Musculoskeletal Assessment
Unit 8

Overview

Anatomy & Physiology

Musculoskeletal system provides

 

A & P
Structures of the MS System

voluntary/striated
involuntary/smooth

held together by ligaments

A & P
Structures of the MS System

Joint is the functional unit of the MS system
Skeletal muscles attach to each of 2 bones

flexor
extensor

Which is stronger ?

ROM is maximum possible joint movement

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

Young adults injuries
(check pulses with Fx)

Adult (degenerative)

non-inflammatory
weight bearing joints

inflammation of the joint

systemic disease
chronic inflammation leads to erosion/destruction of joint

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

Generally assess (screen):

Further assessment based on findings in history and physical exam

History

Family History

Risk Factors

Musculoskeletal Assessment

Begins with the meet and greet

("get up and go")

Assess muscles, bones and joints of:

spine, shoulder,
posterior iliac crest
 
head, neck, thorax
upper extremities
lower extremities

Inspection

Inspect for:

position, deformity
surrounding tissue
swelling
atrophy
ROM

Inspect gait and stance

Range of Motion -
Assessment and Exercises

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

During active or passive ROM, palpate bones, muscles and joints.

Palpate temperature
sensation
edema
crepitus
nodules
strength


tone
infection, inflammation?
paresthesia?



0-5 scale, active/resistive
COMPARE, expect dominant side to be stronger

tension at rest and passive ROM

Terms related to muscle assessment

  • Atrophy
  • Hypertrophy
  • Contracture
  • Fasciculation
  • muscle wasting
  • increased muscle mass
  • muscle shortening
  • involuntary muscle movement

Nursing Diagnoses

 

Range of Motion Exercises

Range of Motion Exercises

Active

Active-Assistive

Passive

Independent

Some support

Full support

       muscle mass

       muscle tone

       muscle mass

       muscle tone

       jt mobility

       muscle    strength

       jt mobility

       some strength

jt mobility

 

 

Musculoskeletal injuries

Teaching Opportunities

Musculoskeletal findings

Upright posture, good alignment, no evidence of abnormal spinal curvature.

Symmetrical musculature, equal strength bilaterally. No atrophy, hypertrophy or masses noted.

Symmetrical joints, full ROM head, neck, spine, upper and lower extremities. No swelling, tenderness or crepitation. Bones symmetrical, aligned. No tenderness, masses.

Case Study

KA, a 17-yr-old high school gymnast, fell and fractured his L femur several weeks ago. He has been on bedrest in skeletal traction since then. Because of painful muscle spasms, he often refuses to be turned or to move voluntarily.

Nursing Diagnosis?
Goals/Expected Outcomes?
Nursing Orders?