Transcript Musculoskeletal Assessment

Musculoskeletal Assessment
Spring 14
Musculoskeletal System
Provides support for the body
Protection for the internal
organs
Mobility to engage in physical
activities
Production of red blood cells
Storage of minerals
Musculoskeletal System
Bones muscles
Ligaments
Tendons
Cartilage
joints
MRI of the shoulder
Musculoskeletal System
Neurological assessment important in
Musculoskeletal assessment
CNS coordinates muscle and bone function
Disorders can affect the individual at any age
Musculoskeletal System
M/S concerns vary at different ages
Children and young adults
Injuries
Middle-aged and Older adults
Inflammatory
Degenerative
Rheumatic conditions
Purpose of Assessment
Perform a systematic functional assessment
Activities of daily living
Detection of common dysfunctions
Assessment
Correct diagnosis depends on an accurate
patient history and thorough examination
Can be made on a specific body part or part
of a general physical examination
Accidents often result in trauma to the
musculoskeletal system and require a
thorough assessment
Complaints that should alert the nurse to
obtain subjective and objective data related
to the M/S system is:
JOINT OR MUSCLE
PAIN
JOINT SWELLING
DECREASING
STRENGTH OR
FUNCTION
CHANGE IN SIZE
OF AN EXTREMITY
OR MUSCLE
DEFORMITY
SPASM
CREPITATION
CHANGES IN
SENSATION
STIFFNESS
CHANGES IN GAIT
Health Perception
Health Management
Describe your usual daily activities
Do you experience any difficulties
performing these activities?
Describe what you do when you experience
difficulty in dressing,
feeding yourself,
performing basic hygiene,
or maintaining your home.
Health Perception
Health Management
Do you use any mechanical assistive devices?
Do you have to lift heavy objects? If so,
describe how you do this.
Describe any specialized equipment you use
or wear when you work or exercise that helps
protect you from injury.
What type of safety precautions do you take?
Health Perception
Health Management
Do you take any medications to manage
your musculoskeletal problem? If so, what
is/are the name(s) of the medication?
When did you have your last tetanus and
polio immunization? When were you last
tested for tuberculosis?
Health Perception
Health Management
A 3- generation family history should be
obtained related to rheumatoid arthritis,
degenerative joint disease, gout,
osteoporosis, and scoliosis
Nutrition-Metabolic Pattern
Give a 24 hour diet recall
Do you take supplemental vitamins or
minerals?
Ask specifically about calcium and vitamin
D supplements
What is your weight?
Have you had recent change in your
weight? If yes, describe.
Nutrition-Metabolic Pattern
Obesity predisposes to ligamentous
instability (especially in the back)
Adequate amounts of vitamins C and D,
calcium, and protein essential for healthy,
intact musculoskeletal system
Evaluate patient’s tolerance to milk
products
Elimination Pattern
Does your musculoskeletal problem make it
difficult for you to reach the toilet in time?
Do you experience constipation related to
immobility?
Do you need any assistive
devices or equipment to
achieve satisfactory toileting?
Elimination Pattern
Ability to ambulate and reach toilet can
affect bowel and bladder health
Constipation and incontinence
can be caused by immobility
Grab bars or elevated toilet seat
Activity-Exercise Pattern
Do you have any limitations in your
activities of daily living because of your
musculoskeletal problem?
Describe your usual exercise
pattern.
Do you experience symptoms
related to your musculoskeletal
system before, during, or after
exercising?
Activity-Exercise Pattern
Are you able to move all your joints
comfortably through full range of motion?
Describe any limitations in mobility.
Do you require assistance in moving or in
doing activities of daily living?
Do you use any prosthetic or
orthotic devices?
Activity-Exercise Pattern
Extremes of activity related to occupation
can affect the musculoskeletal system
Tile layer
Heavy lifting
Laborer
Sedentary lifestyle does not allow for
muscle flexibility and strength
Sleep-Rest Pattern
Do you experience any difficulty sleeping
because of a musculoskeletal problem?
Do you require frequent position changes at
night? Why?
Do you wake up at
night because of
musculoskeletal pain?
Sleep-Rest Pattern
Musculoskeletal disorders might require
frequent position changes
Discomfort, therefore, would interfere with
restful sleep
Type of bedding, pillows used
Sleeping partner
Sleeping positions
Cognitive-Perceptual Pattern
Describe any musculoskeletal pain you
experience.
How do you mange your pain?
Swelling, decreased strength, changes in
sensation can cause problems
Self Perception- Self Concept
Pattern
Describe how changes in your
musculoskeletal system (posture, walking,
muscle strength) or the ability to do certain
things have affected how you feel about
yourself.
How have these changes affected your
lifestyle?
Role- Relationship Pattern
Do you live alone?
Describe how your family or others assist
you with your musculoskeletal problems.
Describe the effect of your musculoskeletal
problem on your work and on your social
relationships.
Sexuality-Reproduction Pattern
Describe the effect of your musculoskeletal
problem on your sexual activity. How do
you feel about this?
Pain, movement, and positioning may cause
problems
Coping-Stress Tolerance Pattern
Describe how you deal with the problems
such as pain or immobility that have
resulted from your musculoskeletal
problem.
Serious stressors- acute or chronic pain
Pain is exhausting!! Physically and
emotionally
Value-Belief Pattern
Describe any cultural or
religious beliefs that may
influence the treatment of
your musculoskeletal
problem.
Pain Assessment
Character
Precipitating or alleviating factors
Onset
Location
Timing
Referred pain
Specific Complaints
Character: which joint(s) affected,
number of joints involved, pain,
ache, stiffness or limitation of
movement, redness, increased
warmth, or swelling, pain
associated with particular
movement or weight bearing
Onset: specific date of first
episode (or age when occurred),
sudden, gradual
Specific Complaints
Duration: length of episode
Frequency: change in pattern,
similar episodes in past
Precipitating factors: specific movements,
prolonged activity, rest, injury, weather,
time of day, specific foods, medications
(diuretics) alcohol intake
Specific Complaints
Alleviating factors: rest, movement
Associated symptoms: fever, weight loss,
fatigue, malaise, rash, chronic diarrhea
Efforts to treat and their effectiveness:
medications, heat and/or ice, exercise,
weight reduction, splints, home remedies
Injury Complaint
Mechanism of Injury: what happened-direct
trauma, overuse, overstretching, fall
Character: location of pain; any noise with
injury (popping, click, tearing) numbness;
tingling;loss of sensation, strength, or
mobility; warmth or coldness, swelling
(immediate or gradual)
Injury Complaint
Duration: length of episode
Frequency: similar episodes in the past
Precipitating factors: sudden movement,
repetitive movement, stress
Injury Complaint
Alleviating factors: rest, position of comfort
Associated symptoms or conditions: loss of
consciousness, other injuries
Efforts to treat and their effectiveness:
medications, heat and/or ice, splints,
immobilization, home remedies
Objective Data
Primary methods used in the physical
examination of the musculoskeletal system
Inspection
Palpation
Clues received from health history
Inspection
Observe for any asymmetry
Sitting and standing posture
General body build
Configuration of muscles
Limitations in patient’s ability to perform
normal activities (dressing, toileting, eating)
Inspection
Condition of the skin
General color
Scars
Overt signs of previous injury or operations
Head – to – toe
Avoids missing anything
Joint motion
Asymmetry of movement
Inspection
Swelling
Deformity
Masses
Evidence of limb-length or muscle-size
discrepancies
Opposite body part used for comparison
when abnormality is suspected
Palpation
Any area that has aroused concern should
be carefully palpated
Hands should be warm to prevent spasm
Palpation of soft tissues (including muscles
and joints) enables examiner to evaluate
skin temperature, local tenderness, swelling,
and crepitation
Establish relationship of adjacent structures
Palpation
Evaluate general contour
Evaluate abnormal prominences
Evaluate local landmarks
Both superficial and deep palpation are performed
Evaluate passive and active range of joint motion
Passive- someone else doing the moving
Be careful not to overextend patient’s limitations
Manipulation must cease immediately if this
occurs
Palpation
Active- patient moves own joints through
their normal ROM
Functional- assessed by asking patient to go
about doing own ADLs (eating, bathing,etc)
Patient may require assistive device to
perform functional
Joint motion most accurately measured by
goniometer
Palpation
Measures amount of bending or angles of
joints
Not usually measured unless a
musculoskeletal problem has been
identified
Less accurate but valuable method is to
compare ROM of one extremity with the
corresponding opposite one!
Measurement
Limb length
When gait disorders are detected
Measured and compared between 2 bony
prominences
Circumferential measurement
Muscle mass
Muscle-strength testing
Individual muscle or muscle groups
Graded in performance
Applied resistance
Gait
Assess by walking across
the room
Observe Stance-andSwing Phase
Musculoskeletal and
neurologic problems can
result in gait abnormalities
Other
Assessment of reflexes
Movement of Synovial Joints
Flexion
Bending of joint that decreases angle between two
bones
Shortening of muscle length
Extension
Bending of joint that increases angle between two
bones
Hyperextension
Extension in which angle exceeds 180 degrees
Movement of Synovial Joints
Abduction
Movement of part away from midline
Adduction
Movement of part toward midline
Pronation
Turning of palm downward or sole outward
Supination
Turning of palm upward or sole inward
Movement of Synovial Joints
Circumduction
Combination of flexion, extension, abduction, and
adduction
Resulting in circular motion of body part
Rotation
Movement about longitudinal axis
Inversion
Turning of sole inward toward midline
Eversion
Turning of sole outward away from midline
Common Assessment
Abnormalities
Ankylosis
Scarring within a joint leading to stiffness
or fixation
Chronic joint inflammation
Common Assessment
Abnormalities
Atrophy
Wasting of muscle
Characterized by decrease in circumference and
flabby appearance
Resulting in decrease in function and muscle
tone
Prolonged disuse
Contracture
Immobilization
Muscle denervation
Common Assessment
Abnormalities
Contracture
Resistance to movement of muscle or joint
A result of fibrosis of supporting soft tissues
Shortening of muscle or ligament structure
Tightness of soft tissue
Immobilization
Incorrect positioning
Common Assessment
Abnormalities
Crepitation
Crackling sound or grating sensation as
result of friction between bones
Fracture
Chronic inflammation
Dislocation
Common Assessment
Abnormalities
Effusion
Fluid in joint possibly with swelling and
pain
Trauma
Especially to knee
Common Assessment
Abnormalities
Felon
Abscess occurring in pulp space (tissue
mass) of distal phalanx of finger
Result of infection
Minor hand injury
Puncture wound
laceration
Common Assessment
Abnormalities
Ganglion
Small, fluid-filled synovial
cyst
Usually dorsal surface of
wrist and foot
Degeneration of connective
tissue close to tendons and
joints
Leading to formation of
small cysts
Common Assessment
Abnormalities
Hypertrophy
Increase in size of muscle
Result of enlargement of existing cells
Exercise
Increased andogens
Increased stimulation or use
Common Assessment
Abnormalities
Kyphosis (round back)
Anterioposterior or forward bending of spine
with convexity of curve in posterior direction
Common at thoracic and sacral levels
Poor posture
Tuberculosis
Chronic arthritis
Growth disturbance of vertebral epiphysis
osteoporosis
Common Assessment
Abnormalities
Lordosis
Deformity of spine
Results in anterioposterior curvature
with concavity in posterior direction
Common in lumbar spine
Secondary to other deformities
of the spine
Muscular dystrophy
Obesity
Flexion contracture of hip
Congenital dislocation of hip
Common Assessment
Abnormalities
Pes planus
Flatfoot
Congenital condition
Muscle paralysis
Mild cerebral palsy
Early muscular dystrophy
Common Assessment
Abnormalities
Scoliosis
Deformity resulting in lateral curvature of
spine
Idiopathic or congenital condition
Fracture or dislocation
Oseomalacia
Functional condition
Common Assessment
Abnormalities
Subluxation
Partial dislocation of
joint
Instability of joint
capsule and
supporting ligaments
(trauma, arthritis)
Common Assessment
Abnormalities
Valgus
Angulation of bone
away from midline
Alteration in gait
Pain
Abnormal erosion
of articular cartilage
Common Assessment
Abnormalities
Varus
Angulation of bone
toward midline
Alteration in gait
Pain
Abnormal erosion of
articular cartilage
Normal Physical Assessment of
the Musculoskeletal System
Full ROM of all joints
No joint swelling, deformity, or crepitation
Normal spinal curvatures
No tenderness on palpation of spine
No muscle atrophy or asymmetry
Muscle strength of 5
draining wound)
Study visualizes course of sinus and tissues involved
Same nursing responsibilities as arthogram