Objectives:

I. Overview: Focused Musculoskeletal System Assessment

II. Anatomy and Physiology Review:

 

III. Medical Terminology

Important Terms to know:

Ankylosis – fixation of a joint, usually resulting from destruction of articular cartilage

Ataxia – inability to coordinate muscular movement

Bradykinesia – abnormal slowness of movement

Crepitus – a grating, creaking, or cracking sound or sensation heard or felt when moving a join

Dyskinesia – uncontrolled, involuntary movements

Erythema – redness of the skin

Kyphosis – abnormal outward curvature of the spine

Lordosis – abnormal inward curvature of the lumbar spine

Osteoarthritis – a form of arthritis

Scoliosis – lateral curvature of the spine

Sprain – traumatic injury to the ligament

Strain – traumatic injury to the muscle or the tendon

Tendinitis – inflammation of a tendon


ROM Terms:

Abduction – movement of a limb away from the body

Adduction – movement of a limb toward the body

Circumduction – circular movement of a limb

Dorsiflexion – backward or upward motion of a body part

Extension – movement of bringing a joint into a straight position

External Rotation – or lateral rotation, turning a limb outward from the mid line of the body

Flexion – movement that brings a joint into a bent position

Hyperextension – extension of a body part beyond normal limits of extension

Internal Rotation – inward turning of a limb

Plantar Flexion – bending of the foot or toes toward the sole of the foot

 

IV. Step-by-step assessment of the Musculoskeletal System

A focused musculoskeletal assessment includes collecting subjective data about the patient’s mobility and exercise level, collecting the patient’s and the patient’s family’s history of musculoskeletal conditions, and asking the patient about any signs and symptoms of musculoskeletal injury or conditions. Objective data is also assessed.

The focused musculoskeletal assessment in Checklist 22 outlines the process for gathering objective data.

Focused Musculoskeletal System Assessment

Safety considerations:
  • Perform hand hygiene.
  • Check room for¬†contact precautions.
  • Introduce yourself to patient.
  • Confirm patient ID using two patient identifiers (e.g., name and date of birth).
  • Explain process to patient.
  • Be organized and systematic in your assessment.
  • Use appropriate listening and questioning skills.
  • Listen and attend to patient cues.
  • Ensure patient‚Äôs privacy and dignity.
  • Assess¬†ABCCS/suction/oxygen/safety.
  • Apply principles of¬†asepsis and safety.
  • Check¬†vital signs.
  • Complete¬†necessary¬†focused¬†assessments.

Steps

 Additional Information

1. Check patient information prior to assessment:

  • Activity order
  • Mobility status
  • Falls risk
  • Need for assistive devices
Determine patient’s activity as tolerated (AAT)/bed rest requirements.

Patient position prior to standing
Patient position prior to standing

Determine if patient has non-weight-bearing, partial, or full weight-bearing status.

Determine if patient ambulates independently, with one-person assist (PA), two-person assist (2PA), standby, or lift transfer.

Check alertness, medications, pain.

Ask if patient uses walker/cane/wheelchair/crutches.

Consider non-slip socks/hip protectors/bed-chair alarm.

2. Conduct a focused interview related to mobility and musculoskeletal system. Ask relevant questions related to the musculoskeletal system, including pain, function, mobility, and activity level (e.g., arthritis, joint problems, medications, etc.).
3. Inspect, palpate, and test muscle strength and range of motion:

  • Bilateral handgrip strength
  • Range of motion (ROM) of knees
  • Dorsi/plantar flexion

Evaluate client’s ability to sit up before standing, and to stand before walking, and then assess walking ability.

Note strength of handgrip and foot strength for equality bilaterally.

Assess strength on dorsiflexion
Assess strength on dorsiflexion
Assess strength on plantar flexion
Assess strength on plantar flexion
Assess grip strength
Assess grip strength

Note patient’s gait, balance, and presence of pain.

4. Report and document assessment findings and related health problems according to agency policy. Accurate and timely documentation and reporting promote patient safety.
Data source: Assessment Skill Checklists, 2014; Jarvis et al., 2014; Perry et al., 2014; Stephen et al., 2012; Wilson & Giddens, 2013

V. Documentation

VI. Related Laboratory and Diagnostic Tests

VII. Learning Activity

VIII. Citations and Attributions

License

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Guide to Health Assessment for Nurses Copyright © by Raki Bertiz and Ching-Chuen Feng is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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