The Musculoskeletal System Skeletal Muscle Movements Health History Inspection Palpation

Skeletal Muscle Movements Flexion – bending a limb at the joint Extension – straightening a limb at a joint Abduction – moving a limb away from the midline (-) Adduction – moving a limb to the midline (+) Internal rotation – turning a body part toward the midline External rotation – turning a body part away from the midline

Skeletal Muscle Movements Pronation – turning the palm downward Supination – turning the palm upward Inversion – moving the foot inward Eversion – moving the foot outward Circumduction – moving the arms in a circular motion

Skeletal Muscle Movements Rotation – moving the head around a central axis Protraction – moving a body part forward Retraction – moving a body part backward Elevation – raising a body part Depression – lowering a body part

Health History Joints – any pain, stiffness, swelling, heat, redness. Evaluate ROM Muscles – any pain/cramps, muscle strength/weakness Bones – any pain, deformity, trauma Functional assessment – performance of ADL’s Self-care behaviors – Exercise, weight gain/loss, current meds, disability

Developmental Considerations Infants and Children Birth history Achieved motor development milestones Any broken bones or deformities Check for dislocation of hip – Ortolani’s maneuver Adolescents Scoliosis screen Sports participation, warms-up, special equipment Elderly Hx. of falls, mobility, weakness, ability to perform ADL’s

Ortolani’s Maneuver With a (+) Ortolani’s you will hear a click and feel the femur shift

Inspection Gait – should be smooth, rhythmic and coordinated Symmetry, alignment, size - of body parts Any swelling, masses, deformities or atrophy ROM – should be smooth without clicking

Palpation Joints, muscles, bony articulations ROM Any heat, tenderness, swelling or masses ROM Active Active-assisted Passive Muscle strength: should be (=) bilaterally Grade strength 0-5 scale – Table pg. 641

ROM Active ROM – Client performs unassisted Active Assisted ROM – Nurse helps client with ROM exercises Passive ROM –nurse must perform all ROM. It is useful to prevent atrophy, contractures and promote joint mobility. Does not increase muscle strength. **Stop and reestablish correct body alignment for a client who experiences pain or cramping with ROM.

Temporomandibular Joint (TMJ) Inspection – observe for swelling Palpation Open mouth Normal opening 3-6 cm, or 3 fingers Move side to side Stick out lower jaw Clench teeth Note size, strength Provide resistance to chin, assesses CN V

Cervical Spine Inspection Palpation Muscle strength Check alignment of head and neck Spine should be straight and head erect Palpation Palpate spinous processes, sternomastoid, trapezius and paravertebral muscles. Should be firm, without tenderness or spasms. Muscle strength Place hand against side of head or jawline.

Cervical Spine: ROM Extension Hyperextension Flexion Lateral bending 0° Hyperextension 55° Flexion 45° Lateral bending 40° Rotation 70°

Lower Spine Inspection Palpation Vertical alignment and symmetry Spine should be straight with hips and shoulders of (=) height. Leg length discrepancy Palpation Spinous processes Paravertebral muscles

Lower Spine -ROM Have client touch toes Bend sideways Bend backward Flexion 75-90° Bend sideways Lateral bending 35° Bend backward Hyperextension 30° Twist shoulders to one side and then the other Rotation 30°

Upper Extremities - Shoulders Inspection Compare posteriorly and anteriorly Palpation Place one hand on shoulder Palpate for muscle spasms, atrophy, swelling, heat or tenderness Muscle Strength Have client shrug shoulders against resistance Tests CN XI – Spinal accessory

Shoulders: ROM Forward flexion Hyperextension Internal rotation External rotation Abduction Adduction

Upper Extremities - Elbow Inspection Palpation Muscle strength Apply resistance to forearm ROM Pronation –palm down Supination – palm up

Upper Extremities: Wrist and Hand Inspection Palpation Include wrist, metacarpal joints

Upper Extremities: Muscle Strength Resistance Carpal Tunnel Syndrome Phalen’s Test Acute flexion Numbness or burning with CTS Tinel’s Sign With direct percussion of median nerve, burning and tingling occurs with CTS

Lower Extremities - Hip Inspection Palpation Muscle strength With hand on thigh have client push upward

ROM - Hip Flexion Extension Internal rotation External rotation

ROM - Hip Abduction Adduction Hyperextension Will not do in clinical

Knee - ROM Flexion Extension Hyperextension

Lower Extremities: Ankle & Foot Inspection Ankle and Metatarsals Palpation Muscle Strength Dorsiflex and plantar flex foot against resistance

Ankle & Foot - ROM Dorsiflexion Plantar flexion Eversion Inversion