Musculoskeletal System
D yana M . M . Saplan, R N , M A N
The Muskuloskeletal System
Muscles, bones, and joints Assessed for:
muscle strength Tone Size symmetry of muscle development, and for tremors
Dyana M. M. Saplan, RN, MAN
Tremors
Involuntary trembling of a limb or body part May involve large groups of muscle fibers or small bundles of muscle fibers
Intention tremor more apparent when an individual attempts voluntary movement Resting tremor more apparent when the client is @ rest and diminishes w/ activity
Dyana M. M. Saplan, RN, MAN
Muskuloskeletal assessment
Bones
Assessed for normal form
Joints
Tenderness Swelling Thickening crepitation (sound of bone grating bone) Nodules, and Range of motion (ROM)
Body posture
Normal standing and sitting positions
Dyana M. M. Saplan, RN, MAN
Planning
Equipment:
Goniometer
tool which measures a joint's axis and range of motion device that measures the angle of the joint in degrees
Dyana M. M. Saplan, RN, MAN
Assessment
Inspect muscles for size. Compare the muscles on both sides of the body.
Normal: Equal size Deviations: atrophy (decrease in size); hypertrophy (increase in size), asymmetry
Inspect muscles and tendons for contractures (shortening)
D: malposition of body part (foot drop)
Dyana M. M. Saplan, RN, MAN
Muscle Atrophy
Dyana M. M. Saplan, RN, MAN
Hypertrophy
Dyana M. M. Saplan, RN, MAN
Contractures
Dyana M. M. Saplan, RN, MAN
Burn contractures
Dyana M. M. Saplan, RN, MAN
Assessment
Palpate muscles:
At rest to det. muscle tonicity (normal condition of tension or tone of a muscle @ rest
D: atonic lacking tone
While active and passive for flaccidity, spasticity, and smoothness of movement
D: flaccidity weakness or laxness or Spasticity sudden involuntary muscle contraction
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
Grading scale:
0 = 0% of normal strength; complete paralysis 1 = 10%; no movement, contraction of muscle palpable or visible 2 = 25%; full muscle movement against gravity w/ support 3 = 50%; normal movement against gravity 4 = 75%; N full movement against gravity and against minimal resistance 5 = 100%; normal full movement against gravity and against full resistance
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
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 try to push it down.
Biceps:
Client fully extends each arm and tries to flex it while you attempt to hold arm in extension.
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
Triceps:
Client flexes each arm and then tries to extend it against your attempt to keep arm in flexion.
Wrist and finger muscles:
Client spreads the fingers and resists as you attempt to push the fingers together.
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
Grip strength:
Client grasps your index 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.
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength 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 for hip abduction. Place your hands between the knees; client brings the legs together against your resistance.
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
Hamstring:
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 ankles and feet:
Client resists while you attempt to dorsiflex the foot and again resists while you attempt to flex the foot
Dyana M. M. Saplan, RN, MAN
Test Muscle Strength
Normal:
Equal strength on each body side
Deviation:
25% or less of normal strength
Dyana M. M. Saplan, RN, MAN
Bones
Inspect skeleton for structure
N: no deformities D: bones misaligned
Palpate bones to locate any areas of edema or tenderness
N: no tenderness, swelling, crepitation, or nodules D: presence of tenderness or swelling (fracture, neoplasms, or osteoporosis
Dyana M. M. Saplan, RN, MAN
Joints
Inspect for swelling. Palpate for tenderness, smoothness of movement, swelling, crepitation, presence of nodules
N: no swelling, tenderness, crepitation, or nodules D: one or more swollen joints; presence of tenderness, crepitation, nodules Dyana M. M. Saplan, RN, MAN
Joints
Assess range of motion Ask client to move selected body parts.
The amount of joint movement can be measured by a goniometer a device that measures the angle of the joint in degrees
Dyana M. M. Saplan, RN, MAN
Joints
Normal:
Varies to some degrees in accordance w/ persons genetic make-up and degree o physical activity
Deviation:
Limited ROM in one or more joints
Dyana M. M. Saplan, RN, MAN
Lifespan Considerations
Infants
Palpate clavicle of newborns
Mass or crepitus = fracture during vaginal delivery Limited movement of arm and shoulder on affected side
When arms and legs of newborns are pulled to extension and released = return to flexed fetal position Check muscle strength by holding the infant lightly under the arms w/ feet lightly on a table.
should not fall through the hands and be able to bear body weight on legs if normal muscle Dyana M. M. Saplan, RN, MAN strength is present.
Infants
Check for developmental dysplasia of the hip (congenital dislocation) by examining asymmetric gluteal folds, and Asymmetric abduction of legs = (Ortolani and Barlow Test), or apparent shortening of femur
Dyana M. M. Saplan, RN, MAN
Ortolani and Barlow test
a hip abduction evaluation to evaluate for congenital hip dislocation in the newborn Any resistance to abduction or a pop feeling felt on palpation is a positive finding for dislocation.
Dyana M. M. Saplan, RN, MAN
Infants
8 mos. sits w/o support 7 10 mos. crawls 12 15 mos. walks Observe for symmetry of muscle mass, strength, and function
Dyana M. M. Saplan, RN, MAN
Children
Genu varum
bowleg; common in children for about 1 year after beginning to walk
Genu valgus
knock-knee; normal in preschool and early school age children
Lordosis
swayback; common before age 5
Assessed for scoliosis by age 12 and annually until growth slows
Dyana M. M. Saplan, RN, MAN
Dyana M. M. Saplan, RN, MAN
Lordos is
Dyana M. M. Saplan, RN, MAN
Elders
Bones more fragile and osteoporosis leads to loss of total bone mass = predisposed to fractures and compressed vertebrae
Dyana M. M. Saplan, RN, MAN
Video Presentation
D yana M . M . Saplan, R N , M A N
