Faculty of Nursing-IUG

Chapter (12)Assessment of Musculo-Skeletal System

The primary structures of the musculoskeletal system are the bones, muscles, cartilage, ligaments, tendons and joints.

The bony skeleton provides a sturdy framework to support body structures. The bone matrix stores calcium, phosphorus, magnesium and fluoride.

In addition, the red bone marrow located within bone cavities produces red and white blood cells in a process of hematopoiesis.

There are 206 bones in the human body, divided into four categories.

Long bones (eg, femur)Short bones (eg, metacarpals)Flat bones (eg, sternum)Irregular bones (eg, vertebrae)Assessments are made of muscles, bones and joints. When

assessing the musculoskeletal system keep in mind that injury or inflammation of any part of the system can cause pain, stiffness, or an alteration in motor strength or mobility.2

Musculoskeletal assessment is conducted from head to toe with inspection and palpation

Assessment of musculo-skeletal system done firstly when the client walks, moves in bed or performs any type of physical activity.

The nurse usually assesses the musculoskeletal system for:

Muscle – size, contractures, tremors, muscle tonicity, smoothness of movement and muscle strength.

Bones – skeletal structure, tenderness, edemaJoints – swelling, tenderness, smoothness of

movement, crepitation, nodules, range of motion.

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Terms used to describe joint movement:Flexion – bend that decrease angle between bonesExtension – straightening a limb to increase the angle of

jointAbduction – moving a limb away from the body’s midlineAdduction – moving a limb towards the body or beyond itInternal rotation – turning a body part towards midlineExternal rotation – turning a body part away from midlineCircumduction – circular movement of a body partSupination – turning the palm upwardsPronation – turning the palm downwardsInversion – turning the hand or foot inward Eversion – turning the hand or foot outward

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Musculoskeletal AssessmentSubjective data: Observer gait and posture as client walks into room.

Normally the client walks with arms swinging freely at sides and the head and the face leading the body.

Pain: assess pain at rest, with exercise, changes in shape or size of an extremity, changes in mobility to carry out activities of daily living, sports, and works.

Stiffness of jointDecreased or altered or absent sensations.Redness or swelling of joints.History of fractures and orthopedic surgery.Occupational history

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Objective dataDetermine range of motion, muscle strength and tone, joint

and muscle condition. Muscle problems commonly are manifestations of

neurological disease, so you must do neurological assessment simultaneously.

Joints vary in their degree of mobility, range from freely movable e.g. knee, to slightly movable joints e.g. the spinal vertebra.

During assessment of muscle groups: assess muscle weakness, or swelling, and size, then compare between sides. Joints should not be forced into painful positions.

Loss of height is frequently the first clinical sign of osteoporosis. Small amount of height loss expected with aging.

Ask client to put each joint through its full range of motion, if there is weakness, gently supporting & moving extremities through their Range of motion, to assess abnormalities.

Normal joints are non tender, without swelling and move freely.

In elderly joints often become swollen & stiff, with reduced range of motion, resulting from cartilage erosion and fibrosis of synovial membranes

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