PHYSICAL ASSESSMENT-

MUSCULOSKELETAL SYSTEM
MS. ANALYN GARINGANAO
learning comes in 3 parts

mypart
yourpart
ourpart
MUSKULOSKELETAL (MSK)
ASSESSMENT
• Assessment of MSK system includes the
joints, its range of motion, and its
surrounding structures of muscles,
ligaments, tendons and bursae.
Skeleton – 206 bones
 Functions of Bones

– Protection
– Shape
– Movement
– Supports the surroun-
ding tissues.
 My rib cage…

…protects
my
heart
and
lungs.
 My skull…

protects
my
brain.
– Mineral storage
● Blood production
•

● Red bone marrow

● (hematopoiesis)
 What can you do to take care
of your skeletal system?
exercis
e
Eat dairy foods
ca
pl ully

straight
Sit up
re
ay
f
Bones of skeletal
system are divided
into:

1. AXIAL skeleton
2. APPENDICULAR
skeleton
Axial skeleton- form
the body’s long axis.
3 regions:
Skull, vertebral,ribcage
Appendicular -made
up of the upper and
lower extremities.
 Skeletal System
• 2 Types of Connective Tissue in skeletal
system:

• Cartilage- is a tough, flexible connective tissue

that forms the frameworks of the ear and nose.
2. Ligaments- are stretchy bands of tissue
that holds one bone to another
 JOINTS
Articulations, or joints
●3 Classes of joints:
1. Diarthrosis
◦Synovial (have a cavity of synovial fluid which is a
lubricant for the joint) or freely movable joints.
2. Synarthrosis
3. Amphiarthrosis
TENDONS
Bursae
 Muscles

- A tissue composed of fibers capable of contracting to

effect bodily movement.
 MUSCLES
• 3 TYPES OF MUSCLES
1. Skeletal muscles
• 2. Smooth muscles (involuntary muscles)
• 3. Cardiac Muscles
 Positional Terminology

• Changes in Joint Angles

– Dorsiflexion
• Flexing the foot at the
ankle so that the toes
move toward chest

– Plantar Flexion
• Moving the foot at the
ankle so the toes move
away from chest
• Pointing toes
Range of Motion
Range of Motion
 PHYSICAL EXAM
• 3 Basic Maneuvers:
1. inspection
2. palpation
3. evaluation of passive & active ROM
 Range of Motion (ROM)
• Active
– person does the moving
– Have person move joint through each of its
various ROM movements
– Note the angle of each joint movement
– Note any pain, tenderness, or crepitus
 Range of Motion (ROM)
• Passive
– person relaxes and allows you to move the
joints
– Done if person is unable to do active ROM
• ALWAYS stop if the person complains of pain
• NEVER push a joint beyond its anatomic angle
• Use a Goniometer to determine exact
ROM in joints with limited ROM
 Grading Muscle Strength

• 5 Normal 100% Complete ROM against full

resistance
• 4 Good 75% Complete ROM against
moderate resistance
• 3 Fair 50% Complete ROM without
resistance
• 2 Poor 25% Complete ROM only if joint
fully supported
• 1 Trace 10% Muscle contraction visible
but insufficient to move joint
• 0 None 0% No visible or palpable muscle
contraction
 OBJECTIVES:
1. Identify health history questions for
assessment of the MSK system.
2. Describe the techniques required for
assessment of the MSK system.
3. Demonstrate health assessment of the MSK
system.
4. Differentiate normal from abnormal findings
of the MSK system.
5. Apply critical thinking in selected simulations
related to physical assessment of the MSK
system
 General Considerations:
1. Evaluate the sources of data:
a. Patient
b. significant others
c. patient record
d. other health professionals
2. Introduce yourself.
3. Gain verbal consent to examine.
4. Look for scars, swelling, rashes and
muscle wasting.
5. Feel for temperature, swelling, and
tenderness of the joints.
6. The full range of movement of the joint
should be assessed. Compare 1 side with the
other.
7. Examine the muscles for strength and
movement.
• PREPARATION:
1. Assemble all equipment and supplies.

Goniometer- measure
angles of the joints.
- to determine exact ROM in joints with
limited ROM
tapemeasure- measures
deviation in muscles
Reflex hammer (optional)
Goniometer
2. Explain the procedures to the client.
3. Wash your hands.
A. INSPECTION OF GAIT
Gait- a manner of walking, stepping or
running
1. OBSERVE GAIT FOR THE FF:
a. base of support
if weight is evenly distributed, limping
b. weight bearing stability
if able to stand on 1 foot, maintain
balance
 c. foot position
toes pointing forward
d. stride
if patient can walk with long steps as
in passing an obstacles

e. arm swing
swing on opposition
f. posture
maintenance of upright posture and
keep eyes level
 Indications of Gait Disturbance
• Hesitancy
• Unsteadiness • Slow, rapid step speed
• Grasping for external • Asymmetry of step height
support
or length
• High stepping
• Limping
• Floor scraping
• Stooping during walking
• Excessive pointing of toes
inward or outward
• 2. Assess for the risk of falling backward by
performing the “NUDGE TEST”

- Stand behind the client and put your arms

around the client while you gently nudge the
sternum.
B. INSPECTION AND PALPATION-
TEMPOROMANDIBULAR JOINT (TMJ)
1. Inspect and Palpate each temporomandibular
joint (TMJ) for movement, sounds, and
tenderness, to evaluate pain and dysfunctional
of TMJ.
• Place the tips of your index fingers directly in
front of the tragus of each ear
• Note any decreased range of motion,
tenderness, or swelling, pain
2. Test for range of motion (ROM)
– Open and close mouth
– Move jaw laterally side to side
– Protruding and retracting jaw

• Palpate joint space during these

motions for
– Clicking
– Pain

• Strength of temporalis and masseter muscles

– Palpate contracted muscles with teeth clenching
 C. INSPECTIONN AND PALPATION –
STERNOCLAVICULAR JOINT
1. Inspect the sternoclavicular joint for location
in midline, color, swelling and masses.

2. Palpate for tenderness or pain

 D. INSPECTION AND PALPATION of
Cervical, Thoracic & Lumbar Spine
 Have the client stand
1. Observe cervical, thoracic and lumbar curves
from side to side then from behind; posture
SCOLIOSIS
2. Palpate the spinal processes, and
paravertebral muscles on both side of the
spine for tenderness and pain.
3. Test for range of motion (ROM) of the
cervical spine.

• ROM
– Forward flexion (75°)
– Hyperextension (30°)
– Lateral bending (35°)
– Rotation
4. Test for range of motion (ROM) of the
thoracic and lumbar spine.
5. Test for back and leg pain by performing
Lasegue’s
Test, to determine h erniated disk, often located
at L5 (5th lumbar spinal nerve)
- Lie flat on bed, raise each relaxed leg
independently to the point of pain, then
dorsiflex the foot. Note degree of elevation
when pain occurs, distribution of pain
6. Measure leg length
- - from umbilicus to a fixed point (medial
malleolus)
Unequal- scoliosis or abnormalities in the
structure/position of the hips.
 E. INSPECTION AND PALPATION-
SHOULDER, ARMS AND ELBOW
1. Inspect and palpate shoulders and arm.
- for equality of height and contour.
- for firmness, tenderness, presence of
mass and pain.
2. Inspect elbows for size, shape,
deformities, redness or swelling.
3. Test for range of motion (ROM)
– Shrugging shoulders; against resistance
(equally strong)
– Internal and external rotation
 -ROM of the Elbows.
• ROM
– Flexion (160°)
– Extension (180°)
– Pronation and supination
• Muscle strength
– Flexion
– Extension
 F. INSPECTION AND PALPATION -
WRISTS
1. Inspect wrist size, shape, symmetry color
and swelling.
2. Palpate for tenderness and nodules.
3. Palpate the anatomic snuffox ( the
hollow area on the back of the wrist, at the
base of the fully extended thumb)
4. Test for Range of motion ( ROM ).
5. Test for Carpal Tunnel Syndrome (CTS)
CARPAL TUNNEL SYNDROME-  is a condition
in which there is pressure on the median
nerve due to repetitive movement of the
hand
 Tests to diagnose carpal tunnel syndrome:
- Tinel's sign test
Tap the wrist over the median nerve. If client
feel tingling, numbness, "pins and needles," or
a mild "electrical shock" sensation in your
hand, client may have carpal tunnel syndrome.
- Phalen's sign test
ask client to place the back of both hands
against each other while flexing the wrist
for 60 secs. If client feel tingling,
numbness, or pain in the fingers within 60
seconds, you may have carpal tunnel
syndrome.
 G. INSPECTION AND PALPATION-
HANDS AND FINGERS
1. Inspect size, shape, symmetry, swelling
and color.
2. Palpate the fingers from the distal end
proximally, noting tenderness, swelling,
bony prominences, nodules or crepitus of
each interphalangeal joint
3. Assess the metacarpophalangeal joints.
- for swelling, pain, presence of
nodules, crepitus.
4. Palpate each metacarpal of the hand,
noting tenderness and swelling..
5. Test for Range of Motion ( ROM )
 H. INSPECTION AND PALPATION OF
HIPS
1. Inspect symmetry and shape of hips
- buttocks are equally sized, iliac crest are
symmetry in height.
2. Palpate for stability, tenderness, and
crepitus
3. Test for range of motion ( ROM ) - flexion,
extension, side bending, rotational
I. INSPECTION AND PALPATION - KNEES

1. Inspect for size, shape, symmetry,

swelling deformities and alignment.
- Observe for quadriceps muscle atrophy.
2. Test for swelling.
3. Perform the ballottement test.
Perform ballottement test
– Technique used to detect fluid or floating body
structures in the knee.
– With thumb and fingers, firmly grasp the thigh just
above the knee.
– Tap the patella with fingers of left hand. If it
rebounds against your fingers, fluid is present.
– Presence of fluid- trauma, osteoarthritis, gout..
Test knees for Bulge sign.
– To detect the presence of small amounts of
fluid in the knee joint
– Apply pressure to the lateral side of the knee
while observing medial side for bulging.
– Normally no fluid is present.
6. Test for pain and injury by performing Mc
Murray’s Test.
Patient is in supine position, ask client to flex
knee and extend, rotation, noting for pain and
clicking.
 I. INSPECTION AND PALPATION –
ANKLES AND FEET
1. Inspect position, alignment, shape and
skin.
2. Palpate ankles and feet for tenderness,
heat, swelling and nodules.
3. Test for range of motion (ROM)
– Dorsiflexion and plantar flexion
– Inversion and eversion
– Flexion and extension of the toes
• Muscle strength
– Plantar flexion
– Dorsiflexion
END OF MSK ASSESSMENT..