Musculoskeletal system assessment, diagnosis, and disorders. This training material covers the important and critical points to focus on while assessing and treating musculoskeletal system related disorders.

1. 1
HamzaA. Chehade
M.Sc., MBA., B.Sc.
Assistant Professor

2. Hamza Chehade
Assistant Professor
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Musculoskeletal System

3. Focused Assessment and Diagnostic Studies of Musculoskeletal System
Hamza Chehade
Assistant Professor
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4. Common symptoms of
musculoskeletal impairment include
pain, weakness, and
deformity, limitation of movement,
stiffness, and joint CREPITATION.
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5. 5
Hamza Chehade
Assistant Professor
Musculoskeletal
System
Gait
Joint
mobility
Neuro-
vascular
status
Pain
Fall risk
Assessment of
musculoskeletal
status includes:

6.  Gait
■ Assess patient’s ability to ambulate independently.
■ Assess need for assistive devices. If the patient uses an assistive
device, asses if he or she is using it safely.
Hamza Chehade
Assistant Professor
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Scoliosis is a lateral S-shaped
curvature of thoracic and lumbar
spine. Unequal shoulder and
scapula height is usually noted
when patient is observed from back.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
 Joint Range of Motion (ROM)
■ Joint ROM is assessed initially and for those whom receiving a physical therapy.
■ Ask patient to put shoulders, elbows, wrists and fingers, hips, knees, and ankles
full joint ROM as indicated. Neck and back can be included if appropriate.
■ If the patient is not able to move or participate, passively move the joints to
■ Do not push a joint past its
range, even if limited.
■ Do not push the joint if the
patient has pain.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
 Neurovascular status (CMS: Circulation, Motion, Sensation)
■ Palpate peripheral pulse and check capillary refill.
■ Note skin color of extremity; compare with that of opposite extremity.
■ Have patient move hands and fingers, flex and extend feet. Focus on the extremity of interest, but
initially compare with the contralateral arm, hand, leg, or foot.
■ Assess strength by having patient push or pull against resistance.
■ Ask about paresthesias: lightly trace your finger over different surfaces of the at-risk area to
assess sensation. Have the patient close his or her eyes while you do this.
■ Pain assessment (PQRST…)

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
Diagnostic Studies
· X-rays provide information about bone deformity, joint congruity, bone density, and calcification in soft tissue:
diagnosis and management are indications for x-ray; also useful in evaluation of hereditary, developmental, infectious,
infectious, inflammatory, neoplastic, metabolic, and degenerative disorders.
· A fiberoptic tube called an arthroscope is used to directly examine interior of joint cavity in an arthroscopy: Torn
be repaired through arthroscopic surgery, eliminating the need for a larger incision and greatly decreasing the recovery time.
recovery time.
· Arthrocentesis or joint aspiration is usually performed for a synovial fluid analysis. The fluid is examined grossly
volume, color, clarity, viscosity, and mucin clot formation.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
Disorders of the Musculoskeletal System

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
SOFT-TISSUE INJURIES
· A SPRAIN is an injury to tendinoligamentous structures surrounding a joint, usually caused by wrenching or twisting
motion.
· A STRAIN is an excessive stretching of a muscle and its fascial sheath. It often involves the tendon.
· Symptoms include pain, edema, decrease in function, and contusion.
· Mild S/S are usually self-limiting, with full function returning within 3 to 6 weeks.
· Severe strains may require surgical suturing of muscle and surrounding fascia.
· RICE (rest, ice, compression, elevation) can decrease inflammation and pain for most of these injuries.

12. DISLOCATION
• Dislocation is a severe injury of the
ligamentous structures that surround a
• The most obvious sign is DEFORMITY, also
local pain, tenderness, loss of function of
injured part, and swelling of soft tissues in
region.
• Requires prompt attention with the
joint first realigned in its original anatomic
position.
• Extremity then is immobilized by bracing,
taping, or using a sling to allow torn ligaments
tissue time to heal.
Hamza Chehade
Assistant Professor 12
Musculoskeletal
System

13. COMPARTMENT SYNDROME
Hamza Chehade
Assistant Professor
■ Muscle groups are contained
within a tough, inelastic tissue
called fascia. This envelope of
tissue creates a compartment
that contains muscles, nerves,
veins, and arteries.
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Musculoskeletal
System

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Hamza Chehade
Assistant Professor
Musculoskeletal
System

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
Injury/Burns/
Fracture/ or
surgery
swelling of the
muscles in the
fascial
compartment
increased
pressure
closes off
capillaries,
arterioles and,
eventually,
arteries, causing
ischemia
Necrosis if not
treated.
because the fascia
cannot expand
with the swelling.
POSSIBLE ETIOLOGIES
Compartment Syndrome
Severe muscle injury, burns, fractures, and surgery.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
CLINICAL PICTURE
Compartment Syndrome
5Ps
Pain
Pallor
Pulselessne
ss
Paresthesia
Paralysis The patient may have or
complain of the “5 Ps.”
 Diminished capillary refill time
(3 seconds).
The extreme pain is the
first warning sign

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
INTERVENTION
Compartment Syndrome
■ Notify MD and administer medication for pain as prescribed
■ Focused assessment.
■ Elevate the extremity to prevent further swelling and increase venous return.
■ Do not put ice bags on the extremity.
■ Loss of pulses and/or the extreme pain that accompanies compartment syndrome constitutes a surgical
emergency: Get the patient ready for an emergency fasciotomy in the OR: draw blood,
start an IV, etc. Make sure the time of the patient’s last meal or fluids is documented and easy to find.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
FOCUSED ASSESSMENT
Compartment Syndrome
■ Palpate pulses. Use a Doppler if not palpable.
■ Note skin color and if pallor is present.
■ Blanch the skin, and check capillary refill time.
■ Assess nerves in the affected extremity. Is there altered sensation or impaired mobility?

19. CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome (CTS) is caused
by compression of the median nerve,
enters the hand through the narrow
of the carpal tunnel.
CTS is often caused by pressure from
or edema caused by inflammation of
(tenosynovitis), rheumatoid arthritis, or
tissue masses.
Signs are weakness (especially in thumb),
burning pain, and numbness.
Holding the wrists for 60 seconds
tingling and numbness over the
the median nerve, a positive Phalen’s
Hamza Chehade
Assistant Professor
19
Musculoskeletal
System

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
 Prevention involves educating employees and employers to identify risk factors.
 Early symptoms usually relieved by stopping the aggravating movement and by placing hand and
wrist at rest by immobilizing them in a hand splint. Injection of a corticosteroid drug directly into
carpal tunnel may provide some relief.
 If CTS continues, median nerve may need to be surgically decompressed. Rehabilitation can last up to
7 weeks.

21. HIP FRACTURE
CLINICAL PICTURE
The patient may have:
■ Groin, knee, or hip pain.
■ Inability to bear weight on affected extremity.
■ Shortened and externally rotated leg.
■ Inability to move affected leg.
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Musculoskeletal
System
Hamza Chehade
Assistant Professor
POSSIBLE ETIOLOGIES
■ Osteoporosis, trauma.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
INTERVENTIONS
Hip Fracture
■ Do not move leg; allow patient to maintain position of comfort.
■ Inspect and palpate for deformity, hematoma, laceration, and asymmetry.
■ Call 4–6 staff members to help transfer patient from stretcher to bed or, if
fallen, to lift patient into bed.
■ Assess vital signs (VS);
■ Notify MD

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
FOCUSED ASSESSMENT
Hip Fracture
■ If patient has experienced trauma, perform a PRIMARY then SECONDARY survey.
■ Assess VS, level of consciousness (LOC), and orientation.
■ Observe for signs and symptoms of shock.
■ Inspect affected leg for shortening and rotation as compared with the opposite leg.
■ Do not assess ROM unless x-ray is negative.
■ Assess distal circulation, sensation, and ability to move toes.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
ONGOING CARE AND ASSESSMENT
Hip Fracture
■ Administer pain medication (determine that there is no associated head injury first).
■ Avoid PO medications!
■ Monitor patient’s response to pain management.
■ Insert a urinary catheter, and monitor urinary output.

25. PATIENT
FALL
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Musculoskeletal
System

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
CLINICAL PICTURE
Patient Fall
The patient may have or be:
■ Found on floor, unexplained abrasions, or reported falling.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
INTERVENTIONS
Patient Fall
■ Do not move patient if he or she is unconscious, complains of severe pain, or has a deformity of an extremity
fracture, internal rotation of hip or knee).
■ If unconscious, get help, assess ABCs, immobilize cervical spine (with light traction, hold head and neck in
alignment with body).
■ If conscious, have patient lie still while you call for help.
■ If patient is alert with no obvious injuries, assist to bed or chair with help from another staff member.
■ Notify MD and Document patient’s status.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
FOCUSED ASSESSMENT
Patient Fall
Assess:
■ LOC, orientation, VS and pain level.
■ alignment , ability to move all extremities, and symmetry of extremities.
■ soft tissue and skin for abrasions, swelling, deformity.
■ for acute underlying condition as TIA, hypotension, or cardiac dysrhythmia.
■ for orthostasis, problems with gait, changes in mental status, and recent changes in functional status.
■ medication administration record for POLYPHARMACY!
■ environment for potential cause of fall and safety hazards.
■ Ask if patient felt dizzy or lightheaded before
falling.
■ Review records for preexisting conditions,
medication use, and previous falls.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
POSSIBLE ETIOLOGIES
Patient Fall
■ Sedation, debilitation, unfamiliar surroundings, side rails left down, call-bell malfunction
within easy reach, drug reaction, improper use of restraints, dysrhythmias, altered LOC,
proprioception, spill on the floor.

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Hamza Chehade
Assistant Professor
Musculoskeletal
System
LET`S PRACTICE!

31. 31
Hamza Chehade
Assistant Professor
Musculoskeletal
System
Complete the following table:
Risk Factor Nursing Intervention
1. Polypharmacy
2. Specific medications: benzodiazepines,
antipsychotics, hypnotics, sedatives,
antidepressants
3. Deconditioning
4. Postural hypotension;
change in proprioception
5. Uneven surfaces, poor
lighting

32. End of The Lecture
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Musculoskeletal
System