Assessment of the
Musculo-Skeletal System
Dr –Essmat Gemaey
230 NUR
Outlines
1. Review of Anatomy and physiology
of musculoskeletal system
2. Physical Exam
3. Inspection
4. Palpation
5. ROM (Rang of motion)
Objectives
• Apply knowledge of Anatomy and
physiology of musculoskeletal system
• Differentiate between normal and
abnormal
• Implement physical assessment
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
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
Physical 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.
• 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?
• 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.
heels
tiptoes
tandem
Upper 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.
Determine muscle power
by
• Gently trying to
overpower
contraction of each
group of muscles.
Abduction
– Shoulder:
Abduction
(Deltoid)
–, Adduction
–, Shrug
(Trapezius)
Adduction
Trapezius)
– Elbow: flexion (Biceps)
– Elbow extension
(Triceps)
– Wrist: Flexion ( )and
extension().
– Hand: Grip
Grip
– opposition of thumb
and index finger
– opposition of thumb
and little finger and
– finger abduction and
adduction.
• 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
Normal 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.
Neck: 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
Touch chin
• Range of motion
– Active
• Touch chin for flexion
• Throw head back for extension
Throw head back
• 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.
Muscles 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
The 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 knockkneed (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
more ,deormity
marked on the left
leg
• 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
– 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 .
Knee extension
Knee flexion
Dorsiflexion
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 .
• .
• 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