Assessing the Musculoskeletal System
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Normal Findings
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Deviation from Normal
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1.
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Inspect the muscles for size.
• Compare each muscle on one side of the body to the same muscle on the other side. For any apparent discrepancies, measure the muscles with a tape.
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Equal size on both sides of body
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Atrophy (a decrease in size) or hypertrophy
(an increased in size)
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2.
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Inspect the muscles and tendons for contractures.
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No contractures
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Malposition of body part (foot drop or foot flexed forward)
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3.
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Inspect the muscles for tremors.
• Inspect any tremors of the hands and arms by having the client hold arms out in front of body.
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No fasciculation or tremors
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Presence of fasciculation or tremors
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4.
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Palpate muscles at rest to determine muscle tonicity.
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Normally firm
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Atonic ( lacking tone)
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5.
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Palpate muscles while the client is active and passive for flaccidity, spasticity, and smoothness of movement.
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Smooth coordinated movements
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Flaccidity (weakness or laxness) or spasticity (sudden involuntary muscle contraction)
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6.
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Test muscle strength. Compare the right side with left side.
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Equal strength on each body side
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25% or less muscle strength
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Grading Muscle Strength
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GRADE
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DESCRIPTION
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5
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100% of normal muscle strength; normal full movement against gravity and against full resistance.
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4
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75% of normal strength; normal full movement against gravity and against minimal resistance.
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3
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50% of normal strength; normal movement against gravity.
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2
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25% of normal strength; full muscle movement against gravity, with support.
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1
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10% of normal strength; no movement, contraction of muscle is palpable or visible.
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0
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0% of normal strength; complete paralysis
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Sternocleidomastoid
Client turns the head to one side against the resistance of your hand. Repeat with the other side.
Trapezius
Client shrugs the shoulders against the resistance of your hands.
Deltoid
Client holds arm up and resists while you try to push it down.
Biceps
Client fully extends each arm and tries to flex it while you attempt to hold arm in extension.
Triceps
Client flexes each arm and then tries to extends it against your attempt to keep in flexion
Wrist and Finger Muscles
Client spreads the fingers and resists as you attempt to push the fingers together.
Grip strength
Client grasps your index finger and middle fingers while you try to pull the fingers out.
Hip Muscles
Client is supine, both legs extended; client raises one leg at a time while you attempt to hold it down.
Hip abduction
Client is supine, both legs extended. Place your hands on the lateral surface of each knee; client spreads the legs apart against your resistance.
Hip adduction
Client is in same position as in hip abduction. Place your hands between the knees; client brings the legs together against your resistance.
Hamstrings
Client is supine, both knees bent. Client resists while you attempt to straighten the legs.
Quadriceps
Client is supine, knee partially extended; client resists while you attempt to flex the knee.
Muscles of the ankle and feet
Client resists while you attempt to dorsiflex the foot and and again resists while you attempt to flex the foot.
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Bones & Joints
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NORMAL FINDINGS
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DEVIATION FROM NORMAL
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7.
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Inspect the skeleton for normal structure and deformities.
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No deformities
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Bones misaligned
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8.
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Palpate the bones to locate any areas of edema or tenderness.
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No tenderness of swelling
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Presence tenderness of swelling
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9.
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Inspect the joint for swelling.
• Palpate each joint for tenderness, smoothness of movement, swelling, crepitation, and presence of nodules.
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No swelling
No tenderness, swelling, crepitation, or nodules
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One or more swollen joints
Presence of tenderness, sweeling, crepitation, or nodules
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10.
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Assess joint range of motion.
• Ask the client to move selected body parts. If available, use a goniometer to measure the angle of the joint in degrees.
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Varies to some degree in accordance with person’s genetic makeup and degree of physical activity
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Limited range of motion in one or more joints
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