NURS 347 Towson University. Musculoskeletal Assessment Fundamentals:
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Transcript of NURS 347 Towson University. Musculoskeletal Assessment Fundamentals:
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MUSCULOSKELETAL ASSESSMENT
NURS 347Towson University
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Musculoskeletal Assessment Fundamentals:
ANATOMY AND PHYSIOLOGY
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STRUCTURE & FUNCTION
Bones: 206 126 appendicular, 80 axial Joints: Where two or more bones join Muscles: Contraction = movement
Voluntary skeletal muscles under conscious control
Support: Maintain stature Movement Protect vital organs Produce red blood cells in bone marrow (hematopoiesis) Storage of minerals, such as calcium and phosphorus
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JOINTS (ARTICULATION)
Synovial Joints Bones are separated but enclosed in a joint cavity Opposing bones covered with cartilage Freely moveable
Ligaments: Fibrous bands connect two bones, strengthen joint
Bursa: Enclosed sac filled with synovial fluid that aim to reduce friction in areas such as the knee, shoulder.
Tendon: Attached the skeletal muscle to the bone
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RANGE OF MOTION
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RANGE OF MOTION
Active and Passive Range of Motions should the be same
Active: When the patient can perform range of motion independently
Passive: When the patient has a limitation Anchor the joint with one hand Use your other hand and move to the
joint’s limit
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RANGE OF MOTION
Assessing and Documenting a Limitation: Goniometer: Used to precisely measure
joint angles
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RANGE OF MOTION
Flexion: Bending limb at a joint
Extension: Straightening a limb at a joint
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RANGE OF MOTION, CONTINUED
Abduction: Moving a limb away from body’s midline
Adduction: Moving a limb towards the body’s midline
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RANGE OF MOTION, CONTINUED
Pronation: Turning forearm so palm is down
Supination: Rotating forearm so palm is up
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RANGE OF MOTION, CONTINUED
Internal Rotation: External Rotation
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RANGE OF MOTION, CONTINUED
Inversion: Moving the sole of the foot inward at the ankle
Eversion: Moving the sole of the foot outward at the ankle
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RANGE OF MOTION, CONTINUED
Circumduction: Movement of the arm in a circle around the shoulder
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SUBJECTIVE ASSESSMENT
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SUBJECTIVE INTERVIEW
1. Joints: Pain, stiffness, swelling, warmth, or limited range of movement?
2. Muscles: Cramps, pain, or weakness?3. Bones: Pain, deformity, trauma (fractures,
sprains, dislocations?)4. Activities of Daily Living: Any difficulty bathing,
toileting, dressing, eating, communicating, or mobility?
5. Occupational Hazards: Heavy lifting, repetitive movement?
6. Self-Care: Recent weight gain, exercise program?
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OBJECTIVE ASSESSMENT
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INSPECTION
Skeleton: Symmetry of skeleton; Size and contour of joint(s)
Skin: Color or swelling Gait: Steady or unsteady
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PALPATION
Joints Muscles Bones Range of Motion Tenderness Crepitus Muscle Strength
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JOINTS: INSPECTION
1. Inspect paired joints for: Symmetry Size Contour Color Swelling Deformities or Masses
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JOINTS: PALPATION
1. Palpate to: Stage edema: Pitting versus Non-Pitting Masses Warmth Tenderness Range of Motion (ROM) Crepitus: An audible or palpable “crunching”
or “grating” with movement
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Head to Toe
MUSCULOSKELETAL ASSESSMENT
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TEMPOROMANDIBULAR JOINT
Inspect: Area anterior to ear for: masses, symmetry, discoloration
Palpate: Crepitus or tenderness temporalis and masseter muscles when teeth are
clenched Range of Motion:
Open mouth maximally Vertical motion Partial mouth open Lateral motion Stick out lower jaw Protrusion without deviation
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CERVICAL SPINE
Inspect the alignment of the head and neck Palpate the spinous processes and
sternomastoid, trapezius, and paravertebral muscles
Range of motion: Chin to chest 45’ flexion Chin to ceiling 55’ hyperextension Touch ear to shoulder 40’ lateral bend Turn chin to shoulder 70’ rotation
DO NOT ASSESS IF SUSPECTED CERVICAL TRAUMA
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UPPER EXTREMITIES: SHOULDER
Inspect posteriorly and anteriorly: Joint size and contour Equality of bony landmarks
Palpate: Spasm Atrophy Swelling Heat Tenderness Crepitus during ROM
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UPPER EXTREMITIES: SHOULDERS
How would you assess Range of Motion?
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UPPER EXTREMITIES: SHOULDERS
How would you assess Range of Motion? Circumduction Abduction Adduction Internal Rotation External Rotation
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UPPER EXTREMITIES: SHOULDERS
Strength Shrug Shoulders (also assesses which
CN?) Flex arms forward and up against
resistance
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UPPER EXTREMITIES: ELBOW
Inspect joint and tissue Range of Motion:
Bend and Straighten elbow (Flexion and Extension)
With slightly extended elbow, touch thefront and back of the hand to the table (Pronation and Supination)
Strength: Flex and extend elbow against resistance
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UPPER EXTREMITIES: WRIST AND HANDS Inspect joints (knuckles) and
surrounding skin Palpate for warmth, crepitus,
tenderness, or nodules
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UPPER EXTREMITIES: WRIST AND HANDS ROM:
Bend hand up and down at wrist Bend fingers at metacarpophalangeal
joints Palms flat on table: Rotate in and outward Spread fingers apart, make a fist Touch thumb to each finger
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LOWER EXTREMITIES: HIP
Inspection of the Hips should be delayed until spinal he assessment
With patient in the supine position, palpate the hip joints for crepitus or tenderness
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LOWER EXTREMITIES: HIP Range of Motion
Raise each leg with knee extended
Bend each knee up to the chest, keeping the other leg straight
Extend leg straight, then direct foot inward and outward
Swing leg laterally and medially, keeping knee straight
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LOWER EXTREMITIES: KNEE
Inspection and Palpation: Skin free from lesions, smooth and even in
coloring Bilateral comparison: length and alignment Swelling or fullness at the knee, pre- and
suprapatellar bursa Atrophy at quadriceps
Strength: Ask patient to push your hand away using their foot, assessing quadriceps’ strength
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LOWER EXTREMITIES: KNEE
Range of Motion Bend and Extend each knee Assess ROM during ambulation
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LOWER EXTREMITIES: FOOT AND ANKLE Inspect and compare both
feet and toes, and their position. Examine: skin color Lesions Contour alignment with the upper leg
Note areas of calluses or bursal reactions, as they reveal areas of abnormal friction
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LOWER EXTREMITIES: FOOT AND ANKLE Range of Motion
Point toes towards floor Point toes towards nose Turn soles of feet in and out Flex and straighten toes
Strength Maintain dorsiflexion and plantar flexion
against resistance (hand)
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SPINAL ASSESSMENT: POSTERIOR
Stand behind patient so you can see the entire back
Inspect for spine’s straightness by following an imaginary vertical line from the head to the gluteal cleft
Inspect for symmetry of shoulders, scapulae, and iliac crests (hips) bilaterally.
Knees should be aligned and pointing forward
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SPINAL ASSESSMENT: LATERAL
Inspect for normal curvature of the spine Convex thoracic curve Concave lumbar curve
Range of Motion Bend forward, touch toes
(concave curve should disappear) Bend Sideways (35’) Bend backward (Hyperextension 30’)
Assess for pain and decreased ROM
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SPINAL ASSESSMENT
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AGE CONSIDERATIONS: INFANTS & CHILDREN
Infants Barlow-Ortolani’s Maneuver:
Assesses for congenital dislocation of hips in infants. Normal finding reveals smooth abduction and adduction of
bilateral legs while in the supine position Spina Bifida:
A tuft of hair over a dimple on the spinal midline may indicate spinal bifida
Children Juvenile Rheumatoid Arthritis: Discomfort greater
in the morning, decreased ROM and pain in bilateral joints. Scoliosis: Spinal asymmetry
Adolescents Scoliosis: Spinal asymmetry
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AGE CONSIDERATIONS & PREGNANCY Older Adults
Dorsal kyphosis Rheumatoid Arthritis: Bilateral joint pain and decreased
ROM, worse in the morning Osteoarthritis: Unilateral or unrelated joint pain in which pain
increases later in the day Osteoporosis: Risk Factors & Prevention
Pregnancy Waddling Gait Backache Muscle cramps Lordosis
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FUNCTIONAL ASSESSMENT
Walk (with shoes on) to observe gait and balance
Climb up and down stairs to assess balance and bilateral strength
Pick up object from the floor Rise from sitting in chair Rise from lying in bed
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GRADING MUSCLE STRENGTH