Assessment of the
Musculoskeletal System
 Past health history- these includes TB, polio, DM,
parathyroid problems, soft tissue infection, &
neuromuscular disabilities. Possible sources of
bacterial infection, such as ears, tonsils or GU and
trauma.
 Medications- regarding prescription, OTC, herbal
products & nutritional supplements. Women should
be question about their menstrual hx. , use of
hormone therapy, CA and vitamin D supplements
are important for postmenopausal women.
Assessment of the
Musculoskeletal System
Surgery or other treatments- past
hospitalizations from musculoskeletal problems.
Functional health patterns= Nutritional-metabolic pattern-dietary
supplements.
= Elimination= Activity-exercise-require assistance in
completing ADL.
= sleep-rest- difficulty sleeping.
= Cognitive-perceptual-musculoskeletal pain
Assessment of the
Musculoskeletal System
Functional Health patterns con’t…..
= Self-perception-self-concept-changes
in MS system-posture, walking,etc…
= Role-relationship- live alone, effect on
work.
= Sexuality-reproductive-sexual
concerns.
= coping-stress tolerance- problems
such as pain or immobility.
= value-belief- cultural & religious
practices.
Assessment of the
Musculoskeletal System
Physical examination:
* Inspection-use of an assistive
devices such as walker. Observe general
body build, muscle configuration, &
symmetry of joint movement. Note for
swelling, deformity, nodules or masses &
discrepancies in limb length or muscle
size.
Assessment of the
Musculoskeletal System
 Physical Examination con,t…
* Palpation: of both muscles & joints allows
for evaluation of skin temperature, local
tenderness, swelling and crepitation.
* Gait, motion of spine- smoothness, rhythm,
limpimg, unsteady. Note height of shoulders,
iliac crests, gluteal folds, shoulder & hip
symmetry. Note for lumbar lordosis( concavity
of the spine), kyphosis-(excessive curvature
of thoracic spine), scoliosis (deviation to L or
right)
Assessment of the
Musculoskeletal System
Upper extremities- evaluate muscle
strength. If joint motion compromised or
painful-exam for fluid (effusion), increase
temperature (inflammation). Passive
movements elicits crunching noise
(crepitus)-exam for nodules.
Lower extremities- evaluate muscle action,
ROM, pulses( femoral, tibial, dorsalis
pedis).reflexes- (patellar, achilles,
babinski)
Assessment of the
Musculoskeletal System
Muscle Strength scale
0
No detection of muscular contraction
1
A barely detectable flicker or trace of contraction
with observation or palpation.
Active movement of body part with elimination of
gravity.
Active movement against gravity only and not
against resistance
2
3
4
Active movement against gravity & some
resistance
5
Active movement against full resistance without
evident fatigue (Normal muscle strength)
Assessment of the
Musculoskeletal System
Injured extremity- Observe for bleedingarterial (spurts), venous (steady), bones
(oozes, oily). Pressure over main artery-if
pressure at the site does’nt work. Check for
deformities- if can’t move= need attention.
Assessment of the
Musculoskeletal System
 Diagnostic tests:
X-ray- determine density of the bone.
Arthrogram- visualization of joint structure &
movement.
Diskogram- vizualization of intervertebral
disk abnormalitiy.
Sinogram- visualizes course of sinus &
tissues involved.
CT- to identify soft tissue & bone
abnormalities, and various MS trauma.
MRI- to view soft tissue- useful in the dx. Of
ligament tears, osteomyelitis, disk disease.
Assessment of the
Musculoskeletal System
Bone Mineral Density (BMD) measurements:
Dual energy x-ray absorptiometry
(DEXA)- allows assessment of bone density
with minimal radiation exposure- to monitor
changes in bone density with treatment.
Qualitative ultrasound (QUS)- evaluates
density, elasticity & strength of patella &
calcaneus using ultrasound rather than
radiation.
Assessment of the
Musculoskeletal System
Radioisotope Studies:
Bone scan- injection of
radioisotopes that is taken up by bone,
then scan entire body for degree of
uptake-related to blood flow. Increased
uptake- osteoporosis, Ca of the bone,
fractures. Decreased uptake-avascular
necrosis.
Assessment of the
Musculoskeletal System
 Endoscopy:
Arthroscopy- insertion of arthroscope
into joint (usually knee) for visualization of
structure and contents. It can be used for
exploratory surgery (removal of loose bodies
& biopsy) and dx. of abnormalities of
meniscus, articular cartilage, ligaments, or
joints capsule. Other structures that can be
visualized include-shoulder, elbow, wrist,
jaw, hip and ankle.
Assessment of the
Musculoskeletal System
 Invasive Procedures:
Arthrocentesis- incision or puncture of
joint capsule to obtain sample of synovial
fluid from joint cavity or to remove excess
fluid. Useful in dx. Of joint inflammation,
infection, and subtle fractures.
Electromyogram (EMG)- evaluates
electrical potential associated with skeletal
muscle contraction-useful in providing
information related to lower motor neuron
dysfunction and primary muscle disease.
Assessment of the
Musculoskeletal System
Muscle enzymes- used to distinguish
between muscle weakness that is due
to nerve innervation problems and
dystrophic disease of the muscle itself.
The level of enzymes reflects the
progress of the disorder and the
effectiveness of treatment. ExampleCreatine kinase (CK),aldolase.
Assessment of the
Musculoskeletal System
 Serologic Studies:
Rheumatoid factor(RF)- assess presence
of autoantibody (RF) in serum.
Erythrocyte sedimentation rate (ESR)index of inflammation.
Antinuclear antibody (ANA)- assesses
presence of antibodies capable of destroying
nucleus of body’s tissue cells.
Anti-DNA antibody- detects serum
antibodies that react with DNA. It is the most
specific test for systemic lupus
erythematosus.
Assessment of the
Musculoskeletal System
 Mineral Metabolism:
Alkaline phosphatase-produced by
osteoblast of bone-needed for mineralization of
organic bone matrix. Normal: 20 to 90 U/L (0.3
to 2,7 mmol/L).
Calcium- bone primary organ for calcium
storage. Normal: 9 to 11 mg/dl (2.3 to 2.7
mmol/L).
Phosphorus- amount present indirectly
related to calcium metabolism. Normal: 2.8 to
4.5 mg/dl (0.9 to 1,5 mmol/L)
Assessment of the
Musculoskeletal System
 Miscellaneous:
Thermograpgy- uses infrared detector,
which measures degree of heat radiating
from skin surface. Useful in investigation of
cause of inflamed joint and in following up
pt.’s response to antiinflammatory drug
therapy.
Plethysmography- Study records
variatios in volume & pressures of blood
passing through tissues. Nosspecific.
Somotosensory evoked potebtial (SSEP)evaluates evoked potential of muscle
contractions. Help to identify neuropathy and
myopathy.