Assessment of the Musculoskeletal System

1. Assessment of the Musculoskeletal System Health Assessment Across the Lifespan NRS 102

2. Structure and Function • Subjective Data—Health History Questions • Objective Data—The Physical Exam • Abnormal Findings

3. Structure and Function • Joints • Nonsynovial or synovial joints • Cartilage • Ligament • Bursa • Muscles • Fasciculi • Tendon • Skeletal muscle movements

4. Synovial Joint

5. Skeletal Muscle Movements

6. Structure and Function (cont.) • Temporomandibular joint • Spine • Vertebrae • Landmarks of the spine • Intervertebral disks • Shoulder • Glenohumeral joint • Rotator cuff • Subacromial bursa • Acromion process • Greater tubercle of the humerus • Coracoid process

7. Landmarks of the Spine

8. Shoulder

9. Structure and Function (cont.) • Elbow • Medial and lateral epicondyles • Olecranon process of ulna • Wrist and carpals • Radiocarpal joint • Midcarpal joint • Metacarpophalangeal joints • Interphalangeal joints

10. Right Elbow

11. Bones of the Hand

12. Hip Acetabulum and head of femur Anterior superior iliac spine Ischial tuberosity Greater trochanter of femur Knee Femur, tibia, and patella Suprapatellar pouch Medial and lateral menisci Cruciate ligaments Prepatellar bursa Quadriceps muscle Ankle and foot Tibiotalar joint Medial and lateral malleolus Metatarsals Structure and Function (cont.)

13. Hip Joint

14. Landmarks of the Knee

15. Ankle and Foot

16. Subjective Data—Health History Questions • Joints • Pain • Stiffness • Swelling, heat, and redness

17. Subjective Data—Health History Questions (cont.) • Muscles • Pain (cramps) • Weakness

18. Subjective Data—Health History Questions (cont.) • Bones • Pain • Deformity • Trauma (fractures, sprains, dislocations)

19. Subjective Data—Health History Questions (cont.) • Functional assessment (activities of daily living) • Self-care behaviors

20. Preparation Screening musculoskeletal examination Complete musculoskeletal examination Equipment needed Tape measure Goniometer, to measure joint angles Skin marking pen Order of the examination Inspection Size and contour of joint Skin and tissues over joint Palpation Skin temperature Muscles, bony articulations, area of joint capsule Range of motion Muscle testing Apply opposing force Grading muscle strength Objective Data—The Physical Exam

21. Objective Data—The Physical Exam(cont.) Temporomandibular joint • Inspect joint area • Palpate as person opens mouth • Motion and expected range • Open mouth maximally • Protrude lower jaw and move side to side • Stick out lower jaw • Palpate muscles of mastication

22. Cervical spine Inspect alignment of head and neck Palpate spinous processes and muscles Motion and expected range Chin to chest Lift chin Each ear to shoulder Turn chin to each shoulder Shoulders Inspect joint Palpate shoulders and axilla Motion and expected range Arms forward and up Arms behind back and hands up Arms to sides and up over head Touch hands behind head Objective Data—The Physical Exam(cont.)

23. Elbow Inspect joint in flexed and extended positions Palpate joint and bony prominences Motion and expected range Bend and straighten elbow Pronate and supinate hand Wrist and Hand Inspect joints on dorsal and palmar sides Palpate each joint Motion and expected range Bend hand up, down Bend fingers up, down Turn hands out, in Spread fingers, make fist Touch thumb to each finger Phalen’s test Tinel’s sign Objective Data—The Physical Exam(cont.)

24. Hip Inspect as person stands Palpate with person supine Motion and expected range Raise leg Knee to chest Flex knee and hip; swing foot out, in Swing leg laterally, medially Stand and swing leg back Knee Inspect joint and muscle Palpate Bulge sign Ballottement of patella Motion and expected range Bend knee Extend knee Check knee during ambulation McMurray’s test Objective Data—The Physical Exam(cont.)

25. Ankle and foot Inspect with person sitting, standing, and walking Palpate joints Motion and expected range Point toes down, up Turn soles out, in Flex and straighten toes Spine Inspect while person stands Palpate spinous processes Motion and expected range Bend sideways, backward Twist shoulders to each side Straight leg raising Measure leg length discrepancy Objective Data—The Physical Exam(cont.)

26. Sample Charting

27. Abnormal FindingsAbnormalities Affecting Multiple Joints • Inflammatory conditions • Rheumatoid arthritis • Ankylosing spondylitis • Degenerative conditions • Osteoarthritis (degenerative joint disease) • Osteoporosis

28. Abnormal FindingsAbnormalities of the Shoulder • Atrophy • Dislocated shoulder • Joint effusion • Tear of the rotator cuff • Frozen shoulder—adhesive capsulitis • Subacromial bursitis

29. Abnormal FindingsAbnormalities of the Elbow • Olecranon bursitis • Gouty arthritis • Subcutaneous nodules • Epicondylitis—tennis elbow

30. Ganglion cyst Colles’ fracture Carpal tunnel syndrome Ankylosis Ulnar deviation or drift Degenerative joint disease or osteoarthritis Acute rheumatoid arthritis Abnormal FindingsAbnormalities of the Wrist and Hand

31. Abnormalities of the Knee Abnormalities of the Ankle and Foot Abnormal Findings • Mild synovitis • Prepatellar bursitis • Swelling of menisci • Achilles tenosynovitis • Chronic/acute gout • Hallux vagus with bunion and hammer toes • Callus • Plantar wart • Ingrown toenail

32. Abnormalities of the Spine Common Congenital or Pediatric Abnormalities Abnormal Findings (cont.) • Scoliosis • Herniated nucleus pulposus • Congenital dislocated hip • Talipes equinovarus (clubfoot) • Spina bifida • Coxa plana (Legg-Calvé-Perthes syndrome)

33. Ankylosis is… • one or more bones in a joint being out of position • partial dislocation of a joint • shortening of a muscle leading to limited range of motion of joint • stiffness or fixation of a joint

34. Why would the examiner ask a high school athlete “what do you do when you get hurt?” • Because so many young athletes are injured that it is important to plan ahead. • Because many athletes are reticent to report injuries because they think it will limit their playing time. • Because it is important for young athletes to understand the risks involved in playing sports. • Because it is important for the athlete to report an injury to a clinician, rather than a coach, who may not take the injury seriously.