Musculoskeletal Orthopaedic Assessment
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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.
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[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.
- 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[edit | edit source]
- 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[edit | edit source]
- Gather supplies: Documentation, assessment tools. 
- Take measures for proper hygiene during examination.
- Be organized and systemic. 
Sequence of examination[edit | edit source]
- Detailed History
- General observation of the patient: Arms, legs, gait, ability to sit and stand, posture, balance . 
- 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.
- Palpate bones, joints, muscles, and surrounding tissue. 
- Performance of special test. 
- Tests and outcome measure.
- Order further investigations if required.
- Document the assessment. 
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)
- 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[edit | edit source]
- 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[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:
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]
- Stuart Porter, Lynne Gaskell at al. Tidy’s Physiotherapy, Chapter 2 “Musculoskeletal Assessment". 2003 Edition 13
- HATHAWAY L. Pump up your musculoskeletal assessment. Nursing made incredibly easy. 2004 May 1;2(3):46-50.
- 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
- Clarkson HM. Musculoskeletal assessment. Wolters Kluwer Health/Lippincott Williams & Wilkins,; 2013.
- Musculoskeletal Key. Musculoskeletal assessment. PHYSICAL MEDICINE & REHABILITATION; 2016. Available from: https://musculoskeletalkey.com/musculoskeletal-assessment/
- Gaskell L. Musculoskeletal assessment . Musculoskeletal Key. 2017. Available from: https://musculoskeletalkey.com/musculoskeletal-assessment-3/