ASSESSMENT OF

MUSCULO-SKELETAL
SYSTEM
2ND YEAR B. SC NURSING

BRANCH- MEDICAL – SURGICAL NURSING

UNIT – 10

TITLE – DISORDERS OF MUSCULO-SKELETAL SYSTEM

Nursing Assessment

Health History
Initial Interview
Assessment Data
Pain
Altered Sensations
HEALTH HISTORY
 Past health history- these includes TB, polio, DM,
parathyroid problems, soft tissue infection, &
neuromuscular disabilities. Possible sources of
bacterial infection, such as ears, tonsils or GU and
trauma.
 Medications- regarding prescription, OTC, herbal
products & nutritional supplements. Women should
be question about their menstrual hx. , use of
hormone therapy, CA and vitamin D supplements
are important for postmenopausal women.
 HEALTH HISTORY

 Surgery or other treatments- past

hospitalizations from musculoskeletal problems.
 Functional health patterns-
= Nutritional-metabolic pattern-dietary
supplements.
= Elimination-
= Activity-exercise-require assistance in
completing ADL.
= sleep-rest- difficulty sleeping.
= Cognitive-perceptual-musculoskeletal pain
HEALTH HISTORY

 Functional Health patterns con’t…..

con’t
= Self-perception-self-concept-changes
in MS system-posture, walking,etc…
= Role-relationship- live alone, effect on
work.
= Sexuality-reproductive-sexual
concerns.
= coping-stress tolerance- problems
such as pain or immobility.
= value-belief- cultural & religious
practices.
5P’s Assessment for Orthopedic
Patients
Symmetric comparison:
 Pain- location, severity
 Pulse- distal to injury, check bilaterally.
 Parasthesias- numbness, tingling,
compare bilaterally. Sensaton check
 Pallor- check skin color and temp.
 Paralysis- Assess mobility, watch for foot
drop, compartment syndrome.
RISK FACTORS

 Autoimmune disorders
 Calcium deficiency
 Degenerative conditions
 Falls
 Hyperuricemia
 Infection
RISK FACTORS (Continued)

 Medications
 Metabolic disorders
 Neoplastic disorders
 Obesity
 Postmenopausal
states
 Trauma and injury
Nursing Assessment

 Physical Assessment
Posture
Gait
Bone Integrity
Joint Function
Muscle Strength & Size
Skin
Neurovascular Status
 Assessment of the
Musculoskeletal System

 Physical examination:
* Inspection-use
Inspection of an assistive
devices such as walker. Observe general
body build, muscle configuration, &
symmetry of joint movement.

 Note for swelling, deformity, nodules or

masses & discrepancies in limb length or
muscle size.
 Assessment of the
Musculoskeletal System
 Physical Examination con,t…
con,t
* Palpation:
Palpation of both muscles & joints allows for
evaluation of skin temperature, local tenderness,
swelling and crepitation.

* Gait, motion of spine- smoothness, rhythm,

limpimg, unsteady. Note height of shoulders, iliac
crests, gluteal folds, shoulder & hip symmetry.
Note for lumbar lordosis( concavity of the spine),
kyphosis-(excessive curvature of thoracic spine),
scoliosis (deviation to L or right)
 Assessment of the
Musculoskeletal System
 Upper extremities- evaluate muscle
strength. If joint motion compromised or
painful-exam for fluid (effusion), increase
temperature (inflammation). Passive
movements elicits crunching noise
(crepitus)-exam for nodules.
 Lower extremities- evaluate muscle action,
ROM, pulses( femoral, tibial, dorsalis
pedis).reflexes- (patellar, achilles,
babinski)
Assessment of the
Musculoskeletal System
Muscle Strength scale
0 No detection of muscular contraction

1 A barely detectable flicker or trace of contraction

with observation or palpation.
2 Active movement of body part with elimination of
gravity.
3 Active movement against gravity only and not
against resistance
4 Active movement against gravity & some
resistance
5 Active movement against full resistance without
evident fatigue (Normal muscle strength)
 Assessment of the
Musculoskeletal System
 Injured extremity- Observe for bleeding-
arterial (spurts), venous (steady), bones
(oozes, oily).

 Pressure over main artery-if pressure at the

site does’nt work. Check for deformities- if
can’t move= need attention.
Diagnostic Evaluation

 Imaging Procedures
X-ray
Computed Tomography (CT)
Magnetic Resonance
Imaging (MRI)
Arthrography
Bone Densitometry
Diagnostic Evaluation
 Nuclear Studies  Laboratory Studies
 Bone Scan  (CBC)
 Endoscopic Studies  Urinalysis (Calcium)
 Arthroscopy  Blood Chemistry
 Other Studies  Serum Calcium
 Arthrocentesis  Serum Phosphate
 Electromyography  Uric Acid
 Biopsy  Serum Creatinine
 LDH, SGOT, CPK
 Assessment of the
Musculoskeletal System
 Diagnostic tests:
X-ray- determine density of the bone.
Arthrogram- visualization of joint structure &
movement.
Diskogram- vizualization of intervertebral
disk abnormalitiy.
Sinogram- visualizes course of sinus &
tissues involved.
CT- to identify soft tissue & bone
abnormalities, and various MS trauma.
MRI- to view soft tissue- useful in the dx. Of
ligament tears, osteomyelitis, disk disease.
X-RAYS

 Determine density of
the bone
ARTHROGRAM

 visualization of joint
structure &
movement.

Arthrogram of the Knee

 Assessment of the
Musculoskeletal System
 Bone Mineral Density (BMD) measurements:
Dual energy x-ray absorptiometry
(DEXA)- allows assessment of bone density
with minimal radiation exposure- to monitor
changes in bone density with treatment.
Qualitative ultrasound (QUS)- evaluates
density, elasticity & strength of patella &
calcaneus using ultrasound rather than
radiation.
Assessment of the
Musculoskeletal System
 Radioisotope Studies:
Studies
Bone scan- injection of
radioisotopes that is taken up by bone,
then scan entire body for degree of
uptake-related to blood flow. Increased
uptake- osteoporosis, Ca of the bone,
fractures. Decreased uptake-avascular
necrosis.
BONE SCAN
Assessment of the
Musculoskeletal System
 Endoscopy:
Endoscopy
Arthroscopy- insertion of arthroscope
into joint (usually knee) for visualization of
structure and contents. It can be used for
exploratory surgery (removal of loose bodies
& biopsy) and dx. of abnormalities of
meniscus, articular cartilage, ligaments, or
joints capsule. Other structures that can be
visualized include-shoulder, elbow, wrist,
jaw, hip and ankle.
ARTHROSCOPY
Assessment of the
Musculoskeletal System
 Invasive Procedures:
Arthrocentesis- incision or puncture of
joint capsule to obtain sample of synovial
fluid from joint cavity or to remove excess
fluid. Useful in dx. Of joint inflammation,
infection, and subtle fractures.
Electromyogram (EMG)- evaluates
electrical potential associated with skeletal
muscle contraction-useful in providing
information related to lower motor neuron
dysfunction and primary muscle disease.
ARTHROCENTESIS
ELECTROMYOGRAPHY (EMG)

From Mourad LA (1991) Orthopedic disorders. St. Louis: Mosby.

MYELOGRAM

From Herlihy B, Maebius NK: The human body in health and illness, Philadelphia, 2000,
W.B. Saunders.
BONE OR MUSCLE BIOPSY

Muscle Biopsy Showing

Polymyositis
Assessment of the
Musculoskeletal System
 Muscle enzymes- used to distinguish
between muscle weakness that is due
to nerve innervation problems and
dystrophic disease of the muscle itself.
The level of enzymes reflects the
progress of the disorder and the
effectiveness of treatment. Example-
Creatine kinase (CK),aldolase.
Assessment of the
Musculoskeletal System
 Serologic Studies:
Studies
Rheumatoid factor(RF)- assess presence
of autoantibody (RF) in serum.
Erythrocyte sedimentation rate (ESR)-
index of inflammation.
Antinuclear antibody (ANA)- assesses
presence of antibodies capable of destroying
nucleus of body’s tissue cells.
Anti-DNA antibody- detects serum
antibodies that react with DNA. It is the most
specific test for systemic lupus
erythematosus.
 Assessment of the
Musculoskeletal System
 Mineral Metabolism:
Alkaline phosphatase-produced by osteoblast
of bone-needed for mineralization of organic
bone matrix. Normal: 20 to 90 U/L (0.3 to 2,7
mmol/L). Calcium-
bone primary organ for calcium storage.
Normal: 9 to 11 mg/dl (2.3 to 2.7 mmol/L).
Phosphorus-
amount present indirectly related to calcium
metabolism. Normal: 2.8 to 4.5 mg/dl (0.9 to 1,5
mmol/L)
Assessment of the
Musculoskeletal System
 Miscellaneous:
Thermograpgy- uses infrared detector,
which measures degree of heat radiating
from skin surface. Useful in investigation of
cause of inflamed joint and in following up
pt.’s response to antiinflammatory drug
therapy.
Plethysmography- Study records variatios in
volume & pressures of blood passing
through tissues. Nosspecific.
Somotosensory evoked potebtial (SSEP)-
evaluates evoked potential of muscle
contractions. Help to identify neuropathy and
myopathy.