◾ (indicates normal ndings)

# (indicates abnormal ndings)

MUSCULOSKELETAL ASSESSMENT

Posture
163. Instructs the client to stand then inspects posture from Front, Back, and Side
◾ Posture is erect and comfortable for age.
# Spinal deformities include:
# Kyphosis: Accentuated thoracic curve. I Scoliosis: Lateral “S” spinal deviation.

165. Inspects for spine curve and deformities from the client’s back such as Scoliosis by having
the client bend forward from the waist with arms relaxed.
◾ Cervical and lumbar spines are concave; thoracic spine is convex.
# Spinal deformities include:
# Kyphosis: Accentuated thoracic curve. I Scoliosis: Lateral “S” spinal deviation.

166. Lordosis
Have the patient stand against a wall and atten her back against it while I slide my hand
through the lumbar curve.
◾ Lumbar spines are concave.
# Spinal deformities include:
# Kyphosis: Accentuated thoracic curve. I Scoliosis: Lateral “S” spinal deviation.

Alternative method
With patient supine and knees slightly exed, instruct patient to atten back against mattress
while I slide my hand through the lumbar curve.
◾ Lumbar spines are concave.
# Spinal deformities include:
# Kyphosis: Accentuated thoracic curve. I Scoliosis: Lateral “S” spinal deviation.

Gait
167. Instructs the client to walk and observe while she is walking
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 ◾ Posture erect and arms swing in opposition.
# Scissors gait (legs cross over): Disorders of motor cortex or corticospinal tracts, such as
bilateral spastic paresis.

Cerebellar Function
169. Balance
Instructs the client to perform the balance tests

- Tandem walk
- Heel-and-Toe walk
- Deep Knee Bend
- Hop in Place
- Romberg Test Coordination
◾ Balance intact. Patient can tandem walk, heel-and-toe walk, perform deep knee bend, and
hop in place. Negative Romberg test.
# Balance problems: Cerebellar disorder

170. Coordination
Determine the client’s dominant side.
Instructs the client to perform the coordination tests
- Rapid alternating movements RAMs
Have patient perform RAMS by patting thigh with one hand, alternating with supination and
pronation.
- Finger thumb opposition
- Toe tapping
- Heel down shin
◾ Positive RAM, nger-thumb opposition, toe tapping, and heel down shin.
# Balance problems: Cerebellar disorder
# Inaccurate movements: Cerebellar disorder.

171. Accuracy of Movements

Have patient perform Point-to-point localization
Stand in front of patient, hold your nger about 12 inches in front and instruct patient to touch
your nger and then touches her own nose.
◾ Movements accurate.
# Balance problems: Cerebellar disorder
# Inaccurate movements: Cerebellar disorder.

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Measurements
172. Arm lengths
Measures arm length from acromion process to tip of middle nger
◾
# Leg length discrepancies can cause back and hip pain, gait problems, and pseudoscoliosis, or
apparent scoliosis.
# Circumference differences " 1 cm may re ect muscular atrophy or hypertrophy.

173. Arm circumference

Measures midpoint of extremity and then measures arm circumference.
◾
# Leg length discrepancies can cause back and hip pain, gait problems, and pseudoscoliosis, or
apparent scoliosis.
# Circumference differences " 1 cm may re ect muscular atrophy or hypertrophy.

174. Leg lengths

Measures leg from anterior iliac crest, crossing over knee to the medial malleolus
◾
# Leg length discrepancies can cause back and hip pain, gait problems, and pseudoscoliosis, or
apparent scoliosis.
# Circumference differences " 1 cm may re ect muscular atrophy or hypertrophy.

175. Leg circumference

Measures midpoint of extremity then measures leg circumference.
◾
# Leg length discrepancies can cause back and hip pain, gait problems, and pseudoscoliosis, or
apparent scoliosis.
# Circumference differences " 1 cm may re ect muscular atrophy or hypertrophy.

Muscles
176. Muscle Tone
Palpate muscles of upper and lower extremities in relaxed and contracted state
◾ Muscles soft, pliable, and nontender in relaxed state; rm and nontender in contracted state.
# Atrophy (muscle wasting), unexplained hypertrophy (excessive muscle size), accidity (atony),
weakness (hypotonicity), fasciculations (involuntary twitching of muscle bers), or tremors
(involuntary contraction of muscles).
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177. Muscle Strength
Upper extremities
Cross index and middle ngers and ask patient to squeeze.
◾ Muscles nontender and no abnormal movements.
# Atrophy (muscle wasting), unexplained hypertrophy (excessive muscle size), accidity (atony),
weakness (hypotonicity), fasciculations (involuntary twitching of muscle bers), or tremors
(involuntary contraction of muscles).

Lower Extremity
Have patient raise leg against your hand as you apply resistance.
◾ Muscles nontender and no abnormal movements.
# Atrophy (muscle wasting), unexplained hypertrophy (excessive muscle size), accidity (atony),
weakness (hypotonicity), fasciculations (involuntary twitching of muscle bers), or tremors
(involuntary contraction of muscles).

Joints and Comprehensive muscle strength

Test ROM of joints and palpate, then note condition of skin, erythema, edema, heat, deformity,
crepitus, tenderness, and stability of all joints.
Demonstrate movement of each joint and have patient return movement.
To test muscle strength, repeat against resistance.
🔸 Temporomandibular joints
🔸 Cervical spine
🔸 Thoracic and Lumbar spine
🔸 Shoulders
🔸 Upper arm and elbow
🔸 Wrist
🔸 Hands and Fingers
🔸 Hips
🔸 Knees
🔸 Ankle and feet

◾ Uniform skin color, no redness or swelling; nontender; without deformities. ROM performed
without dif culty, grade strength 5 and that is normal.
# Decreased ROM, tenderness, swelling, crepitus: Arthritis.
# Pain, swelling, popping, clicking, or grating sounds: TMJ dysfunction.
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 Additional Tests
182. Carpal Tunnel Syndrome
a. Phalen's Test
Have the patient ex the hands back to back at a 90-degree angle and hold this position for
about 1 minute.
Assesses for numbness or tingling from thumb to ring nger
◾ No tingling and numbness experienced from Phalen test.

b. Tinel's test
Percusses lightly over the median nerve
Assesses for numbness and tingling on palmar aspect
◾ No tingling and numbness experienced from Tinel test.

183. Spinal Problems (Straight Leg Raise)

a. Instructs the patient to lie at and raise the affected leg to point of pain
◾ Straight Leg Raise performed without dif culty.

184. Arm Weakness (Pronator Drift)

Have the patient stand with arms extended, hands supinated, and eyes open and then closed
for at least 20 to 30 seconds.
Checks for downward pronation of arms and hands.
◾ Pronator Drift performed without dif culty.

185. Hip problems

a. Thomas Test
Have the patient lie supine with both legs extended and then ex one leg to her chest.
Watches for elevation of opposite leg.
◾ Thomas test negative.

b. Trendelenburg test
Have patient stand erect and check the iliac crest it should be level. Then, have the patient
stand on one foot and check again for iliac crest symmetry.
◾ Iliac crest is level.

186. Knee Problem’s

a. Bulge Test
With the patient supine, stroke the medial side of the knees upward several times to displace the
uid.
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 Then, press the lateral side of the knee, and inspect for the appearance of a bulge on the medial
side
◾ No bulge of uid appears on the medial side of the knee.

b. Patellar Ballottement
With the patient supine, press rmly with your left thumb and index nger on each side of the
patella. Gently tap the patella.
◾ No movement of the patella is noted.

c. Lachman Test.
To assess medial and lateral stability, have the patient extend the knee and attempt to abduct
and adduct it.
To assess the anterior and posterior plane, have the patient ex the knee at least 30 degrees.
Stabilize and grasp the leg below the patella, and attempt to move it forward and back.
◾ No abnormal movements occurred.

d. McMurray's Test
With the client supine and knees exed, place one hand on the heel and other on the knee and
gently rotate the foot internally and externally
◾ No pain or clicking noted.

e. Apley's Test
With the patient supine and her knee exed at 90 degrees.
Place one hand on the heel and the other hand on the knee.
Apply pressure with both hands and gently rotate the foot.
◾ No pain or clicking noted.

TEMPOROMANDIBULAR
Opens and closes mouth
Projects and retracts jaw

CERVICAL SPINE
Flexion (touch chin to chest)
Hyperextension (look up)
Extension (head in neutral position)
Turn head side to side
Rotation

THORACIC AND LUMBAR SPINE

Flexion
Hyperextension
Lateral bending
Rotation (left and right)

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SHOULDER
Forward exion (move arms forward)
Backward extension (move arms backward)
Abduction and adduction
Circumduction
Abduction
Adduction

UPPER ARM AND ELBOW

Flexion and extension of the forearm
Supination and pronation of the forearm

WRIST
Flexion
Extension
Hyperextension
Adduction
Radial deviation
Ulnar deviation

HANDS AND FINGERS

Abduct (spread ngers apart)
Adduct (bring ngers together)
Flex (make a st)
Extend (open st)
Hyperextension

HIP
Flexion with knee exed and with knee extended
Extension and hyperextension
Circumduction
Rotation (internal and external)
Abduction
Adduction

KNEE
Flexion
Extension

ANKLE AND FOOT

Plantar exion and dorsi exion
Inversion and eversion
abduction, adduction
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