FOUNDATION: Mobility Assessment

mobility definition

Purposeful physical movement, including gross motor, fine motor and coordination

positive consequences of mobility

Purposeful movement

Changing position and/or location without pain or discomfort

negative consequences of mobility

Weakness or loss of function

Patient Injury

Pressure Ulcers

Contractures

what does the musculoskeletal system do

provide support and mobility for the body and the protection of our internal organs

bones

continually remodeling and changing

muscles

attach to bones and help facilitate movement

joints

where two or more bones come together to allow extension and flexion

tendons

help connect muscle to bones

ligaments

connects bone to bone

cartilage

help support weight and facilitate movement

bursae

sacs within the joint that help reduce friction and pain

Joint motion includes

 flexion, extension, hyperextension

 abduction, adduction

 internal & external rotation

 circumduction

 supination, pronation

 inversion, eversion

 thumb opposition

 rotation of the upper trunk

present health status

any chronic diseases

do patient take medication

Changes in ability to move/participate in usual activities?

present health status: any chronic diseases

Loss of bone density or osteoporosis?

present health status: medications

What, and how often?

Take as prescribed?

what type of medicine is it prescribed, over the counter, supplements, etc?

present health status: Changes in ability to move/participate in usual activities?

Changes in muscle strength?

How did you adapt to changes?

past health history questions

Have you ever had accidents or trauma?

Have you had surgery on bones or joints?

past health history questions: Have you ever had accidents or trauma?

like fractures, dislocations, broken bones, etc and are there any continuing problems from those accidents or trauma

past health history questions: have you had a surgery on bones or joints

what was the outcome

Family history questions

Is there a history of curvature of spine (scolosis) or back problems/ pain in your family? (tends to be genetic)

Is there history of: Arthritis? (Rheumatoid arthritis? Osteoarthritis?Gout?)

personal and psychosocial history questions

do you exercise

do you play sports

Do you lift, push, pull, bend, or stoop frequently as part of daily routine at home or work?

personal and psychosocial history questions: do you exercise

how often and what kind of exercise do you do

personal and psychosocial history questions: do you play sports

Which ones, and how often?( certain sports have common injuries associated with them)

how do you protect yourself from injury while exercising or playing sports?

personal and psychosocial history: Do you lift, push, pull, bend, or stoop frequently as part of daily routine at home or work?

How do you protect yourself from muscle strain or injury?

Problem-Based History

Pain

Problems with movement

Problems with daily activities

problem based history: pain questions

where was pain felt

did pain occur suddenly or gradually

does pain move from one joint to another

what makes the pain worse

what was done to relieve the pain

pain questions: where was pain felt

When was it first noticed?

Is it related to movement?

pain questions: Did pain occur suddenly or gradually?

When during day, when do you feel pain?

pain questions: Does pain move from one joint to another?

Any injury, overuse, or strain of muscles or joints?

pain questions: what makes pain worse

Does pain shoot to another part of your body?

pain questions: what was done to relieve the pain

how effective was that

problems with movement (in joints) questions: How long have you had movement problems/ impaired ROM?

Are joints swollen, red, or hot to touch?

problem with movement questions: have you had a recent sore throat

idk

problem with movement questions: muscle weakness

Which muscles?

Does it get worse throughout day/ how does the pain change throughout the day?

problems with movement questions: Do knees or ankles give way with pressure?

What do you think makes it happen?

• getting up from couch? standing up, etc

problems with movement questions: joints felt as if locked and will not move

When?

What relieves it?

What makes it worse?

problem based history: problem with movement questions

How long have you had movement problems?

Have you had a recent sore throat?

Muscle weakness?

Do knees or ankles give way with pressure?

Joints felt as if locked and will not move?

problems with daily activities questions: Are activities limited by musculoskeletal disorder?

To what extent are activities limited?

How do you compensate?

problems with daily activities questions: For patients who have chronic disability or crippling disease:

How has illness affected interactions with family?

Has it affected relationships with friends?

impaired mobility or function may cause…

a self care deficit

how to musculoskeletal system

use a cephalocaudal (head to toe) organization with side-to- side comparisons for examining bones, muscles, and joints.

what are inspecting axial skeleton and extremities for

alignment, contour, symmetry, size, and gross deformities

Inspect axial skeleton and extremities for alignment, contour, symmetry, size, and gross deformities: expected outcomes

Body symmetric, straight spine, knees straight line (hips and ankles), feet flat, forward.

Inspect axial skeleton and extremities for alignment, contour, symmetry, size, and gross deformities: variances

Scoliosis, kyphosis, lordosis.

Scoliosis

lateral curvvature of the spine

kyphosis

posterior curvature of thoracic spine

lordosis

anterior curvature of the spine

what are you inspecting muscles for

size and symmetry

Inspect muscles for size and symmetry: expected outcomes

Bilateral symmetry, muscle circumference equal.

Inspect muscles for size and symmetry: variances

Asymmetry of muscles, unequal muscle circumference (atrophy or hypertrophy).

what are palpating musculoskeletal system for

bones for tenderness;

joints and muscles for tenderness, heat, edema, masses & tone.

Palpate bones for tenderness; joints and muscles for tenderness, heat, edema, masses & tone: expected outcomes

Bones nontender,

joints or muscles same temp as tissue, no tenderness or edema on palpation; firm muscles.

Palpate bones for tenderness; joints and muscles for tenderness, heat, edema, masses & tone: variances

Bones tender

joints or muscles warmer then tissue, with tenderness and/or edema, muscle atrophy or muscle hypertrophy

Inspect range of motion and palpate major joints and adjacent muscles for

tenderness on movement, joint stability, and deformity

Inspect range of motion and palpate major joints and adjacent muscles for tenderness on movement, joint stability, and deformity: expected outcomes

-- Full, active range of motion (ROM) of all joints.

Inspect range of motion and palpate major joints and adjacent muscles for tenderness on movement, joint stability, and deformity: variances

Limited range of motion of any joint

what are you testing for in the muscoskeletal system

muscle strength and compare sides.

• Grade muscle strength--(0-5 Scale)

Test muscle strength and compare sides: expected outcomes

Muscle strength graded 5/5 bilaterally

• Scale of 0-5 where 5 is complete range of motion against gravity with full resistance (to opposing force).

Test muscle strength and compare sides: variances

Muscle strength graded < 5/5, asymmetrical muscle strength.

examination of the spine

Inspect & Palpate shoulders and cervical, thoracic, and lumbar spine for alignment and symmetry:

Inspect & Palpate shoulders and cervical, thoracic, and lumbar spine for alignment and symmetry: expected outcomes

Vertebrae aligned in straight line, shoulders level, no warmth or edema.

Inspect & Palpate shoulders and cervical, thoracic, and lumbar spine for alignment and symmetry: variances

Spinal deformities, erythema, pain, edema.

examination of spine: observation

Observe range of motion of thoracic and lumbar spine.

Observe range of motion of thoracic and lumbar spine: expected outcomes

75 degrees of flexion while touching toes,

30 degrees back from neutral with hyperextension,

35 degrees lateral flexion (Full ROM of the spine).

Observe range of motion of thoracic and lumbar spine: variances

decreased flexion, hyperextension, lateral flexion (decreased ROM of the spine).

examination of the shoulders: Test trapezius muscles for strength: expected outcomes

Strength graded 5/5 bilaterally

examination of the shoulders: Test trapezius muscles for strength: variances

Unequal muscle strength, strength graded <5/5 bilaterally

examination of the shoulders: Inspect shoulders for range of motion: expected outcomes

180 degrees forward flexion,

up to 50 degrees of hyperextension,

180 degrees abduction,

50 degrees adduction,

90 degrees external or internal rotation (full ROM of the shoulder).

examination of the shoulders: Inspect shoulders for range of motion: variances

Decreased flexion, hyperextension, abduction, adduction, external or internal rotation (decreased ROM of the shoulder).

what do you observing elbows for

range of motion

Inspect elbows for range of motion: Expected outcomes

160 degrees of flexion,

180 degrees of extension,

90 degrees of both pronation & supination (full ROM).

Inspect elbows for range of motion: Variances

decreased flexion, extension, supination or pronation

what do you palpate arms and elbows for

tenderness, edema, and nodules.

Palpate arms & elbows for tenderness, edema, and nodules: expected outcomes

-no tenderness, edema or nodules.

Palpate arms & elbows for tenderness, edema, and nodules: variances

-tenderness, swelling, nodules detected when palpating.

what do you test arms (biceps and triceps) for

muscle strength

Test arms (biceps & triceps) for muscle strength expected outcomes

-strength graded 5/5 bilaterally.

Test arms (biceps & triceps) for muscle strength expected: variances

-unequal muscle strength, strength graded <5/5 bilaterally.

what are you inspecting joints of wrists and hands for

symmetry, contour, and number of digits

Inspect joints of wrists and hands for symmetry, contour, and number of digits: expected outcomes

Symmetrical wrists and hands, no edema, and no deformities.

Inspect joints of wrists and hands for symmetry, contour, and number of digits: variances

Asymmetry of wrists or hands, missing digits, deformities

• if deformities present ask if they born with it or due to potential injury

what do yo palpate each joint of hand and wrist for

surface characteristics an tenderness

Palpate each joint of hand and wrist for surface characteristics and tenderness: expected outcome

No edema, lesions, nodules or pain.

Palpate each joint of hand and wrist for surface characteristics and tenderness: variances

Noted edema, pain, nodules or lesions in hand wrist or fingers

what are you testing for in wrists and fingers

muscle strength and observe for range of motion

Test for muscle strength and observe for range of motion of

wrists and fingers: expected outcomes

Symmetrical flexion or extension, able to overcome resistance; bilaterally equal hand grip strength.

70 degrees hyperextension;

90 degrees palmar flexion,

90 degrees metacarpophalangeal (fingers) joint flexion,

30 degrees finger extension;

50 to 60 degrees ulnar deviation,

20 degrees radial deviation (Full ROM of the wrist & hand).

Test for muscle strength and observe for range of motion of

wrists and fingers: variances

asymmetrical muscle strength, muscle strength <5/5, and any decreased ROM of the wrist & hand.

what are you inspecting hips for

symmetry

what are you palpating hips for

stability, tenderness, edema

Inspect hips for symmetry and palpate hips for stability, tenderness, edema: expected outcomes

Symmetrical & stable hips without tenderness, or swelling.

Inspect hips for symmetry and palpate hips for stability, tenderness, edema: variances

- Asymmetrical hips, instability of hip joints, tenderness or edema of the hips.

what do you observe hips for

range of motion

Observe hips for range of motion: expected outcomes

120 degrees flexion from straight extended position,

90 degrees hip flexion from straight extended position,

45 degrees external hip rotation from straight midline position,

40 degrees internal hip rotation from straight midline position,

45 degrees abduction,

30 degrees adduction,

30 degrees hyperextension (Full ROM of the hip).

Observe hips for range of motion: variances

any decrease in flexion, extension, external or internal rotation, abduction, adduction, hyperextension (decreased ROM of the hip)

what do you inspect knees for

symmetry and alignment

Inspect knees for symmetry and alignment: expected outcomes

Knees lined with tibia; ankle without medial or lateral deviation.

Inspect knees for symmetry and alignment: variances

 Knees unaligned with tibia; ankle with decreased medial or lateral deviation.

 -Deformities of the knee: genu valgum (knock-kneed) & genu varum (bowlegged).

what do you palpate knees for

contour tenderness and edema

Palpate knees for contour, tenderness, and edema: expected outcomes

Suprapatellar pouch smooth, nontender, nonedematous, medial and lateral aspects of tibiofemoral joint space nonedematous, nontender, popliteal space smooth, nontender.

Palpate knees for contour, tenderness, and edema: variances

Asymmetrical contour, pain or swelling of the knees.