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.

Alright, 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 point forward and be aligned with the trunk. If they deviate outward, it's called genu varum or bow leg; 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 pes cavus, which is a higher-than-normal arch.

Finally, inspect the toes, which should appear straight and in alignment. Abnormalities of the toes include hammertoe, where the middle joint is bent; claw toe, where the toes are bent in a claw-like position; hallux valgus, or bunion, where there’s a lateral deviation of the hallux, or great toe; and hallux varus 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 structures 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 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 boutonniere deformities.