Andres (1NUR-5)

MUSCULOSKELETAL SYSTEM c. HEAT PRODUCTION (as

muscles contract, they create
ASSESSMENT
body heat)
• OVERVIEW
➢ Musculoskeletal complaints and
disorders are the LEADING cause of
healthcare visits
➢ The musculoskeletal system CAN be
examined at the same time as the
neurologic system.
• MAJOR FUNCTIONS
1. Provide structure and movement
for body parts. (Bones and muscles)
2. For SKELETAL SYSTEM:
a. SUPPORT (to maintain an
erect position)
b. PROTECTION (provides *Sarcomeres – basic structural and
protection for organs, ex. functional unit of muscle contraction
Brain, spinal cord, ribs) (composed of actin and myosin
c. MOVEMENT (bones act as myofilaments)
levers; muscles attached in *The presence of a signal would stimulate
bones transmit signals to the sarcomere to contract.
move) *EXTERNAL TO INTERNAL STRUCTURE:
d. STORAGE (stores calcium for EPIMYSIUM -> PERIMYSIUM -> FASCICLES -
our body) > ENDOMYSIUM -> MUSCLE FIBERS
e. BLOOD CELL PRODUCTION *Muscle cells are the same as muscle fibers
(long bones undergo *MUSCLE CONTRACTION:
hematopoiesis)
*Axial – Cranium, Mandible, Vertebrae,
Shoulder and Pelvic Girdles
*Appendicular – upper and lower
extremities
3. For MUSCULAR SYSTEM:
a. BODY MOVEMENT (muscles
attach to bones and
contract/shorten or
dilate/lengthen)
b. MAINTENANCE OF POSTURE
(muscle tone maintain
intrinsically)
Andres (1NUR-5)

• JOINT STRUCTURES AND FUNCTIONS - STRUCTURE OF SYNOVIAL

1. ARTICULAR STRUCTURES JOINTS
- Joint capsule
- Articular cartilage
- Synovium
- Synovial fluid
- Intra-articular ligaments
- Juxta-articular bone
2. EXTRA-ARTICULAR STRUCTURES
*TMJ – temporomandibular joint
- Periarticular ligaments
- Tendons
- Bursae
- Muscle
- Fascia
- Bone
- Nerve
- Overlying skin
*Synovial fluid – for absorbing pressure *BURSAE
applied to bones and to cushion two bones - Disc shaped synovial sacs that allow
together as they move adjacent muscles/muscles/tendons
*Tendons – collagen fibers that connect to glide over each other
MUSCLE TO BONE (T.B.M.) - Lie between skin and convex surface
*Ligaments – rope-like bundles of collagen of a bone or joint
fibrils that connect BONE to BONE (L.B.B.) - Lie in areas where tendons or
*Cartilage – another type of collagen matrix muscles run against bone, ligaments,
*Bursae – pouches of synovial fluid that or other tendons or muscles
acts as cushion during movements of 2. CARTILAGINOUS JOINTS
tendons and muscles over the bones - Slightly movable
• TYPES OF JOINT ARTICULATION - Made of fibrocartilaginous
1. SYNOVIAL JOINTS discs centered with nucleus
➢ Freely movable joints that are pulposus
covered by ARTICULAR CARTILAGE - Ex. Vertebral column, pubic
➢ Synovial cavity and joint capsule symphysis
➢ Ex. Knee and shoulder
Andres (1NUR-5)

3. FIBROUS JOINTS f. MUSCLE WEAKNESS

- Intervening layers of fibrous *use OLDCART
tissue or cartilage that hold ONSET – when did the pain start
bones together LOCATION – POINT location of pain
- Almost in direct contact DURATION – how long does the pain
between bones appear, or if it is intermittent or continuous
- No appreciable movements CHARACTERISTIC MANIFESTATIONS – sharp,
- Ex. Skull sutures dull, numbing pain
• HEALTH HISTORY OF THE ASSOCIATED SYMPTOMS – fever, chills,
MUSCULOSKELETAL SYSTEM rashes where the pain is felt, body
➢ Common or concerning symptoms weakness or malaise, weakness in area of
a. JOINT PAIN pain, weight loss
- may be associated with RELIEVING AND AGGRAVATING FACTOR –
systemic symptoms (ex. resting, walking
Fever, chills rash, weakness, TREATMENT – medication (ask if it is
and weight loss) successful or not)
- Myalgias (Muscle aches and
pain) • EXAMINATION OF JOINTS: ANATOMY
- Arthralgias (Joint pain) AND PHYSIOLOGY AND PHSYICAL
b. LOW BACK PAIN EXAMINATION
- Midline or off the midline ➢ IMPORTANT AREAS OF
- Radiation EXAMINATION OF THE MAJOR
- Associated with bladder or JOINTS (INSPECT AND PALPATE)
bowel dysfunction a. Inspection of joint SYMMETRY,
c. NECK PAIN ALIGNMENT, and BONY
- Usually self-limited DEFORMITIES
- Ask about radiation into arm; - Compare joint with
arm or leg weakness or corresponding joint
PARESTHESIA, an abnormal b. Inspect and palpate surrounding
sensation of the skin that tissues for skin changes (rashes,
may be tingling, prickling, wounds, pus), nodules, muscle
chilling, or burning with no atrophy, and CREPITUS
apparent physical cause *CREPITUS - (audible, crackling
- Change in bowel or bladder sensation under the skin due to
functions the presence of air in the
- Persisting pain after blunt subcutaneous tissue)
trauma or motor vehicle c. Range of motion maneuvers to
accident WARRANTS further test joint function and stability,
evaluation as well as integrity of ligaments,
d. BONE PAIN tendons, bursae, especially if
e. MUSCLE PAIN OR CRAMPS there is pain or trauma
Andres (1NUR-5)

d. Assessment of INFLAMMATION b. Atrophy – decrease in muscle

of joints or ARTHITIS, especially size/muscle deterioration
swelling (tumor), warmth (calor), c. Hypertrophy – increase in
tenderness (dolor), redness muscle size (common in
(rubor) weightlifters)
e. Assessment of muscle strength d. Fasciculations – flickering
movements or small group of
➢ SYSTEMIC EXAMINATION muscles
a. INSPECTION e. Thenar eminence and
b. PALPATION (Bones and joints, hypothenar eminence (full or
Range of motion, and Muscle convex ang NORMAL)
Strength) *THENAR EMINENCE
c. RANGE OF MOTION - mound formed at the base of
- Passive – patient hardly try the thumb on the palm of the
or cannot make an effort to hand by the intrinsic group of
make movements of their muscles of the thumb
joints (examiner exerts the - atrophy of thenar eminence
effort) indicated damage in median
- Active – patient can make an nerve
effort to move their muscles *HYPOTHENAR EMINENCE
and joints - atrophy of this indicates
➢ EQUIPMENT NEEDED: damage in the radial nerve
1. Tape measure
2. Goniometer – measures range of
movements of a joint in terms of
angle
3. Skin marking pen
➢ TIPS FOR A SUCCESSFUL
EXAMINATION
1. Look for symmetry – compare
affected area with the other
extremity
2. Use INSPECTION and
PALPATION to assess
surrounding tissues
3. Test range of motion and ➢ MUSCLE TONE
maneuvers a. Slight residual tension is
4. Test muscle strength maintained when a normal
➢ MUSCLE BULK muscle with intact nerve supply
a. Inspect size and contour of is relaxed voluntarily
muscles
Andres (1NUR-5)

b. Assess by feeling muscle’s

resistance with passive stretch ➢ SCALE FOR GRADING MUSCLE
c. Hypotonia – excessive flaccidity STRENGTH
or floppiness
d. Spasticity – increase in
resistance that worsens at
extreme ranges of movement
e. Rigidity – increase in resistance
throughout every range of *Make the patient flex a muscle and the
movement nurse must exert full resistance to the
*the more active, the better the muscle flexed muscle
tone *Normal (5) grading: No evident
➢ MUSCLE STRENGTH fatigue
a. Allow for variables: *4 grading: Barely moving against
- AGE – the younger, the full resistance
greater muscle strength *3 grading: Not moving against full
- SEX – built of male usually resistance
has greater muscle bulk *2 grading: Extremities cannot be
- MUSCULAR TRAINING – raised upwards against gravity, but
weightlifting, physical can perform movements such as
exercise, sports supination and pronation
b. Dominant side usually slightly
stronger
c. Active resistance testing
d. Paresis, paralysis (plegia)
*PARESIS – weakness
*PLEGIA - paralysis
- Hemiparesis – one part of
the body is weak (if left brain
is affected, right side is weak
and vice versa)
- Hemiplegia – one part of the
body is paralyzed
- Paraplegia – lower
extremities are paralyzed
- Quadriplegia – four
extremities are paralyzed