Musculoskeletal Orthopaedic Assessment: Difference between revisions
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Human body is bi-laterally symmetrical. Hence during a musculoskeletal assessment each body part is compared not only to an ideal normal but also to symmetrical other side of the body in a sequential manner in order to determine abnormalities in alignment of bone/joint/muscle to other. <ref name=":0" /><ref name=":2">Thompson J, Walton A. [https://rheum.ca/wp-content/uploads/2017/11/The_Musculoskeletal_Screening_Examination_Booklet.pdf The Musculoskeletal Screening Examination booklet]. University of Western Ontario. Available from: <nowiki>https://rheum.ca/wp-content/uploads/2017/11/The_Musculoskeletal_Screening_Examination_Booklet.pdf</nowiki></ref> | Human body is bi-laterally symmetrical. Hence during a musculoskeletal assessment each body part is compared not only to an ideal normal but also to symmetrical other side of the body in a sequential manner in order to determine abnormalities in alignment of bone/joint/muscle to other. <ref name=":0" /><ref name=":2">Thompson J, Walton A. [https://rheum.ca/wp-content/uploads/2017/11/The_Musculoskeletal_Screening_Examination_Booklet.pdf The Musculoskeletal Screening Examination booklet]. University of Western Ontario. Available from: <nowiki>https://rheum.ca/wp-content/uploads/2017/11/The_Musculoskeletal_Screening_Examination_Booklet.pdf</nowiki></ref> | ||
== Basic | == Basic Principles == | ||
* Upon qualifying, physiotherapist are legally responsible for performing accurate assessment and management skills. | * Upon qualifying, physiotherapist are legally responsible for performing accurate assessment and management skills. | ||
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* Always re-access your patient using subjective and objective markers following each treatment to judge the efficacy of each intervention to determine in short term and long term effects.<ref name=":1" /><ref name=":2" /> | * Always re-access your patient using subjective and objective markers following each treatment to judge the efficacy of each intervention to determine in short term and long term effects.<ref name=":1" /><ref name=":2" /> | ||
== Patient | == Patient Preparation == | ||
* Introduce yourself and explain your role to the patient.<ref name=":3">Clarkson HM. [https://wtcs.pressbooks.pub/nursingskills/chapter/13-6-checklist-for-musculoskeletal-assessment/ Musculoskeletal assessment]. Wolters Kluwer Health/Lippincott Williams & Wilkins,; 2013.</ref> | * Introduce yourself and explain your role to the patient.<ref name=":3">Clarkson HM. [https://wtcs.pressbooks.pub/nursingskills/chapter/13-6-checklist-for-musculoskeletal-assessment/ Musculoskeletal assessment]. Wolters Kluwer Health/Lippincott Williams & Wilkins,; 2013.</ref> | ||
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* At each step of examination use a verbal command to let patient what is to be done. <ref name=":2" /> | * At each step of examination use a verbal command to let patient what is to be done. <ref name=":2" /> | ||
== Checklist for Musculoskeletal | == Checklist for Musculoskeletal Assessment == | ||
#Gather supplies: [[Documentation Compliance - Reduce your insurance denials!|Documentation]], assessment tools. <ref name=":3" /> | #Gather supplies: [[Documentation Compliance - Reduce your insurance denials!|Documentation]], assessment tools. <ref name=":3" /> | ||
#Take measures for proper hygiene during examination.<ref name=":3" /> | #Take measures for proper hygiene during examination.<ref name=":3" /> | ||
#Be organized and systemic. <ref name=":3" /> | #Be organized and systemic. <ref name=":3" /> | ||
== Sequence of | == Sequence of Examination == | ||
# Detailed History<ref name=":4">Musculoskeletal Key. [https://musculoskeletalkey.com/musculoskeletal-assessment/ Musculoskeletal assessment]. PHYSICAL MEDICINE & REHABILITATION; 2016. Available from: <nowiki>https://musculoskeletalkey.com/musculoskeletal-assessment/</nowiki></ref> | # Detailed History<ref name=":4">Musculoskeletal Key. [https://musculoskeletalkey.com/musculoskeletal-assessment/ Musculoskeletal assessment]. PHYSICAL MEDICINE & REHABILITATION; 2016. Available from: <nowiki>https://musculoskeletalkey.com/musculoskeletal-assessment/</nowiki></ref> | ||
# General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance . <ref name=":3" /><ref name=":4" /> | # General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance . <ref name=":3" /><ref name=":4" /> | ||
# Examination of '''movements''' (ROM- Range of Motion), '''[[muscle strength]]''' and '''muscle tone.''' <ref name=":2" /><ref name=":3" /><ref name=":4" /> a. '''''Standing Position''''': Sagittal plane, frontal plane (coronal), transverse plane. b. '''''Sitting Position''''': Sagittal plane, frontal plane (coronal), transverse plane. c. '''''Lying down Position''''': Sagittal plane, frontal plane (coronal), transverse plane. | # Examination of '''movements''' (ROM- Range of Motion), '''[[Muscle Strength Testing|muscle strength]]''' and '''muscle tone.''' <ref name=":2" /><ref name=":3" /><ref name=":4" /> a. '''''Standing Position''''': Sagittal plane, frontal plane (coronal), transverse plane. b. '''''Sitting Position''''': Sagittal plane, frontal plane (coronal), transverse plane. c. '''''Lying down Position''''': Sagittal plane, frontal plane (coronal), transverse plane. | ||
# Palpate bones, joints, muscles, and surrounding tissue. <ref name=":3" /> | # Palpate bones, joints, muscles, and surrounding tissue. <ref name=":3" /> | ||
# Performance of special test. <ref name=":2" /><ref name=":4" /> | # Performance of special test. <ref name=":2" /><ref name=":4" /> | ||
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# Document the assessment. <ref name=":3" /> | # Document the assessment. <ref name=":3" /> | ||
== Aims of | == Aims of Subjective Assessment == | ||
*To gather all relevant information about patients chief complaint. (Site, nature and duration of pain, Onset, past treatments if any)<ref name=":1" /><ref name=":5">Gaskell L. [https://musculoskeletalkey.com/musculoskeletal-assessment-3/ Musculoskeletal assessment] . Musculoskeletal Key. 2017. Available from: <nowiki>https://musculoskeletalkey.com/musculoskeletal-assessment-3/</nowiki></ref> | *To gather all relevant information about patients chief complaint. (Site, nature and duration of pain, Onset, past treatments if any)<ref name=":1" /><ref name=":5">Gaskell L. [https://musculoskeletalkey.com/musculoskeletal-assessment-3/ Musculoskeletal assessment] . Musculoskeletal Key. 2017. Available from: <nowiki>https://musculoskeletalkey.com/musculoskeletal-assessment-3/</nowiki></ref> | ||
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*Formulation of further tests and treatment. <ref name=":1" /><ref name=":5" /> | *Formulation of further tests and treatment. <ref name=":1" /><ref name=":5" /> | ||
== Aims of | == Aims of Objective Assessment == | ||
*To seek abnormalities of function<ref name=":1" /> | *To seek abnormalities of function<ref name=":1" /> | ||
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*To re-access the effectiveness of treatment. <ref name=":1" /><ref name=":5" /> | *To re-access the effectiveness of treatment. <ref name=":1" /><ref name=":5" /> | ||
== Subjective | == Subjective Assessment == | ||
===== '''Initial | ===== '''Initial Questioning:''' ===== | ||
===== '''Present | ===== '''Present Condition''' ===== | ||
* '''Area of | * '''Area of Pain:''' | ||
* '''Severity of | * '''Severity of Pain:''' | ||
* '''Duration of | * '''Duration of Pain''': | ||
* '''Aggravating | * '''Aggravating Factors of Pain''': | ||
* '''Easing | * '''Easing Factors of Pain:''' | ||
* '''Time | * '''Time Bound Factors of Pain - 24hour Pattern:''' | ||
* '''Nature of | * '''Nature of Pain:''' | ||
* '''Irritability of | * '''Irritability of Pain:''' | ||
===== History of | ===== History of Present Condition ===== | ||
* '''Onset | * '''Onset:''' ''Insidious Onset'' ''or Traumatic Onset'' | ||
* '''Progression of | * '''Progression of Pain/Condition:''' | ||
* '''Duration/ | * '''Duration/Chronicity of Pain/Condition:''' | ||
* '''Previous | * '''Previous Treatments:''' | ||
* '''Investigations:''' | * '''Investigations:''' | ||
===== '''Past | ===== '''Past Medical History:''' ===== | ||
===== '''Medication | ===== '''Medication History:''' ===== | ||
== Objective | == Objective Assessment == | ||
== Spinal | == Spinal Assessment == | ||
==== Lumbar | ==== Lumbar Spine ==== | ||
==== Cervical | ==== Cervical Spine ==== | ||
== Peripheral | == Peripheral Joint Assessment == | ||
==== Shoulder | ==== Shoulder Joint ==== | ||
==== Hip | ==== Hip Joint ==== | ||
==== Knee | ==== Knee Joint ==== | ||
==== Ankle and | ==== Ankle and Foot ==== | ||
== References == | == References == |
Latest revision as of 13:33, 3 September 2023
This article is currently under review and may not be up to date. Please come back soon to see the finished work! (3/09/2023)
Original Editor - Niha Mulla
Top Contributors - Niha Mulla, Oyemi Sillo, Naomi O'Reilly and Kim Jackson
Introduction[edit | edit source]
Complex clinical reasoning decisions in real time and becoming competent in patient assessment takes practice, refinement and reflection. Patient assessment is an essential skill for every student and practicing physiotherapist.[1]
A complete musculoskeletal examination of the patients gives an over view of patients body structure and function. Musculoskeletal/orthopaedic patient assessment is a process of appropriate subjective assessment with the understanding of particular joints , with use of specific tests at those particular joints and also appropriate subjective and objective markers along with understanding the need for continuous reassessment. [1][2]
Human body is bi-laterally symmetrical. Hence during a musculoskeletal assessment each body part is compared not only to an ideal normal but also to symmetrical other side of the body in a sequential manner in order to determine abnormalities in alignment of bone/joint/muscle to other. [2][3]
Basic Principles[edit | edit source]
- Upon qualifying, physiotherapist are legally responsible for performing accurate assessment and management skills.
- Physiotherapist are suppose to access the patient on first contact for their initial assessment to determine patients problem and establish line of treatment for the patient.[1]
- Reassessment of patient is mandatory in- between treatment sessions to be aware and alert of any improvement or deterioration in patient condition. [1]
- Always re-access your patient using subjective and objective markers following each treatment to judge the efficacy of each intervention to determine in short term and long term effects.[1][3]
Patient Preparation[edit | edit source]
- Introduce yourself and explain your role to the patient.[4]
- Confirm patient ID using a valid identifier for name and age.. Also ensure patients privacy and dignity.[4]
- Explain the process to the patient and let them know they can ask any questions they have.
- Let the patient know they will be observed, inspected/palpated for assessment.[3][4]
- Patient should be in comfortable, loose clothing. It is a good idea to provide a clean and hygienic gown. [3][4]
- It is advisable to have an assistant/patients caregiver in the examination room at all time.
- At each step of examination use a verbal command to let patient what is to be done. [3]
Checklist for Musculoskeletal Assessment[edit | edit source]
- Gather supplies: Documentation, assessment tools. [4]
- Take measures for proper hygiene during examination.[4]
- Be organized and systemic. [4]
Sequence of Examination[edit | edit source]
- Detailed History[5]
- General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance . [4][5]
- Examination of movements (ROM- Range of Motion), muscle strength and muscle tone. [3][4][5] a. Standing Position: Sagittal plane, frontal plane (coronal), transverse plane. b. Sitting Position: Sagittal plane, frontal plane (coronal), transverse plane. c. Lying down Position: Sagittal plane, frontal plane (coronal), transverse plane.
- Palpate bones, joints, muscles, and surrounding tissue. [4]
- Performance of special test. [3][5]
- Tests and outcome measure.
- Order further investigations if required.[5]
- Document the assessment. [4]
Aims of Subjective Assessment[edit | edit source]
- To gather all relevant information about patients chief complaint. (Site, nature and duration of pain, Onset, past treatments if any)[1][6]
- To review patients general Health. [1]
- Medical History
- Social history [1]
- To acquire knowledge of any past and present investigations.[6]
- Formulation of further tests and treatment. [1][6]
Aims of Objective Assessment[edit | edit source]
- To seek abnormalities of function[1]
- To determine the pattern of pain or difficulty of movement[1]
- To identify the predisposing factors of the disorder.[6]
- To re-access the effectiveness of treatment. [1][6]
Subjective Assessment[edit | edit source]
Initial Questioning:[edit | edit source]
Present Condition[edit | edit source]
- Area of Pain:
- Severity of Pain:
- Duration of Pain:
- Aggravating Factors of Pain:
- Easing Factors of Pain:
- Time Bound Factors of Pain - 24hour Pattern:
- Nature of Pain:
- Irritability of Pain:
History of Present Condition[edit | edit source]
- Onset: Insidious Onset or Traumatic Onset
- Progression of Pain/Condition:
- Duration/Chronicity of Pain/Condition:
- Previous Treatments:
- Investigations:
Past Medical History:[edit | edit source]
Medication History:[edit | edit source]
Objective Assessment[edit | edit source]
Spinal Assessment[edit | edit source]
Lumbar Spine[edit | edit source]
Cervical Spine[edit | edit source]
Peripheral Joint Assessment[edit | edit source]
Shoulder Joint[edit | edit source]
Hip Joint[edit | edit source]
Knee Joint[edit | edit source]
Ankle and Foot[edit | edit source]
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Stuart Porter, Lynne Gaskell at al. Tidy’s Physiotherapy, Chapter 2 “Musculoskeletal Assessment". 2003 Edition 13
- ↑ 2.0 2.1 HATHAWAY L. Pump up your musculoskeletal assessment. Nursing made incredibly easy. 2004 May 1;2(3):46-50.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Thompson J, Walton A. The Musculoskeletal Screening Examination booklet. University of Western Ontario. Available from: https://rheum.ca/wp-content/uploads/2017/11/The_Musculoskeletal_Screening_Examination_Booklet.pdf
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 Clarkson HM. Musculoskeletal assessment. Wolters Kluwer Health/Lippincott Williams & Wilkins,; 2013.
- ↑ 5.0 5.1 5.2 5.3 5.4 Musculoskeletal Key. Musculoskeletal assessment. PHYSICAL MEDICINE & REHABILITATION; 2016. Available from: https://musculoskeletalkey.com/musculoskeletal-assessment/
- ↑ 6.0 6.1 6.2 6.3 6.4 Gaskell L. Musculoskeletal assessment . Musculoskeletal Key. 2017. Available from: https://musculoskeletalkey.com/musculoskeletal-assessment-3/