The document presents a comprehensive overview of musculoskeletal system examination techniques, including history-taking, observation, palpation, range of motion, and red flag assessments. It highlights the anatomy and function of various components like bones, muscles, tendons, and ligaments, as well as neurological aspects affecting motor control and pain perception. The document also outlines specific assessment methods for various joints and provides recommendations for imaging and laboratory investigations.

1. UNIVERSITY OF LUSAKA
PRESENTATION ON:
EXAMINATION OF THE MUSCULOSKELTAL
SYSTEM
By;
KENNEDY CHIBWE MBCHB2012069
SAMUEL CHOMBA SIMUCHENJE MBCH211483635

2. INTRODUCTION
Exam of MSC involves
History
Observation
Palpation
Range of motion
Joint stability
Neurological
Imaging
Laboratory test
Red flag assessment

3. OBJECTIVES
make an accurate diagnosis
determine severity of the condition
management plan

4. Overview Anatomy
Composed of
Bones: provide structure, protection & support
Muscles: for generating movements
Tendons: connects muscles to bones
Ligament: connective tissue that connects bone to bone
Joints: where two joints meet
Cartilage: acts a cushion reduces friction and facilitate smooth movements
Tendons and Bursae: fluid filled sac that reduce friction between muscles,
tendons and joints

5. Anatomy of musculoskeletal image

6. Role of Nervous System
Motor control: sends signals to muscles
Reflexes: enables rapid, involuntary response to stimuli
Proprioception: receptors in muscles give information to NS about
bodys position & movements
Pain perception: nerves transmit signals related pain
Fine motor skills: allows delicate movement of hands & fingers
movements
Muscular tone: NS regulate muscle tone, ensuring stability and posture
Muscle contraction pattern: ensures smooth & coordinated actions

7. History
Skin rash
H/o alcohol or caffeine use cigarette smoking
Family H/o of osteoporosis
Joint/bone pains
Joint swellings
Yellowing of eyes/palms

8. Observation
Observe patient gait
Obvious deformities
Swelling
Note common postural abnormalities

9. Palpation
Tenderness
Edema
Resistance to pressure
Discomforts during palpation
Swellings in the joint and muscle
Muscle should be firm

10. Eliciting pain in Hx
WILDA pain assessment
Words - description of character of pain
Intensity - rating scale 0 - 10
Location - site of pain
Duration – how long, acute or chronic
Aggravating/Alleviating factors- explore factors that make pain worse
or better.

11. Muscle Power Assessment

12. Range of Motion
Includes both active & passive ROM
Put each major joint through active & passive ROM
Demonstrate & instruct the patient

13. Range of motion

14. GALS FOR LOCOMOTOR SYSTEM
G – GAIT
A –ARMS
L – LEGS
S – SPINE

15. GAIT
observe gait: symmetry, smoothness
Shoulder Symmetry, gluteal, quadricep & calf muscle
Assess equal levels of iliac crest.
Popliteal swelling

16. Types of Gait
• Normal: healthy walking pattern
• Antalgic: avoiding putting weight on limb e.g injured limb
• Trendelenburg: side to side sway
• Ataxic: irregular steps and a staggering/stumbling motion
• Hemiplegic: one side dragging leg e.g stroke
• Parkinsonian: shuffling with small steps
• Spastic: stiff jerky movements- increased muscle tone
• Scissors: a scissors-like motion
• High steppage: excessive lifting of leg- foot drop
• Waddling: side to side rocking motion with wide-based stance

17. Arms
Movements- abduction,external rotation & flexion
Hands and wrist-Asses joint swelling and deformity
Asses MCPJs- for inflammatory joints disease
Any signs of upper limb deformity

18. Rheumatoid Arthritis image

19. Legs
observe swellings, deformities, muscle wasting, anterior or popliteal
swelling.
Asses internal rotation of knee.
Perform patellar tap.
Inspect feet- for any deformities, callosities on the soles
MTPJs- check inflammatory joint disease

20. Spine
Kyphosis
lordosis
scoliosis
Assess posture

21. Spine Deformities

22. Examination of the Hip
Active Movements Special Tests
active hip flexion - normal is 120 degree Thomas test - used to asses for fixed flexion deformity.
active hip extension - normal 180 degree +ve test- if the affected thigh raises off the bed
passive hip flexion- normal 120 degree not performed on pts who have undergone hip
replacement as it can dislocate
passive hip internal rotation- normal 40 degree
passive hip Abduction - normal 45 degree trendelenburgs test - used to asses hip abductor
weakness (gluteus medius and minimus)
passive hip Adduction - normal 30 degree +ve test- if the pelvis drops on the side of the raised
leg it suggests contralateral hip abductor weakness
passive hip extension- normal 10 to 20 degree when positive it is known as Trendelenburg’s sign

23. Physical examination of Thigh and Hip

24. INVESTIGATIONS
IMAGING
X-ray
CT scan
MRI
Ultrasound
Bone scan(nuclear medicine)
Bone densitometry

25. Investigations
Laboratory test:
Blood specimen
CBC
ESR
Rheumatoid Factor
Urine
Urine test

26. Red Flag Assessment
Severe pain
Night pain
Unexplained weight loss
Fever
Hx of cancer
Trauma or fall
Unexplained swelling or mass
Loss of joint function
Severe stiffness

27. REFERENCES
 http://geekymedics.com/muscle-power-assessment-mrc-scale/
visited on 18th September 2023.
Hutchison’s clinical methods of medicine. An Integrated approach to
clinical practice. 23rd
Edition, Michael Glynn and William Drake.
Standring, S (2015), Then Anatomy Basic of Clinical Practice. 41st
ed.
London: Elsevier

28. THANK YOU…