Musculoskeletal Orthopaedic Assessment

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (26/02/2023)

Original Editor - Niha Mulla

Top Contributors - Niha Mulla, Oyemi Sillo and Kim Jackson  

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.

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.

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.

Basic principles

• 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.
• Reassessment of patient is mandatory in- between treatment sessions to be aware and alert of any improvement or deterioration in patient condition.
• 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.

Patient preparation

• Introduce yourself and explain your role to the patient.
• Confirm patient ID using a valid identifier for name and age.. Also ensure patients privacy and dignity.
• 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.
• Patient should be in comfortable, loose clothing. It is a good idea to provide a clean and hygienic gown.
• 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.

Checklist for Musculoskeletal assessment

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

Sequence of examination

1. Detailed History
2. General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance .
3. Examination of movements (ROM- Range of Motion), muscle strength and muscle tone. 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.
5. Performance of special test.
6. Tests and outcome measure.
7. Order further investigations if required.
8. Document the assessment.

Aims of subjective assessment

• To gather all relevant information about patients chief complaint. (Site, nature and duration of pain, Onset, past treatments if any)
• To review patients general Health.
• Medical History
• Social history
• To acquire knowledge of any past and present investigations.
• Formulation of further tests and treatment.

Aims of objective assessment

• To seek abnormalities of function
• To determine the pattern of pain or difficulty of movement
• To identify the predisposing factors of the disorder.
• To re-access the effectiveness of treatment.

Subjective assessment

Present condition

• 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

• Onset of pain: Insidious onset or Traumatic onset -
• Progression of pain/condition:
• Duration/chronicity of pain/condition:
• Previous treatments:
• Investigations: