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What questions should you ask in the musculoskeletal health history? (5)

1. • Joints
- Pain (When?, when exercising?)
- Stiffness = when the most, better over time, alleviating factors
- Swelling, heat, and redness = is it hot to touch
2. • Muscles
- Pain (cramps)
- Weakness = UE, LE, Right, left? Alleviating factors?
3. • Bones
- Pain = activity related, constant, come & go? what do you do for pain? does it help?
- Deformity = anything new?
- Trauma (fractures, sprains, dislocations)
4. • **Functional assessment (activities of daily living) = bath themselves, cook, walk, drive, stairs, dressing, toilet, grooming
5. • Self‐care behaviors = exercise

What four steps are used in all musculoskeletal examinations? (4)

*on exam* --> every muscle & bone group
1. - INSPECTION (redness, swelling)
• Size and contour of joint
• Skin and tissues over joint
• Skin temperature = warmth of joints
• Muscles, bony articulations, area of joint capsule = clicking of joint on movement
3. - RANGE OF MOTION = General. don't have to test all but can they move arms, legs (can they walk)
4. - MUSCLE TESTING = grip strength
• Apply opposing force
• Grading muscle strength (0-5)

Routinely performed examination techniques? (5)

• Inspect skeleton, extremities
• Inspect muscles for size & symmetry
• Palpate bones for tenderness, joints,
• Observe joint movement
• Test muscle strength

How is a patient assessed for TMJ & what is normal and abnormal?

• Inspect joint area
• Palpate as person opens mouth
• Motion and expected range (with ROM ask all along if experiencing pain)
- Open mouth maximally
- Protrude lower jaw and move side to side - Stick out lower jaw
• Palpate muscles of mastication
* Note: clicking is normal, pain is not

How is the cervical spine assessed, including ROM?

• Inspect alignment of head and neck
• Palpate spinous processes and muscles
• Motion and expected range
- Chin to chest
- Lift chin
- Each ear to shoulder
- Turn chin to each shoulder

what is done during a neck exam, including ROM?

• Rotation against resistance
- sternocleidomastoid palpation (whiplash)

what is done during a shoulder exam, including ROM?

• Inspect joint = redness, swelling, skin changing
• Palpate shoulders and axilla
• Motion and expected range
- Arms forward and up
- Arms behind back and hands up
- Arms to sides and up over head
- Touch hands behind head

what is done during a elbow exam, including ROM?

• Inspect joint in flexed and extended positions = redness & swelling
• Palpate joint and bony prominences
• Motion and expected range
- Bend and straighten elbow
- Pronate and supinate hand
160° flexion & extension

what is done during a wrist & hand exam, including ROM?

• Inspect joints on dorsal and palmar sides
• Palpate each joint
• Motion and expected range
- Bend hand up, down
- Bend fingers up, down
- Turn hands out, in
- Spread fingers, make fist
- Touch thumb to each finger
• Phalen's test
• Tinel's sign
• Muscle test = grip 2 fingers of nurses hand, both hands at the same time

What is Phalen's test?

flex both wrists and press the dorsum (back of hand) of hands together for 1 minute. No numbness, tingling or pain = negative for carpal tunnel syndrome

What is Tinel's sign

tap on the medial nerve where it passes thru the carpal tunnel under the flexor retinaculum & velar carpal ligament. no tingling = negative for carpal tunnel

what is done during a hip exam, including ROM?

• Inspect as person stands
• Palpate with person supine
• Motion and expected range
- Raise leg
- Knee to chest
- Flex knee and hip; swing foot out, in = internal & external rotation
- Swing leg laterally, medially = abduction & adduction
- Stand and swing leg back = hyperextension

Hip Exam: ROM tests(4)

1. External rotation = knee flexed & ankle over opposite knee, touch flexed knee to table
2. Internal rotation = knee bent & move medially
3. Abduction & adduction = leg extended, move laterally (abduction) & medially (adduction)
4. Hyperextension of hip, leg extended = move leg posteriorly

what is done during a knee exam, including ROM?

• Inspect joint and muscle
• Palpate
• Bulge sign
• Ballottement of patella
• Motion and expected range
- Bend knee
- Extend knee
- Check knee during ambulation

What is Bulge sign?

- to determine if there is fluid in the joint (small amount)
- milk the medial aspect of the knee (1-3 times) & then tap on the lateral side and watch for a fluid wave on the medial aspect.
Positive = inflammatory process such as osteoarthritis

What is Ballottement of patella?

- to determine if there is fluid in the joint (large amount)
- supine, knee extended, apply pressure on the supra patellar pouch with thumb and fingers of one hand & with the other hand push patella towards femur. Release the patella but leave hand there to feel for fluid wave
Positive = injury mostly, some infection

What is McMurray's test?

- patient is supine with knee flexed, foot flat near buttocks. place thumb & index finger on either side of joint space and raise lower leg until 90° (parallel with table). rotate knee both externally & internally.
- Positive test is clicking or locking of knee or pain, tear of meniscus

what is done during a ankle & foot exam, including ROM?

• Inspect with person sitting, standing, and walking
• Palpate joints
• Motion and expected range
- Point toes down, up
- Turn soles out, in = eversion, inversion, abduction, adduction (have patient do this before having them walk if you don't know if they can)
- Flex and straighten toes

what is done during a spine exam, including ROM?

• Inspect while person stands
• Palpate spinous processes
• Motion and expected range
- Bend sideways, backward
- Twist shoulders to each side
• Straight leg raising
• Measure leg length discrepancy

Four test for spine ROM

1. flexion = touch your toes 75°
2. hyperextension = start backbend 30°
3. lateral bending = bend at waist to right & left 35°
4. rotation of upper trunk = twisting 30°

Abnormal findings: Inflammatory conditions (2)

- Rheumatoid arthritis = chronic autoimmune inflammatory disease of the connective tissue
- Ankylosing spondylitis

Abnormal findings: Degenerative condition & where it can effect (1)

- Osteoarthritis (degenerative joint disease) = degenerative changes of articular cartilage
- effects weight bearing joints (ex. knee)

Abnormal findings: shoulder (1)


Abnormal findings: Elbow (4)

1. lateral epicondylitis (tennis elbow) = overuse, repetitive use
2. Subcutaneous nodules
3. Gouty arthritis = uric acid crystal build up
4. Bursitis = inflammation of bursa (large bump on elbow)

Abnormal findings: Wrist & hand (6)

1. • Syndactyly = fused fingers (repair quickly)
2. • Polydactyly = extra finger
3. Colles' fracture = use hands as brace
4. Ganglion cyst = along a nerve
5. Ankylosis = fixation of a joint, often in abnormal position
6. Dupuytren's contracture

Abnormal findings: Knee (3)

• Mild synovitis
• Prepatellar bursitis
• Medial collateral Ligament (MCL) Tear & ACL

Abnormal findings: Foot (6)

• Achilles tenosynovitis
• Chronic/acute gout
• Hallux vagus with bunion and hammer toes
• Callus
• Plantar wart
• Ingrown toenail

Abnormal findings: Spine (2)

• Scoliosis
• Herniated nucleus pulposus

What is supination?

palm up
want supination & pronation in order to feed themselves

What is pronation?

palm down
want supination & pronation in order to feed themselves

What is osteoporosis & what can happen when you have it?

• loss of bone density & decreased bone strength
• spontaneous fracture

What is dislocation?

on or more bones in a joint being out of position

What is subluxation?

partial dislocation of a joing

What is contracture?

shortening of a muscle leading to limited range of motion of joint

What is ankylosis?

stiffness or fixation of a joint

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