assessment of the musclo-skletal system 2

8/12/2019 Assessment of the Musclo-Skletal System 2

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Outlines

1. Review of Anatomy and physiologyof musculoskeletal system

2. Physical Exam

3. Inspection

4. Palpation

5. ROM (Rang of motion)


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The parts of the skeleton

The human skeleton is divided into twodistinct parts:

Axial

Appendicular


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Axial Skeleton

The axial skeleton consists ofbones that form the axis of thebody and support and protect the

organs of the head, neck, andtrunk.

The Skull

The Sternum

The Ribs

The Vertebral Column
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Appendicular Skeleton

The appendicular skeleton iscomposed of bones that anchorthe appendages to the axial

skeleton.

The Upper Extremities

The Lower Extremities

The Shoulder Girdle

(the sacrum and--The Pelvic Girdlecoccyx are considered part of the

vertebral column)
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What do muscles do ?

Muscles simply move you!

Without muscles you couldn't open yourmouth, speak, shake hands, walk, talk, or

move your food through your digestivesystem.

There would be no exploring, running,climbing, smiling, blinking, breathing. You

couldn't move anything inside or outsideyou. The fact is, without muscles, youwouldn't be alive for very long


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The skeleton is the name given to thecollection of bones that holds our bodyup.

Our skeleton is very important to us. Itdoes three major jobs.

1. It protects our vital organs such as

the brain, the heart, and the lungs.2. It gives us the shape that we have.

Without our skeleton we would just bea blob of blood and tissue on the floor.

3. It allows us to move. Because ourmuscles are attached to our bones,when our muscles move, they move

the bones, and we move


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Ask the client to point to, orotherwise identify, any painful areas,including sites of radiation of

pain.

Screening questions formusculoskeletal disorders

1.Do you have any pain orstiffness in your arms, legs orback?

2. Can you walk up and downstairs without difficulty?

3. Can you dress yourself ineveryday clothes without any

difficulty?


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Assessment of Gait

Ask the patient to walk back and forth

across the room. Observe for equality of arm swing ,balanceand rapidity andease ofturning.

Next, ask the patient to walk on histiptoes,then onheels.

Ask the patient totandemwalk. Test patient's ability to stand with feet

together with eyes open and thenclosed. (Romberg's test.)Reassurepatient that you will support him, in

case he becomes unsteady. Normal :Person can walk in balance

with the arms swinging at sides and canturn smoothly. Person should be able tostand with feet together without fallingwith eyes open or closed.

tiptoes

heels

tandem
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Upper Extremity Muscles

Inspect the musclesof

the shoulder, arm,

forearm and hand. Note muscle size (bulk).

Look for asymmetry,atrophy and

fasciculation. Look for tremor and

other abnormalmovement at rest and

with arms outstretched.
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Determine muscle powerby

Gently trying tooverpowercontraction of each

group of muscles.Shoulder:

Abduction(Deltoid)

,Adduction

, Shrug(Trapezius)

Abduction

Adduction

Trapezius)
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Elbow: flexion(Biceps)

Elbow extension

(Triceps)

Wrist: Flexion ( )andextension().
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Hand: Grip

opposition ofthumband index finger

opposition of thumband little fingerand

finger abduction and

adduction.

Grip

i li b
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Determine limb tone(resistance topassive stretch).

With the patientrelaxed

Gently move thelimb at the shoulder,elbow and wrist

joints and note

whether tone isnormal, increased ordecreased
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Normal findings

Muscles are symmetrical in size withno involuntary movements.

In some, muscles may be slightly

larger on the dominant side. Muscle power obviously varies. You

should not be able to overpower withreasonable resistance.

You have to learn to appreciate thenormal tone from practice.


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Neck: Range of Motion of Fix the head with one hand while you

examine neck Inspection

Note the normal concavity of cervicalspine

Identify Transverse process of C7 Observe Trapezius and Sternomastoid

muscles

Palpation Feel each spinous process looking for focal

areas of tenderness Joint

Feel for crepitus during passive motion

Para spinal muscles

Range of motion Active

Touch chin for flexion Throw head back for extension

Touch chin

Throw head back
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M l f L E t it


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Muscles of Lower Extremity

Inspect the muscles of the hip,knee and ankle.

Note musclesize ( bulk.) Look for asymmetry, atrophy

and fasciculation. Look forabnormal movement. Determine musclepowerby

gently trying to overpower

contraction of each group ofmuscles. Hip:Flexion ( Iliopsoas), Extension

(Gluteus maximus), Abduction,

Adduction.

Hip flexion
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The Knee Exam

Inspection

Make sure that both knees arefully exposed. The patient shouldbe in either a gown or shorts.

Rolled up pant legs do notprovide good exposure! Watch the patient walk. Do they limp or appear to be in

pain?

When standing, is there evidenceof bowing (varus) or knock-kneed (valgus) deformity? Thereis a predilection for degenerativejoint disease to affect the

medical aspect of the knee, acommon cause of bowing.

varus Kneedeormity,more

marked on the leftleg


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Knee: Flexion( Hamstrings,)Extension ( Quadriceps)

Ankle : Dorsiflexion ( Tibialis

anterior), Plantar flexion(Gastronemius.) Determine limbtone

resistance to passive stretch.With the patient relaxed,

gently move the limb at thehip, knee and ankle and notewhether tone is normal,increased or dicreased.Flex the hip and knee.

Support the knee, dorsiflexthe ankle sharply and hold thefoot in this position checkingforclonus .

Dorsiflexion

Knee extension

Knee flexion
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Spine (Bone) The examiner should stand behind the

patient and observe thealignment of thespinein the flexed position to determinescoliosis.

View the spine from thesideto determinekyphosis.

Ask the patient if he is aware of sore spots.Palpate the spinous process and be gentle

with the sore spots.Percussone vertebraat a time, starting from head.

.

A f ti
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Assessrange of motionof spine byhaving patientbend downto pick up anobject without bending his

legs while you hold hiships.

Normal : Gentle concavities in

cervical and lumbarregions and a convexity inthe thorax.

Vertebral line and gluteal

cleft align
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assessment of the musclo-skletal system 2

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