Assessment of the
Musculoskeletal
System
Kevin Ross
Clinical Educator
Before you start!!
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Introduce yourself.
Check patient details.
Give a good explanation of what is involved.
Obtain informed consent.
Wash hands.
Ensure privacy and dignity (consider chaperone).
Ask to undress down to underwear when
appropriate.
Screening Questions
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Do you have any pain or stiffness in your
muscles, joints or back?
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Can you dress yourself completely without any
difficulty?
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Can you walk up and down stairs without any
difficulty?
Screening Questions
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If the patient has no stiffness, pain and no
difficulty undertaking tasks, it is unlikely that
the patient has any significant musculoskeletal
problem.
If there is a positive response to any of these
questions, a more detailed history and
examination should be undertaken.
Abnormal findings should lead to a regional
examination. (R.E.M.S.)
Screening Examination
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Gait, Arms, Legs and Spine (GALS)
Should take 1-2 minutes.
Designed to detect abnormalities of the
musculoskeletal system.
Looks at joints for normal movement, joint
swelling and abnormal posture.
Can vary the sequence.
GAIT
Ask the patient to walk up and down the room,
turning at the end.
 Observe for :symmetry
smoothness
ability to turn quickly
If abnormal gait, pain?
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Normal Gait
Abnormal Gait
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Antalgic Gait
Ataxic Gait :- sensory
cerebellar
Scissor Gait
Waddling Gait
Trendelenburg Gait
Parkinsonian Gait (festinating gait)
Look at patient
ARMS
Ask the patient to :
Put their hands behind their head.
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Hold arms straight out, palms down, fingers
outstretched.
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Turn hands over.
ARMS
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Make a fist.
squeeze your fingers
To bring each finger to the thumb in turn.
You should gently squeeze across the
metacarpophalangeal (mcp)joints testing for
tenderness.
LEGS
With patient laid on a couch:
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Assess knee flexion and extension.
Assess internal/external rotation of the hips.
Perform patella tap.
Inspect feet.
Squeeze the MTP’s.
SPINE
With the patient standing:
Inspect the spine from behind and side view.
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Assess lateral flexion of the neck (cervical
spine).
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Assess lumbar spine movement.
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Assess temporal mandibular joints.
Recording Findings
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Should record normal and abnormal findings.
Usually recorded in grid form.
Record appearance and movement.
X indicates abnormality
If you find abnormalities, you should undertake
a detailed history, or R.E.M.S.
Recording Findings
Appearance
Movement
Gait
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Arms
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Legs
X
X
Spine
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findings
Knee swelling Restricted
Any Questions