Musculoskeletal Assessment

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Musculoskeletal Assessment
2010-03-13 17:25:11

Nursing 307
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  1. Musculoskeletal Functions
    Support & Stand, Movement, Protect vital inner organs, Hematopoiesis, Resevoir (Calcium and Phosphorous)
  2. Musculoskeletal Components
    • Bones/Cartilage
    • Joints
    • Ligaments
    • Muscles - Smooth, Skeletal, Cardiac
    • Tendons
  3. Movements
    • Flexion / Extension
    • Abduction / Adduction
    • Pronation / Supination
    • Circumduction
    • Inversion / Eversion
    • Elevation / Depression
    • Plantar Flexion / Dorsiflexion
    • Protraction / Retraction
  4. History (Subjective Data)
    • A. Joint pain
    • B. Joint stiffness
    • C. Joint swelling, heat, redness
    • D. Any limitation of movement
    • E. Muscle pain/cramping
    • F. Muscle weakness
    • G. Bone pain
    • H. Bone deformity, decreased ROM
    • I. Hx of accidents or trauma, hx of fx(s), sprains, dislocation
    • J. Functional assessment - any joint, muscle, bone problems that limit activities of
    • daily living (ADLs).
    • K. Self Care Behaviors - occupational hazards, chronic stress or repetitive motion to
    • joints, heavy lifting
  5. Physical Exam/Assessment (Objective)
    • A. Inspection - note the size and contour of the joint. Note color, swelling, masses,
    • or any deformities
    • B. Palpation - palpate joints for temperature, tenderness, heat, bony articulations,
    • swelling or masses
    • C. Range of motion - active and passive
    • D. Muscle testing - resistant ROM, note strength by R and L - compare
    • E. Temporomandibular joint
    • F. Cervical spine
    • G. Shoulders
    • H. Elbow
    • I. Wrist and Hand
    • 1. Phalen’s test - pt to hold hands back to back while flexing the wrists 90
    • degrees X 60 seconds
    • 2. Tinel’s sign - direct percussion of the median nerve at the wrist
    • J. Hip
    • K. Knee
    • 1. Bulge sign - mild fluid or effusion of the knee
    • 2. Ballottement of the patella - not routinely done
    • 3. McMurray’s test - pt supine, hold the heel and flex the knee and hip, place
    • hand on medial side of knee, rotate the lef in and out, then rotate the leg
    • and push on the knee, then slowly extend the knee - if you hear or feel a
    • click this is a positive sign for a torn meniscus (special test/procedure)
    • L. Ankle and foot
    • M. Spine
  6. Rheumatoid Arthritis
    • chronic, systemic inflammatory disease of joints and
    • surrounding connective tissue; characterized by heat, redness, swelling, and painful motion of the affected joints
  7. Osteoarthritis
    noninflammatory, localized, progressive disorder involving deterioration of articular cartilages and subchondral bone, and formation of new bone at joint surfaces; affected joints have stiffness, swelling with hard bony protuberances, pain with motion, and limitation of motion
  8. Osteoporosis
    decrease in skeletal bone mass occurring when rate of bone resorption is greater than that of bone formation
  9. Atrophy
    loss of muscle mass
  10. Dislocated Shoulder
    anterior dislocation (95%) is exhibited as a hollow where it would normally look rounded
  11. Joint Effusion
    swelling from excess fluid in the joint capsule
  12. Torn Rotator Cuff
    characteristic “hunched” position and limited abduction of arm
  13. Gouty Arthritis
    joint effusion or synovial thickening; characterized by redness, heat, soft, boggy or fluctuant fullness to palpation and limited ROM
  14. Epicondylitis
    tennis elbow - chronic disabling pain at the lateral epicondyle of humerous, radiates down extensor surface of forearm
  15. Ganglion Cyst
    round cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist
  16. Carpal Tunnel Syndrome
    atrophy occurs from interference with motor function due to compression of the median nerve inside the carpal tunnel, caused by chronic repetitive motion
  17. Syndactyly
    webbed fingers, congenital deformity
  18. Polydactyly
    extra digits
  19. Osgood Schlatter Disease
    • painful swelling of the tibial tubercle just below the
    • knee, due to repeated stress on the patellar tendon
  20. Scoliosis
    curvature of the spine
  21. Congenital Dislocated Hip
    • head of the femur is displaced out of the cup shaped
    • acetabulum
  22. Spina Bifida
    incomplete closure of the posterior part of vertebrae results in a neural tube defect, usually occurs 4th week if gestation