Health Assessment, part 38: Musculoskeletal Assessment

Hi. I'm Meris. And in this video, I'm going to be talking to you today about how to perform a musculoskeletal assessment. I'm going to be following along using flashcards from our health assessment flashcards. These are available on our website, leveluprn.com, if you want to grab a set for yourself. Or if you are more of a fan of digital products, I would invite you to check out our Flashables, which are the digital version of all of our flashcards. They're really cool. Check them out. All right. If you're ready, let's go ahead and get started.

So in this video, I'm going to be talking to you about the assessment components that go into assessing the musculoskeletal system. And as with our other systems, we're going to be using our senses when we assess this patient. So we're going to start by inspecting our patient's body size and shape. We're looking at the symmetry of the muscles. We're looking at the size of the muscles. Do I see any sort of atrophy or hypertrophy of these muscles, things that I need to be looking for? Do I see any swelling of joints, any redness, which we call erythema, any kind of masses or deformities? I'm looking for all of these things when I assess the musculoskeletal system.

One of the other things we're going to be assessing in the musculoskeletal system is the normal curvatures of the spine. And when I talk about this, sometimes people are like, "Curvature of the spine. That's not normal." And you're thinking about an abnormal curvature of the spine, which we will talk about in the next video. And I will also talk to you more in depth about the normal curves of the spine in the next video. But one of the ones I do like to point out is the neck or the cervical spine. In this region, we are going to have that concave curvature. As you're looking from the posterior, we'll have that concave curvature of the cervical spine. It is not severe. It's not pronounced, but it's normal. It comes from our head sitting on top of our neck. And the pressure from gravity creates that normal curvature. So we should be assessing for normal curvatures in our patients. And if we find that those curves are exaggerated or absent, then that is something worth noting and investigating further.

We are also going to be looking at joint movements. So when I am doing a musculoskeletal assessment, the palpation portion is not really a pushing kind of a touching. It's going to be assessing range of motion. How does my patient's arm move both actively and passively? Now, remember, active range of motion is the patient actually doing it themselves, right? I think about an athlete or somebody doing yoga. That's how I remember active range of motion. But again, this just means that the patient is doing it themselves. I'm demonstrating to you my active range of motion on this right arm. Passive range of motion means that the range of motion is being done by another person. So this might be where I'm assessing, can I bring the arm across the midline, for instance, with just me, the examiner, doing it? That is called passive range of motion.

One of the last things that I want to talk to you about here in musculoskeletal assessment is when we are assessing for muscle strength. Now, what am I looking for here? I am going to oppose my patient's action - and I'm going to explain this in a minute - and I'm going to see if they can overcome my resistance. And what this means, for instance, is if I tell my patient that I want them to pull me towards them, I'm going to give them my hands, right, and say, "Pull me towards you," but I'm going to kind of be resisting, right? I'm pulling back. I want to see, can they overcome that resistance? Can they pull me to them strongly? Or when I'm assessing their feet, for instance, I'll put my hand there and say, "I want you to push down like you're pushing on a gas pedal." But I'm not just going to let them push my hand away, right? I'm going to make sure that I'm providing some resistance and see that they are able to overcome that.

We grade this muscle strength on a 0 to 5 scale, with 5 meaning that we have full range of motion with full opposition to resistance and 0, meaning that there is no muscle tone whatsoever. This is a flaccid muscle entirely. I would caution you to make sure that you know what your facility uses for each of those because the different facilities I've worked have a slightly different interpretation of what 0 through 5 means. So just make sure that you are aware of your documentation practices and standards.

All right. So that is it for this video, but stay just a little bit longer because I do have some quiz questions to test your knowledge of key facts provided in this video. How should the nurse grade a patient's muscle strength if they have full range of motion against full resistance? 5 out of 5. All right. That is it for this video. Thank you so much for watching. I would love it if you would leave me a comment. We read every single one. And if you found this video to be especially helpful or something was especially memorable for you, I would love to know that. It means a lot to me. And if you have a good way of remembering things that I didn't cover, I know other learners would love to hear those ways that you have of remembering things as well. All right. In case nobody's told you today, we're really proud of you. Thanks so much, and happy studying.