The musculoskeletal system

The musculoskeletal system
General
• Note the normal activity of daily living.
• Note asymmetry, weakness, swelling, tenderness and rang of motion (ROM).
• Note joint deformities or malalignment do bone.
The temporomandibular
• Inspect the anterior to the ear.
• To locate and palpation, place the tip of your index finger in temporomandibular joint, and ask the pt to open mouth (check for smooth ROM, note weakness and tenderness).
• Test the muscle strength (ask the pt to move jaw against your resistance).
ROM:
• Ask the pt to
- Opening and closing his mouth.
- Protrusion and retraction his mouth.
- Move his mouth lateral or side to side.
Cervical spine
• Inspect the head and neck, (the spine should be straight, asymmetry).
• Palpate the spinous process and stervomadtoid, trapezius, and paravertebral muscles (tenderness and hard muscles with muscle spasm).
• Test the muscle strength (ask the pt to move head against your resistance).
ROM
• 6 motions:
1-2: flexion and extension.
3-4: right and left lateral bending.
5-6: right and left rotation.
Upper extremity
The shoulder
• Inspect both shoulders posteriorly and anteriorly.
• Inspect the counter of the shoulder and the clavicle, acromion, coracoids process, and greater tubercle of the humerus
• Note any swelling, deformity, or muscle atrophy.
• Palpate the top of shoulder, acromioclavicular joint, lateral and anterior of the shoulder (Note the location of pain, redness, swelling, and hard muscles with muscle spasm).
• Test the muscle strength (ask the pt to move shoulder against your resistance).
ROM:
• 6 motions:
1-2: flexion and extension.
3-4: abduction and adduction:
5: internal rotation: ask the pt to place both hands on the back of trunk.
6: external rotation: ask the pt to place both hands on the back of head.
Elbow
• Inspect the size and contour of the elbow in flexed and extended position (look any deformity, redness, or swelling).
• Palpate with the elbow flex and relax (local heat or tenderness [signs of inflammation], swelling).
• Test the muscle strength (ask the pt to move forearm against your resistance).
ROM
• 4 motions:
1-2: flexion and extension.
3-4: pronation and supination.
Wrist and hand
• Inspect the size and contour (swelling or redness and deformity).
• Palpate firmly on each joint in the wrist and hand, on the metacarpophalangeal with your thumps, and with thump, index finger on the interphalangeal joint (swelling and tenderness).
• Test the muscle strength (ask the pt to move against your resistance).
ROM
• 14 motions:
1-2: flexion and extension of the wrist.
3-4: flexion and hyperextension of the metacarpal.
5-6: ulnar and redial deviation.
7-8: abduction and adduction of finger.
9-10: opening and closing of the hand.
11-12-13-14: flexion, extension, adduction, and opposition the thump.
Phalen's test:
• Ask the pt to hold both hands bake to back while flexing the wrist 90º for 60 sec.
• Normally: no numbness.
Tinel's sing:
• Direct percussion of the location of the median nerve.
• Normally: wrist produces no symptom (burning and tingling).
Lower extremity
Hip
• Inspect the hip joint with the pt stand (and size).
• Palpate the hip joint (asymmetry, swilling and tenderness).
• Test the muscle strength (ask the pt to move against your resistance).
ROM
• 7 motions:
1-2-3: extinction and flexion the hip with and without knee flexion.
4-5: internal and external rotation.
6-7: abduction and adduction.
Knee
• Inspect both knees (size, contour, asymmetry, swelling, and redness [sign of inflammation]).
• Palpate the knee (swelling, tenderness, the patella movement).
• Test the muscle strength (ask the pt to move leg against your resistance).
ROM
• 3 motions:
1-2-3: flexion, extension, and hyperextension).
Ankle and foot
• Inspect both feet (size, asymmetry, ulcer, swelling, and redness [sign of inflammation]).
• Palpate firmly with thumps in the joint spaces and metatarsophalangeal between thump on the dorsum and others finger on the plantar surface (smooth, swelling, tenderness).
• Test the muscle strength (ask the pt to move foot against your resistance).
ROM
• 4 motions:
1-2: dorsiflexion and plantar flexion:
3-4: eversion and inversion.
Spine
• Inspect the spin laterally, pasteriorly and anteriorly (straight and deformity).
• Palpate the spinous process (swilling, tenderness, or spasm).
• Convex of the thoracic, and concave of the cervical and lumbar.
ROM
4 motions
1-2: extension and flexion.
3-4: right and left bending.
5-6: right and left rotation.
Special technique
1. Measure leg length
• Measure from the anterior iliac spine to the medial malleolus.
• Normally: both legs are equal.
2. Leg Raising or Lasegue's test (low back pain).
• Supine position.
• Elevated the pt's leg and keeping the knee extension.
• Normally: on pain.
3. Test of fluid in the knee joint
a. The Bulge sign:
 Place your hand on the medial aspect of the knee 2 or 3 times
 Strike laterally and watched the medial side.
 Normally: no bulge or fluid wave.
b. Ballotting the patella:
 With left hand compress the suprapatellar pouch and with right hand push the patella sharply against femur.
 Normally: no fluid returning to the suprapatellar pouch.
c. The balloon sign:
 Place thump and index finger of your right hand on each side of the patella; and with left hand compress the suprapatellar pouch against femur.
 Normally: no feel fluid entering (or ballooning into) to space