Musculoskeletal Assessment Subjective data:
Musculoskeletal Assessment Subjective data: 1-Joints; pain, stiffness, swelling, heat, redness, limitation of movement 2-Muscles; pain, cramps, weakness 3-Bones; Pain, deformity, trauma (fractures, sprains, dislocations) 4-Functional assessment ( activities of ADL’s) 5-Self-care behaviors Inspection: Note size and contour of the joint. Inspect the skin and tissues over the joints for colour, swelling and any masses or deformity. The presence of swelling is significant and signals joint irritation. TMJ (Temporomandibular joint) Inspection; Symmetry, Color, Swelling Palpation: With the pt seated, inspect the area just anterior to the ear. Place the tips of your first two fingers in front each ear, ask the pt to open and close the mouth. Drop your fingers in the depressed area over the joint, and note smooth motion of the mandible. An audible and palpable snap ou clock occurs in many healthy people as the mouth opens. Crepitus and pain occur with temporomandibular joint dysfunction. Range of motion: Ask pt to open mouth maximally: vertical motion=normal space is 3-6 cm or 3 fingers between upper and lower incisors. Ask pt to trust lower jaw side to side: Lateral motion= normal extent is 1-2 cm Ask pt to stick out jaw: Protusion without deviation Ask pt to clench teeth and palpate contracted temporalis and masseter muscles. Compare firmness and strength+ again resistance.
Cervical spine Inspection: Inspect alignment of head and neck and symmetry of muscles. The spine should be straight and the head erect. While standing assess position, alignment of spine vertically/horizontally at scapulas, cervical curve and thoracic curve. Palpation: Palpate the spinous processes and the sternomastoid, trapezius, and paravertebral muscles. They should feel firm, with no muscle spasm or tenderness. Range of motion: Touch chin to chest= flexion of 45 degrees Lift chin to ceiling= hyperextension of 55 degrees Move each ear toward the corresponding shoulder. Do not lift shoulder.= Lateral bending of 40 degrees Turn the chin towards each shoulder= Rotation of 70 degrees Ask the pt to repeat the motions while you apply opposing force. The pt normally can maintain flexion against your full resistance. This also tests cranial nerve XI. Shoulders Inspection: Inspect and compare both shoulders posteriorly and anteriorly. Check the size and contour of the joint, and compare the shoulders for equality of bony landmarks. Normally no redness, muscular atrophy, deformity, or swelling is present. Check the anterior aspect of the joint capsule and the subacromial bursa for abnormal swelling. Palpation: While you stand in front of pt, palpate both shoulders, noting any muscular spasm or atrophy, swelling, heat or tenderness. Start at the clavicle and methodically explore the acromiuclavicular joint, scapula, greater tubercle of the humerus, area of the sunacromial bursa, the biceps groove, and the anterior aspect of the glenohumeral joint. Palpate the pyramid-shaped axilla; no adenopathy or masses should be present. Range of motion: (abduction, adduction, horizontal foward flexion, horizontal backward flexion, circumduction, external rotation, internal rotation) With arms at sides and elbows extended, move both arms foward and up in wide vertical arcs, and then move them back= fowars flexion of 180 degrees; hyperextension of up to 50 degrees.
Rotate arms internally behind back, and place back of hands as high as possible toward the scapulae= internal rotation of 90 degrees With arms at sides and elbows extended, raise both arms in wide arcs in the coronal plane. Touch palms together above head= Abduction of 180 degrees and adduction of 50 degrees Touch both hands behind the head with elbows flexed and rotated posteriorly= external rotation of 90 degrees Test the strength of the shoulder muscles by asking the pt to shrug the shoulders, flex them foward and up, and abduct them against your resistance. Elbow Inspection: ( symmetry, texture and color) Inspect size and contour of the elbow in both flexed and extended positions. Look for any deformity, redness, or swelling. Check the olecranon bursa and the normally present hollows on either side of the olecranon process for abnormal swelling. Palpation: Palpate the pts elbow flexed and 70 degrees and as relaxed as possible. Palpate the extensor surface of the elbow, the olecranon process and the medial and lateral epicondyles of the humerus. Normally, tissues and fat pads feel fairly solid. Check for any synovial thickening, swelling, nodules, or tenderness. Palpate the area of the olecranon bursa for heat, swelling, tenderness, consistency or nodules. Range of motion: Bend then straighten the elbow= flexion of 150-160 degrees, extension at 0 ( some healthy pp lack 5-10 degres of full extension and others have 5-10 degrees of hyperextension Hold the hand midway ; then touch the front and back sides of the hand to the table= movement of 90 degrees in pronation and supination While you test muscle strength; stabilize the pt’s arm with one hand. Apply resistance just proximal to the wrist, and instruct the pt to flex the elbow against resistance. Then ask the pt to extend the elbow against your resistance. Wrists and hands Inspection: Inspect the hands and wrists on the dorsal and palmer sides, noting position, contour and shape. In the normal functional position of the hand, the wrist is in slight extension. Normally no swelling, or redness, deformity, or nodules are present. The skin looks smooth, with knuckle wrinkles present and no swelling or lesions.
Muscles are full, with palm showing a rounded mound proximal to the thumb ( the thenar eminence) and a smaller rounded mound proximal to the little finger. Palpation: Palpate each joint in wrist and hands, while wrist is relaxed and in straight alignment. Normally joints surfaces feel smooth, with no swelling, bogginess, nodules, or tenderness. Palpate interphalangeal joints. Normally no synovial thickenin, tenderness, warmth, or nodules are present. Range of motion: Bend the hand up at the wrist= hyperextension of 70 degrees Bend hand down the wrist= palmar flexion of 90 degrees Bend fingers up and down at metacarpophalangeal joints= flexion of 90 degrees and hyperextension of 30 degrees With palms flat on table, turn them outward and in = Ulnar deviation of 50-60 degrees; radial deviation of 20 degrees Spread fingers apart; then make a fist= Abduction of 20 degrees: tight fist; equal bilateral responses Touch the thumb to each finger and to the base of the little finger= ability to perform this manoeuvre, and equal bilateral responses Muscle testing Position the pt’s forearm supinated (palm up) on a resting table. Stabilize the pt’s arm by holding your hand at mid-forearm. Ask the pt to flex wrist against your resistance at the palm. Phalen test Ask pt to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 sec produces no symptoms in the normal hand. Numbness and burning with carpal tunnel syndrome. Tinel’s sign Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand. Burning and tingling in carpel tunnel.
Cervical spine Inspection: Inspect alignment of head and neck and symmetry of muscles. The spine should be straight and the head erect. While standing assess position, alignment of spine vertically/horizontally at scapulas, cervical curve and thoracic curve. Palpation: Palpate the spinous processes and the sternomastoid, trapezius, and paravertebral muscles. They should feel firm, with no muscle spasm or tenderness. Range of motion: Touch chin to chest= flexion of 45 degrees Lift chin to ceiling= hyperextension of 55 degrees Move each ear toward the corresponding shoulder. Do not lift shoulder.= Lateral bending of 40 degrees Turn the chin towards each shoulder= Rotation of 70 degrees Ask the pt to repeat the motions while you apply opposing force. The pt normally can maintain flexion against your full resistance. This also tests cranial nerve XI. Shoulders Inspection: Inspect and compare both shoulders posteriorly and anteriorly. Check the size and contour of the joint, and compare the shoulders for equality of bony landmarks. Normally no redness, muscular atrophy, deformity, or swelling is present. Check the anterior aspect of the joint capsule and the subacromial bursa for abnormal swelling. Palpation: While you stand in front of pt, palpate both shoulders, noting any muscular spasm or atrophy, swelling, heat or tenderness. Start at the clavicle and methodically explore the acromiuclavicular joint, scapula, greater tubercle of the humerus, area of the sunacromial bursa, the biceps groove, and the anterior aspect of the glenohumeral joint. Palpate the pyramid-shaped axilla; no adenopathy or masses should be present. Range of motion: (abduction, adduction, horizontal foward flexion, horizontal backward flexion, circumduction, external rotation, internal rotation) With arms at sides and elbows extended, move both arms foward and up in wide vertical arcs, and then move them back= fowars flexion of 180 degrees; hyperextension of up to 50 degrees.
Rotate arms internally behind back, and place back of hands as high as possible toward the scapulae= internal rotation of 90 degrees With arms at sides and elbows extended, raise both arms in wide arcs in the coronal plane. Touch palms together above head= Abduction of 180 degrees and adduction of 50 degrees Touch both hands behind the head with elbows flexed and rotated posteriorly= external rotation of 90 degrees Test the strength of the shoulder muscles by asking the pt to shrug the shoulders, flex them foward and up, and abduct them against your resistance. Elbow Inspection: ( symmetry, texture and color) Inspect size and contour of the elbow in both flexed and extended positions. Look for any deformity, redness, or swelling. Check the olecranon bursa and the normally present hollows on either side of the olecranon process for abnormal swelling. Palpation: Palpate the pts elbow flexed and 70 degrees and as relaxed as possible. Palpate the extensor surface of the elbow, the olecranon process and the medial and lateral epicondyles of the humerus. Normally, tissues and fat pads feel fairly solid. Check for any synovial thickening, swelling, nodules, or tenderness. Palpate the area of the olecranon bursa for heat, swelling, tenderness, consistency or nodules. Range of motion: Bend then straighten the elbow= flexion of 150-160 degrees, extension at 0 ( some healthy pp lack 5-10 degres of full extension and others have 5-10 degrees of hyperextension Hold the hand midway ; then touch the front and back sides of the hand to the table= movement of 90 degrees in pronation and supination While you test muscle strength; stabilize the pt’s arm with one hand. Apply resistance just proximal to the wrist, and instruct the pt to flex the elbow against resistance. Then ask the pt to extend the elbow against your resistance. Wrists and hands Inspection: Inspect the hands and wrists on the dorsal and palmer sides, noting position, contour and shape. In the normal functional position of the hand, the wrist is in slight extension. Normally no swelling, or redness, deformity, or nodules are present. The skin looks smooth, with knuckle wrinkles present and no swelling or lesions.
Muscles are full, with palm showing a rounded mound proximal to the thumb ( the thenar eminence) and a smaller rounded mound proximal to the little finger. Palpation: Palpate each joint in wrist and hands, while wrist is relaxed and in straight alignment. Normally joints surfaces feel smooth, with no swelling, bogginess, nodules, or tenderness. Palpate interphalangeal joints. Normally no synovial thickenin, tenderness, warmth, or nodules are present. Range of motion: Bend the hand up at the wrist= hyperextension of 70 degrees Bend hand down the wrist= palmar flexion of 90 degrees Bend fingers up and down at metacarpophalangeal joints= flexion of 90 degrees and hyperextension of 30 degrees With palms flat on table, turn them outward and in = Ulnar deviation of 50-60 degrees; radial deviation of 20 degrees Spread fingers apart; then make a fist= Abduction of 20 degrees: tight fist; equal bilateral responses Touch the thumb to each finger and to the base of the little finger= ability to perform this manoeuvre, and equal bilateral responses Muscle testing Position the pt’s forearm supinated (palm up) on a resting table. Stabilize the pt’s arm by holding your hand at mid-forearm. Ask the pt to flex wrist against your resistance at the palm. Phalen test Ask pt to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 sec produces no symptoms in the normal hand. Numbness and burning with carpal tunnel syndrome. Tinel’s sign Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand. Burning and tingling in carpel tunnel.
