Musculoskeletal 1
ALLENTOWN COLLEGE OF ST. FRANCIS DE SALES
DEPARTMENT OF NURSING AND HEALTH
Nursing 201
Nursing Skills Lab Procedure: Assessment of the Musculoskeletal System
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
ACTION
Test the ROM of the neck, by asking the client to 1) touch his/her chin to his/her
chest (flexion), 2) tilt his/her head back (extension), 3) touch his/her chin to each
shoulder (rotation), and 4) touch his/her ear to the corresponding shoulder (lateral
flexion)
NORMAL FINDINGS
 Full ROM
Inspect the neck, by observing the client’s neck from all angles
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Palpate the temporomandibular joints, by 1) placing the tip of your index finger
just in front of the tragus of each of the client’s ears, and 2) asking the client to
open and close his/her mouth
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Test the ROM of the temporomandibular joints, by asking the client to 1) open
and close his/her mouth, 2) jut his/her chin out, 3) tuck his/her chin in, and 4)
move his/her lower jaw side to side

Normal lordotic spinal
curve
Symmetry
Full ROM
Nontender
Dropping of your
fingers into the
depressed area over
the joint as the mouth
opens
Opening of the mouth
at least 2 inches
Full ROM
ABNORMAL FINDINGS
 Limited ROM
 Increased mobility and
joint instability
(ligamentous laxity)
 Pain
 Audible crepitation
 Nuchal rigidity
 Abnormal spinal
curves
 Asymmetry
 Deformities
 Abnormal posture
 Limited ROM
 Increased mobility and
joint instability
(ligamentous laxity)
 Tenderness
 Audible crepitation
 Audible click
 Trismus (muscle
spasm)
 Swelling
 Limited ROM
 Increased mobility and
joint instability
(ligamentous laxity)
 Pain
Musculoskeletal 2
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
Audible crepitation
Palpate the spinous processes of the cervical spine, by 1) placing the thumb of
your right hand on one side of each spinous process, and 2) placing the index
finger of your right hand on the other side of each spinous process
Palpate the trapezius muscles and muscles between the scapulae
Test the ROM of the hands and wrists, by asking the client to 1) make a fist with
each hand with his/her thumb across the knuckles (flexion, adduction, opposition
of the thumb), 2) open the fist and spread the fingers of each hand (extension,
abduction), 3) raise and lower each hand at the wrist (flexion, extension), and 4)
deviate each hand toward the thumb and the little finger (radial deviation, ulnar
deviation)

Nontender

Tenderness
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Nontender
Full ROM
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Inspect the hands and wrists, by observing the client’s hands and wrists from all
angles

Symmetry

Palpate the proximal and distal interphalangeal joints of the right hand, by 1)
placing the thumb of your right hand on the medial aspect of each proximal and
distal interphalangeal joint of the client’s right hand, and 2) placing the index
finger of your right hand on the lateral aspect of each proximal and distal
interphalangeal joint of the client’s right hand (Reverse to palpate the proximal
and distal interphalangeal joints of the left hand)
Test for tenderness of the metacarpophalangeal joints of the right hand, by 1)
placing the thumb and fingers of your right hand around the client’s right hand,
just proximal to the metacarpophalageal joints, and 2) compressing the
metacarpophalangeal joints of the client’s right hand with the thumb and fingers
of your right hand (Reverse to test for tenderness of the
metacarpophalangeal joints of the left hand)
Palpate the metacarpophalangeal joints, by placing the thumbs of your right and
left hands just distal to, and on each side of, each of the client’s knuckles
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Nontender
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Tenderness
Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Pain
Audible crepitation
Asymmetry
Swelling
Redness
Nodules
Deformities
Muscular atrophy
Tenderness
Swelling
Bogginess
Bony enlargement
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Nontender
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Tenderness
Swelling
Bogginess

Nontender
Palpate the wrist joint of the right hand, by 1) placing the thumbs of your right and
left hands on the dorsal (top) surface of the client’s right wrist, and 2) placing your
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Nontender
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Tenderness
Swelling
Bogginess
Tenderness
Swelling
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Musculoskeletal 3
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fingers of your right and left hands on the palmar (bottom) surface of the client’s
right wrist (Reverse to palpate the left wrist joint)
Test the ROM of the right elbow, by asking the client to 1) bend his/her right
elbow (flexion), 2) straighten his/her right elbow (extension), 3) turn the palm of
his/her right hand up (supination), and 4) turn the palm of his/her right hand down
(pronation) (Reverse to test ROM of the left elbow)


Bogginess
Full ROM


Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Pain
Audible crepitation
Nodules
Swelling
Thickening
Tenderness
Palpate the right elbow, by 1) standing at an oblique right angle to the client, 2)
supporting the client’s right forearm with your left hand so that his/her elbow is
flexed to 70º, 3) placing the thumb of your right hand 10 centimeters proximal to
and on one side of the client’s right elbow, 4) placing the fingers of your right hand
10 centimeters proximal to and on the other side of the client’s right elbow, and 5)
moving your right thumb and fingers distally in progressive steps along the sides
of the client’s right elbow (Reverse to palpate the left elbow)
Test the ROM of the shoulders, by asking the client to 1) raise both of his/her
arms to a vertical position at the sides of his/her head (flexion), 2) lower both of
his/her arms to his/her sides (extension), 3) place both of his/her hands behind
his/her neck with both of his/her elbows out to the side (external rotation,
abduction), and 4) place both of his/her hands behind the small of his/her back
with both of his/her elbows out to the side (internal rotation, adduction)

Nontender
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Full ROM
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Inspect the shoulders anteriorly, by 1) standing directly in front of the client, and
2) observing the client’s shoulders anteriorly from all angles

Symmetry

Inspect the shoulders posteriorly, by 1) standing directly behind the client, and 2)
observing the client’s shoulders posteriorly from all angles

Symmetry

Test the ROM of the right ankle and foot, by 1) having the client lie down on an
examining table, 2) asking the client to point the toes of his/her right foot
downward (plantar flexion), 3) asking the client to point the toes of his/her right
foot towards his/her nose (dorsiflextion), 4) stabilizing the client’s right ankle with
one hand, grasping the client’s right heel with your other hand, and turning the
sole of the client’s right foot inward (inversion) and outward (eversion) at the
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Full ROM
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Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Pain
Audible crepitation
Asymmetry
Swelling
Deformities
Muscular atrophy
Asymmetry
Swelling
Deformities
Muscular atrophy
Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Pain
Audible crepitation
Musculoskeletal 4
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subtalar joint, 5) stabilizing the client’s right ankle with one hand, grasping the
client’s right forefoot with your other hand, and turning the client’s right foot inward
(inversion) and outward (eversion) at the transverse tarsal joint, 6) asking the
client to curl up the toes of his/her right foot (flexion, adduction), and 7) asking the
client to straighten and spread the toes of his/her right foot (extension, abduction)
(Reverse to test the ROM of the left ankle and foot)
Inspect the ankles and feet, by 1) having the client lie down on an examining
table, and 2) observing the client’s ankles and feet from all angles
Palpate the achilles tendon of the right ankle, by 1) having the client lie down on
an examining table, and 2) feeling along the back of the client’s right ankle
(Reverse to palpate the left achilles tendon)
Palpate the anterior aspect of the right ankle joint, by 1) having the client lie down
on an examining table, 2) placing the thumbs of your right and left hands on the
dorsal (top) surface of the client’s right ankle joint, and 3) placing the fingers of
your right and left hands on the palmar (bottom) surface of the client’s right ankle
joint (Reverse to palpate the left ankle joint)
Test for tenderness of the metatarsophalangeal joints of the right foot, by 1)
having the client lie down on an examining table, 2) placing the thumb and fingers
of your right hand around the client’s right forefoot, just proximal to the
metatarsophalageal joints, and 3) compressing the client’s right forefoot between
the thumb and fingers of your right hand (Reverse to test for tenderness of the
metatarsophalangeal joints of the left foot)
Palpate the metatarsophalangeal joints of the right foot, by 1) having the client lie
down on an examining table, 2) placing the thumb of your right hand on the dorsal
(top) surface of each of the client’s metatarsophalangeal joints of his/her right
foot, and 3) placing the index finger of your right hand on the plantar (bottom)
surface of each of the client’s metatarsalphalangeal joints in his/her right foot
(Reverse to palpate the metatarsalphalangeal joints of the left foot)
Test the ROM of the right knee and hip, by 1) having the client lie down on an
examining table, 2) asking the client to bend his/her right knee up to his/her chest
and pull it firmly against the abdomen (flexion), 3) asking the client to straighten
his/her right knee and place it on the examining table (extension), 4) flexing the
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Symmetry
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Asymmetry
Deformities
Nodules
Swelling
Calluses
Corns
Tenderness
Nodules
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Nontender
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Nontender
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Tenderness
Bogginess
Swelling
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Nontender
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Tenderness
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Nontender
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Tenderness

Full ROM


Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Musculoskeletal 5
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client’s right leg to 90º at the hip and knee, stabilizing the client’s right thigh with
one hand, grasping the client’s right ankle with your left hand, and swinging the
client’s lower leg inward or medially (external rotation) and outward or laterally
(internal rotation), and 5) stabilizing the client’s left pelvis with your left hand,
grasping his/her right ankle with your right hand, and pulling his/her right leg away
from midline until you feel the client’s left iliac spine move (abduction), and
moving his/her right leg toward the midline (adduction) (Reverse to test ROM of
the left knee and hip)
Inspect the knees, by 1) having the client lie down on an examining table, and 2)
observing the client’s knees from all angles

Symmetry
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Pain
Audible crepitation
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Asymmetry
Deformities
Atrophy of the
quadriceps muscle
Loss of normal
hollows around the
patella
Swelling
Tenderness
Warmth
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Palpate the right knee, by 1) having the client lie down on an examining table, 2)
placing the thumb of your right hand 10 centimeters above and proximal to one
side of the client’s right kneecap (patella), 3) placing the fingers of your right hand
10 centimeters above and proximal to the other side of the client’s right kneecap
(patella), and 4) moving your right thumb and fingers distally in progressive steps
along the sides of the client’s right kneecap (patella) (Reverse to palpate the left
knee)
Test ROM of the spine, by 1) sitting behind the standing client, 2) asking the client
to bend forward and touch his/her toes (flexion), 3) asking the client to stand
straight up (extension), and 4) stabilizing the client’s pelvis with both of your
hands and asking the client to bend to his/her right then left (lateral flexion), bend
backwards (hyperextension), and twist his/her shoulders to the right then left
(rotation)
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Nontender
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Full ROM
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Inspect the lateral spinal profile, by 1) standing at the side of the standing client,
and 2) observing the client’s spinal profile laterally from all angles
Inspect the posterior spinal profile, by 1) standing behind the standing client, and
2) observing the client’s spinal profile posteriorly from all angles
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Normal kyphotic and
lordotic spinal curves
Normal spinal curves
Symmetry (especially
of the heights of the
shoulders, iliac crests,
and skin creases in
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Limited ROM
Increased mobility and
joint instability
(ligamentous laxity)
Pain
Audible crepitation
Abnormal spinal
curves
Abnormal spinal
curves
Asymmetry (especially
of the heights of the
shoulders, iliac crests,
Musculoskeletal 6
the buttocks)
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Palpate the spinous processes of the thoracic and lumbar spine, by 1) placing the
thumb of your right hand on one side of each spinous process of the client’s
thoracic and lumbar spine, and 2) placing the index finger of your right hand on
the other side of each spinous process of the client’s thoracic spine
Palpate the paravertebral muscles of the thoracic and lumbar spine
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Nontender
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Nontender
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and skin creases in
the buttocks)
Tenderness
Tenderness
Trismus (muscle
spasm)
Musculoskeletal 7
FULL RANGE OF MOTION OF THE JOINTS
JOINT
Temporomandibular
Joint
Neck
Shoulder

MOVEMENT
TMJ opening

DESCRIPTION
Open mouth

FULL RANGE OF MOTION
3-6 centimeters (1-2.3 inches)
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TMJ closing
Protrusion
Retrusion
Lateral motion
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Close mouth
Jut chin out
Tuck chin in
Move jaw from side to side

Complete closure
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Move the head from the upright
midline position forward, so that the
chin rests on the chest
Move the head from the flexed
position to the upright position
Move the head from the upright
position back as far as possible
Move the head laterally to the right
and left shoulders, while facing front
Turn the face as far as possible to
the right and left
Raise each arm from a position by
the side forward and upward to a
position beside the head
Move each arm from a vertical
position beside the head forward
and down to a resting position at the
side of the body
Move each arm from a resting side
position to behind the body
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
Move each arm from a position
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1-2 centimeters (0.3-0.7 inches)
from midline
45 from midline
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Flexion
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Extension
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45 from midline
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Hyperextension
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10
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Lateral flexion
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40 from midline
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Rotation
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70 from midline
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Flexion
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180 from the side
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Extension
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180 from vertical position beside
the head
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Hyperextension
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50 from side position
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Abduction
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180
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Adduction (anterior)
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230
Musculoskeletal 8
Elbow
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Adduction (posterior)
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Horizontal flexion
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Horizontal extension
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Circumduction
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External rotation
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Internal rotation
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Flexion
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Extension
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Rotation for supination
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Rotation for pronation
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beside the head downward laterally
and across the front of the body as
far as possible
Move each arm from a position
beside the head downward laterally
and across behind the body as far
as possible
Extend each arm laterally at
shoulder height and move it through
a horizontal plane across the front
of the body as far as possible
Extend each arm laterally at
shoulder height and move it through
a horizontal plane as far behind the
body as possible
Move each arm forward, up, back,
and down in a full circle
With each arm held out to the side
at the shoulder level and the elbow
bent to a right angle, fingers
pointing down, move the arm
upward so that the fingers point up
With each arm held out to the side
at shoulder level and the elbow bent
to a right angle, fingers pointing up,
bring the arm forward and down so
that the fingers point down
Bring each lower arm forward and
upward so that the hand is at the
shoulder
Bring each arm lower arm forward
and downward, straightening the
arm
Turn each hand and forearm so that
the palm is facing upward
Turn each hand and forearm so that
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230

130 -135
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45
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360
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90
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90
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150
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150
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70 - 90
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70 - 90
Musculoskeletal 9
Wrist
Hands and Fingers
Thumb
Hip
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Flexion
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Extension
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Hyperextension
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Radial flexion (abduction)
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Ulnar flexion (adduction)
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Flexion
Extension
Hyperextension
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Abduction
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Adduction
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Flexion
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Extension
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Abduction
Adduction
Opposition
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Flexion
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Extension
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the palm is facing downward
Bring the fingers of each hand
toward the inner aspect of the
forearm
Straighten each hand to the same
plane as the arm
Bend the fingers of each hand back
as far as possible
Bend each wrist laterally toward the
thumb side with hand supinated
Bend each wrist laterally toward the
fifth finger with the hand supinated
Make a fist with each hand
Straighten the fingers of each hand
Bend the fingers of each hand back
as far as possible
Spread the fingers of each hand
apart
Bring the fingers of each hand
together
Move each thumb across the
palmar surface of the hand toward
the fifth finger
Move each thumb away from the
hand
Extend each thumb laterally
Move each thumb back to the hand
Touch each thumb to the tip of each
finger of the same hand. The
thumb joint movements involved are
abduction, rotation, and flexion
Move each leg forward and upward.
The knee may be extended or
flexed
Move each leg back beside the
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80 - 90
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80 - 90
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70 - 90
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0 - 20
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30 - 50
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90
90
30
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20
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20
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90
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90
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30
30
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Knee extended, 90; knee flexed,
120

90 - 120
Musculoskeletal 10
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Hyperextension
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Abduction
Adduction
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Circumduction
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Internal rotation
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External rotation
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Flexion
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Extension
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Ankle
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Extension (plantar flexion)
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Foot and Toes
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Flexion (dorsiflexion)
Eversion
Inversion
Flexion
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Extension
Abduction
Adduction
Flexion
Extension
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Hyperextension
Lateral flexion
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Knee
Trunk
other leg
Move each leg back behind the
body
Move each leg out to the side
Move each leg back to the other leg
and beyond in front of it
Move each leg backward, up, to the
side, and down in a circle
Turn each foot and leg inward so
that the toes point out as far as
possible toward the other leg
Turn each foot and leg outward so
that the toes point as far as possible
away from the other leg
Bend each leg bringing the heel
toward the back of the thigh
Straighten each leg, returning the
foot to its position beside the other
foot
Point the toes of each foot
downward
Point the toes of each foot upward
Turn the sole of each foot laterally
Turn the sole of each foot medially
Curve the toe joints of each foot
downward
Straighten the toes of each foot
Spread the toes of each foot apart
Bring the toes of each foot together
Bend the trunk toward the toes
Straighten the trunk from a flexed
position
Bend the trunk backward
Bend the trunk to the right and to
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30 - 50
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
45 - 50
20 - 30 beyond other leg

360
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90

90
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120 - 130
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120 - 130
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45 - 50
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20
5
5
35 - 60
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35 - 60
0 - 15
0 - 15
70 - 90
70 - 90
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
20 - 30
35 on each side
Musculoskeletal 11

Rotation

the left
Turn the upper part of the body from
side to side

30 - 45