Chapter 18
Musculoskeletal System
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Competencies
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Elicit a health history from a
patient with a musculoskeletal
chief complaint.
Perform inspection and
palpation of the
musculoskeletal system.
Describe the range of motion
movements of the major joints.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Measure range of joint motion
with a goniometer.
Assess muscle strength of the
arms and legs using the muscle
strength grading scale.
Document the findings of the
musculoskeletal assessment.
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Anatomy and
Physiology
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Bones
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206 bones
Axial skeleton
Appendicular skeleton
Structure
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Diaphysis
Epiphysis
Periosteum
Medullary cavity
(continues)
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Anatomy and
Physiology
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Muscles
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600 muscles
Types
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Cardiac
Smooth
Skeletal
Involuntary vs. Voluntary
Tendons
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Attach muscle to bone
(continues)
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Anatomy and
Physiology
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Ligaments
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Connect bone to bone at the joint level
Bursae
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Fluid-filled sacs
(continues)
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Anatomy and
Physiology
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Joints
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Union between two bones
Permit some movement of bones
Types
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Synarthroses
Ampliarthroses
Diarthroses (synovial)
(continues)
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Anatomy and
Physiology
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Types of joints
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Condyloid
Hinge
Saddle
Ball and socket
Gliding
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Descriptive Terms for
Joint ROM
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Flexion
Extension
Hyperextension
Adduction
Abduction
Internal rotation
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Descriptive Terms for
Joint ROM
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External rotation
Circumduction
Supination
Pronation
Opposition
Eversion
Inversion
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Descriptive Terms for
Joint ROM
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Dorsiflexion
Plantar flexion
Elevation
Depression
Protraction
Retraction
Gliding
Copyright 2002, Delmar, A division of Thomson Learning
Health History: Patient
Profile
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Age
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Gender
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Early adult
Mid to late adult
Female
Male
Race
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Caucasian
African American
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Common Chief
Complaints
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Pain
Weakness
Limited movement
Stiffness
Deformity
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Characteristics of
Chief Complaint
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Location
Quantity
Quality
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing
Copyright 2002, Delmar, A division of Thomson Learning
Medical History
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Musculoskeletal specific
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Joint disorders
Bone or skeletal disorders
Neuromuscular disorders
Nonmusculoskeletal specific
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Infections
Blood disorders
Peripheral vascular disorders
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Surgical History
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Arthroscopy
Arthroplasty
Diskectomy or Laminectomy
Internal fixation
External fixation
Amputation
Reattachment of a limb
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Health History
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Common medications
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Anti-inflammatory agents
Analgesics: narcotic or non-narcotic
Muscle relaxants
Steroids
Calcium supplements
Communicable diseases
(continues)
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Health History
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Injuries/accidents
Special needs
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Amputation
Use of assistive devices
Hemiplegia, quadriplegia, paraplegia
Childhood illnesses
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Polio
Juvenile arthritis
(continues)
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Health History
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Family history
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Rheumatoid arthritis
Paget’s disease
Osteoporosis
Social history
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Alcohol or tobacco use
Work environment: role of repetitious movements
Home environment: physical layout/barriers
(continues)
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Health History
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Hobbies/leisure activities
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Contact activities
Weight-bearing activities
Nonweight-bearing activities
(continues)
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Health History
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Health maintenance activities
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Sleep
Diet
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Exercise
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Intake of calcium, nutritional supplements
Weight-bearing, nonweight-bearing,
aerobic
Use of safety devices
Health checkups
Copyright 2002, Delmar, A division of Thomson Learning
Safety Tips to
Decrease Fall Risk
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Avoid the following
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Scatter or throw rugs
Slick floors
Dim lighting
Clutter
Cords on the floor
Ill-fitting shoes
Stairways without banisters
Copyright 2002, Delmar, A division of Thomson Learning
Assessment
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Equipment
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Goniometer
Tape measure and felt tip marker
Sphygmomanometer
General approach
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Patient comfort
Compare nonaffected to affected
Proceed in cephalocaudal order
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General Assessment
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Overall appearance
Posture
Gait and mobility
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Weight-bearing status
Gait patterns
Transfer ability
(continues)
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General Assessment
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Normal findings
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Height and weight are proportionate
Full ROM
Ambulate independently
No structural defects
Shoulders and hips are level
Head and torso are upright
Stable gait
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Inspection
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Muscle size and shape
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Hypertrophy
Atrophy
Involuntary muscle movements
Limb circumference
Joint contour and periarticular tissue
(continues)
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Inspection
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Normal findings
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Symmetrical muscle contour
No involuntary muscle movements
Bilateral limb circumference is
within 1–3 cm of each other
Joints are flat when extended, and
smooth/rounded during flexion
No joint enlargement or deformity
Copyright 2002, Delmar, A division of Thomson Learning
Palpation
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Muscle tone
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Joints
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Special techniques
Range of motion
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Measure
Movement against resistance or
gravity
Goniometer
Muscle strength
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Scale
Copyright 2002, Delmar, A division of Thomson Learning
Special Techniques for
Assessing Joints
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Temporomandibular
Cervical spine
Shoulders
Elbows
Wrist and hands
Knees
Ankles and feet
Spine
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Special Assessments
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Chvostek’s sign
Drop arm test
Trousseau’s sign
Grip strength
Tinel’s sign
Phalen’s sign
(continues)
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Special Assessments
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Tredelenburg test
Measuring limb length
Patrick’s test
Bulge sign
Patellar ballottement
Apley’s sign
(continues)
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Special Assessments
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McMurray’s sign
Drawer test
Lachman’s test
Varus stress test
Valgum stress test
Thompson test
Milgram test
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Use of Assistive
Devices
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Crutches
Cane
Walker
Brace, splint, immobilizer
Cast
Copyright 2002, Delmar, A division of Thomson Learning
Normal Findings
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Normal muscle tone
No crepitus or masses
Joints without pain, tenderness, or
swelling
Full ROM
Normal muscle strength
Muscle strength is equal bilaterally
No lordosis, kyphosis, or scoliosis
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Gerontological
Variations
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Bone density decreases
Weaker bones, increased risk
for osteoporosis
Muscle atrophy
Decreased muscle strength
Deterioration of articulating
cartilage
Vertebral inflexibility
Thoracic kyphosis
Copyright 2002, Delmar, A division of Thomson Learning