Musculoskeletal

Incorporate with ADL

Movement Walking Brushing Teeth Bathing Other ADL

Determine Muscle Strength

A. Grasp fingers B. Push/pull hands or feet C. Crepitus joint rubbing D. ROM

Full/complete Partial

Inspection
Normal arms swing freely/head leads body/equal step intervals: A. Gait & posture B. Elderly

Foot dragging Smaller steps Wider base of support

Inspection

Curvatures:

Kyphosis Lordosis Scoliosis Barrel chest

Kyphosis

Lordosis

Scoliosis

If found early can be treated Can cause lung expansion problems with heart problems Staged - ABCD

Osteoporosis

Decreased height related to vertebral fracture/collapse

Assessing Extremities

Size & Shape Symmetry Deformities Bone enlargement Alignment Gross deformity

Palpation

Assess muscles and joints

Heat Edema Resistence to pressure Contractures/atrophe Injury/pain/tenderness

Range of Motion

Active and Passive Observe for:

Symmetry Limited mobility/Joint instability Spastic movements Contractures Long term bedrest

Muscle Tone

Slight muscular resistance felt by nurse as relaxed extremity is passively moved through ROM Hypertonicity increased resistance frozen Hypotonicity decreased resistance, feels flabby

Muscle Strength

Dominate side usually stronger than nondominate To assess have patient extend and flex against resistance: do both sides at same time

ROM Terminology

Flexion - bending Extension - straighten Abduction away from midline (may be limited with hip surgery) Adduction toward midline

Grading Muscle Strength

0 = no muscular contractility 1 = slight contractility without movement 2 = FROM, passive 3 = FROM, active 4 = FROM with some resistance 5 = FROM with full resistance

The End