Introduction
Musculoskeletal system assessment involves collecting. validating, and analyzing the data about the patient’s health. A detailed clinical assessment provides information to identify treatment of the disease and helps nurses to monitor the patient’s response to treatment and interventions.
Definition
Musculoskeletal assessment focuses on assessment of range of motion and evaluation of joints or soft-tissue structures, the patient’s ability to perform activities of daily living, and its impact on health and quality of life.
Purposes
- To identify the ability to perform activities of daily living (ADLs).
- To collect valid information regarding the patient’s health status.
- To explore past injuries and measures to self-treat pain.
- To assess the swelling, stiffness, and inflammation.
Indications
- As a part of routine health checkup.
- Any systemic infection or disease such as arthritis, uncoordinated gait, and loss of function.
Preparation of Equipment
| Articles | Purpose |
| A clean tray containing; | |
| Mackintosh and towel. | To protect the bed from soiling and being wet. |
| Sterile masks, gowns, and gloves. | To follow aseptic technique. |
| Goniometer. | It is a physical therapy to track the process of a joint movement. |
History Collection (Subjective Data)
Focused complaints include the following:
- Mode of onset and duration of symptoms of pain (aching, throbbing, sharp, dull), swelling, redness, warmth, or stiffness.
- Ability to weight-bearing/rest and ability to perform ADLs.
- Past history of musculoskeletal disease (osteoarthritis, osteoporosis, rheumatoid arthritis, etc.) and swelling or neurological condition affecting muscles.
- Previous history of sprain, strain, fracture, repair or hip/knee surgery, intake of supplements/medication/herbs, and impairment of movement.
Physical Examination (Objective Data)
General assessment includes the following: G, gait; A, arms; L, leg; and S, spine.
- Assess gait.
- Inspect the spine.
- Observe range of motion of joints.
- Inspect muscles and extremities for size and symmetry.
- Assess muscle strength.
- Palpate extremities.
Sites of Somatic Reference of Different Joint Pains
| Joint Pain | Site of Referred Pain |
| Cervical spine | Head/over the shoulder. |
| Lumbar spine | Buttocks/posterior thigh. |
| Shoulder | Lateral aspect of the upper arm. |
| Elbow | Forearm. |
| Hip | Outer aspect of the thigh or knee or both. |
Procedure
| Assessment Component | What to Evaluate | Key Considerations |
|---|---|---|
| Subjective Data | Pain, stiffness, weakness, limited mobility, history of injury or surgery | Use PQRSTU to explore pain; assess impact on ADLs and functional status |
| Inspection | Posture, gait, symmetry, swelling, deformities, muscle mass | Look for scoliosis, kyphosis, lordosis, atrophy, or joint abnormalities |
| Palpation | Tenderness, warmth, swelling, crepitus, muscle tone | Palpate joints and muscles for abnormalities or discomfort |
| Range of Motion (ROM) | Active and passive ROM of major joints | Compare bilaterally; note limitations or pain |
| Muscle Strength | Strength of major muscle groups (graded 0–5) | 5 = full strength; 0 = no movement |
| Neurovascular Checks | Color, temperature, capillary refill, pulses, sensation, movement | Especially important post-injury or post-op |
| Special Tests | Straight leg raise, Phalen’s, Tinel’s, McMurray, Lachman | Used to assess for nerve impingement or ligament/tendon injury |
Special Considerations
When assessing older adults, it is important to assess their mobility and their ability to perform activities of daily living:
- To identify the use of any assistive devices such as a brace, cane, walker, or wheelchair.
- To identify whether the patient had fallen or had any near falls in the past few months, and if so, whether there was any injury or whether the patient sought medical care.
- To identify the mobility and notice any changes in the ability to complete usual daily activities such as walking, going to the bathroom, bathing, doing laundry, or preparing meals.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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