Health Assessment

Musculoskeletal Assessment
- Carpals

are short bones

- Long bones could be the femur or the humorous
- Flat bones sternum and out ribs
- Irregular bones such as our hips or our vertebrae
- Non synovial joint- united by fibrous tissue, it could be
immovable or slightly immovable. Ej is the sutures of our skull.
- Synovial joints: connected by ligaments which are fibrous
bands.
- Smooth muscles are is our internal organs or arteries.
- Cardiac muscle:
- Skeletal muscles: they are under conscious control, they attach
to the bone through fibrous tendons, but they are very specific
in sites.
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SKELETAL MUSCLE MOVEMENTS

SKELETAL MUSCLE MOVEMENTS

Subjective Data

Joint pain: RA- symmetric joints pain. Is worst in the morning/

Osteoarthiritis is worse later in the day.
Tendinitis is worse in the morning, but improves throughout the day.
Stiffness, Swelling, heat, redness

Muscles: Myalgia: muscle pain felt as cramping or aching. Viral can

worsen situation.
Pain, cramping, weakness

Bones: Fractures causes sharp pain that increases with movement

Deformity (Someone who had a bone injury/ rickets) , pain

Limited movement
Assistive devices. Do they need to use a cane or a walker?

Exercise or activity pattern

Functional assessment. Can they Exercise and do certain movements?

History of injury or overuse

Occupation (repetitive movements) carpals movement.
Trauma, sprains (A sprain is a stretched or torn ligament. Ligaments are tissues
that connect bones at a joint) , dislocations (Dislocations are joint injuries that
force the ends of your bones out of position).

Health history
Rheumatoid arthritis, osteoporosis (loss of bone density/ more prominent in white
4 and vitamin D
females or early menopausea), nutritional status (Ca ++ intake)

OBJECTIVE DATA
Inspect all major joints and muscles

Inspection: all major joint and muscle

Size and contour of joint

Skin color and characteristics: swelling, masses or deformity (Dislocation).

Swelling may be excess joint fluid.

Symmetry
Position and shape

GAIT EVALUATION
Posture

Erect, stooped over because of osteoporosis

Movements

Coordinated and rhythmic

Stride: Walking fast.

Appropriate length

Heel to foot placement

difficulty lifting the front part of the foot. If you have foot drop, you may drag the
front of your foot on the ground when you walk. (a lot in the elderly).
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OBJECTIVE DATA
Palpate all major joints and muscles
We can palpate and inspect at the same time
Joints normally are not tender to palpation! ROS is done.
Synovial membranes are usually non-palpable, when thicken
it feels Doughty or Boggy!

Palpation of joint area

Skin
Muscles
Bony articulations
Joint capsule
note tenderness/pain, warmth, swelling, can you feel for
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fluid.

OBJECTIVE DATA
Can they move all of these joints?
Range of Motion
Active
Passive: you would rate it as a 2 in a scale 0-5.
If there is limitation upon assessment do passive motion for the
client. Anchor the joint w/ one hand and the other hand will
slowly move it until it reaches its limit. Normal ranges of active
and passive motion should be the same. Use a Goniometer.
Goniometer if abnormality present, measure that joint when
there is some problems. We are looking at how much Extension
and Flexion of the joint does the person have?
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OBJECTIVE DATA
Muscle testing
Test strength: when we ask them to push our hand or
pull against resistance. We grade them!
Muscle strength should be equal bilaterally and
should fully resist opposing force. (muscle status
and joint status are interdependent [dependent on
each other] and should be interpreted together.

TMJ: You are assessing the integrity of CN V.

- Does this individual have full range of motion or do we hear
any crepitation.
- they should be able to open (vertical version) it from 3-6 cm
- The lower mandible ( Partially open, protrude, lower jaw
and lateral mov. 1-2 cm.
- they should protrude the lower jaw with any kind of deviation.

Cervical Spine: testing the integrity of cranial nerve XI (spinal)

- Rotate on an axis, we are able to flex, or even extent
our head.
- The Spine should be straight and head erect.
- Palpate the spinous process and sternomastoid,
trapezius, and paravertebral muscles.
- They should be firm no spasm or tenderness.

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Shoulder assessment also test for cranial nerve XI, Spinal

accessory.

Abduction & adduction

Internal rotation

Forward flexion & hyperextension

External rotation
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Joint effusion:
Dislocated shoulder

Atrophy
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ELBOW
LEFT POSTERIOR VIEW

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Olecranon Bursitis

Gouty arthritis
Subcutaneous Nodules
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FINGERS AND WRIST

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Carpal Tunnel

Phalens test
Tinels sign
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Ulnar drift/rheumatoid arthritis

Swan neck deformities

Dupuytrens contracture

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Rheumatoid arthritis
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Syndactyly

polydactyly

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Hip

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The Hip:

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KNEE

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Synovitis with effusion

Cyst in medial meniscus

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FOOT AND ANKLE

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Achilles tenosynovitis
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Hallux valgus, bunion & hammer toe

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Gout
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Back

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Movement of the Back

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Scoliosis

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Scoliosis Screening
Screening of school aged children

Tip: involves a lateral curvature of the

spine with an increase in convexity on
the side that is curved
- The curve will go away if the move a
certain way.
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Scoliosis Screening Procedure

Have client stand with feet together and aligned
Maintain a forward directed gaze when
standing
Stand erect with shoulders relaxed and arms
fully extended at sides while slowly bending
forward at the waist
Look at the buttuck
Slowly return to erect position after forward
bending
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Scoliosis
Functional Scoliosis
Flexible
Apparent when
standing
Disappears with
forward bending
May be a
compensation for
other deformities (leg
length discrepancy)

Structural Scoliosis
Fixed
Curvature shows both
on standing and
bending forward

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The aging adult

Postural changes
Change in height: compression of the vertebra
Kyphosis
Flexion of the hips and knees, they will walk with
more flexion.

Gait
Shuffling pattern
Broader base of support

Osteoporosis
Rheumatoid arthritis
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