this power point includes the details of examination of musculoskeletal system (inspection, palpation, range of motion, muscle tone & strength)

1. Examination of
Musculoskeletal
System

2.  Assess this system while bathing or
positioning
 Focus on range of joint motion, muscle
strength, tone, joint & muscle condition
 Muscular disorders may result from
neurological disease
 Simultaneous muscular & neurological
examination

3.  Visualize : Bone anatomy, muscle
placement & joint structure
 Assess the degree of mobility
 Provide proper position while
examination

4. Nursing History
 Determine involvement in competitive
sports
 H/o alcohol or caffeine use, cigarette
smoking, constant dieting
 Menopause before age 45, estrogen
deficiency
 Family H/o osteoporosis
 Chronic diseases

5. Cont…
 History of problems in bone, muscle or
joint function
 Nature and extent of pain
 Normal activity pattern
 Height loss in women over age 50

6. Inspection
 Observe client’s gait
 Note: how client walks, sits & rises from a
sitting position
 Note foot dragging, limping, shuffling &
position of legs in relation to trunk
 Observe client in standing position
 Note common postural abnormalities

7. Cont…
 Check for kyphosis, lordosis & scoliosis
 Assess for signs of osteoporosis
 Extremities: overall size, gross deformity,
bony enlargement, alignment &
symmetry

8. Palpation
 Gentle palpation : bones, joints,
surrounding muscles
 Note heat, tenderness, edema or
resistance to pressure
 During palpation: no discomfort to client
 Muscles should be firm

9. Terminology
 Flexion
 Extension
 Hyperextension
 Pronation
 Supination
 Abduction
 Adduction
 Internal rotation
 External rotation
 Eversion
 Inversion
 Dorsiflexion
 Plantar flexion

10. Range of motion
 Includes both active & passive ROM
 Put each major joint through active and
passive full ROM
 Demonstrate and instruct the client

12. Cont…
 Goniometer : measures precise degree
of motion in a particular joint

13. Muscle tone and strength
 Check for hypertonicity & hypotonicity
 In case of pain: support the extremity
 Slight resistance can be there
 Compare symmetrical muscle pairs

14. Maneuvers to assess muscle
strength
 Neck (sternocleidomastoid muscle)
Place hand firmly against client’s upper jaw
& ask the client to turn the head laterally
against resistance

15. Cont..
 Shoulder (trapezius)
Place hand over midline of client’s shoulder
exerting firm pressure. Have the client to
raise shoulder against resistance

16. Cont…
 Elbow
◦ Biceps : pull down on forearm as client
attempts to flex arm
◦ Triceps : as you flex client’s arm, apply
pressure against forearm. Ask client to
straighten the arm

17. Cont..
 Hip
◦ Quadriceps : when client is sitting, apply
downward pressure to thigh.Ask client to
raise leg up from table
◦ Gastrocnemius : client sits, while examiner
holds shin of flexed leg.Ask client to
straighten leg against resistance

18. Muscle strength
Muscle function
level
Grade % Normal Lovett scale
No evidence of
contractility
0 0 0(zero)
Slight contractility, no
movement
1 10 T(trace)
Full range of motion,
gravity eliminated
2 25 P(poor)
Full range of motion
with gravity
3 50 F(fair)
Full range of motion
against gravity, some
resistance
4 75 G(good)
Full range of motion
against gravity, full
resistance
5 100 N(normal)