Transcript Assessment of the Musculoskeletal System

Assessment of the
Musculoskeletal
System
Sara H. Mitchell, Ph.D., RN,
CPNP
The impact of diseases of the
musculoskeletal system
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Composition of the
Musculoskeletal System
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The skeleton proper (bones & joints)
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Skeletal muscles
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Tendons
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Ligaments
Nutrition & Musculoskeletal
Function
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Fluoride
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Aluminum
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Magnesium
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Copper
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Zinc
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Iron
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Manganese
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Iodine
Assessment of the musculoskeletal
system
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History-taking
Inspect & Palpate joints
Assess range of motion
Assess muscle strength
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Joint motion - a review of terms
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Flexion
Extension
Dorsiflexion
Plantar flexion
Adduction
Abduction
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Inversion
Eversion
Internal rotation
External rotation
Pronation
Suppination
Measuring Range of Motion
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If any limitation or
increase in ROM is
noted, use a
___________ to
measure the angles
precisely
Cervical Spine Assessment
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Abnormal findings
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Upper Extremity Assessment
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Abnormal findings:
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ROM of wrist & hand
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Flexion –
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Extension –
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Hyperextension –
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Ulnar deviation –
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Radial deviation –
Spinal Assessment
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Abnormal findings:
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Torso Range of Motion
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Abnormalities:
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Lower Extremity ROM
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Hip flexion with knee
straight –
Hip flexion with knee
flexed:
Internal & External
rotation :
Abduction :
Adduction :
Range of Motion of the Knee
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Flexion-extension – 1350
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Hyperextension - 100
Ballottement
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Used to test for joint effusion
If there is an effusion present a palpated tap
will be present and the transmitted impulse
will be felt by the fingers on either side of the
patella
Ankle Range of Motion
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Dorsiflexion – 20o
Plantar Flexion – 500
Inversion of hind foot – 50
Eversion of hind foot - 50
Alterations of Musculoskeletal
Function
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Musculoskeletal
Injuries
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Disorders of bone
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Disorders of joints
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Disorders of skeletal
muscle
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s
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Primary symptoms of
musculoskeletal disease
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Phalen’s test
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Ask the person to
hold both hands back
to back while flexing
the wrists 90 degrees.
Acute flexion of the
wrist for 60 seconds
produces numbness
and burning in a
person with carpal
tunel syndrome
Tinel’s Sign
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In carpal tunnel
syndrome, percussion
of the median nerve
produces burning and
tingling along its
distribution, which is a
positive Tinel’s sign
The musculoskeletal system of
the young
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S
Musculoskeletal assessment in
the pediatric patient
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Limp
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_____________ Maneuver for
Congenital Dislocated Hip
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With a dislocated hip, the
head of the femur is not
cupped in the acetabulum
but rests posterior to it.
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Hip instability feels like a
clunk as the head of the
femur pos into place. This
is a positive
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Lower Extremity Findings in
Children
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______________:
“bowlegged” stance is
normal through the first
two years of life.
Resolves with growth and
ambulation
____________: knockkneed stance occurs
normally between 2 and
3½ years of age
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Dislocation of the
hip functionally
shortens and
weakens hip and
pelvis muscles.
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When a child stands
on the dislocated
hip, the opposite
side of the pelvis
drops
Scoliosis
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_________ scoliosis
is flexible. It is
apparent with
standing and
disappears with
forward standing.
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scoliosis is fixed. The
curvature shows both
on standing and on
bending forward
The Musculoskeletal system of
the elderly
Muscle atrophy
 Osteoporosis
 Kyphosis
 Decreased
intervertebral disc
space
 Joint stiffness
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Osteoarthritis
 Reduced range of
motion
 Degenerative
changes
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Degenerative Joint Disease of
Osteoarthritis
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Osteoarthritis is
characterized by hard,
nontender nodules, 203
mm or more. These
osteophytes (bony overgrowths) of the distal
interphalangeal joints are
called ____________
nodes and those of the
proximal interphalangeal
joints are called
_______________ nodes
Osteoporosis
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Risk Factors
Classification
Diagnosis
Prevention
Treatment
Areas of yellow indicate
bone loss from osteoporosis
The Musculoskeletal system of
the elderly (continued)
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“Musculoskeletal problems have the most
significant impact on the aged population.
More than 1 billion dollars is spent
annually by Medicare for hospitalization of
elderly patients with these conditions.
This represents 20% of all Medicare
payments.
Reaching a conclusion
Based on history & physical examination
does there appear to be a musculoskeletal
disease or impairment?
 Do the history and finding suggest a
primary musculoskeletal concern or signs
& symptoms of a systemic disease?
 What is the differential diagnosis?
 What additional tests (labs, diagnostic
studies) are indicated?
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Differential diagnoses - what is
the primary problem
Fracture
 Sprain
 Dislocation or subluxation
 Joint or muscle inflammation
 Age specific abnormality
 Systemic illness (examples)
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 neuropathy
 myopathy
 connective
tissue disease
Test for musculoskeletal
function
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Bone function
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Joint function
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a
Muscular function
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U
EMG
f
m
Remember...
 “Diseases
of the musculoskeletal
system rank first among disease
conditions that alter the quality of
life…the cost of which exceeds 60
billion dollars annually…”