ASSESSMENT OF

MUSCULOSKELETA
L SYSTEM
• Helps to evaluate the client’s level of
functioning with activities of daily living (ADLs)
• Provides data regarding the client’s: POSTURE,
GAIT, BONE STRUCTURE, MUSCLE STRENGTH ,
JOINT MOBILITY
MUSCULOSKELETAL SYSTEM
• Comprises your bones, muscles and joints
• Controlled and innervated by nervous system
• Purpose: provide structure and movement of
body parts
REVIEW OF
ANATOMY
BONES
PURPOSE:
Provide structure and protection
Serve as lever- help in movement
store calcium
Produce blood cells
BONES
A total of 206 bones
-axial skeleton ( head and trunk)
-appedicular skeleton (extremities, shoulders
and hips)
Composed of osseous tissue
2 types:
Compact bone- hard and dense
Spongy bone-numerous spaces and makes up the ends and centers
of the bone.
BONES
Bone tissue is formed by active cells called OSTEOBLASTS
Degraded by cells referred as OSTEOCLASTS
Contains RED MARROW  Blood cells
YELLOW MARROW Fats
PERIOSTEUM- covers the bone
-contains osteoblast, blood vessels(nourishment) and
formation of new bone tissue.
SHAPES: short(carpals), long (femur), flat ( sternum), irregular
shape (vertebrae)
SKELETAL MUSCLES
• 3 TYPES OF MUSCLES
-SKELETAL (VOLUNTARY)-650
 under conscious control
 made up of long muscle fibers (fasciculi)
attach to bones by way of strong, fibrous cords called TENDON
 Assist with posture, produce body heat, allow body to move
-SMOOTH
-CARDIAC
 Major
Muscle
involved
in
move-
ment
 SKELETAL MUSCLE BODY
MOVEMENT
• ABDUCTION – moving away from midline of the body
• ADDUCTION– moving toward the midline of the body
• CIRCUMDUCTION– circular motion

CIRCUMDUCTION
 SKELETAL MUSCLE BODY
MOVEMENT
• INVERSION– moving inward
• EVERSION– moving outward
• EXTENSION– straightening the extremity at the joint and increasing
the angle joint
• HYPEREXTENSION- joint bends greater than 180 degrees
• FLEXION- bending the extremity at the joint and decreasing the angle joint
 SKELETAL MUSCLE BODY
MOVEMENT
• DORSIFLEXION- toes draw
upward to ankle
• PLANTAR FLEXION- toes point
away from the ankle
• PRONATION– turning or
facing downward
• SUPINATION—turning or
facing upward
 SKELETAL MUSCLE BODY
MOVEMENT
• PROTRACTION- Moving forward
• RETRACTION-moving backward
• ROTATION – turning a bone on its own long axis
• INTERNAL ROTATION- turning a bone toward the center of the body
• EXTERNAL ROTATION- turning a bone away from the center of the body
JOINTS (ARTICULATION)
Place where two or more bones meet.
Provides variety of Range of motion (ROM) for thr body parts
Classification:
 FIBROUS JOINTS –joined by fibrous connective tissue
--immovable
e.g. sutures bet. Skull bone
 CARTILAGINOUS/ SYNOVIAL JOINTS –A space bet. the bones that is filled w/
synovial fluids ( lubricant for sliding movt of ends of bones)
contain BURSAE- small sac filled with synovial fluid to cushion the joint
e.g. shoulders, hips, knees, ankles
 MAJOR JOINTS
TEMPOROMANDIBULAR JOINT (TMJ)

MOTION:
Open and closes
mouth
Projects and retracts
jaw
Moves jaw from side
to side
 STERNOCLAVICULAR JOINT

NO MOTION
 ELBOW
MOTION:
Flexion and extension of
the arm
Supination and pronation
of the arm
 SHOULDER
MOTION
Flexion and extension
Abduction and adduction
Circumduction
Rotation ( internal and
external )
 WRIST, FINGERS, THUMB
MOTION
WRISTS: flexion, extension,
hyperextension, adduction, radial
and ulnar deviation
FINGERS: flexion, extension,
hyperextension, abduction and
circumduction
THUMB: flexion, extension,
opposition
 VERTEBRAE (LATERAL VIEW)

MOTION:
Flexion
Hyperextension
Lateral bending
Rotation
 HIP
MOTION:
Flexion w/ knee flexed and
w/ knee extended
Circumduction
Rotation ( internal and
external)
Abduction
adduction
 KNEE
MOTION
Flexion
extension
 ANKLE AND FOOT
MOTION
ANKLE: plantar flexion and
dorsiflexion
FOOT: inversion and eversion
TOES: flexion, extension,
abduction and adduction
ASSESSMENT
PRESENT/ PERSONAL HEALTH
HISTORY
• Recent weight gain ? increases physical stress and strain on MS

• Difficulty in chewing? TMJ dysfunction

• Any joint, muscle or bone pain (COLDSPA) Athritis/ fibromyalgia

• Any past injuries/fractures in the past?

• Last tetanus and polio immunization? transient joint stiffening

• Been diagnosed with DM, sickle cell anemia, SLE or osteoporosis
DM higher risk of having osteoporosis & osteomyelitis

• Menopause higher risk if osteoporosis bec. of decreased level

of estrogen decrese bone density

• Medications? -> diuretics(muscle weakness), steroids ( deplete

bone mass
• Alcohol and caffeine (osteoporosis)
• Routine exercise?
• Occupation-> incorrect body mechanics
• Difficulty performing ADLS  use of assistive device
 ASSESS THE SEVEN FEATURES OF
ANY JOINT PAIN
1. Location. Where is it? Does it radiate?
2. Quality. What is it like?
3. Quantity or severity. How bad is it? (For pain, ask for a rating on a scale of 1 to
10.)
4. Timing. When did (does) it start? How long did (does) it last? How often did
(does) it occur?
5. Setting in which it occurs. Include environmental factors, personal activities,
emotional reactions, or other circumstances that may have contributed to the
illness.
6. Remitting or exacerbating factors. Does anything make it better or worse?
7. Associated manifestations. Have you noticed anything else that accompanies
it?
ASSESSING MUSCLE STRENGTH
RATING EXPLANATION STRENGTH
CLASSIFICATION
5 ACTIVE MOTION AGAINST FULL NORMAL
RESISTANCE
4 ACTIVE MOTION AGAINST SOME SLIGHT WEAKNESS
RESISTANCE
3 ACTIVE MOTION AGAINST AVERAGE WEAKNESS
2 PASSIVE ROM( GRAVITY REMOVE POOR ROM
AND ASSISTED BY EXAMINER)
1 SLIGHT FLICKER OF CONTRACTION SEVERE WEAKNESS
0 NO MUSCULAR CONTRACTION PARALYSIS
 INSPECTION
1.OBSERVE POSTURE
-standing with feet together
NORMAL: posture is erect and comfortable for age
ABNORMAL SPINE CURVATURE :
SCOLIOSIS - A lateral curvature of the spine with an increase
in convexity on the side that is curved/ s-shaped or c-
shaped
KYPHOSIS – a rounded thoracic convexity /sloughing
LORDOSIS – also called SWAYBACK, the spine significantly
inward at the lower back
ANKYLOSING SPONDYLITIS – flattening of the lumbar curvature
-herniated lumbar curvature
Ankylosing spondylitis
 2. OBSERVE GAIT
• Observe as client walk around the room

NOTE: Normal:
Base of support -evenly distributed weight.
Weight-bearing stability -Able to stand on heels and toes
Foot position -Posture erect, movements
Stride and length and cadence of coordinated and rhythmic, arms
stride swing in opposition,
Arm swing -Stride length appropriate
Posture
 ABNORMAL FINDINGS IN GAIT
• CEREBELLAR ATAXIA
- Wide based, staggering, unsteady
gait
- Romberg test (+)
- CEREBELLAR DSE, ALCOHOL OR
DRUG INTOXICATION
 ABNORMAL FINDINGS IN GAIT
PARKINSONIAN GAIT
-shuffling gait, turns accomplished
in very stiff manner
-stooped –over posture with flexed
hips and knees
-PARKINSONS DSE and DRUG
INDUCED PARKINSONIAN( basal
ganglia)
 ABNORMAL FINDINGS IN GAIT
SCISSORS GAIT
Stiff, short gait, thighs overlap
each other with each step
PARTIAL PARALYSIS OF THE
LEGS
 ABNORMAL FINDINGS IN GAIT
SPASTIC HEMIPARESIS
Flexed arm held close to body
while the client drags toe of
legs or circles it stiffy outward
and forward
LESIONS of the UPPER LESION
MOTOR NEURONS in the
CORTICAL SPINAL TRACT
(STROKE)
 ABNORMAL FINDINGS IN GAIT
FOOTDROP
Client lifts foot and knee
high with each step , then
slaps the foot down hard on
the ground
cannot walk on heels
Characteristics of disease of
the lower motor neurons
A Painful Gait (Antalgic Gait)
If bearing weight on a limb is painful, patients adopt
an antalgic gait to minimize the pain.
Trendelenburg gait: pelvis sags on the side opposite the
affected side during single leg stance on the affected side; compensation
occurs during gait by leaning the torso toward the involved side during the
affected extremity's stance phase (congenital dislocation, hip abductor
weakness, rheumatic arthritis, osteoarthritis)
 INSPECT AND PALPATE
TEMPOROMANDIBULAR JOINT
• Inspect the TMJ for swelling or
redness, tenderness.
• Palpate the TMJ as the patient opens
and closes the mouth.
• Palpate the muscles of mastication:
the masseters, temporal muscles,
and pterygoid muscles
• Jaw move side to sidec
• Protrude and retract jaw
 STERNOCLAVICULAR JOINT
• INSPECT: location in
midline, color, swelling, and
masses. (sitting)
• PALPATE: tenderness or pain

• Normal: no bony
overgrowth, swelling or
redness ;joint –non tender
• Abnormal: inflammation of
joint (swollen enlarged
joint, tender)
CERVICAL, THORACIC AND
LUMBAR SPINE
OBSERVE FOR SPINAL CURVES
symmetry, differences in shoulder height, iliac
crest and buttocks creases
 cervical and lumbar –concave ; thoracic—convex
 straight from behind
HYPERLORDOSIS--pregnant
Abnormal : Kyphosis, Lordosis, Ankylosing Spondylitis,
Scoliosis
Ankylosing spondylitis
 TEST FOR ROM OF THE LUMBAR
SPINE
• FLEXION (SCHOBER’S TEST )- 75-
90degree, smooth movt, lumbar
concavity flattens out the spinal
process are in alignment
• HYPEREXTENSION- 30 degrees
• LATERAL – 35 degrees
• ROTATION- 30 degrees
ABNORMAL: low back strain ,
osteoasthritis, a. spondylitis,
congenital abn.
 PALPATE THE SPINOUS PROCESSES
AND PARAVERTEBRAL MUSCLES
• non tender, well developed, firm and smooth, no muscle spasm
• TENDERNESS COMPRESSION FRACTURE AND LUMBOSACRAL
MUSCLE STRAIN
TEST ROM OF THE CERVICAL SPINE
FLEXION (45 DEGREES)AND HYPEREXTENSION OF HEAD
(45DEGREES)
-CERVICAL DISC DEGENERATIVE DISEASE AND SPINAL CORD TUMOR- impaired
ROM ,pain radiates to the back
-CERVICAL STRAIN most common cause of neck pain , impaired ROM
E.g. Sleeping in wrong position, carrying heavy suitcase, car
crash
 LATERAL BENDING can bend 40 degrees both left and right
 LIMITED ROM (Neck injuries, osteoarthritis,
spondylitis, disc degeneration
ROTATION70 degrees
 LIMITED ROM (Neck injuries, osteoarthritis, spondylitis, disc
degeneration
 TEST FOR BACK AND LEG PAIN

STRAIGHT LEG TEST – client has low back pain that radiates down
the back
- check for HERNIATED NUCLEUS PULPOSUS
 MUSCLE LEG LENGTH
• Normal : EQUAL
• UNEQUAL- SCOLIOSIS
- ABN. In the position of hips
pelvis
 SHOULDERS, ARMS, ELBOWS
• INSPECT AND PALPATE SHOULDERS
NORMAL FINDINGS
-Symmetrically round, no redness,
swelling, tenderness , deformity or
heat
-Muscles are fully developed
-clavicles and scapulae –even and
symmetric
ABNORMAL FINDINGS
-Dislocation: flat, hollow, less
rounded shoulders
-Muscle atrophy- nerve/muslce
damage/lack of use
-Strains,sprains, arthritis,
bursitis,degenerative joint
diseaseswelling,tenderness and
heat
 SHOULDERS, ARMS, ELBOWS
RANGE OF MOTION- freely move, no tenderness
 SHOULDERS, ARMS, ELBOWS
RANGE OF MOTION
ABNORMAL:
ROTATOR CUFF TEAR –
painful and limited abduction
accompanied by muscle weakness
and atrophy
 SHOULDERS, ARMS, ELBOWS
RANGE OF MOTION
ABNORMAL:
ROTATOR CUFF
TENDINITIS – sharp
catches if pain when
bringing hands overhead
 SHOULDERS, ARMS, ELBOWS
RANGE OF MOTION
ABNORMAL:
Inability to shrug shoulders against
resistancelesion of CN XI (spinal accesory)
Muscle or joint disease- decreased muscle
strength
 ELBOW
INSPECT and PALPATE SIZE, SHAPE, DEFORMITIES,
REDNESS, OR SWELLING
NORMAL FINDINGS ABNORMAL FINDINGS
Symmetric, without Redness,heat and swelling—
deformities, redness or bursitis of the olecranon process
swelling due to trauma or arthritis
No tenderness Tenderness-epicondylitis (tennis
elbow)
Firm, non tender, subc. Nodule—
rheumatoid arthritis
 ELBOW
RANGE OF MOTION
Flexion-160 degrees
Extension-180 degrees
Pronation/supinaton-90
degrees
-full ROM against resistance
The symptoms of bursitis may include: localized pain,
swelling, warm feeling in or around the affected area,
increased pain at night, pain worsened by movement, stiffness,
reddening of the skin…
WRISTS
• INSPECTION: size, shape, symmetry, color, swelling
• PALPATION: tenderness, nodules
• SQUEEZE TEST : tolerates without pain
 extreme pain: rheumatoid arthritis and psoriatic arthritis
• RANGE OF MOTION: flexion and extension—full ROM /with resistance

ABNORMAL:
RHEUMATOID ARTHRITIS- Swelling, tenderness and nodules
GANGLION- nontender, round, enlarged, fluid filled cyst
FRACTURE- pain,tenderness, swelling and inability to hold a grip , pain goes
away and returns as deep, dull ache
Rheumatoid arthritis Psoriatic arthritis
Rheumatoid arthritis can cause pain, swelling and deformity.
As the tissue that lines your joints (synovial membrane)
becomes inflamed and thickened, fluid builds up and joints
erode and degrade.
SWAN NECK DEFORMITY
BOUTONNIERE
WRISTS
PALPATE THE ANATOMIC SNUFFBOX
 TENDERNESS may indicate scaphoid fracture
 TEST FOR CARPAL TUNNEL
SYNDROME
• PHALEN’S TEST
A patient is asked to hold this position
for 60 seconds.  If a state of Paresthesia
is produced during this time in the area
of the hand that is controlled by the
Median Nerve, then it is concluded that
the patient likely has CARPAL TUNNEL
SYNDROME.
• Paresthesia
• a tingling sensation or the familiar
“pins and needles” sensation a person
feels when a limb is “falling asleep”
 TEST FOR CARPAL TUNNEL
SYNDROME
TINEL’S SIGN
-Tingling or shocking sensation when
percuss lightly over the median
nerve
 HIPS
INSPECTION
NORMAL FINDINGS ABNORMAL FINDINGS

buttocks are equal in size; iliac

FRACTURED HIP- instability,
crest are symmetric in height;
inability to stand, deformed hip
hips are stable, non tender, and
area
without crepitus HIP INFLAMMATION, DJD-
tender,edema decreased ROM,
MUSCLE STRENGTH- FULL ROM crepitus
against resistance -Decreased rom
RANGE
OF
MOTIO
N
 KNEES
INSPECTION AND PALPATION
NORMAL FINDINGS
-Symmetric, hollows present on both
side of the patella, no swelling or
deformities
-Lower leg aligned with the upper leg
-No quadriceps muscle atrophy
-Non tender and cool, muscle firm. No
nodules
-full ROM against resistance
ABNORMAL FINDINGS
-Knock knees (genuvalgum)- knees turn
in
Bowed legs( genuvarum )- turn out
Thickening of synovial fluid- swelling
above or next to the patela
- Asymmetric muscular development
-Synovitis- tenderness and warmth with
boggy consistency
- Decreased muscle strength
KNOCK KNEES
BULGE TEST ( SWELLING IS PRESENT)
• Determine: accumulation of fluid or soft tissue swelling
Normal: No
movement of patella
-patella rests firmly
over the femur

Abnormal: fluid wave

or click palpated with
large amount of
effusion
(+) meniscal tear
RANGE OF MOTION

OSTEOARTHRITIS-
-the protective cartilage that
cushions the ends of your bones
wears down over time. 
-Decreased ROM with synovial
thickening and crepitation
FLEXION CONTRACTURE OF THE KNEE- Inability to
extend knee fully
 TEST FOR PAIN AND INJURY
MCMURRAY TEST
-if complaints of a “giving in or
locking” of the knee

(+)TORN MENISCUS- PAIN OR

CLICKING SOUND
 ANKLES AND FEET
INSPECTION AND PALPATION
-when the client sitting, standing and walking, inspect
POSITION,ALIGNMENT, SHAPE and SKIN
• NORMAL:
• -Toes usually point forward and lie flat.
• -toes and feet are in alignment with the lower legs
• -skin is smooth and free from corns and calluses
 ABNORMAL FINDINGS
HALLUX VALGUS
- A Laterally deviated great toe with possible overlapping
of the second toe and possible formation of enlarged,
painful, inflamed bursa (bunion ) on the medial side
 ACUTE GOUTY ARTHRITIS
-the metatarsophalangeal joint of the great toe is tender, painful,
reddened, hot and swollen
 FLAT FEET (PES PLANUS)
-No arch and may cause pain and swelling of the foot surface
 CALLUS CORN
-non painful, thickened skin - Painful thickening of the skin
that occurs at pressure points that occur on the bony prominences
and at pressure points
 HAMMER TOE
• Hyperextension at the metatarsophalangeal joint with flexion at the
proximal interphalangeal join
• Second toe
 PLANTAR WART
-painful warts (verruca vulgaris) that often occur under a callus.
Appearing a tiny dark spots
 ASSESS THE METATARSOPHALANGEAL
JOINTS
-squeeze the foot from each side with thumb and
fingers
-palpate each metatarsal, noting swelling or
tenderness.
-palpate plantar area of the foot, noting pain and
swelling
-SQUEEZE TEST – middle foot with your hand across
top of foot

Pain: R. athritis, DJD,

plantar facilitis – most common cause of heel pain
• Test ROM
Can dorsiflex and plantar flex
Eversion and inversion
Abduction and adduction
Full ROM against resistance

ABNORMAL: decreased strength against resistance

hammer toe]
Muscles
Sternocleidomastoid test
Trapezius
Deltoid
Biceps
Triceps
Wrist and fingers
Muscle atrophy is when muscles waste away. The main reason
for muscle wasting is a lack of physical activity. This can happen when
a disease or injury makes it difficult or impossible for you to move an
arm or leg. A symptom of atrophied muscles is an arm that appears
smaller, but not shorter, than the other arm.
A contracture deformity is the result of stiffness or constriction in the
connective tissues of your body. This can occur in
your muscles, tendons, ligaments, and skin. You can also experience
a contracture deformity in your joint capsules.
...Contracture deformity restricts normal movement
In physiology, medicine, and anatomy, muscle
tone (residual muscle tension or tonus) is the continuous and passive
partial contraction of the muscles, or themuscle's resistance to passive
stretch during resting state.
Flaccid paralysis is an illness characterized by weakness or paralysis
and reducedmuscle tone without other obvious cause (e.g., trauma).
This abnormal condition may be caused by disease or by trauma
affecting the nerves associated with the involved muscles.