Musculoskeletal Orthopaedic Assessment: Difference between revisions

(Added sections/ headings and sub headings)
No edit summary
 
(11 intermediate revisions by 2 users not shown)
Line 10: Line 10:
</div>  
</div>  
== Introduction  ==
== Introduction  ==
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.  
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.<ref name=":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. <ref name=":1">Stuart Porter, Lynne Gaskell at al. Tidy’s Physiotherapy, Chapter 2 “Musculoskeletal Assessment". 2003 Edition 13</ref><ref name=":0">HATHAWAY L. [https://journals.lww.com/nursingmadeincrediblyeasy/Citation/2004/05000/Pump_up_your_musculoskeletal_assessment.10.aspx Pump up your musculoskeletal assessment]. Nursing made incredibly easy. 2004 May 1;2(3):46-50.</ref>
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. <ref name=":1">Stuart Porter, Lynne Gaskell at al. Tidy’s Physiotherapy, Chapter 2 “Musculoskeletal Assessment". 2003 Edition 13</ref><ref name=":0">HATHAWAY L. [https://journals.lww.com/nursingmadeincrediblyeasy/Citation/2004/05000/Pump_up_your_musculoskeletal_assessment.10.aspx Pump up your musculoskeletal assessment]. Nursing made incredibly easy. 2004 May 1;2(3):46-50.</ref>
Line 16: Line 16:
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 principles ==
== 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.
* 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.<ref name=":1" />
* 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.<ref name=":1" />
* Reassessment of patient is mandatory in- between treatment sessions to be aware and alert of any improvement or deterioration in patient condition. <ref name=":1" />
* Reassessment of patient is mandatory in- between treatment sessions to be aware and alert of any improvement or deterioration in patient condition. <ref name=":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.<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 preparation ==
== Patient Preparation ==


== Sequence of examination ==
* 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>
*bulleted list
* Confirm patient ID using a valid identifier for name and age.. Also ensure patients privacy and dignity.<ref name=":3" />
*x
* Explain the process to the patient and let them know they can ask any questions they have.
or
* Let the patient know they will be observed,  inspected/palpated for assessment.<ref name=":2" /><ref name=":3" />
* Patient should be in comfortable, loose clothing. It is a good idea to provide a clean and hygienic gown. <ref name=":2" /><ref name=":3" />
* 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. <ref name=":2" /> 


#numbered list
== Checklist for Musculoskeletal Assessment ==
#x
#Gather supplies: [[Documentation Compliance - Reduce your insurance denials!|Documentation]], assessment tools. <ref name=":3" />
#Take measures for proper hygiene during examination.<ref name=":3" />
#Be organized and systemic. <ref name=":3" />
== Sequence of Examination ==


== Checklist for Musculoskeletal assessment ==
# 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>
*bulleted list
# General observation of the patient: Arms, legs, gait, ability to sit and  stand, posture, balance . <ref name=":3" /><ref name=":4" />
*x
# 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.
or
# Palpate bones, joints, muscles, and surrounding tissue. <ref name=":3" />
# Performance of special test. <ref name=":2" /><ref name=":4" />
# Tests and outcome measure.
# Order further investigations if required.<ref name=":4" />
# Document the assessment. <ref name=":3" />


#numbered list
== Aims of Subjective Assessment ==
#x


== 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 review patients general Health. <ref name=":1" />
*Medical History
*Social history <ref name=":1" />
*To acquire knowledge of any past and present investigations.<ref name=":5" />
*Formulation of further tests and treatment. <ref name=":1" /><ref name=":5" />


*bulleted list
== Aims of Objective Assessment ==
*x


== Aims of objective assessment ==
*To seek abnormalities of function<ref name=":1" />
*To determine the pattern of pain or difficulty of movement<ref name=":1" />
*To identify the predisposing factors of the disorder.<ref name=":5" />
*To re-access the effectiveness of treatment. <ref name=":1" /><ref name=":5" />


*bulleted list
== Subjective Assessment ==
*x


== Subjective assessment ==
===== '''Initial Questioning:''' =====


== Objective assessment ==
===== '''Present Condition''' =====


== Spinal assessment ==
* '''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:'''


==== Lumbar spine ====
===== History of Present Condition =====


==== Cervical spine ====
* '''Onset:''' ''Insidious Onset'' ''or Traumatic Onset''
* '''Progression of Pain/Condition:'''
* '''Duration/Chronicity of Pain/Condition:'''
* '''Previous Treatments:'''
* '''Investigations:'''


== Peripheral joint assessment ==
===== '''Past Medical History:''' =====


==== Shoulder joint ====
===== '''Medication History:''' =====


==== Hip joint ====
== Objective Assessment ==


==== Knee joint ====
== Spinal Assessment ==


==== Ankle and foot ====
==== Lumbar Spine ====
 
==== Cervical Spine ====
 
== Peripheral Joint Assessment ==
 
==== Shoulder Joint ====
 
==== Hip Joint ====
 
==== Knee Joint ====
 
==== Ankle and Foot ====


== References  ==
== References  ==


<references />
<references />
[[Category:Assessment]]

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]

  1. Gather supplies: Documentation, assessment tools. [4]
  2. Take measures for proper hygiene during examination.[4]
  3. Be organized and systemic. [4]

Sequence of Examination[edit | edit source]

  1. Detailed History[5]
  2. General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance . [4][5]
  3. 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.
  4. Palpate bones, joints, muscles, and surrounding tissue. [4]
  5. Performance of special test. [3][5]
  6. Tests and outcome measure.
  7. Order further investigations if required.[5]
  8. 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. ↑ 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. ↑ 2.0 2.1 HATHAWAY L. Pump up your musculoskeletal assessment. Nursing made incredibly easy. 2004 May 1;2(3):46-50.
  3. ↑ 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. ↑ 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. ↑ 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. ↑ 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/
Retrieved from "https://www.physio-pedia.com/index.php?title=Musculoskeletal_Orthopaedic_Assessment&oldid=340964"