Musculoskeletal System
Assessment – Musculoskeletal System
MSK Assessment consists of the following:
- Basic screening exam
- Assessment of the spine
- Assessment of the lower extremities
- Assessment of the upper extremities
Preparation for Assessment
Equipment & Assessment Sequence
There is no special equipment required to conduct the MSK exam; preparation for the assessment includes washing hands and donning appropriate PPE (as needed). The assessment sequence is inspection, palpation, Assessing ROM, and strength.
Physical Assessment
Basic MSK Screening Exam
- Patient stands facing examiner
- Patient looks at ceiling, floor, over both shoulders, touch ears to shoulder (Neck ROM: observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- Patient shrugs shoulders (resistance)
- Patient abducts arms to 90º (resistance at 90º) (Observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- Patient performs full external rotation of arms (Observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- Patient flexes and extends elbows (Observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- With arms at sides and elbows flexed 90º, patient pronates and supinates hands
- (Observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- Patient spreads fingers and makes fist (Observe for restriction [symmetric or asymmetric], pain, and crepitus.)
- Patient tightens (contracts) quadriceps (Leg extension strength.)
- Patient turns back to examiner (Check spine for abnormal curvature.)
- With knees straight, patient touches toes (Check for flexibility and curvature of the spine, such as scoliosis, smoothness and symmetry of motion, flattening of the lumbar curve with flexion.)
- Patient rises onto toes then heels
- Patient “duck walks” away from and toward examiner (Based on patient mobility, have patient assume a squatting position with knees flexed to the fullest and take at least 4 steps in that position without holding on to any objects for support.)
Assessment of the Spine
- Note position of head and posture of neck and trunk (assess for muscle spasm and abnormal positioning such as torticollis)
- Assess cervical, thoracic, and lumbar curves for increased or decreased concavity or convexity (note presence and degree of cervical and lumbar lordosis and thoracic kyphosis)
- Assess for straight line from C7 through gluteal cleft (both standing and flexed forward at the waist; assess for lateral curvatures such as scoliosis)
- Assess alignment of shoulders and iliac crests with patient standing erect and then in flexion, noting asymmetry (palpate iliac crests to be able to assess them accurately)
- Note ease of gait
- Palpate spinous processes for tenderness or step-off (patient may be standing or sitting up straight)
- Palpate cervical facets for tenderness (palpation may require relaxation of the trapezius muscle for optimal feel of the facets)
- Palpate paravertebral muscles for tenderne