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MUSCULOSKELETAL ASSESSMENT: HEALTH HISTORY - PASSIVE ROM examination is by initiating

manipulation of the joint.
SUBJECTIVE DATA - CHIEF COMPLAINTS - PAIN
 STRENGTH
Pain - comprehensive pain assessment - To evaluate strength, scale of muscle strength
a. Location (MCR-scale) is commonly used that grades the
b. Intensity strength into 0 to
c. Quality
d. Onset and duration
e. Aggravating and relieving factor
 Pain is assessed by asking the patient to rate pain on a
scale from zero to 10.
 Assess the pain score at rest and on passive stretch.
 Assess whether the pain is disproportionate to the injury.
 Any compromise to neurovascular status will result in
pain due to sensory nerve damage and diminished
blood flow (Shreiber 2016).
SPECIFIC ASSESSMENT REGARDING PAIN  SENSATIONS
 REFLEXES
 Is the body in proper alignment? - Reflexes and Sensory Exam - The neuropathy
 Are the joints symmetrical or are bony deformities impairment score (NIS) scores the reflexes and
present? sensation (touch- pressure, pin-prick, and vibration)
 Is there any inflammation or arthritis, swelling, warmth, as:
tenderness, or redness? 0 – Normal
SUBJECTIVE DATA - CHIEF COMPLAINTS - ALTERED 1 – Decreased
SENSATIONS 2 – Absent
 Is the patient experiencing abnormal sensations such as
burning, tingling or numbness ?
MUSCULOSKELETAL ASSESSMENT - PAST HEALTH,
SOCIAL, AND FAMILY HISTORY
 occupation, exercise pattern, alcohol consumption,
tobacco use, dietary intake
 co morbidities – DM, COPD, Heart Dse
 Medications – corticosteroid
 Previous hx of trauma or injury
OBJECTIVE DATA
 Physical Exam
 Special Assessment Techniques
 Diagnostic Tests
BASIC TECHNIQUES OF MUSCULOSKELETAL SYSTEM
PHYSICAL EXAMINATION
1. OBSERVATION  GAIT
2. PALPATION - provides independence and allows functionality,
- inspect visible gross abnormalities of skin and other being the basis of daily living activities.
components of the musculoskeletal system - Evaluation of the biomechanical walking function,
- uses from light to firm pressure to identify and the relation between the upper body and the lower
quantify the abnormalities of the musculoskeletal body, and the dislocation of the gravity center.
system, pain/tenderness, trigger points. PHYSICAL EXAM
FINDINGS (INSPECTION & PALPATION)  Mental Status
 symmetry/asymmetry  General Inspection: Height, Weight, Nutritional Status,
 skin color and appearance, rash, ulcers, lack of Skin
sweating, hair abnormalities  Neurovascular Assessment: (1) pain, (2) pallor, (3)
 warmth and heat pulses, (4) temperature, (5) capillary refill, (6)
 swelling including effusions, nodules, and paresthesia, and (7) mobility of affected joint(s).
inflammatory findings like synovial and periarticular FRACTURE
thickening
 Obvious deformity
 muscle atrophy, tone, contractures, and spasms
 Ecchymosis
 crepitations
 Swelling
 joint deformities including spine like kyphosis and
 Tenderness
scoliosis.
3. MANIPULATION - consists of different techniques to  Pain
access the ff:  Impaired sensation
 RANGE OF MOTION (ROM)  Decreased mobility
- evaluate the joint independently, its restrictions, SPINE ABNORMALITIES
hypomobility / hypermobility
 Kyphosis
- ACTIVE ROM is patient-initiated, which can access
 Scoliosis
not only joint mobility but also an intact
 Lumbar Lordosis
musculoskeletal and nervous system.
 CONGENITAL CLUBFOOT
 CLUBFOOT - is used to describe a common deformity
in which the foot is twisted out of its normal shape or
position.
 TALIPES - any foot deformity involving the ankle;
derived from TALUS, meaning ankle and PES, meaning
foot.
DEFORMITIES OF THE FOOT AND ANKLE
 TALIPES VARUS - An inversion or a bending inward
 TALIPES VALGUS - an eversion or bending outward
 TALIPES EQUINUS- plantar flexion in which the toes
are lower than the heel
 TALIPES CALCANEUS - dorsiflexion, in which the toes
are higher than the heel
 TALIPES EQUINOVARUS - the most frequently
occurring type of clubfoot (approximately 95% ) in which
the foot is pointed downward and inward in varying
degrees of severity.
MUSCULOSKELETAL ASSESSMENT: AGE RELATED
VARIATIONS
OLDER ADULTS
 Osteoarthritis
 Osteoporosis
 Decreased agility, strength, endurance
SPECIAL TESTS
SNUFFBOX TENDERNESS - tenderness is suggestive of
scaphoid fracture
Carpal Tunnel Syndrome
- (A common cumulative- trauma disorder which
causes hand/finger pain and tingling)
- Tinel’s sign
- Phalen’s sign