Muskuloskeletal Muskuloskeletal AssessmentAssessment

Health HistoryHealth History Physical AssessmentPhysical Assessment

InspectionInspection PalpationPalpation Range of MotionRange of Motion Muscular StrengthMuscular Strength

Rachel S. Natividad, RN, MSN

Physical Assessment- Physical Assessment- Cont.Cont.

Cervical spineCervical spine ShouldersShoulders ElbowsElbows Wrists/handsWrists/hands HipsHips KneesKnees Ankles/feetAnkles/feet SpineSpine

Functional Functional assessmentassessment

Inspection/PalpationInspection/Palpation Note size and symmetry color, swelling, Note size and symmetry color, swelling,

masses & deformities of joints, limbs and body masses & deformities of joints, limbs and body regions regions

Palpate for temperature, pain, tenderness, Palpate for temperature, pain, tenderness,

SpineSpine

ROM’sROM’s

Have the pt perform Have the pt perform active ROMactive ROM

If unable to, use If unable to, use passive ROMpassive ROM

Assessing Muscles Assessing Muscles

Strength against Strength against gravity, full gravity, full resistance resistance

note as 0/5-5/5note as 0/5-5/5

“ “5/5” = normal5/5” = normal

Rheumatoid arthritisRheumatoid arthritis

Chronic, systemic, Chronic, systemic, inflammatory inflammatory disease that attacks disease that attacks the joints, and the joints, and surrounding tissues, surrounding tissues, hand, knees, hips, hand, knees, hips, and feetand feet

DeformitiesDeformitiesof RAof RA

Swan neck deformity

Boutinniere Deformity

Ulnar Shift

OsteoarthritisOsteoarthritis

A chronic A chronic degeneration of degeneration of joint cartilage joint cartilage caused by aging caused by aging or traumaor trauma

OsteoarthritisOsteoarthritis•Heberden’s nodes on distal interphalangeal joints (DIP’s )•Bouchards nodes on proximal interphalangeal joints (PIPs) as disease progresses

OsteoporosisOsteoporosis

A A decrease decrease in bone in bone mass, mass, porousporous, , brittle, and brittle, and prone to prone to fracturefracture

ContracturesContractures

Assessment Guide: Assessment Guide: Activity & RestActivity & Rest

Objective DataObjective Data Activity Level and ToleranceActivity Level and Tolerance: :

ambulates with walker independently/ ambulates with walker independently/ with minimal assistance; bedrest; up in with minimal assistance; bedrest; up in wheelchairwheelchair

Assessment Guide: Activity Assessment Guide: Activity & Rest Muscles and joints& Rest Muscles and joints

Description: fair muscle tone, no atrophy; Description: fair muscle tone, no atrophy; atrophy to RLE. No stiffness or contractures; R atrophy to RLE. No stiffness or contractures; R wrist contractedwrist contracted

Movement: limited ROM to RUE; FROM all Movement: limited ROM to RUE; FROM all extremitiesextremities

Strength: strong UE, LE; weak RUE & RLEStrength: strong UE, LE; weak RUE & RLE

Coordination: able to perform most ADLs; can Coordination: able to perform most ADLs; can comb hair and reach for water glasscomb hair and reach for water glass

Assessment Guide: Assessment Guide: Activity & RestActivity & Rest

Posture/GaitPosture/Gait

Slumped, kyphosis, erect; gait Slumped, kyphosis, erect; gait unsteady, shuffling, ataxiaunsteady, shuffling, ataxia

Assessment Guide: Assessment Guide: Activity & RestActivity & Rest

Circulation, Sensation, and MovementCirculation, Sensation, and Movement Describe: Describe:

CSM intact; CSM intact; no sensation to R big toe and second no sensation to R big toe and second

toe; toe; numbness and tingling to LEs;numbness and tingling to LEs;Decreased ROM to LUE due to Decreased ROM to LUE due to

contracturescontractures

Assessment Guide: Assessment Guide: Activity & RestActivity & Rest

Rest/Sleep PatternsRest/Sleep Patterns

Sleeps most of the daySleeps most of the day Takes midday napsTakes midday naps

Assessment Guide: Activity Assessment Guide: Activity & Rest & Rest

Interventions in use: Interventions in use: Assistive device, equipment Assistive device, equipment

Cast, trapeze, foot cradle, Cast, trapeze, foot cradle, Special bedsSpecial beds

Air bed, eggcrate mattressAir bed, eggcrate mattress Med List:Med List:

Glucosamine, Allopurinol, NSAIDS, etc.Glucosamine, Allopurinol, NSAIDS, etc.