NSG2317 Class 11 Musculoskeletal Complete assessment Joy Noel-Weiss RN IBCLC PhD

These slides were prepared with slides from.ppt presentations that accompany the textbook: Jarvis, C. (2009). Physical examination & health assessment (1st Canadian ed.). St. Louis: Saunders-Elsevier. © Joy Noel-Weiss

Today’s plan Course evaluation Musculoskeletal system and locomotor –quiz your readings –Jarvis video –short lecture Pulling it together © Joy Noel-Weiss

Musculoskeletal System Chapter 24

Learning outcomes Explain how to: take Hx; inspect & palpate musculoskeletal system. Assess the person’s ability to carry out functional activities of daily living. Record the history and physical examination findings accurately. Summarize a complete health assessment. © Joy Noel-Weiss

Musculoskeletal Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings © Joy Noel-Weiss

Students in red Student in blue One more © Joy Noel-Weiss

Joints Muscle Bone © Joy Noel-Weiss

Joints –Pain –Stiffness –Swelling, heat, and redness –Limitation of Movement Subjective data—Health Hx questions © Joy Noel-Weiss

Muscles –Pain (cramps) –Weakness Subjective data—Health Hx questions © Joy Noel-Weiss

Bones –Pain –Deformity –Trauma (fractures, sprains, dislocations) Subjective data—Health Hx questions © Joy Noel-Weiss

Functional assessment (activities of daily living) Self-care behaviours Subjective data—Health Hx questions © Joy Noel-Weiss

Objective data—Physical exam Preparation –Screening musculoskeletal examination –Complete musculoskeletal examination Equipment needed –Tape measure –Goniometer, to measure joint angles –Skin marking pen Order of the examination –Inspection Size and contour of joint Skin and tissues over joint –Palpation Skin temperature Muscles, bony articulations, area of joint capsule –Range of motion –Muscle testing Apply opposing force Grading muscle strength © Joy Noel-Weiss

Temporomandibular joint Inspect joint area Palpate as person opens mouth Motion and expected range –Open mouth maximally –Protrude lower jaw and move side to side –Stick out lower jaw Palpate muscles of mastication Objective data—Physical exam © Joy Noel-Weiss

Cervical spine Inspect alignment of head and neck Palpate spinous processes and muscles Motion and expected range –Chin to chest –Lift chin –Each ear to shoulder –Turn chin to each shoulder Objective data—Physical exam Shoulders Inspect joint Palpate shoulders and axilla Motion and expected range –Arms forward and up –Arms behind back and hands up –Arms to sides and up over head –Touch hands behind head © Joy Noel-Weiss

Objective data—Physical exam Wrist and Hand Inspect joints on dorsal and palmar sides Palpate each joint Motion and expected range –Bend hand up, down –Bend fingers up, down –Turn hands out, in –Spread fingers, make fist –Touch thumb to each finger Phalen’s test Tinel’s sign Elbow Inspect joint in flexed and extended positions Palpate joint and bony prominences Motion and expected range –Bend and straighten elbow –Pronate and supinate hand Muscle Strength © Joy Noel-Weiss

Objective data—Physical exam Hip Inspect as person stands Palpate with person supine Motion and expected range –Raise leg –Knee to chest –Flex knee and hip; swing foot out, in –Swing leg laterally, medially –Stand and swing leg back Knee Inspect joint and muscle Palpate Bulge signThe bulge sign occurs with very small amounts of effusion, 4 to 8 mL, from fluid flowing across the joint Crepitation Motion and expected range –Bend knee –Extend knee –Check knee during ambulation Muscle Strength © Joy Noel-Weiss

Objective Data—The Physical Exam Ankle and foot Inspect with person sitting, standing, and walking Palpate joints Motion and expected range –Point toes down, up –Turn soles out, in –Flex and straighten toes Muscle Strength Spine Inspect while person stands Palpate spinous processes Motion and expected range –Bend sideways, backward –Twist shoulders to each side Straight leg raising Measure leg length discrepancy © Joy Noel-Weiss

Sample Charting © Joy Noel-Weiss

Inflammatory conditions –Rheumatoid arthritis –Ankylosing spondylitis Degenerative conditions –Osteoarthritis (degenerative joint disease) –Osteoporosis Abnormal findings - Affecting multiple joints © Joy Noel-Weiss

Dislocated shoulder Tear of the rotator cuff Frozen shoulder—adhesive capsulitis Abnormal findings - Abnormalities of the shoulder © Joy Noel-Weiss

Abnormal findings Abnormalities of the wrist and hand  Ganglion cyst  Carpal tunnel syndrome Degenerative joint disease or osteoarthritis Acute rheumatoid arthritis © Joy Noel-Weiss

Abnormal findings Abnormalities - knee Abnormalities – ankle & foot  Mild synovitis  Swelling of menisci  Chronic/acute gout  bunion and hammer toes  Callus  Plantar wart  Ingrown toenail © Joy Noel-Weiss

Abnormal findings Abnormalities - spineCommon congenital or pediatric abnormalities  Scoliosis  Lordosis  Kyphosis  Congenital dislocated hip  Talipes equinovarus (clubfoot)  Spina bifida- neural tube defect © Joy Noel-Weiss

The Complete Health Assessment: Putting It All Together Chapter 28