Chapter 66
Assessment of Musculoskeletal
Function
Orthopedics
The branch of medicine that deals with the
prevention and correction of the disorders and
diseases of the musculo-skeletal system.
 The primary goal of the nurse caring for a
client with locomotor disorders is the
prevention of contractures (permanent
shortening of a muscle) or deformities.

Skeletal Functions
To provide the body with a structural
framework.
 To act as a protective casing for internal
organs ( the brain, heart, lungs, etc.).
 To allow movement by muscles attached
to the skeleton.
 To store calcium, phosphorus, and
magnesium.
 To manufacture blood cells in the red
bone marrow.

Structure

206 Bones in the body
Long bones
 Short bones
 Flat bones
 Irregular bones

Joints
 Muscles

Bone Cells

Osteoblasts

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Osteocytes

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Function in bone formation
Mature bone cells that function in bone
maintenance
Osteoclasts

Multinuclear cells function in destroying,
resorbing, and remodeling bone
Bone Formation and Maintenance

Osteogenesis: process of bone formation

Ossification: the process of formation of the bone
matrix and deposition of minerals
Bone is in constant state of turnover
 Regulating factors

Stress and weight-bearing
 Vitamin D
 Parathyroid hormone and calcitonin
 Blood supply

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Role of calcium
Bone Healing
Hematoma and inflammation
 Angiogenesis and cartilage formation
 Cartilage calcification
 Cartilage removal
 Bone formation
 Remodeling

Joints
A joint is a junction of two or more bones.
 Three types:

Diarthosis: freely movable such as hinge
(elbow, knee); ball and socket (hip,
shoulder), pivot (skull, first vertebrae), gliding
(wrist) and saddle (thumb).
 Synarthosis: joints are immovable (skull
sutures).
 Amphiarthosis: slightly movable (vertebrae
and pelvic bones).

Hinge Joint of the Knee
Muscles
Attached to bones and other structures by
tendons
 Encased in a fibrous tissue—fascia
 Contraction of muscle causes movement
 Contraction utilizes energy in the form of ATP
 Anaerobic pathways using glucose metabolized
from stored glycogen provide energy for more
strenuous muscle activity
 Movement of the muscles may be voluntary or
involuntary.

Assessment of the
Musculoskeletal System

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Include data related to function ability; ADLs and ability
to perform various activities. Note any problems related
to mobility.
Health history: family history, general health
maintenance, nutrition, occupation, learning needs,
socioeconomic factors, and medications—include OTC
Assessment of pain and altered sensations
Physical assessment: posture, gait, bone integrity, joint
function, muscle strength and size, skin, neurovascular
status
Assessment of the Bony
Skeleton
Notation on any deformities.
 Body alignment.
 Abnormal growths due to bone tumors.
 Shortened extremities, symetry.
 Amputations.
 Abnormal angulation other than at joints.
 Crepitus (a grating or crackling sensation
or sound).
 posture

Assessment of Spine
Three common spinal curvatures:
Scoliosis (crooked back; lateral curving
deviation).
 Kyphosis (hump back; increased
roundness of the thoracic spinal curve).
 Lordosis (sway back; exaggeration of the
lumbar spine curvature as seen in
pregnancy).

Normal Spine and 3
Abnormalities
Range of Motion (ROM)

Active
person does the moving
 Have person move joint through each of its
various ROM movements
 Note the angle of each joint movement
 Note any pain, tenderness, or crepitus

Range of Motion (ROM)

Passive
person relaxes and allows you to move the
joints
 Done if person is unable to do active ROM

• ALWAYS stop if the person complains of pain
• NEVER push a joint beyond its anatomic angle
Muscle Strength
As you are testing ROM
 Test muscle strength


Ability to perform the ROM against resistance
• Symmetry
• Involuntary movements
Detecting Fluid in the Knee
Rheumatoid Arthritis—Ulnar
Deviation and “Swan-Neck”
Deformity
Diagnostic Evaluation
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X-rays
Computed tomography
MRI
Arthrography
Bone densitometry
Bone scan
Arthroscopy
Arthrocentesis
Electromyography
Biopsy
Laboratory studies