Musculoskeletal and Neurological Assessment

• Neuro-Muskoloskeletal Assessment is presented by Keron Fraser-Jones

Objectives

• At the end of three hours, adult learners will be able to do the following:
  • Outline client preparation for the assessment.
  • Explain musculoskeletal and neurological systems for clients being assessed.
  • View assessment videos that describe the assessment of the names systems.
  • Discuss abnormal findings of assessing the named systems.

Muskoloskeletal Assessment

• Ensure the enviornment is appropriate and conducive, including privacy, lighting, and ventilation.
• Be sure to have all necessary equipment on hand.
• Ensure client comfort.
• Assessment of the body systems involves the gathering of subjective and objective data.
• Interviewing the client seeks to garner subjective data including:
  • History of present complaint (COLDSPA)
  • Past health history.
  • Family history.
  • Lifestyle and health practices.

COLDSPA

• Assists with gathering a client's history of the current complaint.
• C - Character: Describe the sign/symptom, sound, or smell.
• O - Onset: When did it begin?
• L - Location: Where is it? Does it radiate?
• D - Duration: How long does it last? Does it recur?
• S - Severity: How bad is it?
• P - Pattern: What makes it better? What makes it worse?
• A: Associated Factors: What other symptoms occur with it?

Muskoloskeletal System

• The Musculoskeletal system consists of the body's bones, joints, and muscles.
• The joint is the place of union of two or more bones.
• Joints are the functional units of the musculoskeletal system because they permit mobility.
• There are three primary types of joint articulation:
• Synovial: Bones do not touch each other, and the joint articulations are freely moveable, e.g., shoulder and knee.
• Cartilaginous: Allows only slight movement, such as those between vertebrae and the symphysis pubis.
• Fibrous: Allows no appreciable movement, such as the sutures of the skull.
• Each skeletal muscle is composed of bundles of muscle fibers.
• Skeletal muscle attaches to bone by tendon and produces different movements.
• Flexion: Bending a limb at a joint.
• Extension: Straightening a limb at a joint.
• Abduction: Moving a limb away from the midline of the body.
• Adduction: Moving a limb away toward the midline of the body.
• Pronation: Turning the forearm so the palm is down.
• Supination: Turning the forearm so the palm is up.

Musculoskeletal Assessment

• Inspect each joint for size, contour, masses & deformity.
• Palpate for musculature, crepitation; assess for temperature, swelling, or tenderness.
• Start with patient in sitting, upright position.
• Begin at the TMJ then do neck...
• Shoulders: Inspect anteriorly and posteriorly and palpate the sterno-clavicular areas and acromio-clavicular joint.
• ROM
  • Flexion and extension should be assessed by raising the arm above the head and extending backward.
  • External rotation is tested by placing both hands at the posterior neck.
  • Internal rotation occurs by placing both hands at the small of the back.
  • Abduction and adduction occur with arms straight; lift slowly laterally, then bring the arm down slowly medially.
• Elbows - inspect elbow while flexed, and palpate the olecranon process and the lateral and medial epicondyle.
• ROM
  • Flexion and extension occur by bend elbow then straighten elbow.
  • Assess pronation and supination by holding the arm at 90° and having the client turn the palm up and then down.
• Wrist & hand - inspect and palpate.
• ROM of wrist.
  • Flexion and extension occur by having the client bend the wrist with fingers pointed downward then upward.
  • Radial and ulnar deviation involves supporting the client's wrist with one hand and using the other to move extended fingers medially and laterally.
• ROM of fingers.
• Flexion and extension occur by having the client make a fist and open fist.
• Hip - inspect and palpate the hip while patient is in lateral position. ROM (while pt. lies supine then/and standing)
  • Flexion: Have client bend knee against abdomen, examiner can place arm beneath back and palpate during flexion of hip
  • Extension: Have patient move to one side of the bed and with one leg off the bed, bend knee backward.
  • Adduction and abduction: Stabilize the opposite hip/iliac and move the other leg laterally and medially across the midline of the body.
  • External rotation and internal rotation: Flex the leg at knee off the bed, stabilize the knee with one hand at the popliteal area, grasp the ankle, and move the limb medially (external) and laterally (internal).
• Knee: Inspect with knee flexed, then straighten limb and palpate patella anterior and lateral.
• Flex knees and palpate medial and lateral along the joint line for tenderness.
• ROM: flex and extend the knee.
  • Ankle & Foot: Inspect and palpate ankle foot & small joints of the toes, compress forefoot joint between fingers.
• ROM
  • Plantar flexion and dorsiflexion.
  • Inversion & eversion place heel in one hand, use other hand to grasp toes and move laterally and medially.
• Back & spine: Inspect vertebral alignment while patient is standing and on flexion for profile of spine and lateral curvature, then palpate spinal column.
• ROM of spine
  • Flexion & extension: bend forward then backward.
  • Lateral bending: stabilize hip and have client bend to right and left.
  • Rotation: client twist shoulders to right and left.
• Complete a Straight leg raising test (bilateral).

Neurological Assessment

• Equipment needed
  • Tuning fork
  • Reflex hammer
  • Cotton
  • Needles
  • Coin/paper clip/key
• Procedure:
  • Mental status assessment should include:
    • Assessing orientation to people, place, and time.
  • Testing memory of 3 objects at 5 minutes.
  • Assessing digit retention forward and reverse (count from 1-10 & then 10-1). -Testing simple calculation ability.
• Cerebellar function (assessing balance)
  • Assess Gait (include tandem walking – heel to toe on a straight line).
  • Have patient walk on heels and toes.
  • Have patient hop on one foot.
  • Assess Rapid alternating movements (pronate-supinate or finger-thumb).
  • Complete a Finger to nose test (bilateral).
  • Complete a Heel to shin test (bilateral).
• Motor function assessment includes:
  • Assessing Muscle tone(upper & lower extremities)
  • Evaluating Drift in upper extremities (pronator drift) – hold out arms for 20-30 seconds. There should be no drifting of the arm downward.
  • Assessing Motor strength (upper & lower extremities)
    • Strength of the biceps
    • Strength of the lower extremities
    • Hand grasps should also be assessed.
• Sensory function
  • Light touch (all 4 extremities) [Assess distal and proximal areas of all extremities].
  • Vibration sense (all 4 extremities) [Have client close eyes and ask what they feel and when the vibration stops while applying tuning fork to fingers & toes]
  • Pain by pin prick (all 4 extremities) [Assess distal and proximal areas of all extremities.
  • Two-point discrimination [use clients finger/hand move slowly from two points to one. The point at which client starts feeling one point should be less than 5mm for finger pad]
  • Kinesthesia - position sense (all 4 extremities) [Have client close eyes then ask them to identify the position of the finger, move finger up, down, right and left]
  • Graphesthesia (bilateral) [identify letter/number drawn in palm]
  • Stereognosis (bilateral) [identify objects placed in palm]
• Deep tendon reflex evaluation:
  • Reflex scoring:
    • 0=absent
    • 1+= present but decreased
    • 2+= normal
    • 3+= increased or brisk
    • 4+= brisk
• Biceps assessment:
  • With the patient sitting, flex his arm at the elbow and rest his forearm on his thigh with the palm up.
  • Place your thumb firmly on the biceps tendon in the antecubital fossa.
  • Strike your thumb with the hammer.The elbow and forearm should flex, and the biceps muscle should contract.
• Triceps Assessment
  • With the patient's arm flexed at a 90° angle and supported, strike the triceps tendon on the posterior arm just above the elbow. -The elbow should extend.
• Brachioradialis Assessment
  • Have the patient rest his slightly flexed arm on his lap with the palm facing downward.
  • Strike the posterior arm about two inches above the wrist on the thumb side.
  • The forearm should rotate laterally, and the palm turns upward.
• Patellar Assessment
  • Have the Patient dangle the patient's legs over the side of the bed.
  • Place your hand on the patient's thigh and strike the distal patellar tendon just below the kneecap.
  • The normal response is contraction of the quadriceps muscle with extension of the knee.
• Achilles Assessment
  • Have the patient dorsiflex (point downward) his foot, and tap the Achilles's tendon on the posterior ankle area.
  • A slight jerking of the foot should be seen. Assessment of Cranial Nerves:
  • I. Olfactory: Carries smell impulse from nasal mucous membrane to brain
  • II. Optic: Carries visual impulses from eye to brain
  • III. Occulomotor: Extraocular muscles – Eyelid elevation; Constrict pupils
  • IV. Trochlear: Extraocular muscles – Controls infero-medial eye movement
  • V. Trigeminal: Carries sensory impulses of pain, touch, & temperature from face to brain; Influences clenching and lateral jaw movement (biting & chewing)
  • VI. Abducens: Extraocular muscles – Controls lateral eye movements
  • VII. Facial: Controls sensory fibers for taste on anterior 2/3 of tongue, secretion from salivary glands and lacrimal glands Supplies facial muscles and affects facial expression (smiling, frowning & closing eyes)
  • VIII. Vestibulocochlear: Controls sensory fibers for hearing and balance (equilibrium)
  • IX. Glossopharyngeal: Controls sensory fibers for taste on posterior 2/3 of tongue & pharynx resulting in 'gag reflex'; provides secretory fibers to parotid salivary glands; and promotes swallowing movement
  • X. Vagus: Carries sensation from throat, larynx, heart, lungs, bronchi, GI tract & abdominal viscera; promotes swallowing, talking, and production of digestive juices
  • XI. Spinal Accessory: Controls trapezius & sternocleidomastoid; promotes movement of shoulders, rotation & larynx
  • XII. Hypoglossal: Controls tongue movements and promotes movement of tongue and talking

This quiz covers joint articulation, range of motion, and musculoskeletal assessment techniques. It also involves neurological examination, cranial nerves and related assessments affecting movement and senses. Key areas include shoulder and hip movements, elbow and wrist assessments.