This document discusses assessment of the musculoskeletal system. It covers topics like orthopedics, skeletal functions, bone cells, bone formation and maintenance, joints, muscles, and how to assess the bony skeleton, spine, range of motion, muscle strength, and diagnostic evaluations. The primary goal in caring for clients with locomotor disorders is prevention of contractures or deformities. A full assessment includes evaluation of posture, mobility, pain, and physical examination of bones, joints, muscles, and neurovascular status.

1. Chapter 66
Assessment of Musculoskeletal
Function

2. Orthopedics
 The branch of medicine that deals with the
prevention and correction of the disorders and
diseases of the musculo-skeletal system.
 The primary goal of the nurse caring for a
client with locomotor disorders is the
prevention of contractures (permanent
shortening of a muscle) or deformities.

3. Skeletal Functions
 To provide the body with a structural
framework.
 To act as a protective casing for internal
organs ( the brain, heart, lungs, etc.).
 To allow movement by muscles attached
to the skeleton.
 To store calcium, phosphorus, and
magnesium.
 To manufacture blood cells in the red
bone marrow.

4. Structure
 206 Bones in the body
 Long bones
 Short bones
 Flat bones
 Irregular bones
 Joints
 Muscles

5. Bone Cells
 Osteoblasts
 Function in bone formation
 Osteocytes
 Mature bone cells that function in bone
maintenance
 Osteoclasts
 Multinuclear cells function in destroying,
resorbing, and remodeling bone

6. Bone Formation and Maintenance
 Osteogenesis: process of bone formation
 Ossification: the process of formation of the bone
matrix and deposition of minerals
 Bone is in constant state of turnover
 Regulating factors
 Stress and weight-bearing
 Vitamin D
 Parathyroid hormone and calcitonin
 Blood supply
 Role of calcium

7. Bone Healing
 Hematoma and inflammation
 Angiogenesis and cartilage formation
 Cartilage calcification
 Cartilage removal
 Bone formation
 Remodeling

8. Joints
 A joint is a junction of two or more bones.
 Three types:
 Diarthosis: freely movable such as hinge
(elbow, knee); ball and socket (hip, shoulder),
pivot (skull, first vertebrae), gliding (wrist) and
saddle (thumb).
 Synarthosis: joints are immovable (skull
sutures).
 Amphiarthosis: slightly movable (vertebrae
and pelvic bones).

9. Hinge Joint of the Knee

10. Muscles
 Attached to bones and other structures by
tendons
 Encased in a fibrous tissue—fascia
 Contraction of muscle causes movement
 Contraction utilizes energy in the form of ATP
 Anaerobic pathways using glucose metabolized
from stored glycogen provide energy for more
strenuous muscle activity
 Movement of the muscles may be voluntary or
involuntary.

11. Assessment of the
Musculoskeletal System
 Include data related to function ability; ADLs and ability
to perform various activities. Note any problems related
to mobility.
 Health history: family history, general health
maintenance, nutrition, occupation, learning needs,
socioeconomic factors, and medications—include OTC
 Assessment of pain and altered sensations
 Physical assessment: posture, gait, bone integrity, joint
function, muscle strength and size, skin, neurovascular
status

12. Assessment of the Bony
Skeleton
 Notation on any deformities.
 Body alignment.
 Abnormal growths due to bone tumors.
 Shortened extremities, symetry.
 Amputations.
 Abnormal angulation other than at joints.
 Crepitus (a grating or crackling sensation
or sound).
 posture

13. Assessment of Spine
 Scoliosis (crooked back; lateral curving
deviation).
 Kyphosis (hump back; increased
roundness of the thoracic spinal curve).
 Lordosis (sway back; exaggeration of the
lumbar spine curvature as seen in
pregnancy).
Three common spinal curvatures:

14. Normal Spine and 3
Abnormalities

15. Range of Motion (ROM)
 Active
 person does the moving
 Have person move joint through each of its
various ROM movements
 Note the angle of each joint movement
 Note any pain, tenderness, or crepitus

16. Range of Motion (ROM)
 Passive
 person relaxes and allows you to move the
joints
 Done if person is unable to do active ROM
• ALWAYS stop if the person complains of pain
• NEVER push a joint beyond its anatomic angle

17. Muscle Strength
 As you are testing ROM
 Test muscle strength
 Ability to perform the ROM against resistance
• Symmetry
• Involuntary movements

18. Detecting Fluid in the Knee

19. Rheumatoid Arthritis—Ulnar
Deviation and “Swan-Neck”
Deformity

20. Diagnostic Evaluation
 X-rays
 Computed tomography
 MRI
 Arthrography
 Bone densitometry
 Bone scan
 Arthroscopy
 Arthrocentesis
 Electromyography
 Biopsy
 Laboratory studies