Muscoloskeletal System
Musculoskeletal System Consists
of:
Bones
Muscles
Joints
cartilage
function
Support to stand erect
Movement
Protect inner vital organs
Hemopoiesis – Bone marrow produces
white & red bld cells and platelets
Reservoir for storage of minerals & energy
– Ca. & Phosphorus in the bones.
Bones
206
Bones & cartilage are types of Connective
tissue
Bone is hard and rigid and dense
Joints
2 or more bones connecting
Mobility
Nonsynovial = immovable, skull sutures
Synovial = movable
Synovial joints – ends of bones are covered
with cartilage & enclosed in a joint cavity
filled with synovial fld.
Ligaments are fibrous bands – connect one
bone to another. Strengthen joint & prevent
movement in the wrong direction
Bursa – enclosed sac filled with synovial
fld.& are located in areas of potential
friction = shoulder, knee. Help muscles &
tendons glide over bone.
Muscles
40 – 50 % body weight
Contract & produce movement
Skeletal muscle is voluntary
Composed of Bundles of muscle fibers or
fasciculi
Muscle is attached to bones via tendons
Skeletal muscles produce the
following movements
Flexion – bending
Extension – straightening
Abduction – away from midline
Adduction – toward midline
Pronation – palm down
Supination – palm up
Circumduction - circular
Skeletal muscles produce the
following movements
Inversion – sole inward
Eversion – sole outward
Rotation – head around central axis
Protraction –forward movement parallel to
ground (chin)
Retraction – backward parallel movement
Depression/elevation – Shoulders up &
down
Temporomandibular Joint (TMJ)
Articulation of temporal & mandible
Depression anterior to tragus of ear
Jaw function for chewing & speaking
Movements
– Hinge – open/close
– Gliding – protrusion/retraction
– Gliding- side to side
Spine
33 Vertebrae
Spinous process posterior midline
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
3 – 4 Coccygeal
 C7 & T1 prominent base of neck
 Inferior angle of scapula in line with T7 & T8
 Highest point iliac crest at L4
 Curves Double S – lateral view
– cervical & lumbar are concave;(inward)
– Thoracic & sacrococcygeal are convex
 Intervertebral discs cushion the spine = shock
absorber
Shoulder
Articulation of humerus & glenoid fossa of
scapula
Ball & socket – enclosed by rotator cuff (4
muscles and tendons)
Acromion process – bump at top of
shoulder
Elbow
Articulation humerus, radius, & ulna
Landmarks are the Medial & lateral
epicondyles of the humerus & large
olecranon process of the ulna in between
Sensitive ulnar nerve
Wrists and Carpals
Wrist –articulation of radius & carpal
bones
Permits flexion, extension & side to side
deviation
Metacarpophalangeal & interphalangeal
joints – permit finger flexion and extension
Hip
Acetabulum & femur
Ball & socket joint
Weight bearing function
Landmarks ( IM injections)
– Anterior, superior iliac crest
– Ischial tuberosity (↓ gluteus maximus, flex
hip)
– Greater trochanter of femur
Knee
Femur, tibia & patella
Largest joint
Hinged joint & largest synovial membrane
2 cartilages – medial & lateral menisci
cushion the tibia & femur
Ankle & Foot
Ankle joint is the articulation of Tibia,
fibula & talus
Hinged joint
– Dorsiflexion
– Plantar flexion
Landmarks
– Medial & lateral malleolus
Aging adult
Loss of bone density = osteoporosis
Postural changes
↓ height due to shortening of the vertebral
column
Subjective Data
Joints
– Pain
– Stiffness
– Swelling, heat, redness
Muscles
– Pain, cramps
– weakness
Subjective Data
Bones
– Pain
– Deformity
– Trauma
Functional Assessment ( ADL’s )
Self – care behaviors
Objective Assessment
Physical Exam Musculoskeletal
Purpose
– To assess function for ADL’s
– Screen for abnormalities
Screening Exams
Inspection
Palpation
ROM with movement active or passive if
apparent limitations
Age Specific
Important to :
Client comfort
Systemic approach
Support joints
Bilateral exam
Equipment
Tape measure
Goniometer
Skin marking pen
Inspection
 Size & contour of joint
 Color, swelling, masses, deformity
Palpation
 Each joint
Temperature
Muscles
Bony articulations joint capsule
Tenderness, swelling, masses
ROM
Active ROM
Limitation – try passive motion

or in ROM, use a goniometer to
measure angles
Muscle Testing
Repeat movements for Active ROM
Client flexes & holds against opposing
force
= bilaterally, resists opposing force
Grade muscle strength (pg. 616)
Values 0- 5
Grade 5= Normal –Full ROM against
gravity, full resistance
TMJ
Swelling, tenderness, crepitation
Crepitation = audible & palpable crunching
or grating with movement
Cervical Spine
 Inspection
– Head & neck alignment
– Spine
 Palpation
– Spinous processes, Trapezius, Paravertebral muscles
– ROM, flexion, extension, hyperextension, lateral
flexion, rotation, circumduction
– Repeat applying opposing force
Shoulders
Inspect
– Bilateral comparison
Palpate
– Bilaterally for muscle spasms, atrophy,
swelling, heat, tenderness
– Clavicle to acromioclavicular joint, scapula,
greater tubercle of humerus, subacromal bursa,
biceps groove & anterior aspect glenohumeral
joint
Test for Shoulder ROM
 Flexion
 Extension
 Internal rotation
 External rotation
 Abduction
 Adduction
 Circumduction
Test for strength; shrug shoulders, flex forward,
up & abduct against resistance
Elbow
 Inspect
– Size & contour with flexion, extension
– Deformity, redness, swelling
– Olecranon bursa
 Palpate
– Flexed 70 degrees
• Olecranon process, medial & lateral epicondyles of humerus
• Olecronon bursa for heat, swelling, tenderness, nodules
ROM of Elbow
Flexion
Extension
 pronation
supination
Muscle Strength of Elbow
Flex elbow – then extend against resistance
applied just proximal to the wrist
Wrist and Hand
Inspect
– Palmar & dorsal surface
• Position, contour and shape
– Swelling, redness, deformity or nodules
Wrist and Hand
Palpate
–
–
–
–
Wrist and hand joints
Support hand, use both thumbs to palpate
Metacarpophanlangeal joints
Use thumb and index finger in a pinching
motion to palpate interphalangeal joints
ROM of Wrists and Hands
Hyperextension
Palmar flexion
Flexion of fingers
Abduction for fingers
Opposition
Ulnar deviation, Radial deviation
Muscle Strength for Wrist and
Hands
Flex wrist against palm resistance
Phalen’s test – both hands flexed & back to
back for 60 secs. Normally no symp.
Carpel tunnel syndrome will give a + result
of numbness & burning
Tinel’s Sign – direct percussion @ median
nerve of wrist. In carpel tunnel + result =
burning & tingling
Hip
Inspect hip joint with spine when client is
standing
Client is supine, palpate the hip joints
ROM
Knee
Supine with legs extended ( knees can be
flexed or dangling for inspection)
Swelling = ? Soft tissue or ↑ fld in the joint
Bulge Sign – stroke up medial aspect 2-3x.
Tap lateral aspect. Watch for a bulge in the
medial hollow.
Ballottement of the Patella – lger amt of
flds
Ankle & foot
Inspect while nonweight- bearing, then
standing & walking
ROM
Muscle strength
Spine
Standing
Inspect
Palpate spinous processes
ROM of spine is checked by asking to
touch toes
Leg measurement
True leg length = measure b/t fixed points,
the anterior iliac spine cross the medial
side of the knee to the medial malleolus