Assessment of the musculoskeletal system
begins with a health history and provides
direction for further assessment. Physical
examination of the musculoskeletal
system can be either general, as in a
screening examination, or focused, for a
specific problem or injury. Similarly,
diagnostic tests can be either general or
specific. The resulting data provide
information to make judgement about the
client’s musculoskeletal health. The
assessment can include an evaluation of
the client’s functional status, ability to
perform activities of daily living (ADL), and
ability to meet self-care needs. This aspect
of the assessment evaluates the client’s
exercise habits and leisure activities that
promote musculoskeletal health.
HISTORY
The musculoskeletal history consists of
biographical and demographic data, chief
complaint, and review of systems
information. Collect information to help
determine the nature and extent of the
client’s current disorder. If the chief
complaint is related to recent trauma,
keep the history brief and focus on the
cause of injury.If the injury is extensive,
the interview may need to be delayed.
Biographical and Demographic Data
Personal information enables
individualized care planning. For example,
knowing where a client lives and the kind
of transportation used helps to
understand the energy required for the
client to live independently and keep an
appointment. Information about the type
of employment and hobbies will provide
insight into the risk for injury. Knowing
the client’s social support system is
essential in planning care as well.
The client’s age and gender may suggest
possible causes of musculoskeletal
problems. Young or athletic people are
more likely to be injured. Osteoarthritis is
found in 85% of people over the age of 70
years. Osteoporosis (porous bone) occurs
most often in post menopausal women.
Reiter syndrome is most common in men
between 20 and 40 years of age.
Osteogenic sarcoma is rare after age 40.
Paget’s disease is rare before the age of
40 and tends to run in families.
Current Health
Chief Complaint
It is important to fully analyze the client’s
chief complaint. Ask the client to describe
the reason for seeking health care.
Common musculoskeletal clinical
manifestations include pain, joint
stiffness, sensory changes, swelling,
limited range of motion (ROM)/deformity,
and infection (Figure 25-1). These
manifestations can effect the ability to
perform ADL. Ask the client and significant
others to recount their perceptions of the
problem and its causes. Answer to these
questions can often provide information
about areas for further assessment and
clues about personal fears and concerns.
Clinical Manifestations
Full analysis of the client’s chief complaint
helps provide the best data for accurate
diagnosis and a baseline for comparison of
changes in future assessment or after any
intervention.
Pain. Pain assessment is considered the
fifth vital sign. One method of pain
assessment is to have the client rate his or
her pain on a 0 to 10 (0 = no pain, 10 =
worst pain) ascending intensity scale. The
client’s description of pain can help to
determine the origin of the discomfort.
Aches generally indicate a muscle strain,
sharp pain may indicate a fracture or
infection, and throbbing pain is often
bone related.
Joint Stiffness. Joint stiffness can
represent local as well as systemic
conditions. Associated muscle weakness
may indicate a neuromuscular disorder.
Crepitus, a grinding sound produced with
range of motioin, indicates joint
irregularity. Locking of the joint is
suggestive of underlying cartilage tear or
bone malalignment.
Sensory changes. Inquire about tingling,
burning, radiating pain, loss of feeling, and
weakness. Postoperative swelling,
fracture, and tumors are examples of
conditions that can put pressure on
nerves or blood vessels and produce
sensory changes.
Swelling. Swelling and pain commonly
accompany bone and muscle injury.
Recent cast removal or application may
produce temporary swelling of the
affected limb. Surgery may also produce
postoperative swelling.
Deformity and Limited Range of Motion.
Circumstances surrounding the
development of the deformity are
important. A gradual onset may indicate
an underlying tumor, whereas a sudden
deformity suggests a fracture. ROM is
measured with a protactor-type device
called a goniometer.
Infection
Clinical manifestations of infection
include redness, swelling, elevated
temperature, pain, and foul-smelling
drainage. Postsurgical clients and those
with a cast need to be evaluated closely
for manifestations of infection. If there is
any question about the cause of pain
under a cast, the cast should be removed
and the skin evaluated. Clients should be
strongly cautioned against sticking
anything down a cast.
Review of Systems
The review of systems includes medical
history, surgical history, allergies,
medications, dietary habits, social history,
and family history.
In addition to the usual review of systems,
ask about musculoskeletal problems such
as muscle pain, spasm or tenderness; joint
pain, stiffness, swelling, or redness;
weakness; limited movement; clumsiness;
crepitus; backache; and changes in joint or
bones. Investigate each reported
problem. Inquire about the effect of the
problem on the client’s ability to perfom
ADL. Assessment findings from other body
systems may indicate musculoskeletal
problems. The following are a few
examples:
 - Pain or burning on urination can for relief of inflammation and morning
be associated with reactive stiffness and for reduction in the use of
arthritis (Reiter syndrome). nonsteroidal anti-inflammmatory drugs
- Tachycardia and hypertension may (NSAIDs) for clients suffering from
accompany gout. rheumatoid arthritis. A systematic review
- Conjunctivitis may indicate Reiter of the literature also provides promising
syndrome. evidence for the use of several herbal
- Nongranulomatous uveitis may preparations for the treatment of
occur with ankylosing spondylitis. persistent pain associated with
- Skin changes may indicate osteoarthritis, such as avocado/soybean
musculoskeletal problems, such as unsaponifiables, topical capsaicin, and
wasting of the thenar muscle devil’s claw. It is important to remember
(palmar surface of hand, base of that herbal preparations are largely
thumb) suggesting carpal tunnel unregulated and may present safety
syndrome. issues in their manufacture and potency.
- Cramping leg pain with activity
may indicate intermittent
claudication.
- Marked muscle atrophy and
weakness accompany hyperpara-
thyroidism.
- Irritable skeletal muscles, cramps,
increased deep tendon reflexes
and paresthesias are suggestive of
electrolyte imbalances.
- Joint pain with reecent chills,
fever, or sore throat may indicate
rheumatic fever.

Specifically ask the client about any

alternative and complementary therapies
that may have been tried or are being
currently used. Some of these can interact
with prescription medications. Two
popular nutritional supplements that have
received considerable attention in the
consumer literature are glucosamine and
chondroitin. These substances are found
in joint fluid and cartilage. While limited
studies show modest benefit in pain relief,
these preparations may cause side effects
(including mild gastrointestinal upset),
and concerns have been raised about
their interaction with warfarin.
Some encouraging evidence exists
about the potential usefulness of fish oil