NURS 347
Towson University
MUSCULOSKELETAL ASSESSMENT
Musculoskeletal Assessment Fundamentals:
ANATOMY AND PHYSIOLOGY
STRUCTURE & FUNCTION
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Bones: 206 126 appendicular, 80 axial
Joints: Where two or more bones join
Muscles: Contraction = movement
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Voluntary skeletal muscles under conscious control
Support: Maintain stature
Movement
Protect vital organs
Produce red blood cells in bone marrow (hematopoiesis)
Storage of minerals, such as calcium and phosphorus
JOINTS (ARTICULATION)
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Synovial Joints
Bones are separated but enclosed in a joint cavity
 Opposing bones covered with cartilage
 Freely moveable
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Ligaments: Fibrous bands connect two bones,
strengthen joint
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Bursa: Enclosed sac filled with synovial fluid that aim
to reduce friction in areas such as the knee, shoulder.
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Tendon: Attached the skeletal muscle to the bone
RANGE OF MOTION
RANGE OF MOTION
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Active and Passive Range of Motions should the be same
Active: When the patient can perform range of
motion independently
 Passive: When the patient has a limitation
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 Anchor
the joint with one hand
 Use your other hand and move to the joint’s limit
RANGE OF MOTION
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Assessing and Documenting a Limitation:
 Goniometer:
Used to precisely measure joint angles
RANGE OF MOTION
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Flexion: Bending limb at a joint
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Extension: Straightening a limb at a joint
RANGE OF MOTION, CONTINUED
Abduction: Moving a limb away from body’s
midline
 Adduction: Moving a limb towards the body’s
midline
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RANGE OF MOTION, CONTINUED
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Pronation: Turning forearm so palm is down
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Supination: Rotating forearm so palm is up
RANGE OF MOTION, CONTINUED
Internal Rotation:
 External Rotation
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RANGE OF MOTION, CONTINUED
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Inversion: Moving the
sole of the foot inward
at the ankle
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Eversion: Moving the
sole of the foot outward
at the ankle
RANGE OF MOTION, CONTINUED
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Circumduction: Movement of the arm in a circle
around the shoulder
SUBJECTIVE ASSESSMENT
SUBJECTIVE INTERVIEW
1.
2.
3.
4.
5.
6.
Joints: Pain, stiffness, swelling, warmth, or limited
range of movement?
Muscles: Cramps, pain, or weakness?
Bones: Pain, deformity, trauma (fractures, sprains,
dislocations?)
Activities of Daily Living: Any difficulty bathing, toileting,
dressing, eating, communicating, or mobility?
Occupational Hazards: Heavy lifting, repetitive
movement?
Self-Care: Recent weight gain, exercise program?
OBJECTIVE ASSESSMENT
INSPECTION
Skeleton: Symmetry of skeleton; Size and
contour of joint(s)
 Skin: Color or swelling
 Gait: Steady or unsteady
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PALPATION
Joints
 Muscles
 Bones
 Range of Motion
 Tenderness
 Crepitus
 Muscle Strength
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JOINTS: INSPECTION
1.
Inspect paired joints for:
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Symmetry
Size
Contour
Color
Swelling
Deformities or Masses
JOINTS: PALPATION
1.
Palpate to:
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Stage edema: Pitting versus Non-Pitting
Masses
Warmth
Tenderness
Range of Motion (ROM)
Crepitus: An audible or palpable “crunching” or
“grating” with movement
Head to Toe
MUSCULOSKELETAL ASSESSMENT
TEMPOROMANDIBULAR JOINT
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Inspect: Area anterior to ear for:
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masses, symmetry, discoloration
Palpate:
Crepitus or tenderness
 temporalis and masseter muscles when teeth are
clenched
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Range of Motion:
Open mouth maximally
 Partial mouth open
 Stick out lower jaw
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 Vertical motion
 Lateral motion
 Protrusion without deviation
CERVICAL SPINE
Inspect the alignment of the head and neck
 Palpate the spinous processes and sternomastoid,
trapezius, and paravertebral muscles
 Range of motion:
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Chin to chest
 45’ flexion
 Chin to ceiling
 55’ hyperextension
 Touch ear to shoulder
 40’ lateral bend
 Turn chin to shoulder
 70’ rotation
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DO NOT ASSESS IF SUSPECTED CERVICAL TRAUMA
UPPER EXTREMITIES: SHOULDER
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Inspect posteriorly and anteriorly:
Joint size and contour
 Equality of bony landmarks
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Palpate:
Spasm
 Atrophy
 Swelling
 Heat
 Tenderness
 Crepitus during ROM
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UPPER EXTREMITIES: SHOULDERS
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How would you assess Range of Motion?
UPPER EXTREMITIES: SHOULDERS
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How would you assess Range of Motion?
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Circumduction
Abduction
Adduction
Internal Rotation
External Rotation
UPPER EXTREMITIES: SHOULDERS
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Strength
 Shrug
Shoulders (also assesses which CN?)
 Flex arms forward and up against resistance
UPPER EXTREMITIES: ELBOW
Inspect joint and tissue
 Range of Motion:
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 Bend
and Straighten elbow (Flexion and Extension)
 With slightly extended elbow, touch thefront and
back of the hand to the table (Pronation and
Supination)
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Strength: Flex and extend elbow against
resistance
UPPER EXTREMITIES: WRIST AND HANDS
Inspect joints (knuckles) and surrounding skin
 Palpate for warmth, crepitus, tenderness, or
nodules
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UPPER EXTREMITIES: WRIST AND HANDS
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ROM:
 Bend
hand up and down at wrist
 Bend fingers at metacarpophalangeal joints
 Palms flat on table: Rotate in and outward
 Spread fingers apart, make a fist
 Touch thumb to each finger
LOWER EXTREMITIES: HIP
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Inspection of the Hips should be delayed until spinal he
assessment
With patient in the supine position, palpate the hip
joints for crepitus or tenderness
LOWER EXTREMITIES: HIP
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Range of Motion
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Raise each leg with knee extended
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Bend each knee up to the chest,
keeping the other leg straight
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Extend leg straight, then direct foot
inward and outward
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Swing leg laterally and medially,
keeping knee straight
LOWER EXTREMITIES: KNEE
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Inspection and Palpation:
 Skin
free from lesions, smooth and even in coloring
 Bilateral comparison: length and alignment
 Swelling or fullness at the knee, pre- and
suprapatellar bursa
 Atrophy at quadriceps
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Strength: Ask patient to push your hand away
using their foot, assessing quadriceps’ strength
LOWER EXTREMITIES: KNEE
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Range of Motion
 Bend
and Extend each knee
 Assess ROM during ambulation
LOWER EXTREMITIES: FOOT AND ANKLE
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Inspect and compare both feet
and toes, and their position.
Examine:
skin color
 Lesions
 Contour
 alignment with the upper leg
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Note areas of calluses or bursal
reactions, as they reveal areas
of abnormal friction
LOWER EXTREMITIES: FOOT AND ANKLE

Range of Motion
 Point
toes towards floor
 Point toes towards nose
 Turn soles of feet in and out
 Flex and straighten toes

Strength
 Maintain
dorsiflexion and plantar flexion against
resistance (hand)
SPINAL ASSESSMENT: POSTERIOR
Stand behind patient so you can see the entire
back
 Inspect for spine’s straightness by following an
imaginary vertical line from the head to the
gluteal cleft
 Inspect for symmetry of shoulders, scapulae,
and iliac crests (hips) bilaterally.
 Knees should be aligned and pointing forward
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SPINAL ASSESSMENT: LATERAL
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Inspect for normal curvature of the spine
 Convex
thoracic curve
 Concave lumbar curve
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Range of Motion
 Bend
forward, touch toes
 (concave
curve should disappear)
 Bend
Sideways (35’)
 Bend backward (Hyperextension 30’)
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Assess for pain and decreased ROM
SPINAL ASSESSMENT
AGE CONSIDERATIONS: INFANTS & CHILDREN
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Infants
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Barlow-Ortolani’s Maneuver:
Assesses for congenital dislocation of hips in infants.
 Normal finding reveals smooth abduction and adduction of bilateral
legs while in the supine position
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Spina Bifida:
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Children
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Juvenile Rheumatoid Arthritis: Discomfort greater
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A tuft of hair over a dimple on the spinal midline may indicate spinal
bifida
in the morning, decreased ROM and pain in bilateral joints.
Scoliosis: Spinal asymmetry
Adolescents
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Scoliosis: Spinal asymmetry
AGE CONSIDERATIONS & PREGNANCY
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Older Adults
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Dorsal kyphosis
Rheumatoid Arthritis: Bilateral joint pain and decreased ROM,
worse in the morning
Osteoarthritis: Unilateral or unrelated joint pain in which pain
increases later in the day
Osteoporosis: Risk Factors & Prevention
Pregnancy
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Waddling Gait
Backache
Muscle cramps
Lordosis
FUNCTIONAL ASSESSMENT
Walk (with shoes on) to observe gait and
balance
 Climb up and down stairs to assess balance
and bilateral strength
 Pick up object from the floor
 Rise from sitting in chair
 Rise from lying in bed
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GRADING MUSCLE STRENGTH