Assessment of the

Musculoskeletal
System
Sara H. Mitchell, Ph.D., RN,
CPNP
The impact of diseases of the
musculoskeletal system
1.
2.
3
4
5
6.
Composition of the
Musculoskeletal System
 The skeleton proper (bones & joints)

 Skeletal muscles

 Tendons

 Ligaments
Nutrition & Musculoskeletal
Function
 Fluoride  Aluminum

 Magnesium  Copper

 Zinc  Iron

 Manganese
 Iodine
Assessment of the musculoskeletal
system
 History-taking
 Inspect & Palpate joints
 Assess range of motion
 Assess muscle strength
1
 2
 3
 4
 5
Joint motion - a review of terms
 Flexion  Inversion
 Extension  Eversion
 Dorsiflexion  Internal rotation
 Plantar flexion  External rotation
 Adduction  Pronation
 Abduction  Suppination
Measuring Range of Motion
 If any limitation or
increase in ROM is
noted, use a
___________ to
measure the angles
precisely
Cervical Spine Assessment
 Abnormal findings
H
A
T
Upper Extremity Assessment
 Abnormal findings:
L
P
S
M
A
C
ROM of wrist & hand
 Flexion –

 Extension –

 Hyperextension –

 Ulnar deviation –

 Radial deviation –
Spinal Assessment
 Abnormal findings:
S
T
S
Torso Range of Motion
 Abnormalities:
L
P
Lower Extremity ROM
 Hip flexion with knee
straight –
 Hip flexion with knee
flexed:
 Internal & External
rotation :
 Abduction :
 Adduction :
Range of Motion of the Knee
 Flexion-extension – 1350

 Hyperextension - 100
 Ballottement
 Used to test for joint effusion
 If there is an effusion present a palpated tap will
be present and the transmitted impulse will be felt
by the fingers on either side of the patella
 Ankle Range of Motion
 Dorsiflexion – 20o
 Plantar Flexion – 500
 Inversion of hind foot – 50
 Eversion of hind foot - 50
Alterations of Musculoskeletal
Function
 Musculoskeletal  Disorders of joints
Injuries n
s i
s  Disorders of skeletal
 Disorders of bone muscle
m  s
 m
I
 m
b  I
Primary symptoms of
musculoskeletal disease
P
W
D
L
S
J
Phalen’s test
 Ask the person to hold
both hands back to
back while flexing the
wrists 90 degrees.
Acute flexion of the
wrist for 60 seconds
produces numbness
and burning in a
person with carpal
tunel syndrome
Tinel’s Sign
 In carpal tunnel
syndrome, percussion
of the median nerve
produces burning and
tingling along its
distribution, which is a
positive Tinel’s sign
The musculoskeletal system of
the young
 C

 E

 B

 S
Musculoskeletal assessment in
the pediatric patient
 O  Limp
T

 L
L

 G I

 G S

 S
_____________ Maneuver for
Congenital Dislocated Hip
 With a dislocated hip, the
head of the femur is not
cupped in the acetabulum
but rests posterior to it.

 Hip instability feels like a

clunk as the head of the
femur pos into place. This
is a positive
_____________________
Lower Extremity Findings in
Children
 ______________:
“bowlegged” stance is
normal through the first
two years of life.
Resolves with growth and
ambulation
 ____________: knock-
kneed stance occurs
normally between 2 and
3½ years of age
 ___________________

 Dislocation of the hip

functionally shortens
and weakens hip
and pelvis muscles.

 When a child stands

on the dislocated
hip, the opposite
side of the pelvis
drops
Scoliosis
 _________ scoliosis is
flexible. It is apparent
with standing and
disappears with forward
standing.
 ____________ scoliosis
is fixed. The curvature
shows both on standing
and on bending forward
The Musculoskeletal system of
the elderly
 Muscle atrophy  Osteoarthritis
 Osteoporosis  Reduced range of
 Kyphosis motion
 Decreased  Degenerative

intervertebral disc changes

space
 Joint stiffness
Degenerative Joint Disease of
Osteoarthritis
 Osteoarthritis is
characterized by hard,
nontender nodules, 203
mm or more. These
osteophytes (bony over-
growths) of the distal
interphalangeal joints are
called ____________
nodes and those of the
proximal interphalangeal
joints are called
_______________ nodes
 Osteoporosis
 Risk Factors
 Classification
 Diagnosis
 Prevention
 Treatment

Areas of yellow indicate

bone loss from osteoporosis
The Musculoskeletal system of
the elderly (continued)
 “Musculoskeletal problems have the most
significant impact on the aged population.
More than 1 billion dollars is spent
annually by Medicare for hospitalization of
elderly patients with these conditions.
This represents 20% of all Medicare
payments.
Reaching a conclusion
 Based on history & physical examination does there
appear to be a musculoskeletal disease or
impairment?
 Do the history and finding suggest a primary
musculoskeletal concern or signs & symptoms of a
systemic disease?
 What is the differential diagnosis?
 What additional tests (labs, diagnostic studies) are
indicated?
Differential diagnoses - what is
the primary problem
 Fracture
 Sprain
 Dislocation or subluxation
 Joint or muscle inflammation
 Age specific abnormality
 Systemic illness (examples)
 neuropathy
 myopathy
 connective tissue disease
Test for musculoskeletal
function
 Bone function  Joint function
 a
g
 a
s  M

r  a

a
 Muscular function
 S________,
b
 U
b  EMG
 f
 m
Remember...
 “Diseases of the musculoskeletal
system rank first among disease
conditions that alter the quality of
life…the cost of which exceeds 60
billion dollars annually…”