musculoskeletal assessment Flashcards
examples of subjective data
pain or discomfort, weakness, stiffness, limited movement, swelling/heat, deformity, lack of balance
examples of past medical history
MSK trauma, surgery, skeletal anomalies, chronic illness
how does chronic illness affect the bones
long term steroids can weaken the bones
health history tips
always obtain mechanism of injury, timing of pain, popping/clicking/grating, joint instability, swelling, effect on ADLs
what is the purpose of the MSK exam?
do assess function for ADLs and to screen for abnormalities
how should the physical exam be performed
head to toe, proximal to distal, bilateral comparison
what are the components of the MSK exam
inspection and palpation only
what should you inspect/palpate for
- posture and gait
- muscle characteristics (tone/bulk)
- ROM
- strength
- joint exam
what is the joint exam looking for
tenderness, swelling, redness, heat, crepitus, reduced ROM
inspection of MSK includes…
size and contour of joint
inspection of skin and tissues for color change
swelling
any masses or deformity
palpation of MSK includes…
palpate each joint, including skin for temperature, muscles, bony articulations, and area of capsule
- joints are normally not tender
muscle strength testing
0/5- no muscle contraction
1/5- slight muscle contraction evident, no joint movement
2/5- full ROM with gravity eliminated (passive only)
3/5- full ROM with gravity
4/5- full ROM against gravity with some resistance
5/5- full ROM against gravity and full resistance
normal spinal curvature
thoracic convexity, cervical and lumbar concavity
abnormal spinal curvatures
scoliosis - lateral curve
kyphosis - hunchback
lordosis - exaggerated lumbar concavity
gait - smooth and rhythmic
balance and coordination tests
walk on heels, toes, tandem walk, sit and stand
rapid alternating movements (ex fingers to thumb and heel to shin)
what do balance abnormalities indicate?
neuro, MSK, or vestibular problems
measuring extremities
muscle bulk and symmetry, strength and tone, range of motion
expected extremities
symmetrical and even
range of motion test
active and passive, if active ROM is full, no need to test passive
always ask patient to perform active first
joint exam expected findings
bony structures aligned, full active and passive ROM, no swelling, tenderness, redness, warmth, or crepitus
abnormalities that affect multiple joints
rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, osteoporosis
shoulder abnormalities
atrophy, dislocated shoulder, joint effusion, tear of rotator cuff, frozen shoulder
elbow abnormalities
olecranon bursitis, arthritis, rheumatoid nodules, epicondylitis
spine abnormalities
scoliosis, herniated intervertebral disc
wrist and hand abnormalities
ganglion cyst, colles’ fracture, carpal tunnel syndrome with atrophy of thenar eminence, ankylosis, dupuytren’s contracture
knee abnormalities
osgood-schlatter disease
post-polio muscle atrophy
prepatellar bursitis
swelling of menisci
ankle and foot abnormalitites
achilles tenosynovitis
tophi with chronic gout/acute gout
hallux vagus with bunion and hammer toes
plantar fascitis
ingrown toenail
plantar wart
scoliosis exam
- stand before examiner
- anterior iliac symmetry
- shoulder symmetry
- bend at waist for spinal alignment and rib hump
older adults MSK possibility
- decreased bone mass
- decreased height
- decreased joint flexibility
- sarcopenia
- decreaased nutritional intake
- osteoporosis - fractures
- decreased strength and muscle bulk
- decreased agility
- calcium/vitmain D deficiency
osteoporosis risk factors
- female
- over 50
- thin
- smoker
- hypothyroid
- alcohol use
- calcium/vitamin D deficiency
common diagnostic tests
- CK, AST, ALT enzymes elevated with muscle injury
- alkaline phosphatase elevated with bone injury
- uric acid - elevated in gouty arthritis
- x ray
red flags in MSK assessment
- inability to bear weight on extremity
- joint out of alignment
- sensory change distal to MSK injury
- motor change distal to MSK injury
- delayed cap refill or loss of pulse distal to injury
intervention of joint assessment
- PRICE
- splint as it lays
- do not remove protruding objects
- clean dressing if open skin
- monitor neurovascular status
phalen’s and tinel’s tests test for what?
carpel tunnel syndrome
phalen’s test
fingers falling, wrist flexion to maximum for 60 seconds
- abnormal finding; numb fingers
tinel’s test
tapping over transverse carpal ligament, should not cause numbness
symptoms of carpel tunnel syndrome
pain, anesthesia, paresthesia
what to check for in neurovascular check
pain, sensation, skin temperature, cap refill, pulses, movement
6 P’s
strain vs. sprain vs. fracture
strain - tendon and muscle
sprain - ligament
fracture - bone break
