Assessing Musculoskeletal System

What are the major functions of the musculoskeletal system?

Support and shape the body, protect internal organs, and allow movement.

What are the major functions of bones?

Provide structure and posture, protect internal organs, store calcium, and provide a site for hematopoiesis.

What is the difference between compact and spongy bone?

Compact bone forms the dense outer portion of bone; spongy bone is located internally and contains spaces associated with bone marrow.

What are the functions of osteoblasts and osteoclasts?

Osteoblasts build bone; osteoclasts resorb or break down bone.

What are the three types of muscle tissue?

Skeletal, cardiac, and smooth muscle.

What are the characteristics and functions of skeletal muscle?

Skeletal muscle is voluntary, attaches to bones through tendons, and contributes to movement, posture, and heat production.

What are the characteristics of cardiac muscle?

Cardiac muscle is involuntary and striated.

What are the characteristics of smooth muscle?

Smooth muscle is involuntary and nonstriated and is found in structures such as blood vessels and the gastrointestinal tract.

What is abduction?

Movement away from the midline of the body.

What is adduction?

Movement toward the midline of the body.

What is circumduction?

Circular movement of a limb that combines flexion, extension, abduction, and adduction.

What is inversion?

Turning the sole of the foot inward.

What is eversion?

Turning the sole of the foot outward.

What is flexion?

Decreasing the angle of a joint.

What is extension?

Increasing the angle of a joint.

What is pronation?

Rotating the forearm so the palm faces downward.

What is supination?

Rotating the forearm so the palm faces upward.

What is protraction?

Moving a body part forward.

What is retraction?

Moving a body part backward.

What is rotation?

Turning a body part around its axis.

What are the three major types of joints?

Fibrous, cartilaginous, and synovial.

What is a fibrous joint?

An immovable joint connected by fibrous tissue, such as the sutures of the skull.

What is a cartilaginous joint?

A slightly movable joint connected by cartilage, such as intervertebral discs and costal cartilage.

What is a synovial joint?

A freely movable joint containing a joint cavity, capsule, and synovial fluid.

What subjective information should be collected during a musculoskeletal assessment?

Ability to perform ADLs, weight gain, TMJ problems, pain, injuries and surgeries, relevant medical history, family history, medications and supplements, tobacco/alcohol/caffeine use, nutrition, activity and exercise, occupation, and use of assistive devices.

What health-history conditions are particularly relevant during a musculoskeletal assessment?

Tetanus and polio history, diabetes, sickle cell disease, systemic lupus erythematosus, osteoporosis, menopause, and hormone replacement therapy.

What nutritional information is important during a musculoskeletal assessment?

Dietary intake of calcium and vitamin D.

What should the nurse inspect during the objective musculoskeletal examination?

Body and joint size, shape and symmetry, skin, and spinal alignment.

What should the nurse assess through palpation of the musculoskeletal system?

Crepitus, edema, effusion, temperature, and tenderness.

What types of range of motion may be assessed?

Active and passive range of motion.

What is active range of motion?

The client independently moves the joint through its range of motion.

What is passive range of motion?

The examiner moves the client's joint through its range of motion.

What does muscle strength grade 5 indicate?

Full range of motion against gravity and full resistance; normal strength.

What does muscle strength grade 4 indicate?

Full movement against gravity with some resistance; slight weakness.

What does muscle strength grade 3 indicate?

Movement against gravity but not against added resistance.

What does muscle strength grade 2 indicate?

Range of motion with gravity eliminated.

What does muscle strength grade 1 indicate?

A trace or flicker of muscle contraction without joint movement.

What does muscle strength grade 0 indicate?

No muscle contraction or paralysis.

What does non-weight-bearing (NWB) mean?

No weight is placed on the affected extremity.

What does toe-touch weight-bearing (TTWB) mean?

The toes may touch the floor for balance, but weight is not transferred through the affected extremity.

What does partial weight-bearing (PWB) mean?

Only a small or prescribed percentage of body weight is placed on the affected extremity.

What does weight-bearing as tolerated (WBAT) mean?

The client places as much weight on the affected extremity as comfort and pain allow.

What does full weight-bearing (FWB) mean?

The client may place full body weight on the affected extremity.

What is the purpose of the Egress test?

To determine whether the client can safely progress with mobility.

What are the steps of the Egress test?

Sit-to-stand with minimal assistance or an assistive device → march in place three times → advance and return each foot.

What age-related change occurs in skeletal muscle?

Sarcopenia, or loss of muscle mass.

What musculoskeletal changes may occur with aging?

Decreased muscle mass, loss of bone density, loss of height from intervertebral disc changes, decreased flexibility and range of motion, decreased cartilage hydration, and changes in posture and stability.

What is osteoporosis?

Progressive bone demineralization that produces porous, weak bones and increases the risk of low-trauma fractures.

Why may osteoporosis remain undetected?

It can be silent until a fracture occurs.

When should women be screened for osteoporosis according to the notes?

At age 65 years and older.

What nonmodifiable risk factors for osteoporosis are identified in the notes?

Advanced age, female sex, family history, previous low-impact fracture, Caucasian or Asian background, postmenopausal status, and glucocorticoid use.

What modifiable risk factors for osteoporosis are identified in the notes?

Alcohol use, smoking, poor nutrition or low calcium intake, vitamin D deficiency, and physical inactivity.

How should the nurse modify a musculoskeletal examination when the client is experiencing pain?

Stop painful assessment steps, provide pain medication before the examination when appropriate, use firm but gentle support, reposition the client as needed, and resume when pain is controlled.

What is a corn?

A localized thickened area with a central core that commonly develops over a bony prominence.

What is a hammer toe?

Hyperextension of the metatarsophalangeal joint with flexion of the proximal interphalangeal joint.

What is a plantar wart?

A vascularized lesion on the plantar surface of the foot associated with HPV.