Musculoskeletal Assessment Standards

• Know the Normal ROM for each joint• Never force a joint beyond current ROM• Use caution when examining an injury• Support the full length of the body part• Consider the client’s level of fatigue

Spring 2012

Skeletal Muscle Movements:

• Flexion---------Extension• Abduction-----Adduction• Pronation----------Supination• Circumduction• Inversion--------Eversion• Rotation• Protraction----Retraction• Elevation----Depression

Spring 2012

Health History• Joints:– Pain, stiffness– Swelling, heat, redness– Limitation of movement

• Muscles:– Pain (cramps)– Weakness

• Bones:– Pain– Deformity– Trauma (fractures, sprains, dislocations)

Spring 2012

Health History

• Functional Assessment – (ADL) – (IADL)

• Self-Care Behaviors• Self-Care Ability Scale:

– Full self care- independent 0– Need to use equipment or device I– Needs supervision II– Needs equipment/ device and supervision III– Unable to help self-dependent IV

Spring 2012

Physical exam

• Routine Examination– Inspect the skeleton and extremities comparing

sides– Size, alignment, contour, symmetry, gross

deformities– Gait

Spring 2012

Physical Exam• Palpate all bones, joints, surrounding muscles• Assess each joint – AROM– PROM– Tenderness – Joint stability– Deformity– Contracture

• Assess muscle strength – Compare contralateral sides– Describe / Scale

Spring 2012

TEST MUSCLE STRENGTH• UE

• Hand – flexion, extension• Forearm - flexion, extension• Upper Arm - flexion, extension• Abduction / Adduction

• LE• Feet - flexion, flexion• Lower Leg - flexion, extension• Thigh - flexion, extension• Abduction / Adduction

Spring 2012

Measure Strength

• Overcomes resistance with normal power • Overcomes resistance• Unable to overcome resistance• Overcomes gravity• Unable to overcome gravity • Flicker

Spring 2012

Special Assessment Techniques• Testing for Carpal Tunnel Syndrome– 1 Phalen’s– 2 Tinel’s

• Testing for Fluid in the Knee– 1 Bulge – 2 Ballottement

Spring 2012

Common Musculoskeletal Conditions

• TMJ joint syndrome• Carpal tunnel syndrome• Gout• Osteomyelitis• Bursitis• Rheumatoid arthritis• Osteoarthritis• Injuries: muscle strain, sprains, dislocation, fracture

Spring 2012

Older Adult

KyphosisKyphosis

HeightHeight

Muscle StrengthMuscle Strength

Spring 2012

Nursing Diagnoses

• Impaired Physical Mobility• Risk for Disuse syndrome• Risk for Trauma• Pain• Activity Intolerance

Spring 2012

Health Promotion

• Risk Factors for Osteoporosis• Maintaining Healthy Body Weight and

Exercising Regularly• Preventing Injuries

Spring 2012