“Hello my name is , a nursing student at USA. Let’s start your musculoskeletal system exam.”
A. Inspect & palpate 2 joints selected by the Faculty for: Color, Swelling, Masses, Deformity, Temp.
1. Temporomandibular Joint (TMJ)
“Please sit on the exam table.” Inspect area in front of ear. “The temporomandibular joint area is a tan-pink color with no swelling, masses, or deformities.”
Palpate. “Please open and close your mouth and tell me if you feel any pain or tenderness. The TMJ is nontender and moves smoothly without pain, or crepitation. No heat, swelling or masses are noted.”
“Please clench your teeth. The temporalis and masseter muscles are firm and bilaterally symmetrical.”
2. Neck
Inspect alignment of head and neck. “The cervical spine is a uniform tan-pink color with no swelling, masses, or deformities. Head and spine are aligned. The spine is straight, and the head is erect.”
Palpate. “Tell me if you feel any pain or tenderness. The spinous processes, sternomastoid and paravertebral muscles are firm and non tender. No heat, swelling or masses are noted.”
3. Shoulder
Inspect and compare both shoulders front and back. “The shoulder is a uniform tan-pink color with no swelling masses, or deformities. There is no muscular atrophy.”
Palpate. “Tell me if you feel any pain or tenderness. The shoulder area is non tender. No heat, swelling or masses are noted.”
4. Elbow
Inspect the size and contour of the elbow in flexed and extended positions. “The elbow is a uniform tan-pink color with no swelling, masses or deformities.”
Palpate. “Tell me if you feel any pain or tenderness.” Palpate with elbow flexed about 70 degrees and relaxed. “The elbow joint is non tender. No heat swelling or masses are noted.”
5. Wrist and Hand
Inspect hands and wrists on dorsal and palmar sides. “The wrists and hands are tan-pink in color with no swelling, masses or deformities.”
“Tell me if you feel any pain or tenderness.” Palpate. “The hands and fingers are nontender. No heat, swelling or masses are noted.”
6. Hip
Inspect. “The iliac crests are level and symmetric, gluteal folds and buttocks are symmetric. The smooth even gait reflects equal leg lengths and functional hip motion. No deformities are noted.”
Palpate. Lie supine. “Tell me if you feel any pain or tenderness. The hip is non tender. No heat, swelling, masses or are noted. There is no crepitance.”
7. Knee
Inspect. The patient should be supine with legs extended. “The lower leg is aligned with the thigh.”
Ask patient to sit up and dangle legs over edge of table. “The knee area is a uniform tan-pink in color with no swelling, masses or deformities noted.”
Palpate. “Please tell me if you feel any pain or tenderness. The knee is non tender. No heat, swelling, or masses are noted.”
8. Ankle and Foot
Inspect ankles and feet while person is sitting, standing and walking. “Feet and ankles are a uniform tan-pink in color with no swelling, masses, or deformities noted. The foot has a longitudinal arch, the toes point forward and lie flat, and the ankles have smooth bony prominences.”
Palpate. “Please tell me if you feel any pain or tenderness.” Support ankle. “The feet and ankles are nontender. No heat, swelling, masses or calluses are noted.”
“Now we’re going to test your range of motion and muscle strength. Please tell me if you feel any pain or tenderness. Please open and close your mouth as wide as you can. Now open your mouth and move it side to side. Please stick out your lower jaw. Please open your mouth. Temporomandibular Joint has full range of motion with smooth movement, no crepitance or tenderness noted.”
“Now we’ll test your cervical spine. Tell me if you feel any pain. Touch your chin to your chest. Full flexion ROM. Lift your chin towards the ceiling. Full extension ROM. Touch each ear towards your shoulder. Full lateral bending ROM. Turn the chin towards each shoulder. Full rotation ROM.”
Patient should be standing. “Please raise your arms with your elbows extended. Full forward flexion ROM. Now lower your arms as far back as possible. Full hyperextension ROM. Now please raise your arms to the sides and above your head until your palms touch. Full abduction ROM. Now lower your arms, crossing in front of your body. Full adduction ROM. Put your hands behind your head. Full external rotation ROM. Now put your hands behind your back. Full internal rotation ROM.”
Test muscle strength. Place both your hands on the patient’s shoulders as resistance. “Please shrug your shoulders, flex your shoulders forward and up. “Patient’s shoulder muscles are graded as 5 for full ROM against full resistance.”
“Please bend and straighten your elbow, and tell me if you feel any pain. Full flexion and extension ROM. To test muscle strength, place your hands just below the wrist as resistance. “Please flex your elbows against my resistance. Now extend your elbows against my resistance. Muscle strength in both arms is graded as 5.”
Patient sits on table. “Please bend your hands up at the wrist. Full extension ROM. Bend your hands down at the wrist. Full flexion ROM. Bend your fingers up and down at the joints. Full flexion and hyperextension ROM. With your palms flat on the table, turn your wrists out and in. Full radial and ulnar deviation ROM. Spread your fingers apart, and make a fist. Full abduction ROM, and bilaterally tight fists. Now touch your thumb to each finger and the base of your pinky. Full ROM noted.”
Place elbow on table. Now please hold your hand midway, and touch the front and back of your hand to the table. Full pronation and supination ROM.”
For muscle testing, place patient’s forearms on the table with palm side up. “Please try to flex your wrist against my resistance. Muscle strength in both wrists is a 5.”
“Please lay on your back, raise your right leg as high as you can, keeping your knees straight, and tell me if you feel any pain. Now do the same with your left leg. Full ROM for hip flexion with knee straight. Bend each knee to your chest while keeping the other leg straight. Full ROM for hip flexion with bent knee. Bend your knee and swing your leg outward and inward. Full ROM for internal and external rotation. Swing your leg out and in, keeping your knees straight. Full ROM for abduction and adduction. All hip movements were smooth and without crepitance.”
“While you are lying down, we can go ahead and assess for sciatic pain and herniated nucleus polposus. Please tell me if you feel any pain.” Raise the patient’s leg 30 degrees while keeping the knee extended. Then dorsiflex the foot upward. “Test is negative.” Repeat with other leg. “No pain noted.”
“Please sit up. Point the toes of both feet down to the floor, and tell me if you feel any pain.” Observe. “Full plantar flexion ROM.” “Point your toes up toward your nose.” Observe. “Full dorsiflexion ROM.” Stabilize the ankle with one hand and hold heel with other hand. “Turn the soles of your feet in and out.” Observe. “Full inversion and eversion ROM.”
Test muscle strength by asking person to maintain dorsiflexion and plantar flexion of both feet against your resistance. “Please point the toes of both feet down to the floor against my resistance. Now point your toes up.” “Muscle strength is graded as 5 for full ROM against resistance.”
Check muscle strength. “Please remain seated, and bend both your knees against my resistance.” Place your hands below each knee and pull patient’s legs forward. “Now please rise from the chair without using your hands for support Muscle strength in both knees is graded as 5.”
“Remain standing. Please bend your knee, and tell me if you feel any pain. Full flexion ROM. Now extend your knee. Full extension ROM.
Inspect alignment of spine. “Spine is straight with equal horizontal positions for shoulders, scapulae, iliac crests and gluteal folds. There is equal space between arm and lateral thorax on both sides. Knees and feet are aligned with the trunk.”
Inspect the side profile. “Normal spine curvatures are noted with concave at cervical, convex at thoracic and concave in the lumbar regions. There is no kyphosis or lordosis.”
“Please bend forward and touch your toes, and tell me if you feel any pain.” Look for flexion of 75 to 90 degrees and smoothness and symmetry of movement. “There is full flexion ROM, and the back has a single convex C-shaped curve.”
Stabilize the pelvis with your hands. “Please bend sideways in each direction. Full ROM with lateral bending.” “Now bend backward. Full ROM with hyperextension. Please twist your shoulders to one side and then the other. Full ROM with bilateral rotation.”
