ASSESSMENT OF THE NORMAL NEUROVASCULAR, MUSCULOSKELETAL, AND

PERIPHERAL VASCULAR SYSTEMS

NEUROVASCULAR SYSTEM
Anatomy Overview
1. Central Nervous System (CNS):
o Brain: Controls voluntary and involuntary functions.
o Spinal Cord: Transmits neural signals between the brain and the rest of the body.
2. Peripheral Nervous System (PNS):
o Cranial Nerves: Twelve pairs of nerves that emerge directly from the brain.
o Peripheral Nerves: Nerves extending from the spinal cord to the rest of the body.
Physical Examination Steps
1. Inspection
 General Appearance:
o Assess for alertness, orientation, and overall appearance.
o Observe for any involuntary movements, tremors, or muscle atrophy.
 Level of Consciousness:
o Determine if the patient is alert and oriented to person, place, time, and situation (A&Ox4).
2. Cranial Nerve Examination
 Cranial Nerves II-XII:
o II (Optic): Assess visual acuity and visual fields.
o III, IV, VI (Oculomotor, Trochlear, Abducens): Check pupil reaction to light and eye movements.
o V (Trigeminal): Test facial sensation and jaw movements.
o VII (Facial): Assess facial expressions and taste.
o VIII (Vestibulocochlear): Test hearing and balance.
o IX, X (Glossopharyngeal, Vagus): Check gag reflex, swallowing, and palate elevation.
o XI (Accessory): Assess shoulder shrug and head turn.
o XII (Hypoglossal): Check tongue movements.
3. Motor and Sensory Function
 Motor System:
o Assess muscle strength and tone in all major muscle groups.
o Test for coordination (e.g., finger-to-nose test, heel-to-shin test).
 Sensory System:
o Test for light touch, pain, temperature, vibration, and proprioception.
4. Reflexes
 Deep Tendon Reflexes:
o Test biceps, triceps, brachioradialis, patellar, and Achilles reflexes.
o Grading scale: 0 (absent) to 4+ (hyperactive).
 Superficial Reflexes:
o Assess abdominal and plantar reflexes.
MUSCULOSKELETAL SYSTEM
Anatomy Overview
1. Bones:
o Provide structure, protect organs, anchor muscles, and store calcium.
2. Joints:
o Areas where two or more bones meet. Types include fibrous, cartilaginous, and synovial joints.
3. Muscles:
o Enable movement, maintain posture, and produce heat.
Physical Examination Steps
1. Inspection
 General Appearance:
o Observe posture, gait, and alignment.
o Check for symmetry, swelling, deformities, and atrophy.
2. Palpation
 Technique:
o Palpate bones, joints, and muscles for tenderness, swelling, and warmth.
3. Range of Motion (ROM)
 Active and Passive ROM:
o Assess active (patient moves) and passive (examiner moves) ROM in all major joints.
 Normal Findings:
o Full ROM without pain or stiffness.
4. Strength Testing
 Muscle Strength:
o Test strength against resistance for all major muscle groups.
o Grading scale: 0 (no contraction) to 5 (full strength).
5. Specific Tests
 Special Tests:
o Phalen’s Test and Tinel’s Sign: For carpal tunnel syndrome.
o Lachman’s Test and McMurray’s Test: For knee stability.
o Straight Leg Raise: For lumbar nerve root irritation.
PERIPHERAL VASCULAR SYSTEM
Anatomy Overview
1. Arteries:
o Carry oxygenated blood from the heart to the body.
2. Veins:
o Return deoxygenated blood to the heart.
3. Capillaries:
o Facilitate the exchange of oxygen, nutrients, and waste products between blood and tissues.
Physical Examination Steps
1. Inspection
 General Appearance:
o Inspect the skin for color, lesions, and hair distribution.
o Look for signs of venous insufficiency (varicose veins, edema) and arterial insufficiency (pallor, thin
skin).
2. Palpation
 Pulses:
o Palpate radial, brachial, carotid, femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
o Note the rate, rhythm, amplitude, and symmetry.
3. Capillary Refill
 Technique:
o Press on a fingernail or toenail until it blanches, then release and observe the time it takes to return to its
original color (normal is less than 2 seconds).
4. Edema Assessment
 Technique:
o Press on the skin over the tibia or medial malleolus to check for pitting edema.
o Grading scale: 1+ (mild) to 4+ (severe).
5. Special Tests
 Ankle-Brachial Index (ABI):
o Measure blood pressure at the ankle and arm to assess for peripheral artery disease.
 Allen’s Test:
o Evaluate the patency of the radial and ulnar arteries.
Conclusion
Assessing the neurovascular, musculoskeletal, and peripheral vascular systems involves careful inspection, palpation, and
specific tests to ensure the detection of any abnormalities. Familiarity with normal findings is essential for accurate
diagnosis and treatment planning. Always ensure patient comfort and privacy during the examination.