Musculoskeletal Assessment: Key Concepts and Clinical Skills

Pain (subjective data)

Main reason for musculoskeletal assessment; ask location, onset, severity.

History of trauma

Ask about injuries such as car accidents.

Occupation

Identify risk-related jobs (healthcare workers, athletes, manual labor).

ADLs

Ask about limitations in daily activities.

History of falls

Ask date of last fall; falls within past 3 months ↑ risk score.

Past medical history

Includes surgeries, chronic conditions.

Gait assessment

Observe walking style; should be smooth and coordinated.

Impact of increased weight

More pressure on joints, degenerative joint disease, decreased mobility.

Side-to-side comparison >1 cm difference is significant.

Limb length assessment

Compare both sides for discrepancies.

Muscle size terms

Atrophy = decreased size; Hypertrophy = increased size.

Muscle tone ability

Ability to maintain a position or hold themselves up.

Involuntary movements

Tremors or twitching.

Active ROM

Patient moves the joint independently.

Passive ROM

Nurse moves the joint for the patient.

Pronation

Turning downward or inward.

Supination

Turning upward or outward.

Flexion

Bending a joint.

Extension

Straightening a joint.

Hyperextension

Extension beyond normal range.

Abduction

Moving away from the midline.

Adduction

Moving toward the midline.

Dorsiflexion

Bending foot upward.

Plantar flexion

Bending foot downward.

Inversion

Turning sole inward.

Eversion

Turning sole outward.

External rotation

Rotating joint away from the body.

Internal rotation

Rotating joint toward the body.

Circumduction

Circular movement of a limb.

Deformities

May include trauma effects, contractures, or spasticity.

Contractures

Permanent muscle shortening causing joint stiffness.

Muscle spasticity

Involuntary tightening and stiffening of muscles.

Palpation of joints

Assess shoulders, elbows, wrists, hands, spine, hips, knees, ankles, feet, TMJ.

Crepitus

Grinding or popping sound during joint movement.

Joint palpation findings

Assess pain, warmth, clicking, swelling.

Muscle strength assessment

Apply opposing force to test strength.

Expected strength

Equal or slightly stronger on dominant side.

Strength grading scale

0-5; 5/5 = strong, 0/5 = no contraction.

Spinal inspection

View spine from side; assess curvature.

Kyphosis

Rounded upper back.

Lordosis

Inward curve of lower back.

Scoliosis

Lateral curvature of spine.

Scoliosis screening steps

Shoes/shirt off → bend at waist → arms hang → check for asymmetry.

Signs of scoliosis

Uneven shoulders, hips, trunk asymmetry.

Order of musculoskeletal exam

Focused exam usually; full exam: head-to-toe.

Upper extremity strength

Assess hand grips, arm resistance.

Lower extremity strength

Assess leg lift, pushes, foot movement.

Radiographic tests

X-ray, MRI (no metal), CT scan (contrast warm feeling), bone scans.

Bone density scan (DEXA)

Measures bone mineral content; remove metal.

RA factor

Test for autoimmune musculoskeletal disease (e.g., lupus).

CRP & ESR

Detect inflammation.

Calcium & vitamin D levels

Important for bone strength and muscle/joint health.

Uric acid test

Detects gout (joint pain, swelling, redness).

Risk time for scoliosis

Older children & adolescents highest risk.

Growth spurts

Cause growing pains; females stop growth ~2 years after menarche; males grow until ~18.

Young children

Teach exercise habits and safety measures.

Older adults

At highest risk for musculoskeletal decline; osteoporosis, muscle loss.

Gender differences

Men have stronger/longer bones; Caucasian women highest osteoporosis risk.

Accident/injury prevention

Teach safe behaviors.

Body mechanics Wide base, bend at knees, tight core, object close, avoid twisting.

Nurse lifting techniques

Raise bed, ask for help, slide sheet, lifts, gait belt.

Preventing immobility

Exercise, nutrition, hospital mobility strategies.

Secondary prevention

Osteoporosis screening; fall-risk assessments.

Cane use

Held on stronger side (not dominant side).

Crutch instructions

Fitted to height; weight on hand grips; elbows flexed 20-30°.

Tripod position

Baseline standing position for crutch walking.

Walker instructions

Walker moves first, then weak leg, then strong leg.

Muscle-related injuries

Includes sprains, tears; treat with PRICE/RICE.

Activity restrictions

NWB = no weight; TTWB = toe-touch only.

Fracture types

Direct vs pathologic; complete vs partial; open vs closed.

Fracture complications

Infection, bleeding, nerve damage, atrophy, compartment syndrome, embolism, pressure ulcers, respiratory issues, sleep problems.

Fracture diagnostics

X-ray and MRI.

Fracture treatment

Immobilization and/or surgery.

Nursing fracture assessment

Check color, swelling, movement, temperature, sensation, pain, complications.

Nursing evaluation

Check if interventions are effective.

Home/lifestyle factors

Consider safety, mobility, support system.

Subcutaneous injection

45° angle; small needle.

Intradermal injection

15° angle; small needle; look for wheal.

Intramuscular injection

90° angle; 1-1.5" needle.

IM sites (Deltoid)

Max 2 mL.

IM sites (Vastus lateralis)

Can handle more than 2 mL.

IM sites (ventrogluteal

Safe site for larger volumes.

Z-track method

Used to prevent medication leakage into subcutaneous tissue.