Physical Exam: Musculoskeletal System

I. History: Participation in sports, risk factors for osteoporosis, impact of current problem on activities of daily living


II. Inspection

• Gait: Normal findings - client walks with arms swinging freely at sides; coordinated and smooth; rhythmic with push off and swing through
• Posture and Balance: Normal findings

1. upright stance with parallel alignment  of hips and shoulders
2. feet aligned; toes pointing straight ahead
3. convex curve to thoracic spine
4. concave curve to lumbar spine
5. can stand still without swaying or tilting

• Extremities: Normal findings - bilateral symmetry in length, circumference. alignment, position and number of skin folds

III. Palpation

• All muscles, bones, joints
• Normal findings - muscles firm, non-tender

IV. Range of Motion: Normal findings - able to move joints through required range of motion

• Abduction - lateral movement of the limbs away from the median plane of the body, or lateral bending of the head or trunk
• Adduction - movement of a limb or eye toward the median plane of the body or, in the case of digits, toward the axial line of a limb
• Dorsiflexion - movement of a part at a joint to bend the part toward the dorsum, or posterior aspect of the body
• Eversion - turning outward
• Extension - a movement that brings the members of a limb into or towards a straight position
• Flexion - the act of bending or condition of being bent in contrast to extension
• Hyperextension - extreme or abnormal extension
• Inversion - a turning inside out of an organ (e.g. the uterus)
• Plantar flexion - extension of the foot so that the forepart is depressed with respect to the position of the ankle
• Pronation - the act of lying prone or face downward
• Supination - the condition of being on the back of having the palm of the hand facing upward or the foot turned inward and upward

V. Muscle Strength and Symmetry: Normal findings - arm on dominant side generally stronger

VI. Alterations

• Kyphosis - exagerration or angulation of the normal posterior curve of the spine, giving rise to the condition commonly known as humpback. hunchback or Pott's curvature
• Lordosis - abnormal anterior convexity  of the lumbar spine
• Scoliosis - lateral curvature of the spine
• Pain

VII. Geriatric Alterations

• Stance less upright with head and neck forward
• Lumbar curvature less pronounced
• Height decreased
• Gait slower to initiate and stop
• Less knee and ankle lifts
• Steps may be shorter and more rapid
• May need to hold unto furniture as age increases
• Muscles atrophy with disuse
• Weaker grip
• Active range of motion may be slower and limited in one or more joints
• Joints appear larger than surrounding tissue; may be stiff

POINT TO REMEMBER:

• Older adults walk with smaller steps and need a wider base of support