Adventist University of the Philippines

COLL EGE OF NURSING

HEALTH ASSESSMENT
SECOND SEMESTER 2020-2021

MUSCULOSKELETAL SYSTEM

SKILL PC RIS REMARKS

INTRODUCTORY PHASE
1 Introduce self, verify client’s identity and obtain health history
2 Explain to the client what you are going to do, why it is necessary, and how
he/she can cooperate
3 Assure client’s confidentiality
4 Gather equipment : Gown
5 Wash hands and observe appropriate infection control procedures
6 Ensure quiet and adequately lighted environment.
7 Provide for client’s privacy then place client in the appropriate position.
WORKING PHASE
Temporomandibular Joint (TMJ)
1 Inspect for facial symmetry and not for deformities and swelling
2 Locate the TMJ. Place index fingers just in front of the tragus of each ear.
3 Ask the patient to open his/her mouth and observe movement.
4 Check for crepitus, snapping or clicking sound and take note of tenderness
5 Range of Motion (3pts)
Ask the patient to demonstrate:
Opening and closing the mouth.
Protrusion and Retraction
Lateral (side-to-side motion)
The Neck
1 Inspect for deformities, abnormal posture, and symmetry
2 Palpate spinous process of the cervical spine, trapezius muscle, and muscle
between the scapulae. Take note of tenderness.
3 Range of Motion (4 pts)
Ask the patient to demonstrate:
Flexion (chin-to-chest)
 Rotation (turn head to left and right sides)
Lateral bending (ear-to-shoulder; both sides)
Extension (tilt head to the back)
The Shoulders
1 Observe the shoulder. Note symmetry, swelling, deformity, and muscle
atrophy,
2 Palpate the sternoclavicular joint, acromial clavicular joint, and sub acromial
area.
3 Range of Motion and Maneuvers (6pts)
Ask the patient to:
Raise your arms in front of you and overhead. (Flexion)
Raise your arms behind you. (Extension)
Raise your arms out to the side. (Abduction)
Cross your arm in front of your body. (Adduction)
Place one hand behind your back and touch the shoulder blade.(Internal
Rotation)
Place one hand behind the head with elbows flexed and touch the
opposite scapula. (External Rotation)
The Elbow
1 Inspect the contours of the elbow. Note any nodules or swelling.
2 Palpate the elbow: medial and lateral epicondyles and olecranon process.
3 Note any displacement, tenderness, or thickening.
4 Range of Motion and Maneuvers (4pts)
Instruct the client to:
Bend your elbow. (Elbow Flexion)
Straighten your elbow. (Elbow Extension)
Turn your palms up. (Forearm Supination)
Turn your palms down. (Forearm Pronation)
The Wrist and Hands
1 Observe the position of the hands in motion to see if movements are smooth
and natural.
2 Inspect the palmar and dorsal surfaces of the wrist. Note deformities and
angulation from radial or ulnar deviation.
3 Inspect the palm for contours. Note thickening and contractures of fingers.
4 At the wrist, palpate the distal radius and ulna on the lateral and medial
surfaces.
5 Palpate the groove at each wrist joint with your thumbs. Note for swelling,
bogginess, or tenderness.

6 Palpate for carpal bones, metacarpals, and phalanges.

7 Palpate the medial and lateral aspects of each joint between the fingers.
8 Range of Motion and Maneuvers: (4 pts)
WRIST: Instruct client to:
With palms down, point your fingers toward the floor. (Flexion)
With palms down, point your fingers toward the ceiling. (Extension)
With palms down, bring your fingers towards the midline. (Adduction)
With palms down, bring your fingers away from the midline. (Abduction)
9 FINGERS: Instruct client to: (4 pts)
Make a tight fist with each hand, thumb across the knuckles. (Flexion)
Extend and spread the fingers. (Extension)
Spread the fingers apart. (Abduction)
Bring back the fingers together. (Adduction)
10 Evaluate muscle strength by testing wrist flexion, hyperextension and hand
grip.
The Spine
1 Drape or gown the patient to expose the entire back.
Observe the patient’s spinal profile observing the cervical, thoracic, and
lumbar curvatures from the side.
2 Inspect the patient lateral curvature from the back. Then ask the patient to
bend forward. Observe for deviations and symmetry.
3 From a sitting or standing position, palpate the:
(a) spinous process of each verterbra with your thumb. *Assess for
tenderness.
(b) paravertebral muscles for tenderness and spasm.
4 SPINAL COLUMN: Request client to: (4 pts)
Bend forward and try to touch your toes. (Flexion)
Bend back as far as possible. (Extension)
Rotate from side to side. (Rotation)
Bend to the side from the waist. (Lateral Bending)

The Hip
1 Assess the leg length for symmetry.
2 Inspect the anterior and posterior surfaces of the hip for areas of muscle
atrophy and bruising.
3 Palpate for the anterior and posterior aspect of the hips.
4 Ask patient to lie down.
5 Range of Motion and Maneuvers (6 pts)
Instruct client to:
Bend your knee to your chest and pull it against your abdomen.(Flexion)
Lie face down, then bend your knee and lift it up. (Extension)
Lying flat, move your lower leg away from the midline. (Abduction)
Lying flat, bend your knee and move your lower leg toward the midline.
(Adduction)
Lying flat, bend your knee and turn your lower leg and foot across the
midline. (External Rotation)
Lying flat, bend your knee and turn your lower leg and foot away from the
midline. (Internal Rotation)
The Knee
1 Check the alignment and contours of the knees. Look normal hollows
around the patella. Observe for atrophy, thickening or swelling, and warmth.
2 Palpate for bony landmarks (a) tibiofemoral joint and (b) patella using your
thumb. Note swelling, pain and irregular bony ridges along joint margins.
3 Range of Motion and Maneuvers (4 pts)
Instruct the client to:
Bend or flex your knee/Squat down to the floor. (Flexion)
Straighten your leg/After you squat down to stand up.(Extension)
While sitting, swing your lower leg toward the midline. (Internal Rotation)
While sitting, swing your lower leg away from the midline. (External Rot.)
The Ankle and Foot
1 Inspection and Palpation
Observe all surfaces of the ankles and feet, noting any deformities, nodules,
swelling, calluses, or corns.
2 Palpate for the: (4 pts)
(a) anterior aspect of the ankle joint using the thumb.
(b) Achilles tendon.
(c) metatarsophalangeal joints. Compress the forefoot between the thumb
and fingers.
(d) the heads of the five metatarsals and grooves between them.

3 Range of Motion and Maneuvers (4 pts)

Instruct client to:
Point your foot toward the floor. (Ankle/Plantar Flexion)
Point your foot toward the ceiling. (Ankle Extension)
Bend your heel inward. (Inversion)
Bend your heel outward. (Eversion)
CLOSING PHASE
11 Termination of interaction
12 Summary and validation
 13 Wash hands and document findings
Perfect Score: 116 pts CHECKLIST SCORE: Passing Score: 100pts
20 pts SUMMARY OF FINDINGS (SCORE):
5 pts MASTERY:
5 pts PUNCTUALITY:
TOTAL SCORE

REVISED 2022 MSS

LEGEND:
PERFORMED C ORRECTLY (P.C.) – 1 PT.
REQUIRES FURTHER INSTRUCTION AND S UPERVISION (R.I.S) – .5 PT. Checklist Score: ___________
NOT PERFORMED (N.P) – 0 PT.
Summary Score: __________

T HE M USCULOSKELETAL S YSTEM / MJSSIBAYAN TOTAL SCORE ________

CLINICAL INSTRUCTOR’S NAME AND SIGNATURE :

Name of Student: ________________________________Date:______ Section:__________
Name of Patient:________________________________
THE MUSCULOSKELETAL SYSTEM

TMJ
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NECK
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SHOULDERS
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ELBOWS
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WRIST AND HANDS

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SPINE
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HIP
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KNEES
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ANKLES AND FOOT

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