Musculoskeletal System

bones,
muscles,
cartilage,
ligaments,
tendons,
joints.

and

 posture,
gait,
bone

size and structure,

joint range of motion (ROM), and
muscle strength.

Normally,
the joints are bilaterally
equal in size, shape, and color; are free of swelling,
pain,
nodules, or crepitus (grating sounds on movement);
and
can move through full ROM.

Abnormal findings
Deformity
limited ROM indicating
injury,
arthritis of the affected joints or bones, and
muscle pain and/or weakness caused by injury or
disease.

A tremor is an involuntary trembling of a limb or body part.

Tremors may involve large groups of muscle fibers or small
bundles of muscle fibers.
An intention tremor becomes more apparent when an
individual attempts a voluntary movement, such as holding a
cup of coffee.
A resting tremor is more apparent when the client is at rest
and diminishes with activity.
A fasciculation is an abnormal contraction of a bundle of
muscle fibers that appears as a twitch.

Equipment
Goniometer
Tape measure

Health History
History

of trauma, arthritis, or neurologic disorder

History of pain or swelling in the muscles and/or joints
Frequency and type of usual exercise
Dietary intake of calcium
History of any surgery on muscles or joints
History of smoking (how long, how many packs/day)
History of alcohol intake

 Muscle

pain: onset, location, character, associated

phenomena
redness and swelling of joints-and aggravating and
alleviating factors;
limitations to movement or inability to perform
activities of daily living;
previous sports injuries;
loss of function without pain.

Positions
standing,
sitting,
supine.

and

INSPECTION AND PALPATION

MUSCLES
BONES
JOINTS
SPINAL CURVES

Muscles

Muscles
Inspect

the muscles for size.

Compare the muscles on one side of the body (e.g.,
of the arm, thigh, and calf) to the same muscle on the
other side.
For any discrepancies, measure the muscles with a
tape.
Equal size on both sides of body
Atrophy (a decrease in size) or
hypertrophy (an increase in size), asymmetry

Muscles
Inspect

the muscles and tendons for contractures

(shortening).

No

contractures

Malposition

of body part, e.g., foot drop (foot

flexed downward)

muscles
Inspect

the muscles for tremors

client hold the arms out in front of the body.
No

tremors

Presence

of tremor

ASSESSING MUSCLE STRENGTH

 Assess

muscle strength by asking the patient to

move against resistance.
Bilateral equal resistance should be present.
Observe muscle contraction and determine muscle
strength exerted.
Muscle strength should be bilaterally equal, with a
slight increase on the dominant side.

Techniques for assessing

the muscles include:

Sternocleidomastoid:
Client turns the head to one side against the
resistance of your hand.
Repeat with the other side.

Trapezius:
Client

shrugs the shoulders against the resistance

of your hands.

Deltoid:

Triceps:

Wrist and finger muscles:

Grip strength:

Hip muscles

Hip abduction:
Client

is supine, both legs extended.

Place your hands on the lateral surface of each
knee;
client spreads the legs apart against your
resistance.

Hip adduction:
Client

is in same position as for hip abduction.

Place your hands between the knees;
client brings the legs together against your
resistance.

Hamstrings:

Quadriceps:

Muscles of the ankles and feet:

Equal strength on each body side

25% or less of normal strength

Grading Muscle Strength

0: 0% of normal strength; complete paralysis

1: 10% of normal strength; no movement, contraction of
muscle is palpable or visible
2: 25% of normal strength; full muscle movement against
gravity, with support
3: 50% of normal strength; normal movement against gravity
4: 75% of normal strength; normal full movement against
gravity and against minimal resistance
5: 100% of normal strength; normal full movement against
gravity and against full resistance

Abnormal findings
atrophy

(a decrease in size),
tremors (involuntary movements), and
flaccidity (without tone) of muscles.
loss of strength and tone,
decreased range of motion,
Uncoordinated movements,
swelling, and pain.

 musculoskeletal

disease,

trauma,
a

neurologic disease.

Bones

Bones
Inspect
No

the skeleton for structure.

deformities

Bones

misaligned

 Palpate

the bones to locate any areas of edema or

tenderness.
palpate for normal contour and
for bilateral symmetry.
No

tenderness or swelling

Abnormal findings include

Tenderness
pain,
Enlargement/swelling,
asymmetry, and
changes in contour.

may indicate
fracture,
Osteoporosis
trauma,
degenerative joint disease,
musculoskeletal disease,
neurologic disease.

Joints

Joints
Inspect the joint for
swelling.

Palpate each joint for

tenderness,
smoothness of movement,
swelling,
crepitation, and
presence of nodules.

 Each

joint is put through its full range of motion to

assess the degree of movement.
Joint movements include
flexion,
extension,
hyperextension,
abduction,
adduction,

 Assess

joint range of motion-joint movements.

Varies

to some degree-persons genetic makeup

and degree of physical activity.

Limited

range of motion in one or more joints

 Ask

the client to move selected body parts.

The amount of joint movement can be measured
by a goniometer,
a device that measures the angle of the joint in
degrees.

INSPECTING SPINAL CURVES

INSPECTING SPINAL CURVES

With

the patient standing, inspect the spine from the

back and from the side.

The

spine normally has

concave curves at the cervical and lumbar spine
and
convex curves at the thoracic and sacrococcygeal
spine.

INSPECTING SPINAL CURVES

Kyphosis

(an increased thoracic spinal curve) is

more often seen in older adults.
An exaggerated lumbar curve (lordosis) is often
seen during pregnancy or in obesity.
Scoliosis is a lateral curvature of the spine with
increased convexity on the side that is curved.

Normal Age-Related Variations

INFANT/CHILD
C-shaped curve of spine at birth; the anterior
cervical
Lordosis (an exaggerated lumbar curve)
Genu varum (bowleg) for 1 year after learning to
walk
Newborn, arms and legs -extension and released,
naturally return to the flexed fetal position.

OLDER ADULT
Loss of muscle mass and strength
Decreased range of motion
Kyphosis
Decreased height
Osteoarthritic changes in joints