Kargbo EmmahNSG 200Musculoskeletal System 03/23/2020. Physical Examination Skills Check List: Musculoskeletal System. Essential Skills 1.Review appropriate medical history, allergies, contraindications, pain 2.Perform hand hygiene before and after client interactions, before putting on gloves, and after gloves are removed 3.Knock prior to entering client space and introduce self to client (name and NVCC student nurse) 4.Provide client privacy 5.Explain the procedure/purpose to the client using language they will understand 6.Verify client’s identity using 2 identifiers (ask them to state name and assess MR# or DOB) 7.Assist client into the proper position for assessment/procedure 8.Complete assessment as indicated Examination Techniques Rationale Patient Instructions/Technique Used Expected Findings Unexpected Findings Perform hand hygiene Introduce Self Patient Verification Allergies To disinfect the hands before conducting the assessment. To introduce the examiner and review patients medical history. To evaluate the patients daily functioning levels. Introduce the patient and Ask patient about musculoskeletal health history, allergies, and pain in joints and muscle. No health history of joint disease or arthritis. No problems with joints and muscle pain. Inspect skeleton and extremities for alignment and symmetry Inspect muscles for symmetry and size Palpate bones for pain, temperature, and edema; and muscles for pain, temperature, edema, and tone. Observe the ROM (ROM) for major joints and adjacent muscles, for pain on movement, joint stability, and deformity Test muscle strength and compare sides To determine posture and alignment To determine the musculature symmetry. To determine the temperature, pain and edema in the bone and muscle. To examine presence of deformity, joint stability, and pain on muscle movement. To test the muscles movement and bilaterally strength. Evaluate the nature of resistance. Ask the patient to stand erect; observe from post-ant-lateral view Ask the patient to perform a movements (ROM) actively and with passive help. The patient should to move and flex the muscle under evaluation while you apply an opposite force to muscle movement. Shoulders have even contour, scapulae and iliac crest are level Muscles have symmetry and have equal sizes The muscle and bones are firm and not tender. No temperature abnormalities. No pain during palpation of bones and muscles. Skin tone is even without noticeable variations. The ROM is full for each joint. No pain on passive and active movement, deformity and crepitus.Kargbo Emmah NSG 200 Musculoskeletal System
03/23/2020.
Physical Examination Skills Check List: Musculoskeletal System.
Essential Skills
1. Review appropriate medical history, allergies, contraindications, pain
2. Perform hand hygiene before and after client interactions, before putting on gloves, and after gloves are removed
3. Knock prior to entering client space and introduce self to client (name and NVCC student nurse)
4. Provide client privacy
5. Explain the procedure/purpose to the client using language they will understand
6. Verify client’s identity using 2 identifiers (ask them to state name and assess MR# or DOB)
7. Assist client into the proper position for assessment/procedure
8. Complete assessment as indicated
Examination Techniques
Rationale
Patient
Expected Findings
Unexpected
Instructions/Technique
Findings
Used
To
disinfect
the
hands
Introduce the patient and
No health history of
Perform hand hygiene
before conducting the
Ask patient about
joint disease or
assessment.
musculoskeletal health
arthritis.
Introduce Self
history, allergies, and pain in
No problems with
Patient Verification
To introduce the examiner joints and muscle.
joints and muscle
and
review
patients
pain.
Allergies
medical history.
Inspect skeleton and
extremities for alignment and
symmetry
To evaluate the patients
daily functioning levels.
To determine posture and
alignment
To determine the
musculature symmetry.
Ask the patient to stand erect;
observe from post-ant-lateral
view
Shoulders have even
contour, scapulae and
iliac crest are level
Inspect muscles for
symmetry and size
Palpate bones for pain,
temperature, and edema; and
muscles for pain,
temperature, edema, and
tone.
Observe the ROM (ROM) for
major joints and adjacent
muscles, for pain on
movement, joint stability, and
deformity
To determine the
temperature, pain and
edema in the bone and
muscle.
To examine presence of
deformity, joint stability,
and pain on muscle
movement.
Ask the patient to perform a
movements (ROM) actively
and with passive help.
The patient should to move
and flex the muscle under
evaluation while you apply an
opposite force to muscle
movement.
To test the muscles
movement and bilaterally
strength. Evaluate the
nature of resistance.
Test muscle strength and
compare sides
Observe gait for conformity,
symmetry, and rhythm
To observe the gait and
symmetry when in motion.
Ask the patient to walk four
steps forward towards and
away from you; observe the
sway and movement
Head and neck
To check for facial
symmetry with and
without expression.
Ask patient to close mouth,
smile and open mouth; check
Muscles have
symmetry and have
equal sizes
The muscle and
bones are firm and
not tender. No
temperature
abnormalities. No
pain during palpation
of bones and muscles.
Skin tone is even
without noticeable
variations.
The ROM is full for
each joint. No pain
on passive and active
movement, deformity
and crepitus.
The patient has gait
conformity.
The patient strides
with a consistent
smooth rhythm with
symmetry of steps
and arm swing.
The patient has
smooth, swaying
movements.
The patient has a
symmetrical face
with or without facial
Inspect musculature of the
face and neck for symmetry
Palpate each
temporomandibular joint for
movement, pain, and sounds
Observe jaw for ROM
Open and close
Side to side
Protrude and retract
Palpate the neck for tone
Observe the neck for ROM
Flexion and Hyperextension
Lateral bending
Rotation
Test neck muscles for
strength
To examine the joint
tenderness, clicking
sounds, movement
mechanism and pain.
To examine the jaw for
ROM.
To determine the neck’s
firmness, softness and
presence of lymph nodes.
the symmetry of the face in all
actions.
Ask the patient to move his
jaw side by side; notice any
clicking sounds.
Ask patient to protrude and
subsequently retract the jaw;
Observe the easiness of the
movement.
The patient should move the
chin forward towards the
chest. Next, hyperextend the
To examine if the neck’s
chin moving it up up. Next,
ROM meets the expected
rotate chin to shoulders.
threshold flexion should be Finally, move the head
45 degrees from midline.
towards the shoulder.
Hyperextension should be
55 degrees from midline.
Ask the patient to rotate and
Normal Rotation should be push his head against the
around 70 degrees.
hand. Next, move the head
towards the chest and resist a
To test for the strength of
push force from the examiner.
sternocleidomastoid
Finally, retaining the position
muscle against applied
try to move the head back to a
force.
straight position against a
pulling force.
expression. The
patient’s neck
muscles are
symmetrical.
The patient’s
mandible has a
smooth and painless
movement—normal
audible clicking
without pain.
Motion is smooth
without pain. The
chin protrudes and
retracts painlessly.
The patient has a
perfectly normal neck
ROM. The ROM is
within the angle of 45
degrees from midline.
The patient has a
perfectly normal neck
ROM. The ROM is
within the angle
requirements.
The patient is able to
resist force applied,
indicating a
contraction of the
sternocleidomastoid
muscle.
To
examine
the
shape
of
The
patient
is
to
stand
in
an
The cervical convex,
Upper body (neck, spine,
the spine, including
erect position.
the thoracic convex
shoulders, extremities)
alignment and symmetry.
and lumbar concave
The patient should attempt to are present have a
Inspect the shoulders and
To determine the ROM of touch their toes. Observe from normal shape. The
cervical, thoracic, and lumbar
the lumbar spine and
the side.
vertebrate is aligned.
spine for alignment and
thoracic spine.
The shoulders are of
Ask the patient stretch
equal heights, shape
symmetry
backwards (Hyperextension)
indicating symmetry.
Observe ROM of the thoracic
Ask the patient flex sideways The posterior
to the left and right side.
thoraces are
and lumbar spine
To check for the
symmetric when
Flexion and Hyperextension
straightness and alignment Ask the patient to stand
touching toes.
of the posterior neck and
straight and rotate the upper
Lateral bending
spine.
trunk to the left and right.
The patient can touch
the toes and achieve
Rotation
To determine the
Ask the patient to flex the
75 degrees of flexion.
symmetry,
firmness,
level,
neck
and
hunch
their
The patient achieves
Palpate the posterior neck,
roundness, nature of
shoulders forward. Inquire if
the expected
spinal processes, and
contour and bone
the palpation is causing pain. Hyperextension,
paravertebral muscles for
prominence.
which is 30 degrees
Request the patient to take a
from the midline.
alignment and pain
To examine the firmness,
seat on the examination table The lateral flexion is
Inspect the shoulders and
fullness, pain and
and face you directly;
normal at around 35
degrees.
shoulder girdle for equality of symmetry of the shoulders. examine the
acromioclavicular junctions
The patient’s rotation
height, symmetry, and
To test for muscle strength and scapulae clavicles for
is normal, ranging
contour
and function of the cranial height and symmetry.
around 30 degrees.
nerve.
The posterior spine
and neck are aligned.
Palpate the shoulders for
firmness, fullness, symmetry,
and pain
To check for shoulder
symmetry, ROM and pain
or crepitus.
Extension: normal range is
Test the trapezius muscles for
180 degrees without
strength
discomfort and pain.
Hyperextension: The
Observe the shoulders for
normal range is 50 degrees
ROM and symmetry.
without discomfort and is
bilaterally equal.
Notice any crepitus or pain
Extension and
Hyperextension
Abduction and adduction
External rotation
Abduction: The normal
range is 180 degrees
without pain or
discomfort.
Adduction: The normal
range is 50 degrees
without discomfort.
Internal rotation
Test the arms for muscle
strength
Palpate the elbows for pain,
edema, temperature, and
nodules
Observe the elbows for ROM
Flexion and extension
Supination and pronation
Normal range for external
rotation is 90 degrees
while for internal rotation
is 60 degrees.
To test arm muscle
strength, triceps muscle
strength and bicep muscle
strength.
To check for temperature,
nodules, pain and edema.
Use pads of the thumbs to
conduct palpations on the
shoulder muscles.
Ask the patient to pull up the
shoulders and resist
downward force from your
hands.
Ask the patient to spread the
arms up beside the ears. Next,
straighten the arm and stretch
backwards. Check the angle
and level of discomfort in
each procedure.
Ask the patient to lift both
arms sideways over the head.
Next swing each arm across
the body. Check the angle
from neutral midline position.
The patient should place the
hand behind their head with
elbow out. Next, place the
hand behind the small back.
Check the angle and
discomfort for each process.
Ask the patient to lift both
arms. Apply downward force
against the arm. Next, the
patient extends the arm in a
The palpation is
painless.
Shoulders have equal
height and are
symmetrical. They
are equidistant from
the vertebral column.
The shoulder is firm,
full, and bilaterally
symmetric—no
discomfort or pain
during palpation.
Shoulders are strong
against resistance.
The patient conducts
all procedures
successfully within
the expected range
and without
discomfort. Extension
and hyperextension
process was bilateral.
Rotation is bilaterally
equal and within the
angle requirement.
No discomfort is
observed.
Inspect the joints of the
wrists and hands for
symmetry, alignment, and
number of digits.
Palpate each joint of the hand
and wrist for surface
characteristics and pain
Test for muscle strength of
fingers and grip
Observe for ROM of wrists
and fingers
Wrist flexion and
Hyperextension
To check for the ROM of
the elbow. The expected
range for elbow extension
and flex is 160 degrees
without any pain and
discomfort. Pronate and
supinate expected range is
around 90 degrees in both.
To check for symmetry,
alignment in both hands
and the number of digits.
To check for pain and
surface characteristics in
the hand joints and the
wrists.
To test for the grip
strength.
flexed position while an
opposite push force is applied.
Finally, the patient tries to
flex the arm against the
extension force applied by the
examiner.
Hold the patient’s arm in their
non-dominant hand and try to
palpate the lateral epicondyle
and olecranon process using
the thumb pads and fingers of
the dominant hand.
The patient should flex the
muscle and extend elbow.
Rotate hand palms up and
down.
Compare the left and right
hand; observe for symmetry
To examine the ROM of
of the two hands, alignment
the
wrist
and
fingers
among five digits, wrist, and
Wrist radial and ulnar
Wrist flexion: the expected fingers and forearm each a
deviation
range is around 70
hand.
Finger flexion, fist formation degrees.
Wrist Hyperextension: the The metacarpophalangeal
Finger extension, thumb to
expected range is 90
joints are palpated using two
each fingertip, to base of little degrees.
thumbs. Palpate the
finger
interphalangeal joints with
Metacarpophalangeal
thumb and index fingers.
flexion and
Palpate the radiocarpal groove
Hyperextension: The
and wrist the using the fingers
Metacarpophalangeal flexion
and Hyperextension
The muscle functions
are normal, with no
discomfort during the
procedure.
No edema, pain,
nodules, and
abnormal heat
noticed on the arm.
The patient extends
the muscle to the
expected range of
160 degrees. The
palm movements are
acceptable at 90
degrees in both
directions.
The patient’s hands
are symmetrical. The
wrist is aligned to the
forearm and five
digits.
No abnormality was
during the palpation
procedure of the wrist
and hand joints.
The patient has
normal grip strength
which is bilateral.
fingers are flexed up and
down: Normal range for
Hyperextension and
flexion is around 30
degrees and 90 degrees,
respectively. ‘
Wrist radial and ulnar
deviation: the expected
range of the inward turn is
20 degrees (radial), and
outward turn is 50 to 60
degrees (ulnar).
To check thumb, finger
movements and ability to
make a fist.
Lower body (Hips, knees,
extremities)
Inspect the hips for symmetry
Palpate the hips for stability
and pain
Observe the hips for ROM
To check for hip
symmetry.
To examine for pain and
stability.
To observe and examine
the ROM of the hips.
on the palmar surface and
thumb on dorsal surface.
The patient should to spread
their fingers and try to push
them together. Next should
grip two fingers of the
examiner on both hands.
Ask the patient to bend the
hand up and down at the
wrist.
The patient’s fingers are
flexed up and down at the
Interphalangeal joints. The
patient to places the palm on a
table and turn then inwards
and outwards. Then make a
fist and finally touch all
fingers of the hand including
the base of the fifth finger
using the thumb.
Ask the patient to stand;
examine the symmetry of the
hips posteriorly and
anteriorly.
The wrist movement
is within the expected
range. The ulnar and
the radial deviation
are within the
expected ranges of 50
degrees and 20
degrees, respectively.
The patient can make
a firm fist. The thumb
motions are
performed as
expected.
The hips have even
heights and observe
symmetry.
The hips are painless
Assist the patient to a supine
and stable during the
position. Determine symmetry palpation process.
by Palpating the iliac crest.
Hip flexion, hip extension
Hip flexion leg extension
External and internal hip
rotation
Hip abduction and adduction
Hip hyperextension, leg
extended
Hip flexion with a flexed
knee: Normal range is 120
degrees flexion.
Hip flexion with extended
leg without bending the
knee. Expected results
should be 90 degrees.
To test external hip
rotation: external and
Internal rotation is around
45 degrees and
40 degrees from the
straight central position
respectively.
Abduction and adduction:
the expected abduction is
up to 45 degrees, the
Hyperextension expected
range for adduction is up
to 30 degrees.
Test hyperextension of the
hip: the expected ROM is
up to 30 degrees.
Ask the patient to pull the
knee towards the chest in a
supinated position.
The hip flexion
movements are
normal.
Ask the patient to extend the
leg without bending the knee.
External rotation is
normal and within 45
degrees.
Internal rotation is
within the expected
angle of 40 degrees.
Ask the patient to place the
heel of left foot on the right
foot’s thigh region. Repeat
and shift the legs. Gently push
the knee to the examination
The abduction and
table.
adduction rotation is
normal and within the
Ask the patient to fix the knee expected range.
and turn inward as you pull
the heel sideways in an
The extended leg
outward position. Repeat the
meets the
procedure with the other hip
hyperextension
requirement of 30
Ask the patient to move one
degrees.
leg sideways with the knee in
a straight position. Repeat the
procedure with the other leg.
Assist the patient to a prone
position. Ask the patient to
raise left leg upward with the
knee at a straight postion.
Repeat the procedure with the
right leg leg.
.
Test the hips for muscle
strength
Test the leg muscles for
strength
Inspect the knees for
symmetry and alignment
Palpate the knees for contour
Observe the knees for ROM
Flexion and Hyperextension
Inspect the ankles and feet
for contour
Observe the ankles and feet
for ROM
Dorsiflexion and plantar
flexion
Inversion and eversion
Abduction and adduction
Flex and extend toes
–
Test ankle and foot
muscles for strength
To test bilateral hip muscle Assist patient to a supine
strength.
position and request them to
lift their legs (one at a time)
To test bilateral leg muscle as you push them down.
strength.
Ask the patient to sit up and
To check for knee
raise the legs from the knee
alignment and symmetry.
joint. Try pushing back the
leg. Next, try to straighten the
To check for firmness and knee while the patient bends
smoothness of the knee.
it.
To evaluate the ROM of
Observe for the knee
knee joints.
symmetry.
Flexion: the expected
range is 130 degrees.
Palpate the knee joints
Hyperextension: the
(suprapatellar pouch) of both
expected range is 15
legs with the thumb and
degrees from the midline.
fingers. Next, flex the knee at
90 degrees and palpate the
To evaluate the ROM for
popliteal and tibiofemoral
the ankles and feet.
joints spaces.
Dorsiflexion of the ankle:
the expected range is 20
Ask the patient to be in
degrees against the middle straight erect position (stand)
line.
and flex the knees, one at a
time.
Plantar flex: the expected
range is 45 degrees from
Ask the patient to raise the
midline.
ankle by pointing towards the
face.
The expected Eversion
angle range is 20 degrees.
The hips strength is
normal 5/5 and
bilateral.
The leg strength is
difficult to flex and
function bilaterally.
The knees are
symmetrical with no
noticeable deviations.
The patient has
smooth and firm knee
joints.
The patients meet the
expected range in the
dorsiflexion
examination.
The knee flexion and
Hyperextension of
were within the
normal range without
any discomfort.
The ankle movements
are normal and within
the required ROM.
The expected inversion
range is 30 degrees from
midline.
The patient to lower the ankle
by pointing the toes towards
the floor.
Abduct: Expected range is
around 10 degrees.
Adduct: Expected range is
around is 20 degrees and
without discomfort or
pain.
The patient to Evert the foot
by rotating it outward and
Invert of the foot by rotating it
inward.
The abduction and
adduction are
The patient to Abduct the foot standard and the
by turning it away from the
movements are in the
midline. Next, Adduct the
range of 10 degrees
foot by turning it inward
and 20 degrees,
toward the midline.
respectively.
Extend and flex: The
movements should be
bilateral and active.
Ask the patient to Extend and
flex the toes towards the face.
The motions of
eversion and
inversion of the foot
were completed as
expected and within
the normal ROM.
The movements of
the toe after flexion
and extension are
normal. The
movements are
bilateral and active.
Assess for nerve root
compression
Essential Skills
1. Assist client to a comfortable position following skill implementation
2. Leave client in the low position, 2 side rails up, and call bell in reach
3. Maintain safety, appropriate body mechanics, infection control, and asepsis throughout skill implementation
4. Discuss findings with client
5. Provide client education
6. Document assessment findings
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