Musculoskeletal assessment

Aims of the subjective assessment

About the site, nature, behavior and onset of symptoms, and past treatments. Review the
patients general health, any past investigations, medication and social history. This should lead
to a formulation of the next step of physical tests.
Aims of the objective assessment me Lin history and background.

The objective assessment aims to seek abnormalities of function, using active, passive,
resisted, neurological and special tests of all the tissues involved. This may be guided
by the history. However, it is important to conduct all tests objectively and equally, and not
attempt to bias the findings in an attempt to make the hypothesis fit. Objective examination is
concerned with performing and recording objective signs.
It aims to:
reproduce all or parts of the patients symptoms;
determine the pattern, quality, range, resistance and Pain response for each movement;
identify factors that have predisposed or arisen from the disorder;
obtain signs on which to reassess the effectiveness of
treatment by producing reassessment asterisks or
markers
Look

SUBJECTIVE ASSESSMENTvatio ae ant of findings.

Assess and remember to involve the patient.

Initial questioning

Subjective assessment needs to include the name, address and telephone number of the patient,
and the patients hospital number, if appropriate. Both the age and the date of birth of the patient
should be recorded. The medical referrers name and practice should also be recorded for
correspondence, discharge letters, etc. It is also essential for the physiotherapist to obtain
sufficient details of the patients employment.
Present condition
Area of the symptoms

It is useful to record the area of the pain by using a body chart, because this affords a quick
visual reference (Maitland 2001). The patient may complain of more than one symptom, so the
symptoms may be recorded or referred to individually as P1 and P2 and so on. Areas of
anaesthesia or paraesthesia may be recorded differently on the pain chart they may be
represented as areas of dots in order to distinguish them from areas of pain
Severity of the symptoms

The severity of the pain may be measured on a visual analogue scale (VAS) or on a numerical
scale of 010 to quantify the pain, where 0 stands for no pain at all and 10 is perceived by the
patient as the worst pain imaginable. The mark on a VAS can then be measured and recorded for
future comparisons using a ruler. Although these measures are not wholly objective, they do
allow changes to be monitored as the treatment progresses
Duration of the symptoms

Establish whether the pain and symptoms are intermittentor constant. Is the pain present all of
the time or does it come and go depending on activities or time of day?
Aggravating and easing factors

Musculoskeletal assessment
Positional factors

Most musculoskeletal pain is mechanical in origin and is therefore made better or worse by
adopting particular positions or postures that either stretch or compress the structure that is
giving rise to the pain. Moreover, aggravating and easing movements may provide the
physiotherapist with a clue as to the structure that is causing the pain.Various body or limb
positions place different structures on stretch or compression and the resultant deformation
Produces an increase in severity of the pain. The aggravating and easing factors can be
recorded on the pain chart. It is also necessary to record the length of time that engaging in
aggravating activities produces an increase in symptoms or, alternatively, takes to settle
down. This indicates the irritability of the patients condition.
Time factors