INTRODUCTION TO THE MUSCULOSKELETAL SYSTEM EXAMINATION Flashcards
History of Present Illness (HPI)
(1) Mechanism of injury (MOI)
(2) OLDCARTS
(3) Specific symptoms
What do you ask for MOI
(a) Direct Trauma
(b) Overuse/Overstretch
(c) Sudden change in direction
(d) Forceful contraction
What do you ask for specific symptoms
(a) Joint symptoms
1) Character:
a) Stiffness, swelling, or change in size
b) Unilateral or bilateral involvement
c) Constant pain or related to activities
d) Locking or giving away
2) Associated events:
a) Time of day
b) Activity, movements, weather
3) Temporal factors:
a) Nature of onset (slow vs rapid)
(b) Muscular symptoms
1) Character:
a) Limitation of movement
b) Weakness or fatigue
c) Paralysis, spasms
d) Wasting (Atrophy)
2) Precipitating factors:
a) Injury
2) Precipitating factors:
a) Injury
f) Catching
g) Locking
h) Grating
i) Snapping
j) Ability to bear weight
2) Pain
a) OLDCARTS
Past Medical History (PMHx)
(1) Trauma
(2) Surgery
(3) Chronic Illness (e.g., arthritis and osteoporosis)
(4) Skeletal deformities or congenital anomalies.
Family History (FHx)
(1) Congenital abnormalities
(a) Hip or foot
(2) Scoliosis or back problems
(3) Joint Disorders
(a) Arthritis
1) Rheumatoid
2) Osteoarthritis
3) Gout
(4) Genetic disorders
(a) Skeletal Dysplasia
Personal and Social History (SocHx)
(1) Employment
(a) Lifting
(b) Potential for unintentional injury
(c) Repetitive motions
(d) Chronic stress on joints
(e) Typing / computer use
(2) Exercise
(a) Extent, type, frequency
(b) Weight bearing, stress on specific joints
(c) Overall conditioning
(d) Sports
1) Level of competition, shoe type, athletic gear
2) Warm-up / cool down routines
(3) Functional Abilities
(a) Personal care
1) Eating, bathing, dressing, grooming, voiding, bowel movement
(b) Other activities
1) Housework
2) Walking
3) Climbing stairs
(c) Use of prosthesis
(4) Weight
(a) Recent gain
(b) Overweight or underweight
(5) Nutrition
(a) Calories, protein, vitamin D, calcium
Exam Components
(1) Inspection
(2) Palpation
(3) Range of Motion (ROM)
(4) Muscle Strength
(5) Sensory Evaluation
(6) Special Tests
Inspection
(1) Posture
(a) Inspect anterior, posterior, and lateral aspect of the posture
(b) Observe ability to stand, sit, walk
Inspection
Extremities
(a) Overall size
(b) Gross deformities
(c) Bony enlargement
(d) Alignment
(e) Contour
Inspection
Skin and Subcutaneous Tissues
(a) Discolorations
(b) Swelling
(c) Masses
Inspection
Muscles
(a) Gross hypertrophy or atrophy
1) Atrophy results from pain, disease to the muscle or damage to the motor neuron
(b) Fasciculations
1) Results from injury to muscle’s motor neuron
(c) Spasms
(d) Overall Symmetry
1) Dominant extremities are expected to be larger.
2) There is no absolute bilateral muscle symmetry.
Palpation
(1) All bones joints and surrounding muscles noting:
(a) Swelling
(b) Heat
(c) Fluctuation (associated with effusion)
(d) Pain
(e) Resistance to pressure
(f) Muscle Tone
1) Should be firm not hard or doughy
2) Spasticity is an increase in muscle tone
(g) Tenderness
1) No discomfort should be felt when palpating bones or joints.
(h) Crepitus
1) Can be felt when two irregular bone surfaces rub together.
2) Can be felt when tendon moves inside the tendon sheath with tenosynovitis.
Range of Motion (ROM)
Patient is instructed to move joint through its range of motion and examiner will note:
(a) Pain
(b) Limitation of motion
(c) Spastic movement
(d) Joint instability
(e) Deformity
(f) Contractures
Pain or any abnormal motion suggest a
joint, muscle, or nerve problem
Passive range of motion typically exceeds active range of motion by ___ degrees.
5
*Passive range of motion should be the same as the contralateral side.
If discrepancies between active and passive range of motion are present then this may indicate
true muscle weakness of joint disorder.
what is used to precisely measure joint angles
goniometer
Muscle Strength:
Evaluating muscle strength is associated with both
joint range of motion and
neurological examination.
Muscle Strength:
How to test muscle strength
(2) Have the patient either push into the examiner’s hand or the examiner will provide
resistance while the patient attempts to hold the joint stationary.
(3) Compare the muscle strength bilaterally.
Muscle Strength:
The grade strength scale varies from no voluntary contraction to full muscle strength
(a) Zero - No evidence of muscle function (including muscle twitch) 0/5
(b) Trace - Muscle contraction but no or very limited joint motion 1/5
(c) Poor - Complete range of motion with gravity eliminated 2/5
(d) Fair - Complete range of motion against gravity 3/5
(e) Good - Complete range of motion against with some resistance 4/5
(f) Normal - Complete range of motion with full or normal resistance 5/5
Muscle Strength:
When is muscle strength considered a disability
3 or less
Muscle weakness may result from
(a) Disuse atrophy
(b) Pain
(c) Fatigue
(d) Overstretching
Sensory Evaluation:
(1) Nerve root function should be tested.
(a) If symptoms might be due to neck or back problems.
(b) If disorder is localized to the extremities.
(2) Evaluate one muscle (myotome) and one area of sensation (dermatome) for each nerve
root or peripheral nerve in question (Essentials: General Orthopedics, Principles of
Musculoskeletal Evaluation, Evaluation of Peripheral Nerves Table)
Vascular / Reflexes
(1) Consider checking pulses and performing reflexes for certain situations:
(a) Trauma
(b) Weakness, numbness, radiating pain from the neck or back.
Special Tests
(1) Test conducted to determine presence or absence of specific pathology.
