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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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