Exam 2: Musculoskeletal Assessment Flashcards
Subjective data for Musculoskeletal
Joints
—Pain, stiffness, swelling, limiting ROM
Muscles
— Trauma/pain, deformity, gain/loss
Exercise program
Weight gain and loss
ADLs
— Bathing. toileting, dressing, grooming, eating
Mobility/ADL aids
Occupational Hazards
— Lifting, repetition of joint movement, uneven surfaces
When obtaining objective data, INSPECT
Gait
mobility
balance
obvious deformities of muscles and bones
skin
spinal curvatures (lordosis, kyphosis, scoliosis)
Symmetry: size, structure, function of muscle mass
When obtaining objective data, palpate each join and note
Heat, edema, tenderness, swelling, masses
When assessing ROM, note
resistance and presence of pain
Any crepitation vs. discrete crack/pop
Active ROM assessment
Patient performs
Passive ROM assessment
nurse performs
— DO NOT FORCE into a painful position, mild stretching/discomfort OK, but we do not want to tear soft tissue
Crepitation
grinding in joints roughened joins as with rheumatoid arthritis
Cracking and popping in the joins is when
Fluid and gasses shift in the joint
Muscle testing during objective data assessment
- Compare both sides at the same time if able
- Flex as you hold opposing force or resist that opposing force
Hypertonicity
increased tone/resistance
Hypotonicity
decreased tone/resistance… very relaxed, floppy or flabby
Atrophy
Reduced size, feels soft/boggy
Assessing cervical spine
Checking the alignment of head and neck
Palpate for spasms and tenderness
testing ROM of cervical spine
Flexion (chin to chest) Hyperextension (look upward) Lateral bend (ear to shoulder) Rotation (turn head to shoulder) --- then repeat with opposing force
Inspecting the lower spine (person should stand if able) and inspect
If spine is straight
shoulder evaluation, uneven scapula, iliac crest, gluteal folds, spacing between arm and lateral thorax
ROM assessment for lower spine
Bend and touch toes, bend sideways, backwards
Twist side to side
The vertebral column has four curves that are
Anterior-posterior curves
The cervical and lumbar curves are
Concave (inward)
The thoracic and sacrococcygeal curves are
Convex (outward)
What allows the spine to absorb shock
balance of the curves with the resilient intervertebral discs
Scoliosis
LATERAL S-shape curvature of the thoracic and lumbar spin
A normal spine has a double s-shape that is
Anterior/posterior, not lateral
Scoliosis ribs
Rib hump on forward flexion
Scoliosis is more prevalent in
adolescence, especially girls
what should be noted for scoliosis
unequal shoulders, scapular height, obvious curvature, unequal elbow level, etc.
Kyphosis
Exaggerated posterior curvature of the thoracic spine, associated with aging. HUMPBACK
Lordosis
Normal lumbar concavity is further accentuated forward towards the belly
Lordosis is often associated with
pregnancy and obesity, can be present secondary to kyphosis without obesity
Shoulder assessment
Inspect - redness, deformity-swelling
Palpate - heat, spasm, atrophy, tenderness
When assessing upper extremity, test the
Strength of the shoulder muscles and cranial nerve XI: Spinal accessory
Assess upper extremity for
Asymmetry
Pain with motion
Crepitus with motion
Bilateral/unilateral weakness
When assessing elbow
Size and contour both flexed and extended
When assessing elbow, palpate
redness, swelling, deformity
When assessing elbow ROM
bend and straighten elbow - flexion and extension
Repeat with resistance
—- Supination/pronation
When assessing wrist and hand, inspect
swelling, redness, deformity, nodules, skin
When assessing wrist and hand, palpate
Joint surfaces, smooth, nodules, tenderness
When assessing ROM for wrist and hand
Bend hand up and down at wrist bend fingers up and down turn palms outward and inward spread fingers, make a fist touch thumb to each finger ----repeat with opposing force
When assessing Hip, inspect
When standing
Symmetrical iliac crest, gluteal folds, buttock size and gait
When assessing hip in supine position
Raise each leg with knee extended
bending knee to chest increases hip flexion
Internal/external rotation
Straighten knee swing leg lateral and medial
Adduct
TOWARDS the body
Abduct
AWAY from body
Testing Hip movement
Squat and raise knee as high as possible (flexion)
leg cross body plane (adduction)
swing leg away from body (abduction)
When standing swing leg behind body (hypertension)
point toe in and out (internal/external rotation)
DUCK walk !!
When assessing knee, inspect
skin, lesions, edema, shape/contour
When assessing knee, assess
Quadriceps for atrophy
ROM knee
Bend each knee (flexion)
extend each knee (extension)
—– Repeat with opposing force
Abnormal knee issues
Pain, limps, popping, clicking, weakness, instability
When assessing ankle and foot, inspect
feet, toes, joints, skin, alignment
— bunions, hammer toes, swelling, inflammation, calluses, ulcers
ROM ankle and foot
point toes to floor (Plantar flexion)
toes to nose (Dorsiflexion)
soles in and out (Eversion and inversion)
flex and straighten toes
Developmental considerations for infants
Normal C curve spine
Support head: the neck isn’t developed
ROM of extremities, toes up to the shin!
Assess preschoolers
Observe crawling, walking, jumping
Assessing toddlers
Protuberant abdomen
broad based gait
use arms of balance
Assessing adolescents
Kyphosis with poor posture
Screen for scoliosis
Growth spurts can result in poor coordination
Development in pregnant women
Lordosis
Waddle type gait due to relaxation of the hip joints in anticipation of childbirth
Development in older adults
Loss of bone mass
Weaker bones
Smaller base of support so they shuffle feet
Increased risk for falls and also for fracture
Common adaptations to aging
Shuffling Holds on to rails, leads with favored leg Holds rail, lowers weak leg first bends at waist pushes off chair rolls from one side pushes with arms
