Musculoskeletal Orthopaedic Assessment

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Original Editor - Niha Mulla

Top Contributors - Niha Mulla 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:
  • Nature of pain:
  • Irritability of pain:
History of present condition[edit | edit source]
  • Onset of pain: 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/