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Assessment of Muscular System

Unit 3 Lesson 14 Part 2

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Student Learning Objectives

Explain the processes, procedures and techniques in the assessment of the muscular system
Differentiate between normal and abnormal assessment findings of the muscular system
Identify nursing health promotion interventions related to the muscular system

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Assessment Techniques

1. Inspection

Gait, posture, symmetry
Visible deformities or swelling

2. Palpation

Muscle tone and strength
Joint stability and range of motion

(Lapum & Hughes, 2020)

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Assessment of Arms, Hands, and Related Joints

Progress from shoulders to fingertips
Joints: Shoulders, elbows, wrists, fingers
Methods

Inspection
Palpation
Range of motion (ROM)
Manual muscle testing (MMT)

(Lapum & Hughes, 2020)

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Inspection and Palpation of the Arms, Hands, and Related Joints

Inspection

Inspect for color, symmetry, swelling, masses, deformities
Normal Findings:

Symmetrical arms and hands
No redness, swelling, masses, or deformities

Palpation

Check temperature, pain, masses, swelling, deformities
Normal Findings:

Warm to touch, no pain, masses, swelling

(Lapum & Hughes, 2020)

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Range of Motion in Arms, Hands, and Related Joints

Shoulders: Flexion, extension, abduction, adduction, external/internal rotation
Elbows: Flexion, supination, pronation
Wrists: Flexion, extension, radial/ulnar deviation
Fingers: Flexion, extension, abduction, adduction
Normal Findings:

Smooth, symmetrical ROM
No crepitus or pain

(Lapum & Hughes, 2020)

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Manual Muscle Testing in Arms, Hands, and Related Joints

Assess resistance during joint movement
Normal Findings:

Full resistance bilaterally
No pain

(Lapum & Hughes, 2020)

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Assessment of Legs, Feet, and Related Joints

Progress from upper leg to toes
Joints: Hips, knees, ankles, toes
Methods

Inspection
Palpation
ROM
MMT

(Lapum & Hughes, 2020)

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Inspection and Palpation of the Legs, Feet, and Related Joints

Inspection

Check color, swelling, masses, deformities, symmetry
Normal Findings:

No discoloration, swelling, masses, deformities
Equal leg length/circumference

Palpation

Assess temperature, pain, masses, swelling, deformities
Normal Findings:

Warm to touch
Cooler at toes
No pain, masses, swelling

(Lapum & Hughes, 2020)

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Range of Motion in Legs, Feet, and Related Joints

Hips: Flexion, extension, abduction, adduction, external/internal rotation
Knees: Flexion, extension
Ankles: Dorsiflexion, plantar flexion, inversion, eversion
Toes: Flexion, extension
Normal Findings

Full ROM
No crepitus
Smooth and symmetrical movements

(Lapum & Hughes, 2020)

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Manual Muscle Testing in Legs, Feet, and Related Joints

Evaluate strength by applying force during joint movement
Normal Findings

Full resistance bilaterally
No pain

(Lapum & Hughes, 2020)

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Critical Thinking and Further Assessment

If a client has limited ROM or pain, consider subjective assessment using PQRSTU to explore symptoms
Bilateral comparison and additional assessments

Example: Functional health evaluations

Utilize a trauma-informed approach

Example: If assessing sensitive areas like hips

(Lapum & Hughes, 2020)

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Inspection of the Rib Cage

Expose the chest area, ensuring patient comfort and privacy
Observe the shape, symmetry, and movement of the rib cage
Note any visible deformities, such as flail chest or pectus excavatum/carinatum
Assess for paradoxical movement (inward movement during inhalation)
Observe the skin for bruising, scars, or signs of trauma

(Lapum & Hughes, 2020)

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Palpation of the Rib Cage

Use the pads of the fingers to gently palpate each rib, starting from the clavicle
Assess for tenderness, crepitus (crackling sensation), or instability
Palpate the intercostal spaces for swelling or masses
Palpate the sternum for any deformities or tenderness
Clinical tip

Rib fractures may present with point tenderness and crepitus

(Lapum & Hughes, 2020)

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Inspection of the Spine

Observe the spine from anterior, posterior, and lateral views
Assess for symmetry of the shoulders, scapulae, and iliac crests
Note any visible curvatures, such as scoliosis, kyphosis, or lordosis
Observe the paraspinal muscles for asymmetry or atrophy
Assess the skin for birthmarks, hair tufts, or dimples (may indicate spinal dysraphism)

(Lapum & Hughes, 2020)

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(Lapum & Hughes, 2020)

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Palpation of the Spine

Palpate the spinous processes from the cervical to the lumbar region
Assess for tenderness, step-offs, or gaps between the processes
Palpate the paraspinal muscles for tenderness, spasms, or trigger points
Assess the sacroiliac joints for tenderness or asymmetry
Clinical tip

Tenderness or step-offs may indicate vertebral fractures or misalignments

(Lapum & Hughes, 2020)

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Range of Motion (ROM) of the Spine

Assess active ROM in flexion, extension, lateral flexion, and rotation
Observe for smoothness, symmetry, and any limitations in movement
Note any pain, discomfort, or crepitus during movement
Measure ROM using a goniometer or inclinometer for objective documentation
Clinical tip

imited ROM may indicate conditions such as ankylosing spondylitis or intervertebral disc disorders

(Lapum & Hughes, 2020)

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Special Tests for the Spine

Perform special tests based on clinical suspicion and patient presentation
Examples:
Straight leg raise test (for lumbar radiculopathy)
Slump test (for neural tension)
Schober's test (for lumbar spine mobility)
Compression/distraction tests (for cervical spine disorders)
Clinical tip

Positive findings on special tests may guide further diagnostic imaging or referrals

(Lapum & Hughes, 2020)

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Evaluation Techniques for Functional Health

Assessing functional health is crucial for understanding patients' abilities and limitations
Multiple evaluation techniques are used to gather comprehensive information
Techniques include self-report measures, performance-based assessments, and clinical observations
The choice of technique depends on the patient's condition, setting, and goals

(Lapum & Hughes, 2020)

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Critical Thinking Question

Which question would best help a nurse understand the impact of musculoskeletal symptoms on a client's functional health?

A) "How would you describe the pain you are experiencing?"

B) "Can you tell me about any activities you find difficult due to your symptoms?"

C) "Have you tried any medications for your symptoms?"

D) "When did your symptoms first start?"

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Performance-Based Assessments

Objective tests that measure patients' actual performance of specific tasks
Examples include:
Timed Up and Go (TUG) test for mobility and balance
Six-Minute Walk Test (6MWT) for cardiovascular endurance
Functional Reach Test (FRT) for balance and stability
*Grooved Pegboard Test for fine motor skills and dexterity

(Lapum & Hughes, 2020)

Contact info: info@nursesinternational.org

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Performance-Based Assessments continued…

Advantages

Provide objective data
Demonstrate real-world functioning

Limitations

Time-consuming
Require standardized equipment and training

(Lapum & Hughes, 2020)

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Clinical Observations

Structured observations of patients' functioning in real-life settings
Can be conducted during clinical encounters, home visits, or rehabilitation sessions
Focus on patients' ability to perform ADLs, IADLs, and other relevant tasks
Observations include
Mobility (e.g., transfers, ambulation, stairs)
Self-care (e.g., bathing, dressing, grooming)
Cognitive functioning (e.g., following instructions, problem-solving)
Social interactions (e.g., communication, participation in activities)

(Lapum & Hughes, 2020)

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Clinical Observations continued…

Advantages

Provide ecologically valid data
Capture contextual factors

Limitations

Time-intensive
May be influenced by observer bias

(Lapum & Hughes, 2020)

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Integrating Evaluation Techniques

Using multiple evaluation techniques provides a comprehensive assessment of functional health
Self-report measures offer insights into patients' perceptions and experiences
Performance-based assessments provide objective data on specific functional abilities
Clinical observations capture real-world functioning and contextual factors

(Lapum & Hughes, 2020)

Contact info: info@nursesinternational.org

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Integrating Evaluation Techniques continued…

Integrating findings from different techniques helps create a holistic picture of patients' functional health
Enables individualized goal-setting, care planning, and outcome evaluation

(Lapum & Hughes, 2020)

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Clinical Tip: Assessment Begins at First Contact

Observe client's physical capacity in daily activities
Examples:

Walking into the room
Moving from standing to sitting
Signing a consent form
Changing into a hospital gown

(Lapum & Hughes, 2020)

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Clinical Tip: Assessment Begins at First Contact continued…

Compare bilaterally during assessment
Ask about changes in movement
Findings guide further examination
Incorporate concept of functional health, which is an individual's ability to perform daily activities and fulfill roles in society, considering their physical, mental and social well-being

(Lapum & Hughes, 2020)

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Critical Thinking Question

A nurse is assessing a client's muscular system. Which of the following actions should the nurse prioritize during the initial observation?

Ask the client to perform a series of strength exercises
Observe the client's gait as they walk into the examination room
Immediately begin palpating the client's muscles
Ask the client to fill out a detailed questionnaire about their exercise habits

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Normal vs Abnormal Findings

Normal	Abnormal
Full range of motion	Limited range of motion
Symmetrical muscle strength	Muscle weakness or asymmetry
No pain during movement	Pain or discomfort during movement
Smooth, coordinated movements	Visible deformities or swelling
Smooth, coordinated movements	Uncoordinated or jerky movements

(Lapum & Hughes, 2020)

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Critical Thinking Question

The nurse is conducting a muscular system assessment on a client. The nurse notices that the client's right shoulder has a limited range of motion compared to the left, and the client reports pain when trying to raise their right arm above their head.

How should the nurse interpret these findings, and what further assessment might be needed?

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Answer Key:

The nurse should interpret these findings as potentially abnormal. The asymmetry in range of motion between the right and left shoulders, combined with the client's report of pain, suggests a possible issue with the right shoulder muscular or joint structure.

Further assessment needed:

Conduct a more detailed examination of the right shoulder, including palpation for any swelling or tenderness.
Perform specific range of motion tests for the shoulder joint.
Assess the strength of the muscles around the shoulder.
Ask the client about any recent injuries or changes in activity that might have affected the shoulder.
Consider referring the client for imaging studies if deemed necessary.

Explanation: Normal findings typically include symmetrical range of motion and strength without pain. The presence of limited motion on one side and associated pain indicates an abnormal finding that requires further investigation. This question tests the nurse's ability to differentiate between normal and abnormal findings and decide on appropriate follow-up assessments.

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Health Promotion: Activity and Exercise

Sedentary lifestyle is a risk factor for musculoskeletal conditions
General guidelines

30-60 minutes of aerobic activity, 5-7 times a week
Include strength training and stretching

Exercise strengthens muscles, bones, and joints
Low-impact activities for those with joint issues

Walking, cycling, water exercises
Yoga and tai chi for balance, flexibility, and strength

(Lapum & Hughes, 2020)

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Health Promotion: Ergonomics and Back Health

Ergonomics

Designing spaces for optimal body function

Consider

Body positioning when sitting
Repetitive actions
Lifting heavy objects

(Lapum & Hughes, 2020)

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Health Promotion: Ergonomics and Back Health continued…

Proper body alignment

Use large muscle groups
Keep objects close to center of gravity
Avoid twisting motions, use pivoting instead
Engage core muscles for stability

(Lapum & Hughes, 2020)

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Health Promotion: Diet

Importance of a healthy diet for musculoskeletal health
Key nutrients

Protein for muscle repair and growth
Calcium and Vitamin D for bone health
Vitamins K, magnesium, and zinc for overall MSK health

Adequate hydration for joint fluid

(Lapum & Hughes, 2020)

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Health Promotion: Diet continued…

Avoid inflammatory foods

Refined carbohydrates, fried foods, processed meats
Sugar, trans fats, and saturated fats

Consider Canada's Food Guide recommendations

(Lapum & Hughes, 2020)

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Health Promotion: Stress Management

Stress can affect musculoskeletal health
Effects of stress

Disrupted sleep patterns
Increased muscular tension (especially in neck and back)
Decreased oxygen to muscles
Increased inflammation
Potential for injury due to distraction

(Lapum & Hughes, 2020)

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Health Promotion: Stress Management continued…

Coping Strategies

Regular physical activity
Relaxation techniques
7-9 hours of sleep per night
Social support and personal time

(Lapum & Hughes, 2020)

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Priorities of Care: Fall Prevention

Falls are a leading cause of injury, especially in older adults
Prevention strategies

Proper footwear with non-slip soles and good support
Regular medical check-ups (including eye and hearing exams)
Safe home environment (grab bars, proper lighting)
Nutritious meals rich in protein and calcium

(Lapum & Hughes, 2020)

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Priorities of Care: Fall Prevention continued…

Prevention strategies continued…

Regular exercise to maintain muscle mass
Medication management to avoid side effects
Monitoring alcohol intake

(Lapum & Hughes, 2020)

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Critical Thinking Question

The nurse is providing health promotion education to a client who spends long hours sitting at a desk job. Which of the following interventions should the nurse prioritize recommending?

Suggest the client quit their job to avoid prolonged sitting
Recommend ergonomic adjustments to the workspace and regular stretching breaks
Advise the client to stand at their desk for the entire workday
Suggest the client only focus on weekend exercise to compensate for sitting

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References

Lapum, J.L. & Hughes, M. (2020). Introduction to Health Assessment for the Nursing Professional. Toronto Metropolitan University. Pressbooks. https://pressbooks.library.torontomu.ca/assessmentnursingmain/

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