assessment of the musclo skletal system
TRANSCRIPT
![Page 1: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/1.jpg)
Assessment of the Assessment of the Musculo-Skeletal System Musculo-Skeletal System
![Page 2: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/2.jpg)
Review of Anatomy and Physiology
• The musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints
• The primary function of which is to produce skeletal movements
![Page 3: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/3.jpg)
Muscles
Three types of muscles exist in the body• 1. Skeletal Muscles
– Voluntary and striated
• 2. Cardiac muscles– Involuntary and striated
• 3. Smooth/Visceral muscles– Involuntary and NON-striated
![Page 4: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/4.jpg)
TENDONS
•Bands of fibrous connective tissue that tie bones to muscles
![Page 5: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/5.jpg)
LIGAMENTS
•Strong, dense and flexible bands of fibrous tissue connecting bones to another bone
![Page 6: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/6.jpg)
BONES
• Variously classified according to shape, location and size
• Functions1. Locomotion2. Protection3. Support and lever4. Blood production5. Mineral deposition
![Page 7: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/7.jpg)
JOINTS
•The part of the Skeleton where two or more bones are connected
![Page 8: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/8.jpg)
CARTILAGES
•A dense connective tissue that consists of fibers embedded in a strong gel-like substance
![Page 9: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/9.jpg)
BURSAE
•Sac containing fluid that are located around the joints to prevent friction
![Page 10: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/10.jpg)
• CHECK YOUR EQUIPMENT PRIOR TO ENTERING THE PATIENT’S ROOM. MAKE SURE YOU HAVE EVERYTHING YOU NEED TO COMPLETE YOUR ASSESSMENT PRIOR TO ENTERING THE PATIENT’S ROOM
![Page 11: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/11.jpg)
Make the Patient ComfortableMake the Patient Comfortable
• Showing concern for privacy and patient modesty must become ingrained in your professional behavior
• Be sure to close nearby doors or examination room PRIOR to beginning physical examination
• Your goal is to visualize one area of the body at a time
![Page 12: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/12.jpg)
Make the Patient Make the Patient ComfortableComfortable
• Be sensitive to the patient’s feelings and physical comfort
• When you have completed the examination, show your attentiveness, by rearranging the patients pillows, or adding blankets for warmth; make sure their immediate environment is to their satisfaction
• Be sure to lower the bed completely, and make sure side rails are up and call bell is in the patient’s reach
• As you leave be sure to WASH YOUR HANDS
![Page 13: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/13.jpg)
GENERAL EXAMGENERAL EXAM
VITAL SIGNS
![Page 14: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/14.jpg)
![Page 15: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/15.jpg)
Cardinal Techniques of ExaminationCardinal Techniques of Examination
• Inspection
• Palpation
• Percussion
• Auscultation
![Page 16: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/16.jpg)
OutlinesOutlines
1.1. Review of Anatomy and physiology Review of Anatomy and physiology of musculoskeletal systemof musculoskeletal system
2.2. Physical ExamPhysical Exam
3.3. Inspection Inspection
4.4. Palpation Palpation
5.5. ROM (Rang of motion)ROM (Rang of motion)
![Page 17: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/17.jpg)
ObjectivesObjectives
• Apply knowledge of Anatomy and Anatomy and physiology of musculoskeletal physiology of musculoskeletal systemsystem
• Differentiate between normal and Differentiate between normal and abnormal abnormal
• Implement physical assessment Implement physical assessment
![Page 18: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/18.jpg)
MusculoskeletalMusculoskeletal• Muscle or joint pain• Stiffness• Arthritis• Gout• Backache• If present, describe location or affected joints or
muscles, any swelling, redness, pain, tenderness, stiffness, weakness, or limitation of motion or activity; include timing of symptoms duration, and any history of trauma
• Neck or low back pain• Joint pain with systemic features such as fever,
chills, rash, anorexia, weight loss, or weakness
![Page 19: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/19.jpg)
SkinSkin• Rashes• Lumps• Sores• Itching• Dryness• Changes in color• Changes in hair or nails
![Page 20: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/20.jpg)
![Page 21: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/21.jpg)
What do muscles do What do muscles do ??• Muscles simply move you!• Without muscles you couldn't open your
mouth, speak, shake hands, walk, talk, or move your food through your digestive system.
• There would be no exploring, running, climbing, smiling, blinking, breathing. You couldn't move anything inside or outside you. The fact is, without muscles, you wouldn't be alive for very long
![Page 22: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/22.jpg)
![Page 23: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/23.jpg)
The skeleton is the name given to the collection of bones that holds our body up.
Our skeleton is very important to us. It does three major jobs.
1. It protects our vital organs such as the brain, the heart, and the lungs.
2. It gives us the shape that we have. Without our skeleton we would just be a blob of blood and tissue on the floor.
3. It allows us to move. Because our muscles are attached to our bones, when our muscles move, they move the bones, and we move
![Page 24: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/24.jpg)
Physical ExamPhysical Exam
1. Inspection • Observe any lack of symmetry and
any evidence of trauma or disease.• Look for muscle wasting;• Inspect the joint contour (shape)
and observe any evidence of swelling, deformity or inflammation.
![Page 25: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/25.jpg)
• Ask the client to point to, or otherwise identify, any painful areas, including sites of radiation of
pain.
Screening questions for musculoskeletal disorders
1. Do you have any pain or stiffness in your arms, legs or back?
2. Can you walk up and down stairs without difficulty?
3. Can you dress yourself in everyday clothes without any difficulty?
![Page 26: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/26.jpg)
• Assessment of Gait
• Ask the patient to walk back and forth across the room.
• Observe for equality of arm swing , balance and rapidity and ease of turning.
• Next, ask the patient to walk on his tiptoes, then on heels.
• Ask the patient to tandem walk.
• Test patient's ability to stand with feet together with eyes open and then closed. (Romberg's test). Reassure patient that you will support him, in case he becomes unsteady.
• Normal: Person can walk in balance with the arms swinging at sides and can turn smoothly. Person should be able to stand with feet together without falling with eyes open or closed.
tiptoes
heels
tandem
![Page 27: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/27.jpg)
Upper Extremity MusclesUpper Extremity Muscles
• Inspect the muscles of the shoulder, arm, forearm and hand.
• Note muscle size (bulk). • Look for asymmetry,
atrophy and fasciculation.
• Look for tremor and other abnormal movement at rest and with arms outstretched.
![Page 28: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/28.jpg)
Determine muscle power Determine muscle power byby
• Gently trying to overpower contraction of each group of muscles. – Shoulder:
Abduction (Deltoid)
– , Adduction– , (Trapezius)
Abduction
Adduction
Trapezius )
![Page 29: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/29.jpg)
– Elbow: flexion (Biceps)
– Elbow extension (Triceps)
– Wrist: Flexion ( )and
extension().
![Page 30: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/30.jpg)
– Hand: Grip
– opposition of thumb and index finger
– opposition of thumb and little finger and
– finger abduction and adduction.
Grip
![Page 31: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/31.jpg)
• Determine limb tone (resistance to passive stretch).
• With the patient relaxed
• Gently move the limb at the shoulder, elbow and wrist joints and note whether tone is normal, increased or decreased
![Page 32: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/32.jpg)
Normal findingsNormal findings
• Muscles are symmetrical in size with no involuntary movements.
• In some, muscles may be slightly larger on the dominant side.
• Muscle power obviously varies. You should not be able to overpower with reasonable resistance.
• You have to learn to appreciate the normal tone from practice.
![Page 33: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/33.jpg)
Neck: Range of Motion ofNeck: Range of Motion of • Fix the head with one hand while you
examine neck • Inspection
– Note the normal concavity of cervical spine
– Identify Transverse process of C7 – Observe Trapezius and Sternomastoid
muscles • Palpation
– Feel each spinous process looking for focal areas of tenderness
– Joint • Feel for crepitus during passive motion
– Para spinal muscles • Range of motion
– Active • Touch chin for flexion • Throw head back for extension
Touch chin
Throw head back
![Page 34: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/34.jpg)
• Touch each shoulder with ears for lateral flexion
• Touch each shoulder with chin for lateral rotation
– Passive • Feel for crepitus during passive
motion
• Normal: – 30 degree rotation, able to
touch chest with chin, 55 degree extension and 40 degree lateral bend.
– No resistance during the range of motion.
![Page 35: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/35.jpg)
Muscles of Lower ExtremityMuscles of Lower Extremity
Inspect the muscles of the hip, knee and ankle.
• Note muscle size (bulk). • Look for asymmetry, atrophy
and fasciculation. • Look for abnormal movement. • Determine muscle power by
gently trying to overpower contraction of each group of muscles. – Hip: Flexion (Iliopsoas), Extension
(Gluteus maximus), Abduction, Adduction.
Hip flexion
![Page 36: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/36.jpg)
Assessment of the Assessment of the Musculoskeletal SystemMusculoskeletal System
Muscle Strength scaleMuscle Strength scale
0No detection of muscular contraction
1A barely detectable flicker or trace of contraction with observation or palpation.
2Active movement of body part with elimination of gravity.
3Active movement against gravity only and not against resistance
4Active movement against gravity & some resistance
5Active movement against full resistance without evident fatigue )Normal muscle strength)
![Page 37: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/37.jpg)
The Knee ExamThe Knee Exam
• Inspection • Make sure that both knees are
fully exposed. The patient should be in either a gown or shorts. Rolled up pant legs do not provide good exposure!
• Watch the patient walk.• Do they limp or appear to be in
pain? • When standing, is there evidence
of bowing (varus) or knock-kneed (valgus) deformity? There is a predilection for degenerative joint disease to affect the medical aspect of the knee, a common cause of bowing.
varus Knee deormity, more
marked on the left leg
![Page 38: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/38.jpg)
• Is there evidence of atrophy of the quadriceps, hamstring, or calf muscle groups? Knee problems/pain can limit the use of the affected leg, leading to wasting of the muscles.
While both legs have well developed musculature, the left calf and hamstring are bulkier than the right
![Page 39: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/39.jpg)
– Knee : Flexion (Hamstrings), Extension (Quadriceps)
– Ankle : Dorsiflexion (Tibialis anterior), Plantar flexion (Gastronemius).
• Determine limb tone resistance to passive stretch. With the patient relaxed, gently move the limb at the hip, knee and ankle and note whether tone is normal, increased or dicreased. Flex the hip and knee.
• Support the knee, dorsiflex the ankle sharply and hold the foot in this position checking for clonus.
Dorsiflexion
Knee extension
Knee flexion
![Page 40: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/40.jpg)
Spine (Bone)Spine (Bone)• The examiner should stand behind the
patient and observe the alignment of the spine in the flexed position to determine scoliosis.
• View the spine from the side to determine kyphosis.
• Ask the patient if he is aware of sore spots. Palpate the spinous process and be gentle with the sore spots. Percuss one vertebra at a time, starting from head.
• .
![Page 41: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/41.jpg)
• Assess range of motion of spine by having patient bend down to pick up an object without bending his legs while you hold his hips.
• Normal: • Gentle concavities in
cervical and lumbar regions and a convexity in the thorax.
• Vertebral line and gluteal cleft align
![Page 42: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/42.jpg)
PosturePosture
•Normal - Comfortably erect
Look for straight lines across body parts
![Page 43: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/43.jpg)
Lordosis - Increased Curvature of the Lordosis - Increased Curvature of the SpineSpine
![Page 44: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/44.jpg)
Kyphosis is a curving of the spine that causes a bowing of the Kyphosis is a curving of the spine that causes a bowing of the
back, which leads to a hunchback or slouching postureback, which leads to a hunchback or slouching posture..
![Page 45: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/45.jpg)
Scoliosis – curvature of the spine away Scoliosis – curvature of the spine away from middle or sidewaysfrom middle or sideways
![Page 46: Assessment of the musclo skletal system](https://reader036.vdocuments.us/reader036/viewer/2022081602/556c8d79d8b42a7a738b4a6e/html5/thumbnails/46.jpg)