Assessment of the

Musculo-Skeletal System
 Review of Anatomy and Physiology

• The musculo-skeletal system consists of the

muscles, tendons, bones and cartilage
together with the joints
• The primary function of which is to produce
skeletal movements
 Muscles

Three types of muscles exist in the body

• 1. Skeletal Muscles
– Voluntary and striated
• 2. Cardiac muscles
– Involuntary and striated
• 3. Smooth/Visceral muscles
– Involuntary and NON-striated
 TENDONS

Bands of fibrous connective tissue that tie •

bones to muscles
 LIGAMENTS

Strong, dense and flexible bands of fibrous •

tissue connecting bones to another bone
 BONES

• Variously classified according to shape, location and

size
• Functions
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition
 JOINTS

The part of the Skeleton where two or more •

bones are connected
 CARTILAGES

A dense connective tissue that consists of •

fibers embedded in a strong gel-like substance
 BURSAE

Sac containing fluid that are located around •

the joints to prevent friction
• CHECK YOUR EQUIPMENT PRIOR
TO ENTERING THE PATIENT’S
ROOM. MAKE SURE YOU HAVE
EVERYTHING YOU NEED TO
COMPLETE YOUR ASSESSMENT
PRIOR TO ENTERING THE
PATIENT’S ROOM
 Make the Patient Comfortable
• Showing concern for privacy and patient
modesty must become ingrained in your
professional behavior
• Be sure to close nearby doors or
examination room PRIOR to beginning
physical examination
• Your goal is to visualize one area of the
body at a time
 Make the Patient
Comfortable
• Be sensitive to the patient’s feelings and
physical comfort
• When you have completed the examination,
show your attentiveness, by rearranging the
patients pillows, or adding blankets for
warmth; make sure their immediate
environment is to their satisfaction
• Be sure to lower the bed completely, and
make sure side rails are up and call bell is in
the patient’s reach
• As you leave be sure to WASH YOUR HANDS
GENERAL EXAM

VITAL SIGNS
 Cardinal Techniques of Examination
• Inspection

• Palpation

• Percussion

• Auscultation
 Outlines

1. Review of Anatomy and physiology

of musculoskeletal system
2. Physical Exam
3. Inspection
4. Palpation
5. ROM (Rang of motion)
 Objectives
• Apply knowledge of Anatomy and
physiology of musculoskeletal
system
• Differentiate between normal and
abnormal
• Implement physical assessment
 Musculoskeletal
• Muscle or joint pain
• Stiffness
• Arthritis
• Gout
• Backache
• If present, describe location or affected joints or
muscles, any swelling, redness, pain, tenderness,
stiffness, weakness, or limitation of motion or
activity; include timing of symptoms duration, and
any history of trauma
• Neck or low back pain
• Joint pain with systemic features such as fever,
chills, rash, anorexia, weight loss, or weakness
 Skin
• Rashes
• Lumps
• Sores
• Itching
• Dryness
• Changes in color
• Changes in hair or nails
 What do muscles do ?
• Muscles simply move you!
• Without muscles you couldn't open your
mouth, speak, shake hands, walk, talk, or
move your food through your digestive
system.
• There would be no exploring, running,
climbing, smiling, blinking, breathing. You
couldn't move anything inside or outside
you. The fact is, without muscles, you
wouldn't be alive for very long
The skeleton is the name given to the
collection of bones that holds our body
up.
Our skeleton is very important to us. It
does 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 be
a blob of blood and tissue on the floor.
3. It allows us to move. Because our
muscles are attached to our bones,
when our muscles move, they move
the bones, and we move
 Physical Exam
1. Inspection
• Observe any lack of symmetry and
any evidence of trauma or disease.
• Look for muscle wasting;
• Inspect the joint contour (shape)
and observe any evidence of
swelling, deformity or inflammation.
• Ask the client to point to, or
otherwise identify, any painful areas,
including sites of radiation of
pain.

Screening questions for

musculoskeletal disorders

1. Do you have any pain or

stiffness in your arms, legs or
back?

2. Can you walk up and down

stairs without difficulty?

3. Can you dress yourself in

everyday clothes without any
difficulty?
• Assessment of Gait

• Ask the patient to walk back and forth

across the room .
• Observe for equality of arm swing ,
balance and rapidity and ease of heels
turning .
• Next, ask the patient to walk on his
tiptoes ,then on heels .
• Ask the patient to tandem walk .

• Test patient's ability to stand with feet tiptoes

together with eyes open and then
closed. (Romberg's test .)Reassure
patient that you will support him, in
case he becomes unsteady .
• Normal :Person can walk in balance
with the arms swinging at sides and can
turn smoothly. Person should be able to
stand with feet together without falling
with eyes open or closed.
tandem
 Upper Extremity Muscles

• Inspect the muscles of

the shoulder, arm,
forearm and hand.
• Note muscle size (bulk).
• Look for asymmetry,
atrophy and
fasciculation.
• Look for tremor and
other abnormal
movement at rest and
with arms outstretched.
 Determine muscle power
by
• Gently trying to
Abduction
overpower
contraction of each
group of muscles.
– Shoulder:
Abduction
(Deltoid) Adduction

–, Adduction
–, (Trapezius) Trapezius)
– Elbow: flexion (Biceps)

– Elbow extension
(Triceps)

– Wrist: Flexion ( )and

extension().
– Hand: Grip
Grip

– opposition of thumb
and index finger

– opposition of thumb
and little finger and

– finger abduction and

adduction.
• Determine limb tone
(resistance to
passive stretch).
• With the patient
relaxed
• Gently move the
limb at the shoulder,
elbow and wrist
joints and note
whether tone is
normal, increased or
decreased
 Normal findings

• Muscles are symmetrical in size with

no involuntary movements.
• In some, muscles may be slightly
larger on the dominant side.
• Muscle power obviously varies. You
should not be able to overpower with
reasonable resistance.
• You have to learn to appreciate the
normal tone from practice.
 Neck: Range of Motion
of
• Fix the head with one hand while you
examine neck
• Inspection
– Note the normal concavity of cervical
spine
– 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 Touch chin
– Para spinal muscles
• Range of motion
– Active
• Touch chin for flexion
• Throw head back for extension

Throw head back

 • Touch each shoulder with ears for
lateral flexion
• Touch each shoulder with chin for
lateral rotation
– Passive
• Feel for crepitus during passive
motion
• Normal:
– 30 degree rotation, able to
touch chest with chin, 55
degree extension and 40
degree lateral bend.
– No resistance during the range
of motion.
 Muscles of Lower Extremity

Inspect the muscles of the hip,

knee and ankle .
• Note muscle size( bulk .)
• Look for asymmetry, atrophy
and fasciculation .
• Look for abnormal Hip flexion

movement .
• Determine muscle power by
gently trying to overpower
contraction of each group of
muscles .
– Hip :Flexion( Iliopsoas), Extension
(Gluteus maximus), Abduction,
Adduction .
 Assessment of the
Musculoskeletal System
Muscle Strength scale

0 No detection of muscular contraction

1 A barely detectable flicker or trace of contraction

with observation or palpation.
2 Active movement of body part with elimination of
gravity.
3 Active movement against gravity only and not
against resistance
4 Active movement against gravity & some
resistance
5 Active movement against full resistance without
evident fatigue (Normal muscle strength)
 The Knee Exam
• Inspection
• Make sure that both knees are
fully exposed. The patient should
be in either a gown or shorts.
Rolled up pant legs do not
provide good exposure !
• Watch the patient walk.
• Do they limp or appear to be in
varus Knee
pain? more ,deormity
• When standing, is there evidence marked on the left
of bowing (varus) or knock- leg
kneed (valgus) deformity? There
is a predilection for degenerative
joint disease to affect the
medical aspect of the knee, a
common cause of bowing .
• Is there evidence of
atrophy of the
quadriceps, hamstring,
or calf muscle groups?
Knee problems/pain can
limit the use of the
affected leg, leading to While both legs have
well developed
wasting of the muscles . musculature,
the left calf and
hamstring are bulkier
than the right
 – Knee : Flexion( Hamstrings ,)
Extension( Quadriceps )
– Ankle : Dorsiflexion( Tibialis Knee extension
anterior), Plantar flexion
(Gastronemius .)
• Determine limb tone
resistance to passive stretch.
With the patient relaxed,
gently move the limb at the
hip, knee and ankle and note
Knee flexion
whether tone is normal,
increased or dicreased.
Flex the hip and knee.
• Support the knee, dorsiflex Dorsiflexion
the ankle sharply and hold the
foot in this position checking
for clonus .
 Spine (Bone)
• The examiner should stand behind the
patient and observe the alignment of the
spine in the flexed position to determine
scoliosis .
• View the spine from the side to determine
kyphosis .

• Ask the patient if he is aware of sore spots.

Palpate the spinous process and be gentle
with the sore spots .Percuss one vertebra
at a time, starting from head .
• .
• Assess range of motion
of spine by having patient
bend down to pick up an
object without bending his
legs while you hold his
hips .
• Normal :
• Gentle concavities in
cervical and lumbar
regions and a convexity in
the thorax .
• Vertebral line and gluteal
cleft align
 Posture

Normal - •
Comfortably erect
Look for straight lines
across body parts
Lordosis - Increased Curvature of the
Spine
Kyphosis is a curving of the spine that causes a bowing of the
back, which leads to a hunchback or slouching posture.
Scoliosis – curvature of the spine away
from middle or sideways