Musculoskeletal Assessment
Unit 8

• A & P
• Developmental
• Musculoskeletal Assessment
• Nursing Diagnoses
• Plan and Implement nursing care
• Teaching

Anatomy & Physiology

Musculoskeletal system provides

• support for body
• protection of internal organs
• mobility to engage in physical activities
• production of RBCs
• storage of minerals

 

• For proper functioning, must be integration between neurologic and musculoskeletal systems
• M-S system provides mobility and stability through the integration of muscles, bones and joints which are assessed together

A & P
Structures of the MS System

• Bones - how many ?
• Muscles - myo

voluntary/striated
involuntary/smooth

• joints - arthro

held together by ligaments

• tendons - join muscle to bone
• ligaments and muscles give joint stability
• cartilage - pads joints during weight bearing

A & P
Structures of the MS System

Synovial joint motion/ ROM
(freely movable)

Flexion Extension Hyperextension Abduction Adduction Int. rotation Ext. rotation Circumduction

Bending a joint; decreases < straightening joint; ­ > moving past extension moving away from midline moving toward the midline rotating toward midline rotating away from midline rotating in complete circle

Developmental Considerations

Infants birth - 

Apgar (muscle tone assessed)

Hips- congenital dislocation
walk 12 - 14 mos
wide gait
lack coordination
bowlegged NL > 18 mos

School age 

check for spinal deformities/scoliosis
degree sports participation/injuries

Adolescents injuries, Osgood-Schlatter

Adult (degenerative)

• degenerative joint disease (DJD)

non-inflammatory
weight bearing joints

• osteoarthritis

inflammation of the joint

• rheumatoid arthritis

systemic disease
chronic inflammation leads to erosion/destruction of joint

• osteoporosis

loss of bone mass; more common after menopause
calcium, exercise

Elderly 

Assess for falls, injuries
changes 2⁰ decreased muscle mass
changes in bone
        collapse of intervertebral discs
        decreased stature
        kyphosis
        barrel chest (increased AP diameter)

Decreased mobility 20	decreased endurance decreased  muscle strength decreased fear of falling decreased CV disease decreased vision decreased bone mass
fear	falling, death loss of independence

Musculoskeletal Assessment

• Current concerns
• General health
• Life style/ADL/functional status
  • employment (repetitive motions)
  • activity level
  • recent or past injuries

• joint inspection/ROM
• muscle strength
• ADL/functional abilities
• activity tolerance

History

• Previous occurrences of the problem
• Past history of trauma to bones, joints, nerves, soft tissue
• Orthopedic surgery
• Congential deformities
• Chronic illness
• Pain Assessment
  • Frequently the reason for seeking care
  • Character
  • Intensity
  • Precipitating events
  • Onset
  • Location
  • Timing
  • Referred pain
  • Aggravating factors
  • Alleviating factors
• Arthritis
  • osteoarthritis
  • rheumatoid
• Gout
• Ankylosing spondylitis
• Congenital Disorders
  • hip
  • foot
• Scoliosis or back problems

Family History

• Arthritis
• osteoarthritis-disintegration of cartilage that covers ends of bones
• rheumatoid- inflammatory changes in connective tissue
• gout- excessive uric acid production
• ankylosing spondylitis- spine

Risk Factors

• Osteoarthritis
  • age > 50
  • Family history
  • Obesity
  • Joint abnormality
  • History of trauma, RA, or other degenerative process

• Osteoporosis
  • age
  • gender
  • family history
  • estrogen deficiency
  • small stature
  • race
  • Northern European descent
  • Heavy cigarette and/or ETOH use
  • Poor diet with low Ca intake
  • Periods of immobilization
  • Use of steroids
  • Sedentary lifestyle

Musculoskeletal Assessment

Begins with the meet and greet

• Watch as rise from seat

("get up and go")

• climb onto examining table
• Watch for coordination
• Note speed of movement

Inspection

• gait -characteristic pattern of walk
• stance - posture
• spinal curves

Range of Motion -
Assessment and Exercises

• Active (isotonic)
• Active-assistive
• Passive
• Static (isometric)
• Resistive

Range of Motion Exercises

Active (isotonic) Active-assistive Passive Static (isometric) Resistive

Ask pt to do help pt (or self-help) do for pt tense muscle without moving joint builds strength

Range of Motion

Active

• joint movement should be smooth and painless
• ask that joint be moved through full range of movement
• less muscle tension and joint compression is seen with active ROM compared to movement against resistance
• Rationale for assessing ROM before strength

Passive-

• move relaxed joint through limits of movement
• if ROM is limited try to determine if:
• excess fluid in joint
• loose bodies are present
• joint surface irregularity or contracture of muscle

Palpation

Terms related to muscle assessment

Atrophy Hypertrophy Contracture Fasciculation

muscle wasting increased muscle mass muscle shortening involuntary muscle movement

Nursing Diagnoses

• Impaired physical mobility
• Risk for injury
• Pain Chronic Pain
• Activity intolerance
• Risk for disuse syndrome
• Fatigue

Range of Motion Exercises

• Nursing order - Frequently encouraged for the bed ridden, immobile
• Frequently incorporated into care
  • bathing
  • getting OOB
• Support joints
• Avoid pain, overexertion, over extension
• Move joint to point of resistance- not pain

Range of Motion Exercises

Musculoskeletal injuries

• Check for fracture
• If fracture check pulses

• Rest
• Ice (20’ on/20’ off) 24 hours
• Compression
• Elevation

Teaching Opportunities

• Risk factors for injury, trauma
• Prevention of injuries
• Risk for osteoporosis
• Benefits of exercise

Musculoskeletal findings

Case Study