Physical assessment - Musculoskeletal system: Nursing

Assessment of the musculoskeletal system should be completed as part of a comprehensive assessment, like during a routine physical exam, or as part of a focused exam if a client is experiencing musculoskeletal pain or has sustained an injury. Examination of the musculoskeletal system gives the nurse information about the mobility and stability necessary for physical movement. Let’s review the process of completing a musculoskeletal system assessment.

Okay, the supplies you’ll need for your assessment include a goniometer, scoliometer, a tape measure, and a good source of light. Prepare for the exam by ensuring your client is in a comfortable position, that your hands are warm, and that the temperature in the room is comfortable. Provide privacy by closing the door and curtains, properly draping your client, and only exposing areas of their body as needed to perform your examination.

Remember to position your client to ensure they’re safe and stable, and adapt positioning to address any current injury or complaints. Assess for a history of unilateral weakness, stroke, or mobility issues, and plan to have an assistant in the room if your client has joint instability or is at risk for falling. Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

Now, locating the anatomical landmarks of the musculoskeletal system will help guide the appropriate placement of your equipment and hands throughout your assessment. As you assess the various structures of the musculoskeletal system, you should move systematically, starting from the head and neck, and moving down to the feet and ankles, locating specific landmarks for each area. So, when you’re assessing the temporomandibular area, important landmarks include the tragus of each ear, whereas the landmarks of the hips are the iliac crests and greater trochanters.

The methods of assessment for the musculoskeletal system include inspection and palpation. There are also specialty tests for range of motion and muscle strength and tone.

Alright, so inspection of the musculoskeletal system begins when you first meet your client, as you assess their gait, posture, and signs of pain as they move into the examination room. Normally, clients should have an upright posture and ambulate with an even, smooth, painless gait. As your client is standing, inspect their general body shape and structure. Then, 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.