Nursing Assessment: Musculoskeletal System

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Nursing Assessment Musculoskeletal System

• George Ann Daniels, MS, RN

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Physical Exam

• Inspection
• Full Rom of all joints
• Symmetry
• Alike on both sides
• Posture
• Spinal curvatures
• gait
• body build
• muscle configuration
• Muscle atrophy, asymmetry, strength
• skin condition

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Palpation

• Skin temperature
• Tenderness
• Swelling
• Crepitation

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Movement

• Range of motion
• active
• passive
• functional
• Goniometer

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Measurement

• Limb length
• Gait disorders
• Circumferential measurement of muscle mass
• Largest area of muscle mass
• Record exact location

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Muscle strength testing

• Resistance to force
• Compare with opposite side
• Muscle strength scale Table 58-5 page 1754
• Scale of 5 is the best

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Common Abnormalities

• Ankylosis
• Scarring within a joint leading to stiffness or
  fixation
• Atrophy
• Wasting of the muscle
• Decrease in size
• Flabby appearance
• Decreased function and muscle tone
• Contracture
• Resistance to movement of muscle or joint,
  fibrosis of soft tissue

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• Crepitus
• Crackling sound or grating sensation from
  friction between two bones
• Kyphosis
• Round back forward bending of spine

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• Lordosis
• Anteriorposterior curvature with concavity in
  posterior direction

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• Scoliosis
• Lateral curvature lf the spine

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Diagnostic Studies

• X-ray
• Arthogram
• X-ray
• Bone Scan
• CT scan
• Arteriogram
• MRI

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• Lab test
• CBC
• Infection
• ESR
• Inflammatory response, Rheumatoid arthritis
• Normal less than 20 mm/hr
• Calcium
• Normal 9-11mg/dl
• Alka Phos
• Normal 29-30 mg/dl
• UA
• Cancer of the bone has increased calcium levels

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• Arthrocentesis
• Aspirated fluid from the joint
• Infection and hemorrhage
• EMG
• Electrical activity of skeletal muscles and
  ability to response to stimuli
• Thermography
• Infrared camera detects amount of heat radiating
  from the soft tissue
• infection

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Arthroscopy

• Endoscopy of the joint
• Direct visualization on interior joint cavity
• Knees, shoulders
• Tears in cartilage can be repaired

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Arthrocentesis

• Ample of synovial fluid for examination
• Instill medication and remove fluid to relieve
  pain
• 1-3 mL