AssessmentoftheMusculo SkeletalSystem Dr EssmatGemaey230NUR Outlines ReviewofAnatomyandphysiologyofmusculoskeletalsystemPhysicalExamInspectionPalpationROM Rangofmotion Objectives ApplyknowledgeofAnatomyandphysiologyofmusculoskeletalsystemDifferentiatebetweennormalandabnormalImplementphysicalassessment Whatdomusclesdo Musclessimplymoveyou Withoutmusclesyoucouldn topenyourmouth speak shakehands walk talk ormoveyourfoodthroughyourdigestivesystem Therewouldbenoexploring running climbing smiling blinking breathing Youcouldn tmoveanythinginsideoroutsideyou Thefactis withoutmuscles youwouldn tbealiveforverylong Theskeletonisthenamegiventothecollectionofbonesthatholdsourbodyup Ourskeletonisveryimportanttous Itdoesthreemajorjobs 1 Itprotectsourvitalorganssuchasthebrain theheart andthelungs 2 Itgivesustheshapethatwehave Withoutourskeletonwewouldjustbeablobofbloodandtissueonthefloor 3 Itallowsustomove Becauseourmusclesareattachedtoourbones whenourmusclesmove theymovethebones andwemove PhysicalExam InspectionObserveanylackofsymmetryandanyevidenceoftraumaordisease Lookformusclewasting Inspectthejointcontour shape andobserveanyevidenceofswelling deformityorinflammation Asktheclienttopointto orotherwiseidentify anypainfulareas includingsitesofradiationofpain Screeningquestionsformusculoskeletaldisorders1 Doyouhaveanypainorstiffnessinyourarms legsorback 2 Canyouwalkupanddownstairswithoutdifficulty 3 Canyoudressyourselfineverydayclotheswithoutanydifficulty AssessmentofGaitAskthepatienttowalkbackandforthacrosstheroom Observeforequalityofarmswing balanceandrapidityandeaseofturning Next askthepatienttowalkonhistiptoes thenonheels Askthepatienttotandemwalk Testpatient sabilitytostandwithfeettogetherwitheyesopenandthenclosed Romberg stest Reassurepatientthatyouwillsupporthim incasehebecomesunsteady Normal Personcanwalkinbalancewiththearmsswingingatsidesandcanturnsmoothly Personshouldbeabletostandwithfeettogetherwithoutfallingwitheyesopenorclosed tiptoes heels tandem UpperExtremityMuscles Inspectthemusclesoftheshoulder arm forearmandhand Notemusclesize bulk Lookforasymmetry atrophyandfasciculation Lookfortremorandotherabnormalmovementatrestandwitharmsoutstretched Determinemusclepowerby Gentlytryingtooverpowercontractionofeachgroupofmuscles Shoulder Abduction Deltoid Adduction Shrug Trapezius Abduction Adduction Trapezius Elbow flexion Biceps Elbowextension Triceps Wrist Flexion andextension Hand Gripoppositionofthumbandindexfingeroppositionofthumbandlittlefingerandfingerabductionandadduction Grip Determinelimbtone resistancetopassivestretch WiththepatientrelaxedGentlymovethelimbattheshoulder elbowandwristjointsandnotewhethertoneisnormal increasedordecreased Normalfindings Musclesaresymmetricalinsizewithnoinvoluntarymovements Insome musclesmaybeslightlylargeronthedominantside Musclepowerobviouslyvaries Youshouldnotbeabletooverpowerwithreasonableresistance Youhavetolearntoappreciatethenormaltonefrompractice Neck RangeofMotionof FixtheheadwithonehandwhileyouexamineneckInspectionNotethenormalconcavityofcervicalspineIdentifyTransverseprocessofC7ObserveTrapeziusandSternomastoidmusclesPalpationFeeleachspinousprocesslookingforfocalareasoftendernessJointFeelforcrepitusduringpassivemotionParaspinalmusclesRangeofmotionActiveTouchchinforflexionThrowheadbackforextension Touchchin Throwheadback ToucheachshoulderwithearsforlateralflexionToucheachshoulderwithchinforlateralrotationPassiveFeelforcrepitusduringpassivemotionNormal 30degreerotation abletotouchchestwithchin 55degreeextensionand40degreelateralbend Noresistanceduringtherangeofmotion MusclesofLowerExtremity Inspectthemusclesofthehip kneeandankle Notemusclesize bulk Lookforasymmetry atrophyandfasciculation Lookforabnormalmovement Determinemusclepowerbygentlytryingtooverpowercontractionofeachgroupofmuscles Hip Flexion Iliopsoas Extension Gluteusmaximus Abduction Adduction Hipflexion TheKneeExam InspectionMakesurethatbothkneesarefullyexposed Thepatientshouldbeineitheragownorshorts Rolleduppantlegsdonotprovidegoodexposure Watchthepatientwalk Dotheylimporappeartobeinpain Whenstanding isthereevidenceofbowing varus orknock kneed valgus deformity Thereisapredilectionfordegenerativejointdiseasetoaffectthemedicalaspectoftheknee acommoncauseofbowing varusKneedeormity moremarkedontheleftleg Isthereevidenceofatrophyofthequadriceps hamstring orcalfmusclegroups Kneeproblems paincanlimittheuseoftheaffectedleg leadingtowastingofthemuscles Whilebothlegshavewelldevelopedmusculature theleftcalfandhamstringarebulkierthantheright Knee Flexion Hamstrings Extension Quadriceps Ankle Dorsiflexion Tibialisanterior Plantarflexion Gastronemius Determinelimbtoneresistancetopassivestretch Withthepatientrelaxed gentlymovethelimbatthehip kneeandankleandnotewhethertoneisnormal increasedordicreased Flexthehipandknee Supporttheknee dorsiflextheanklesharplyandholdthefootinthispositioncheckingforclonus Dorsiflexion Kneeextension Kneeflexion Spine Bone Theexaminershouldstandbehindthepatientandobservethealignmentofthespineinth