Francis Obmerga, PhD, RN
Muscles
NORMAL FINDINGS
Inspect the muscles
for size.
Compare each muscle
on one side of the body
to the same muscle on
the other side. For any
apparent
discrepancies, measure
the muscles with a
tape.
Equal size on both
sides of body
DEVIATION FROM
NORMAL
Atrophy (a decrease in
size) or hypertrophy
(an increased in size)
Muscles of the body
Muscles
NORMAL FINDINGS
Inspect the muscles
and tendons for
contractures.
No contractures
DEVIATION FROM
NORMAL
Malposition of body
part (foot drop or foot
flexed forward)
Muscles
NORMAL FINDINGS
Inspect the muscles
for tremors.
Inspect any tremors of
the hands and arms by
having the client hold
arms out in front of
body.
No fasciculation or
tremors
DEVIATION FROM
NORMAL
Presence of
fasciculation or tremors
Muscles
NORMAL FINDINGS
Palpate muscles at rest Normally firm
to determine muscle
tonicity.
Palpate muscles while Smooth coordinated
the client is active and movements
passive for flaccidity,
spasticity, and
smoothness of
movement.
Test muscle strength.
Equal strength on each
Compare the right side body side
with left side.
DEVIATION FROM
NORMAL
Atonic (lacking tone)
Flaccidity (weakness or
laxness) or spasticity
(sudden involuntary
muscle contraction)
25% or less muscle
strength
Grading Muscle Strength
GRADE
5
4
3
2
1
0
DESCRIPTION
100% of normal muscle strength; normal full movement
against gravity and against full resistance.
75% of normal strength; normal full movement against
gravity and against minimal resistance.
50% of normal strength; normal movement against
gravity.
25% of normal strength; full muscle movement against
gravity, with support.
10% of normal strength; no movement, contraction of
muscle is palpable or visible.
0% of normal strength; complete paralysis
5/9/23 7:09 AM
Lecturer: FRANCIS OBMERGA,
7
Sternocleidomastoid
Client turns the head to one side against the resistance of
your hand. Repeat with the other side.
Trapezius
Client shrugs the shoulders against the resistance of your
hands.
Deltoid
Client holds arm up and resists while you try to push it
down.
Biceps
Client fully extends each arm and tries to flex it while you
attempt to hold arm in extension.
Triceps
Client flexes each arm and then tries to extends it against
your attempt to keep in flexion
Wrist and Finger Muscles
Client spreads the fingers and resists as you attempt to
push the fingers together.
Grip strength
Client grasps your index finger and middle fingers while
you try to pull the fingers out.
Hip Muscles
Client is supine, both legs extended; client raises one leg
at a time while you attempt to hold it down.
Hip abduction
Client is supine, both legs extended. Place your hands on
the lateral surface of each knee; client spreads the legs
apart against your resistance.
Hip adduction
Client is in same position as in hip abduction. Place your
hands between the knees; client brings the legs together
against your resistance.
Hamstrings
Client is supine, both knees bent. Client resists while you
attempt to straighten the legs.
Quadriceps
Client is supine, knee partially extended; client resists
while you attempt to flex the knee.
Muscles of the ankle and feet
Client resists while you attempt to dorsiflex the foot and
and again resists while you attempt to flex the foot.
Bones
NORMAL FINDINGS
Inspect the skeleton
for normal structure
and deformities.
Palpate the bones to
locate any areas of
edema or tenderness.
DEVIATION FROM
NORMAL
No deformities
Bones misaligned
No tenderness of
swelling
Presence tenderness of
swelling
Joints
NORMAL FINDINGS
Inspect the joint for
swelling.
Palpate each joint for
tenderness,
smoothness of
movement, swelling,
crepitation, and
presence of nodules.
DEVIATION FROM
NORMAL
No swelling
One or more swollen
No tenderness,
joints.
crepitation, or nodules Presence of
tenderness, swelling,
crepitation, or nodules
Understanding Major Joints
Understanding Major Joints
Understanding Major Joints
Understanding Major Joints
Joints
NORMAL FINDINGS
Assess joint range of Varies to some degree
in accordance with
motion.
Ask the client to move
selected body parts. If
available, use a
goniometer to measure
the angle of the joint in
degrees.
Palpate each joint for
tenderness, smoothness
of movement, swelling,
crepitation, and presence
of nodules.
person’s genetic
makeup and degree of
physical activity.
Full range of motion.
DEVIATION FROM
NORMAL
Limited range of
motion in one or more
joints
Skeletal muscle movements:
• Abduction: Moving away from midline of the
body
• Adduction: Moving toward midline of the body
• Circumduction: Circular motion
• Inversion: Moving inward
• Eversion: Moving outward
• Extension: Straightening the extremity at the
joint and increasing the angle of the joint
• Hyperextension: Joint bends greater than 180
degrees
• Flexion: Bending the extremity at the joint and
decreasing the angle of the joint
Dorsiflexion: Toes draw upward to ankle
Plantar flexion: Toes point away from ankle
Pronation: Turning or facing downward
Supination: Turning or facing upward
Protraction: Moving forward
Retraction: Moving backward
Rotation: Turning of a bone on its own long axis
Internal rotation: Turning of a bone toward the
center of the body
• External rotation: Turning of a bone away from
the center of the body
•
•
•
•
•
•
•
•
Flexion. Move the head from the upright midline position forward, so that
the chin rests on the chest; Extension. Move the head from the flexed
position to the upright position; Hyperextension. Move the head from the
upright position back as far as possible.
Neck-Pivot Joint
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Lateral flexion. Move the head laterally to the right and left shoulders
Neck-Pivot Joint
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25
Rotation. Turn the face as far as possible to the right and left
Neck-Pivot Joint
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27
Flexion. Raise each arm from a position
by the side forward and upward to a
position
beside
the
head;
Extension. Move each arm from a
vertical position beside the head
forward and down to a resting position
at
the
side
of
the
body;
Hyperextension. Move each arm from
a resting side position to behind the
body.
Shoulder-Ball-and-Socket Joint
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29
Abduction. Move each arm
laterally from a resting position at
the sides to a side position above
the head, palm of the hand away
from
the
head;
Adduction (anterior). Move each
arm from a position at the sides
across the front of the body as far
as possible. The elbow may be
straight or bent.
Shoulder-Ball-and-Socket Joint
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Circumduction. Move each arm forward, up, back, and down in a full circle
Shoulder-Ball-and-Socket Joint
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33
External rotation. With each arm held
out to the side at shoulder level and the
elbow bent to a right angle, fingers
pointing down, move the arm upward
so that the fingers point up;
Internal rotation. With each arm held
out to the side at shoulder level and the
elbow bent to a right angle, fingers
pointing up, move the arm forward and
down so that the fingers point down
Shoulder-Ball-and-Socket Joint
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34
Flexion. Bring each lower arm forward and upward so that the hand is at the
shoulder;
Extension. Bring each lower arm forward and downward, straightening
Elbow-Hinge Joint
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36
Rotation for supination. Turn
each hand and forearm so that
the palm is facing upward;
Rotation for pronation. Turn
each hand and forearm so that
the palm is facing downward.
Elbow-Hinge Joint
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38
Flexion. Bring the fingers of each hand toward the inner aspect of the
forearm; Extension. Straighten each hand to the same plane as the arm.
Wrist-Condyloid Joint
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40
Hyperextension. Bend the fingers of each hand back as far as possible.
Wrist-Condyloid Joint
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42
Radial flexion (abduction).
Bend each wrist laterally
toward the thumb side with
hand supinated;
Ulnar flexion (adduction).
Bend each wrist laterally
toward the fifth finger with
the hand supinated.
Wrist-Condyloid Joint
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43
Flexion. Make a fist with each hand;
Extension. Straighten the fingers of each hand;
Hyperextension. Bend the fingers of each hand back as far as possible.
Wrist-Condyloid Joint
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45
Abduction. Spread the fingers of
each hand apart;
Adduction. Bring the fingers of
each hand together.
Wrist-Condyloid Joint
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47
Flexion. Move each thumb across
the palmar surface of the hand
toward
the
fifth
finger;
Extension. Move each thumb away
from the hand.
Thumb-Saddle Joint
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48
Abduction.
Extend
each
thumb
laterally;
Adduction. Move each thumb back to the hand.
Thumb-Saddle Joint
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49
Opposition. Touch each thumb to the top of each finger of the same hand.
The thumb joint movements involved are abduction, rotation, and flexion.
Thumb-Saddle Joint
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Flexion. Move each leg forward and upward. The knee may be extended or
flexed.
Hip-Ball-and-Socket Joint
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51
Extension. Move each leg back inside the other.
Hyperextension. Move each leg back behind the body.
Hip-Ball-and-Socket Joint
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52
Abduction.
Move
each
leg
out
to
the
side;
Adduction. Move each leg back to the other leg and beyond in front of it.
Hip-Ball-and-Socket Joint
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Circumduction. Move each leg backward, up, to the side, and down in a
circle
Hip-Ball-and-Socket Joint
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Internal rotation. Turn each
foot and leg inward so that
the toes point as far as
possible toward the other
leg; External rotation. Turn
each foot and leg outward so
that the toes point as far as
possible away from the other
leg.
Hip-Ball-and-Socket Joint
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Flexion. Bend each leg, bringing the heel toward the back of the thigh.
Extension. Straighten each leg, returning the foot to its position beside the
other foot.
Knee-Hinge Joint
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Extension (plantar flexion). Point the toes of each foot downward;
Flexion (dorsiflexion). Point the toes of each foot upward.
Ankle-Hinge Joint
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Eversion. Turn the sole of each laterally;
Inversion. Turn the sole of each foot medially.
Foot-Gliding
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Flexion. Curl the toe joints of each foot downward;
Extension. Straighten the toes of each foot.
Toes
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Flexion. Bend the trunk
toward
the
toes;
Extension. Straighten the
trunk from a flexed position;
Hyperextension. Bend the
trunk backward.
Trunk-Gliding Joint
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Lateral flexion. Bend the
trunk to the right and to
the left.
Trunk-Gliding Joint
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Rotation. Turn the upper
part of the body from side
to side.
Trunk-Gliding Joint
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