle to bone Bursa Fluid filled sac, to reduce friction Disc Allows movement of the spine Muscles

Musculoskeletal Assessment

Skeleton 33 vertebral bodies 7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccygeal (fused)

Musculoskeletal Assessment
Major muscle groups Deltoid Biceps Triceps Pectoralis Major Abdominal Quadriceps Hamstrings Gastrocnemius

Musculoskeletal Assessment

Purpose

Support Movement Protection Production of RBCs Reservoir for storage of minerals

Musculoskeletal Assessment

Movements

Flexion Extension Abduction Adduction Pronation Supination Circumduction Inversion Eversion Rotation

Musculoskeletal Assessment

Movements

Protraction Retraction Elevation Depression

Musculoskeletal Assessment
Normal findings for adults Erect posture and spine Fullness to muscles Symmetrical range of motion (ROM) No deformities No swelling No warmth or redness to joints

Musculoskeletal Assessment

Head

TMJ

Hinge action Gliding action

Spine: 33 connecting bones

Intervertebral discs Lateral view: double S shape Motions: flexion, extension, abduction, rotation

Musculoskeletal Assessment

Upper Extremities

Shoulder

Glenohumeral joint Acromioclavicular joint Sternoclavicular Medial and lateral epicondyles Olecranon process Motion: flexion, extension, pronation, supination

Elbows: articulation of humerus, radius, ulna

Musculoskeletal Assessment

Wrist and Carpals

Radiocarpal joint Motion: flexion, extension, side to side Metacarpophalangeal joint: MCP Proximal interphalangeal joint: PIP Distal interphalangeal joint: DIP

Musculoskeletal Assessment

Lower Extremities

Hip: articulation between acetabulum and head of femur Knee: articulation of femur, tibia, patella Ankle and Foot

Tibiotalar joint Medial malleolus Lateral malleolus

Musculoskeletal Assessment

Musculoskeletal Assessment Developmental Considerations

Infants and Children

Skeletal scale 3 months gestation Adolescence rapid bone growth Epiphyses: growth plates

Pregnancy

Lordosis

Musculoskeletal Assessment Developmental Consideration

Aging Adult

Osteoporosis Shortening of vertebral column: decreased height Loss of muscle mass Lifestyle effects

Musculoskeletal Assessment: Subjective Data

Subjective

Muscles

Age Height Weight

Pain/cramping Weakness

Joint problems
Pain Stiffness Limited Movement Swelling warmth Cracking or popping Crepitus bone on bone, grating

Bone deformities ADLs Recent falls Pain

Pain Assessment

P Provocative/Palliative Q Quality/Quantity R Region/Radiation S - Severity T - Timing U Understand Pt Perception

Musculoskeletal Assessment Subjective Data

Functional Assessment/ Self-care behaviors ADLs

How well are you able to care for yourself? Feeding Bathing Dressing & grooming Toileting Mobility Any recent falls? Any use of assistive devices? Canes, crutches, walkers, sticks

Subjective Data Lifecycle

Infants and Children

L&D : trauma Resuscitation Milestones History fractures/injuries Deformity Sports participation

Adolescents

Aging

Weakness Falls Mobility aids

Musculoskeletal Assessment Physical Exam (IPPA)

Inspection Palpation ROM Muscle testing Reflexes CMS (circulation, movement sensation) Special testing

Musculoskeletal Assessment

Preparation

Purpose: Assess function for ADL and screen for abnormalities Screening

Inspect and palpate joints ROM Age-specific screening measures

Complete

Musculoskeletal Assessment Objective Data

Process Inspect Size/contour Skin/ Scars Deformities Atrophy Palpate Heat, tenderness, swelling, masses, Boney prominences Range of Motion Active (AROM) Passive (PROM), if limitations Head to toe Muscle Testing: Strength Grade 0-5

Reflexes Neurological lecture

Muscle Testing
Grade Description % normal Assessment

5 4

Full ROM against gravity, full resistance Full ROM against gravity, some resistance Full ROM with gravity Full ROM with gravity eliminated (PROM) Slight contraction no contraction

100 75

normal good

3 2

50 25

fair poor

1 0

10 0

trace zero

Musculoskeletal Assessment Objective Data

Temporomandibular Joint: Inspect &Palpate

Open/close mouth Protrude jaw, move side to side Note smooth movement Crepitus CN V Inspect alignment, palpate muscles ROM: flexion, extension, lateral bending, rotation Strength

Cervical Spine:

Musculoskeletal Assessment Objective Data

Shoulder

Inspect: compare anterior/posterior Palpate: swelling, heat, atrophy, tenderness ROM: flexion, hyperextension, internal rotation, external rotation, abduction, adduction Strength: shrug shoulders, flex forward, abduct against resistance Inspect: deformity, redness, swelling I flex and extended positions Palpate: olecranon process, medial & lateral epicondyles ROM: flexion, extension, pronation, supination Strength:

Elbow

Musculoskeletal Assessment Objective Data

Wrist & Hand

Inspect: dorsal & palmar surface Palpate: wrist, MCP and interphalangeal joints ROM: flexion, hyperextension, ulnar and radial deviation, spread fingers, make a fist, touch thumb to each finger and base of little finger Strength

Musculoskeletal Assessment Objective Data

Hip

Inspect: standing, swing straight leg back behind body Palpate ROM: flexion, extension, abduction, adduction, internal & external rotation, knee to chest Strength: Inspect Palpate ROM: flexion, extension, hyperextension Strength

Knee

Musculoskeletal Assessment Objective Data

Ankle & Foot

Inspect Palpate ROM: plantar flexion, dorsiflexion, inversion, eversion Strength: plantar and dorsiflexion against resistance

Musculoskeletal Assessment Objective Data

Spine

Inspect from back: note straight vertical line, horizontal position of shoulders, scapulae, iliac crest Inspect from side: convex thoracic curve, concave lumbar Palpate: spinous processes ROM: flexion, extension, lateral bend, rotation

Musculoskeletal Assessment Lifecycle Variations

Infants

Developmental milestones Assess undressed Feet & legs; deformities Hips: Ortalani maneuver Hands & arms: shape and number Clavicle: Back: single C curve

Musculoskeletal Assessment Lifecycle Variation

Preschool & SchoolAge

Back: lordosis Legs & feet: bowlegged, knock-knees, flatfeet, pigeon toes

Adolescent

Screen for scoliosis

Musculoskeletal Assessment Lifecycle Variation

Aging Adult

Postural changes Kyphosis ROM and strength Functional assessment

Health Promotion

Weight management 1lbs decrease 4lbs of pressure on knee joint (stair climbing) Exercise Weight bearing bone growth Aerobic, weights, stretching 30 60 min 3 x week Diet Calcium and Vit D Lifestyle changes Smoking and excessive alcohol (ETOH) Injury prevention Stretching, warming up, proper body mechanics, pads Avoid risky behaviors Speeding, unprotected sports activities, diving shallow pools

Nursing Diagnosis

Activity intolerance Anxiety Ineffective breathing pattern Constipation Disuse syndrome Risk for falls Impaired bed mobility Risk for skin breakdown