MUSCULOSKELETAL ASSESSMENT ANATOMY & PHYSIOLOGY ● Structure ● Bones ● Joints ● Muscles ● Function ● Postural Support ● Movement ● Organ Protect ● Cell Production ● Mineral Storage SKELETAL MUSCLE MOVEMENTS ● Flexion ● Inversion ● Extension ● Eversion ● Abduction ● Rotation ● Adduction ● Protraction ● Pronation ● Retraction ● Supination ● Elevation ● Circumduction ● Depression SUBJECTIVE DATA ● Pain (Joint, Back, Muscles) ● Stiffness, Rigidity ● Swelling, Heat, Redness ● Movement Limitations ● Deformity (Bone or Joint) ● History of Accident(s) or Trauma(s) ● Occupational/Recreational Hazards ● Exercise Habits ● Medications or Supplements ● Smoking or Alcohol/Drug Use FUNCTIONAL ASSESSMENTS – ADLS/IADLS ● Activity Limitations Bathing ○ Toileting ○ Dressing ○ Grooming ○ Eating ○ Mobility ○ Communication ● Lawton-Brody Instrumental Activities of Daily Living (IADL) ● Katz Index of Independence in Activities of Daily Living (ADL) ○ INSPECTION & PALPATION ● Joints & Muscles ○ Size ○ Contour ○ Color ○ Temperature ○ Swelling ○ Tenderness ○ Masses or Deformity Bony Articulations ● Range of Motion (ROM) ○ Crepitation ○ MUSCLE TESTING SCALE Grade Description % Normal Assessment 5 Full ROM against gravity, full resistance 100 Normal 4 Full ROM against gravity , some resistance 75 Good 3 2 Full ROM with gravity Full ROM with gravity eliminated (passive ROM) 50 25 Fair Poor 1 0 Slight contraction No contraction 10 0 Trace Zero TEMPOROMANDIBULAR JOINT (TMJ) ❏ Palpate temporalis and masseter muscles as person clenches teeth ❏ Ask person to move jaw forward and laterally against your resistance, and to open mouth against your resistance (cranial nerve V; trigeminal) CERVICAL SPINE ❏ Alignment of head and neck ❏ Palpate spinous processes and sternomastoid, trapezius, and paravertebral muscles ❏ Person normally can maintain flexion against full resistance (CN XI) SHOULDER ❏ Shoulder also shrug tests integrity of CN XI ELBOW ❑ Check olecranon bursa and the normally present hollows on either side of the olecranon process for abnormal swelling. WRIST AND HAND ❏ Palpate each joint in wrist and hands ❏ Spread fingers, make fist, and touch thumb to each finger POSITIVE (+) = CARPAL TUNNEL Phalen Test Tinel Sign HIP ❑ Inspect for symmetric levels of iliac crests and gluteal folds KNEE ❑ Check quadriceps muscle in anterior thigh for any atrophy ANKLES AND FEET ❏ Inspect alignment ❏ Palpate metatarsophalangeal joints SPINE ❑ Inspect Alignment ❑ Kyphosis: Enhanced thoracic curve ❑ Lordosis: Pronounced lumbar curve ❑ Scoliosis: Lateral curvature of the spine STRAIGHT LEG RAISING OR LASÈGUE’S TEST ❏ ❏ These maneuvers reproduce back and leg pain and may confirm the presence of herniated nucleus pulposus. Positive (+) if it reproduces sciatic pain