MUSCULOSKELETAL ASSESSMENT
I. Health History
A. Current Health status
1. Pain description
2. Weakness
3. Swelling
4. Stiffness
5. Crepitation (scraping, grating sound)
6. Impaired movement
7. Change in elimination
8. Change in ADL's
B. Past Health Status
1. Injury to bones, muscles, ligaments, cartilage, joints, and tendons
2. Surgery
3. Immunizations
4. Use of medications
C. Family History
D. Health Promotion and protection
1. Alcohol
2. Diet
II. Examination of the Musculoskeletal System
A. Inspect Posture
1. Lordosis
2. Kyphosis
3. Scoliosis
4. List
5. Gibbus
B. Gait
C. Coordination
1. Gross motor skills
2. Fine motor skills
D. Inspect and palpate the skin and subcutaneous tissues over bones, muscles, and cartilage joints
1. Limitation in ROM
2. Increase in the mobility of the joint (instability)
3. Signs of inflammation
- Swelling, Tenderness, Warmth, Redness (least common sign)
4. Crepitus
5. Deformities
a. Restricted ROM (flexion deformity of the hip)
b. Malalignment of articulating bones (ulnar deviation)
c. Abnormality in the relationship between two articulating surfaces (dislocation)
6. Condition of surrounding tissue
a. Subcutaneous nodules
- dorsolateral nodules (Heberden's nodes)
- Proximal interphalangeal nodules (Bouchard's nodules)
- Rheumatoid nodules
b. Skin changes
7. Muscle strength
a. Hypertrophy
b. Atrophy
c. Spasms
d. Fasiculations
8. Neurovascular changes with injury
a. Pain
b. Pallor
c. Paraesthesia
d. Pulselessness
e. Paralysis
f. Polar
9. Assessing muscle strength
10. Assessing Joint Range of Motion
a. Use both active and passive range of motion on each joint and its related muscle group. Assess for pain, limitation of motion, spastic movement, joint instability, deformity, or contractures.
b. Use goniometer to precisely measure the angle of the joint when the joint appears to have an increase or limitation in range of motion.
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ROM Cervical Spine |
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Flexion - 45 °; Hyperextension - up to 55° |
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Lateral bending - 40 ° (both right and left) |
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Rotation - 70 ° (both right and left) |
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ROM Thoracic and Lumbar Spine |
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Flexion - 75 °-90°; Hyperextension - 30° |
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Lateral bending - 35 ° (both right and left) |
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Rotation of upper trunk - 30-35 ° (both right and left) |
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ROM of Shoulders |
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Forward Flexion - 180 ° |
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Hyperextension - up to 50 ° |
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Abduction - 180 ° |
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Adduction - 50 ° |
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Internal rotation - 90 ° (place both arms behind hips, elbows out) |
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External rotation - 90 ° (place both arms behind the head, elbows out) |
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ROM of Elbow |
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Flexion - up to 160 ° |
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Extension - 180 ° |
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Supination - 90 ° (palm up) |
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Pronation - 90 ° (palm down) |
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ROM of Hand and Wrist |
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Metacarpophalangeal flexion - 90 ° |
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Metacarpophalangeal hyperextension - 30 ° |
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Finger flexion - (fist formation thumb over fingers) |
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Finger abduction and adduction |
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Finger flexion, proximal interphalangeal joint - 120 ° |
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Finger flexion, distal interphalangeal joint - 80 ° |
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Wrist flexion - 90 ° |
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Wrist hyperextension - 30 ° |
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Wrist radial deviation - 20 ° (toward thumb) |
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Wrist ulnar deviation - 55 ° (toward little finger) |
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ROM of Hip |
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Hip flexion - 90 ° (keep knee straight) |
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Hip flexion - 120 ° (keep knee flexed) |
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Abduction - up to 45 ° |
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Adduction - 30 ° |
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Hyperextension - up to 30 ° (while in prone position) |
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Internal rotation - 40 ° (keep knee flexed) |
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External rotation - 45 ° (keep knee flexed and place lateral aspect of the foot on the knee of the other leg |
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ROM of Knee |
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Flexion - up to 130 ° |
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ROM of Foot and Ankle |
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Dorsiflexion - 20 ° |
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Plantar flexion - 45 ° |
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Inversion - 30 ° |
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Eversion - 20 ° |
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Abduction - 10 ° |
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Adduction - 20 ° |
10. Palpation of joints
a. Palpate the temporomandibular joint while patient opens mouth. Snapping or clicking is normal in many individuals. Swelling, tenderness, or decreased ROM indicates arthritis.
- ROM between upper and lower incisors 3-6 cm.
- Lateral ROM 1-2 cm.
b. Palpate the medial and lateral aspects of each distal and proximal interphalangeal joint with thumbs and index finger. Bony enlargement often seen in Osteoarthritis.
c. Palpate the metacarpophalangeal joints with thumbs. Swelling and tenderness in this area may suggest Rheumatoid Arthritis.
d. Palpate each wrist joint with your thumbs and fingers. Bilateral swelling suggests Rheumatoid Arthritis.
e. Palpate elbow when it's flexed at a 70° angle.
- Olecranon process- bursitis (student's elbow)
- Olecranon grooves
- Lateral epicondyle - tennis elbow
- Medial epicondyle - golf elbow
f. Palpate the sternoclavicular joint, the acromioclavicular joint, the subacromioclavicular joint, the bicipital groove, and the shoulder itself for tenderness. Pain seen in bursitis, tendinitis of the biceps, and rupture of the supraspinatus tendon.
g. Palpate the anterior surface of the ankle noting bogginess, swelling, or tenderness. This may be arthritis or cellulitis or edema.
h. Palpate the Achilles tendon for Rheumatoid Arthritis.
i. Assess for tenderness of the metatarsophalangeal joints by compressing the joints between your thumb and fingers.
- Rheumatoid arthritis
- Gout
- Bunion
- hallux valgus
j. Palpate each metatarsophalangeal joint.
k. Palpate the supratellar pouch on each side of the quadriceps between thumb and fingers. Thickening, bogginess, or tenderness may suggest synovial inflammation of the knees. Bony enlargement is present in advanced osteoarthritis.
l. Compress the suprapatellar pouch with one hand and then palpate on each side of the patella and the tibio-femoral joint space.
m. Assess for the bulge sign
- milk upward over the medial aspect of knees with the ball of your hand.
- press on the knee just behind the lateral margin of the patella.
- watch for a bulge of returning fluid in the hollow area medial to patella.
- bulge indicates a small effusion within the knee joint.
n. Ballottement Test (floating patella)
- firmly grasp the thigh just above the knee with one hand (fording fluid out of the superior portion of the knee into the space between the patella and femur).
- With the other hand, briskly push the patella sharply back against the femur. Feel for a palpable tap.
- If you feel a tap, it indicates a large effusion.
o. Cup your hand over the knee to detect any crepitus.
p. With the patient standing, palpate each spinous process for tenderness.
- gentle percussion may also be used to illicit tenderness of osteoporosis, malignancy, or infection.
- palpate the paravertebral muscles for tenderness and spasm.
11. Special maneuvers
a. Carpal Tunnel Syndrome
- Phalen's test
- Tinel's sign
b. Low Back Pain: straight leg raises-(LaSegue's test)
- raise patient's relaxed and straightened leg until pain occurs
- dorsiflex foot