Assessment of Musculoskeletal System

Assessment of the musculoskeletal system should be completed during a comprehensive assessment or as part of a focused exam if your patient is experiencing issues with their musculoskeletal system.

Methods of musculoskeletal assessment include inspection, palpation, and special tests. All right, so inspection begins when you first meet your patient, as you observe their posture, which should be upright and movement should be even, smooth and painless.

While your patient is standing, inspect their general body shape and structure. Inspect the spine from the neck to the hips and check for the normal curves of the spine, which include a concave curve of the cervical and lumbar spines and a convex curve of the thoracic and sacral spines.

Note any alterations in spinal curvature such as lordosis or an exaggerated inward curvature of the lumbar spine sometimes seen in pregnant patients, kyphosis, where the upper spine appears more rounded, which can occur in elderly patients, and scoliosis, or a lateral curvature of the spine, usually discovered in childhood.

Next, inspect the posterior head and neck. The head should be positioned midline and aligned with the shoulders, spinal column, and gluteal cleft, which is the area just below the sacrum where the buttocks begin to separate.

The shoulders should be symmetrically positioned on either side of the upper trunk, and the iliac crests of each hip should be even and symmetrical.

Then check the knees. Which should point forward and be aligned with the trunk.

If they deviate outward, it's called genu verum or bow legg. If they deviate inward, it's called genu valgum or knock knee.

Move to the ankles, feet, and toes which should face forward and align with the tibia bones. Each foot should have a longitudinal arch.

However, over time, the feet can begin to flatten as a result of weight bearing. Other foot variations include pes planus, or a foot that stays flat even when not bearing weight, and pescavis, which is a higher than normal arch.

Finally, inspect the toes, which should appear straight and in alignment. Abnormalities of the toes include hammer toe, where the middle joint is bent, claw toe, where the toes are bent in a claw-like position, halix valgus or bunion, where there is a lateral deviation of the halyx or great toe, and halix verris, where the great toe deviates away from the other toes.

Now, starting with the head, palpate the temporomandibular joint by placing your fingers in the joint space that appears anterior to the tragus of the ears as your patient opens and closes their jaw.

If there's a slight popping sound or sensation, this can be normal as long as there are no other symptoms like pain. Next, palpate down the posterior neck and surrounding muscles.

After that, assist your patient to bend forward to palpate spinal alignment. If needed, use a scoliometer to measure the degree of rotation of the spine.

Next, palpate the structure surrounding the shoulders, including the clavicles, scapulae, the greater tubercle of the humerus, and the surrounding muscles, checking for unexpected findings like tenderness, swelling, or crepitus, which is a grating sensation.

Moving on to the elbows, if you find a nodule along the ulnar surface, this could be due to a rheumatoid nodule or a gouty tophus.

For the wrist, use your thumbs to palpate the radiocarpal groove over the dorsum of the wrist. If a lump is present, this could be a ganglion cyst.

Next, palpate each joint in the hands, including the interphalangeal joints or the joints that separate the bones that make up the fingers, and metacarpophalangeal joints or knuckles.

If you note tender swelling of the proximal interphalangeal joints, it is likely associated with rheumatoid arthritis, which can lead to deviations called swan neck or boutonnie deformities.

Likewise, bony growths in the distal interphalangeal joints called Heberden nodes and growths along the proximal interphalangeal joints called Bouchard nodes are associated with osteoarthritis.

Then move to the lower extremities and palpate the bones and muscles surrounding the hips, continuing with the muscles of the legs as you move to the knee joints.

Swelling and tenderness of the hips or knee can indicate an injury or joint effusion, while edema in the popliteal space could be due to a popliteal cyst.

Then palpate the tibiofemoral joint, patella, suprapatellar pouch, and the infrapatellar fat pad. Moving down, palpate the Achilles tendon and the medial and lateral aspects of the ankle.

A thick Achilles tendon can occur with tendonitis secondary to spondyloarthritis or xantholasma of hyperlipidemia. Then palpate each metatarsopphalangeal joint that connects the toes to the foot.

Localized warmth, swelling, or tenderness upon palpation can be associated with joint inflammation, a septic joint, fracture, or tendonitis.

An inflamed metatarsopphalangeal joint of the great toe typically indicates gouty arthritis. You should also assess range of motion or ROM along with muscle strength and tone for each major joint.

To test for active ROM, instruct your patient to move each muscle group and joint. Expected findings include smooth and easy movement through the full range without pain.

Spastic movement, limited ROM, pain, and contractures indicate a problem with the joint, muscle group, or associated nerve supply.

Next, perform passive ROM by asking your patient to relax as you move each muscle group and joint. Remember to stop when resistance is felt to avoid forcing a joint to move unnaturally or if your patient reports pain or a muscle spasm.

Finally, to assess muscle strength, ask your patient to contract a muscle by extending or flexing as you provide resistance in the opposite direction.

For example, you can assess the strength of the hamstring muscle by asking your patient to flex their knee while you try to straighten it.

All right, as a quick recap, assessment of the musculoskeletal system should be completed during a comprehensive assessment or as part of a focused exam if your patient is experiencing issues with their musculoskeletal system.

Methods of musculoskeletal assessment include inspection, palpation, and special tests.