Skeletal Muscle Movements Health History Inspection Palpation

Flexion – bending a limb at the joint Extension – straightening a limb at a joint Abduction – moving a limb away from the

midline (-) Adduction – moving a limb to the midline

(+) Internal rotation – turning a body part

toward the midline External rotation – turning a body part

away from the midline

Pronation – turning the palm downward Supination – turning the palm upward Inversion – moving the foot inward Eversion – moving the foot outward Circumduction – moving the arms in a

circular motion

Rotation – moving the head around a central axis

Protraction – moving a body part forward

Retraction – moving a body part backward

Elevation – raising a body part Depression – lowering a body part

Joints – any pain, stiffness, swelling, heat, redness. Evaluate ROM

Muscles – any pain/cramps, muscle strength/weakness

Bones – any pain, deformity, trauma Functional assessment – performance

of ADL’s Self-care behaviors – Exercise, weight

gain/loss, current meds, disability

Infants and Children Birth history Achieved motor development milestones Any broken bones or deformities Check for dislocation of hip – Ortolani’s maneuver

Adolescents Scoliosis screen Sports participation, warms-up, special

equipment Elderly

Hx. of falls, mobility, weakness, ability to perform ADL’s

With a (+) Ortolani’syou will hear a click andfeel the femur shift

Gait – should be smooth, rhythmic and coordinated

Symmetry, alignment, size - of body parts

Any swelling, masses, deformities or atrophy

ROM – should be smooth without clicking

Joints, muscles, bony articulationsAny heat, tenderness, swelling or masses

ROMActiveActive-assistedPassive

Muscle strength: should be (=) bilaterallyGrade strength 0-5 scale – Table pg. 641

Active ROM – Client performs unassisted Active Assisted ROM – Nurse helps client

with ROM exercises Passive ROM –nurse must perform all

ROM. It is useful to prevent atrophy, contractures and promote joint mobility. Does not increase muscle strength.

**Stop and reestablish correct body alignment for a client who experiences pain or cramping with ROM.

Inspection – observe for swelling Palpation

Open mouth Normal opening 3-6 cm, or 3 fingers

Move side to sideStick out lower jawClench teeth

Note size, strength Provide resistance to chin, assesses CN V

InspectionCheck alignment of head and neckSpine should be straight and head erect

PalpationPalpate spinous processes,sternomastoid, trapezius andparavertebral muscles. Should be firm,without tenderness or spasms.

Muscle strengthPlace hand against side of head or jawline.

Extension 0°

Hyperextension 55°

Flexion 45°

Lateral bending 40°

Rotation 70°

InspectionVertical alignment and symmetrySpine should be straight with hipsand shoulders of (=) height.Leg length discrepancy

PalpationSpinous processesParavertebral muscles

Have client touch toesFlexion 75-90°

Bend sidewaysLateral bending 35°

Bend backwardHyperextension 30°

Twist shoulders to one side and then the otherRotation 30°

Inspection Compare posteriorly and anteriorly

Palpation Place one hand on shoulder Palpate for muscle spasms, atrophy, swelling,

heat or tenderness Muscle Strength

Have client shrug shoulders against resistance

Tests CN XI – Spinal accessory

Forward flexion Hyperextension Internal rotation External rotation Abduction Adduction

Inspection Palpation Muscle strength

Apply resistance to forearm ROM

Pronation –palm downSupination – palm up

Inspection Palpation

Include wrist, metacarpal joints

Resistance Carpal Tunnel

Syndrome Phalen’s Test

Acute flexion Numbness or burning

with CTS Tinel’s Sign

With direct percussion of median nerve, burning and tingling occurs with CTS

Inspection Palpation Muscle strength

With hand on thigh have client push upward

Flexion Extension Internal rotation External rotation

Abduction Adduction Hyperextension

Will not do inclinical

Flexion Extension Hyperextension

InspectionAnkle and Metatarsals

Palpation Muscle Strength

Dorsiflex and plantar flex foot against resistance

Dorsiflexion Plantar flexion Eversion Inversion