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Musculoskeletal

AssessmentNUR123 Spring 2009

K. Burger, MS!, MSN, RN, "N

PPP by:

Victoria Siegel RN, CNS, MSN

Sharon Niggemeier RN MSN

Revised by: Kathleen Burger



Musculoskeletal# Re$ie%

Anatom&' ()&siolog&• Seleton: !"# bones

• $ong: %emur, humerus, radius• Short: car&als, tarsals

• 'rregular: vertebrae

• Bones &rotect, su&&ort, allo( %orlocomotion and mineral storage )Ca,Mg*



Musculoskeletal

• +oints: Range %rom oints that don-t move

to oints that %reely move.

• $igaments and tendons: stabili/e oints

• $igaments: attached %rom bone to bone

• 0endons: attached %rom muscle to bone

• Cartilage: ends on bones



Musculoskeletal

• Muscles: controlled by nervous system

• 1ascia: surrounds muscles, divides muscles,

main blood vessels and nerves.

• Bursae: cushions moving &arts

• Muscle tone: ability to resist %orce2 graded

"34

• 5tro&hy: decrease si/e



Assessing# Su*+ecti$e ata

• -oint pain#

• S$'65: Severity, ocation, /ntensity,

uration, Aggravating %actors )alleviating

%actors, associated sym&toms*

• Sti%%ness

• $imited movement




• R)eumatoi! Art)ritis )RA* chronicsystemic in%lammatory disease involves

symmetric oints. 7ther MS disordersinvolve isolated or unilateral oints.

• Rheumatoid arthritis

Sti%%ness

S(elling

$imited R7M

Movement decreases &ain




• steoart)ritis: chronic degeneration o%

oint cartilage caused by aging or trauma

• Sti%%ness

• S(elling

• $imited R7M

• 8eberden-s and Bouchard-s nodules

• May be unilateral




• Muscle (ain#

• S$'65

• 5ching9cram&s

• eaness

• Resistance "34• 5tro&hy




• Bone pain:

• S$'65

• 8;

• 6e%ormity

• 0rauma3 limitations as a result o% trauma




• unctional Assessment#

• 56$-s3 does MS &roblem create limits:

• Bathing3 getting in and out o% tub, turning %aucets

• 0oileting3 getting on9o%% toilet, (i&ing sel%

• 6ressing3 buttons, /i&&ers, tying shoes

• <rooming3 shaving, brushing teeth, &utting onmaeu&

• =ating3 cutting %ood, &re&aring meals etc>




• unctional Assessment#

• Mobility3 (aling u&9do(n stairs,

in and out o% car, out o% house

• Communicating3 taling, using &hone or

com&uter, (riting

• 7ccu&ational9=nvironmental3 heavy li%ting,

re&etitive motions etc.




• Sel care *e)a$iors#

• =;ercise3 ty&e, %re?uency, (arm u&

• Pain during e;ercise@ 8o( t;@

• Recent (eight gain ) &uts stress on

musculoseletal system* >usual daily diet

• 5ny meds3 anti in%lammatory, muscle

rela;ants, &ain relievers




• A!!itional ). or Aging a!ult#

• Ase %unctional assessment to elicit any loss

o% %unction, sel% care de%icit or sa%ety ris:

• eaness

• 1alls9 Stumbling

• Mobility aids used



Assessing# *+ecti$e ata

• ()&sical eam &rovides the nurse (ith

obective data

• <uidelines %or Physical =;am include:

• 1ull visuali/ation o% &art being e;amined

• 6ra&e other &arts %or &rivacy

• 7rderly a&&roach: head to toe and &ro;imal

to distal.



()&sical amination 4ui!elines

• +oint being e;amined should be su&&orted.

• Com&are &aired oints, e;&ect symmetry.

• hen e;amining a &ain%ul area, use %irm

su&&ort, gentle movement.

• 5ssess Range o% Motion )R7M* o% each

oint



()&sical amination

• 5ssess gross motor movement and &osture

• Note &atient-s gait

• Note any %oot dragging, lim&ing, shu%%ling

• Note any s&inal de%ormities

• 'ns&ect sin and subcutaneous tissues



()&sical amination

• 5ssess u&&er and lo(er e;tremities %or:

• 7verall si/e, symmetry

• <ross de%ormity

• Bony enlargement

• 5lignment• Symmetry o% length and &osition



()&sical amination

Bones, +oints, muscles:

• 'ns&ect s(elling, de%ormity, condition

• 5ssess %or sti%%ness, instability, &ain, cre&itus,

unusual oint movement, bogginess, (armth

• 5ssess R7M

• Muscle strength

• 5ssess symmetry



()&sical amination

5ea!

• 0em&oromandibular +oint3 cre&itus and &ain(ith 0M+ disorder

• 7&en mouth: 3# cm

• Move lo(er a( %rom side to side

• Stic out lo(er a(

• Pal&ate tem&oralis and masseter muscles

• 0est muscle strength2 a( thrust, a( lateralmovement



Physical =;amination

• Neck :

• R7M and muscle strength:

• 1le;ion3 touch chin to chest

• =;tension3 tilt head bac(ard

• Cervical rotation3 turn head to R and $.• $ateral bending3 touch ear to R. and $.

shoulders

• Re&eat against resistance



()&sical amination

S)oul!er# Note &osture erect, hunched.

• 5ssess symmetry and &osition o% clavicles.

• Pal&ate clavicles to(ard shoulders, &al&atedeltoid muscle.


1le;ion,=;tension,8y&ere;tension 5bduction,5dduction,Rotation

• 0est muscle strength: shrug, %le;ion,

abduction



()&sical amination

l*o%3 bend elbo( " degrees, ins&ect and

&al&ate &osterior sur%ace

• Note3 medial and lateral condyles o%

humerus and olecranon &rocess o% ulna


1le;ion and =;tension

Su&ination and Pronation

•0est muscle strength2 %le;ion9e;tension



()&sical amination

6rist3 <ras& (rists, assess body &rocesses o%radius )thumb side* and the ulna. Pal&ate

radiocar&al oint and remaining (rist oints.• R7M and muscle strength:

1le;ion and =;tension and 8y&ere;tension

Radial and ulnar (rist deviationCircumduction

• 0est strength2 %le;ion o% (rist



()&sical amination

5an!3 Ase thumb and %ore%inger to &al&ate

the metacar&o&halangeal and

inter&halangeal oints.


1le;ion and =;tension and 8y&ere;tension

5bduction3 have &atient s&read %ingers a&art5dduction3 have &t. hold %ingers together.

0humb91inger 7&&osition



()&sical amination

5ip3 &al&ate hi& oint and surrounding

structures. Position &t. side lying and

&al&ate iliac crest, greater trochanter, hi&,thigh and buttoc muscles


1le;ion,=;tension, 8y&ere;tension

5dduction and 5bduction

=;ternal rotation and 'nternal rotation



()&sical amination

Knee3 have &t. sitting, dangling. 'ns&ect3 note

alignment, de%ormity, contour o% ?uadrice&

muscle.• Pal&ate the su&ra&atellar &ouch and note

any tenderness, edema.


• 1le;ion and =;tension



()&sical amination

• Ankle# Com&are the contour o% R. and $.anles. Pal&ate anle and achilles tendons.

• R7M and muscle strength:6orsi%le;ion3 &oint toes u&(ard.

Plantar 1le;ion3 &oint toes do(n(ard.

'nversion3 turn soles o% %eet in(ard.=version3 turn soles o% %eet out(ard.

Circumduction

• 0est muscle strength2 &lantarDdorsi%le;ion



()&sical amination

oot# ins&ect sin integrity, condition o% nails

and any de%ormities.

• Pal&ate the metatarsal bones and oints,

s?uee/e each %oot.


1le;ion and =;tension

5bduction and 5dduction



()&sical amination

Spine: 8ave &t. bend a (aist, note curvature,ease o% mobility.

• Pal&ate vertebral column (ith %ingerti&s,note tenderness or bony de%ormities.

• R7M

1le;ion and e;tension

$ateral bending

S&inal rotation.



5dditional 5ssessment %or

7lder 5dult• Chec %unctional status

• 5s &atient to:

al (ith shoes onClimb stairs 9 u& D do(n

Pic u& an obect %rom the %loor

Rise %rom sitting in chair Rise %rom lying in bed



Summar& Musculoskelatal am

• 'ns&ect body &arts

• Pal&ate each oint

• 5ssess R7M o% each oint

• 5ssess muscle strength

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