Faculty of Nursing-IUG Chapter (12) Assessment of Musculo-Skeletal System

The primary structures of the musculoskeletal system are the bones, muscles, cartilage, ligaments, tendons and joints. The bony skeleton provides a sturdy framework to support body structures. The bone matrix stores calcium, phosphorus, magnesium and fluoride. In addition, the red bone marrow located within bone cavities produces red and white blood cells in a process of hematopoiesis. There are 206 bones in the human body, divided into four categories. Long bones (eg, femur) Short bones (eg, metacarpals) Flat bones (eg, sternum) Irregular bones (eg, vertebrae) Assessments are made of muscles, bones and joints. When assessing the musculoskeletal system keep in mind that injury or inflammation of any part of the system can cause pain, stiffness, or an alteration in motor strength or mobility. 2

Musculoskeletal assessment is conducted from head to toe with inspection and palpation Assessment of musculo-skeletal system done firstly when the client walks, moves in bed or performs any type of physical activity. The nurse usually assesses the musculoskeletal system for: Muscle – size, contractures, tremors, muscle tonicity, smoothness of movement and muscle strength. Bones – skeletal structure, tenderness, edema Joints – swelling, tenderness, smoothness of movement, crepitation, nodules, range of motion. 3

Terms used to describe joint movement: Flexion – bend that decrease angle between bones Extension – straightening a limb to increase the angle of joint Abduction – moving a limb away from the body’s midline Adduction – moving a limb towards the body or beyond it Internal rotation – turning a body part towards midline External rotation – turning a body part away from midline Circumduction – circular movement of a body part Supination – turning the palm upwards Pronation – turning the palm downwards Inversion – turning the hand or foot inward Eversion – turning the hand or foot outward 4

Musculoskeletal Assessment Subjective data: Observer gait and posture as client walks into room. Normally the client walks with arms swinging freely at sides and the head and the face leading the body. Pain: assess pain at rest, with exercise, changes in shape or size of an extremity, changes in mobility to carry out activities of daily living, sports, and works. Stiffness of joint Decreased or altered or absent sensations. Redness or swelling of joints. History of fractures and orthopedic surgery. Occupational history 5

Objective data Determine range of motion, muscle strength and tone, joint and muscle condition. Muscle problems commonly are manifestations of neurological disease, so you must do neurological assessment simultaneously. Joints vary in their degree of mobility, range from freely movable e.g. knee, to slightly movable joints e.g. the spinal vertebra. During assessment of muscle groups: assess muscle weakness, or swelling, and size, then compare between sides. Joints should not be forced into painful positions. Loss of height is frequently the first clinical sign of osteoporosis. Small amount of height loss expected with aging. Ask client to put each joint through its full range of motion, if there is weakness, gently supporting & moving extremities through their Range of motion, to assess abnormalities. Normal joints are non tender, without swelling and move freely. In elderly joints often become swollen & stiff, with reduced range of motion, resulting from cartilage erosion and fibrosis of synovial membranes 6