MUSCULOSKELETAL

ASSESSMENT
 What is assessment?
 It is the sequential method to fully and
clearly understand the patients problem
from the patient perspective as well as the
clinicians and the physical basis for the
symptoms that have caused the patient to
complain.
 OBJECTIVES OF ASSESSMENT
 Well organized
 Comprehensive
 Reproducible
 Components of an assessment
recording method
SOAP/SOAGP
 S-subjective (history)
 O-objective (observation)
 A-assessment (examination/palpation)
 G-goals of treatment
 P-Plan (treatment plan)
 History taking

History taking includes:

 Demographic profile
 Chief complaints
 History of present illness
 Any Past history of illness
 Treatment history and its results
 Medical history
 family history
 Social history
1) Demographic Profile
• Age:

• Occupation:
• Gender:

Osteoporosis Ankylosing Spondylitis

Common in females Common in Males
2) Chief complaints (to be recorded in
patients own description)
 Body chart
• Area of pain: This defines the precise area of pain and
boundaries of pain.
“ Show me where you feel the pain.”
“Where does it extends, above / below?
• Area of paraesthesia:
“ Do you have pins or needles or other strange
sensations?”
“Do you have any area of numbness?
All areas of the pain & paraesthesia must be charted.
3) History of present illness-

non traumatic
traumatic

Mechanism of injury predisposing factor

 Onset of pain

Sudden Gradual

 Duration of problem-
• acute
• sub acute
• chronic

 Peripherilization or centralizations of pain

 Type of pain
aching, throbbing, sharp, shooting………” etc

 Intensity of pain/severity of pain

Different scales for pain
• Verbal Descriptive scale/numeric rating scale
(VDS/NRS)
• A visual analogue scale (VAS)
• Faces pain scale (FPS)
• McGill-Melzack pain questionnaire

No Pain Worst pain

 pattern and frequency of pain
• continues/constant
• intermittent etc

 Aggravating and relieving factors

 Any sensation of giving away or locking

 Any bilateral cord symptom

4) Past history of illness

5) Treatment history and its results-

6) Medical history

7) family history

8) Social history
OBJECTIVE ASSESSMENT (observation or
inspection )
 Begins with the examiners first contact
with the patient –at bed side in
hospitalized /OPD
 Provides information about the severity of
symptoms, willingness to move, ROM,
strength
 Built
 Normal body alignment( joints location, limb
attitude, symmetry )
 Bandaging /pop cast
 Deformity-structural & functional deformity
 Bony contours
 Soft tissue contours (swelling, effusion,
hypertrophy, atrophy, muscle rupture etc)
 Symmetry in limb position
 Abnormal sounds like snapping, crepitus etc
 Swelling
 Clubbing of nails( cardiovascular disease,
respiratory problems,
 Colour & texture of the skin (cyanosis ,pallor, any
disease, erythema)
glossy skin, decreased elasticity, hairy loss –
PNL/Neurovascular disorders
 Scar –red scar
white scars
 Facial expressions
 EXAMINATION

 Palpation
 Anthropometric characteristic
 range of motion
 Accessory joint motion
 MMT
 Neurological examination
 Special tests
 PALPATION
 Should be before other testing procedures
 Uninvolved side should be palpated first
 Light tactile pressure for superficial tissues
 Deep tactile pressure for deep structures
 Tenderness, myofascial mobility, skin
temperature, spasm, edema
 Bilateral pitting edema indicate
cardiac/renal failure
 Unilateral edema indicate deficit in
returning circulation
 Anthropometric characteristics
 Limb length measurement (true /apparent
)
 Circumferential measurement (effusion
,atrophy, hypertrophy, edema etc
 ROM
 active range of motion (osteokinematics)
 If the patient can complete active ROM
easily without pain then further passive
ROM is not required
 Passive range of motion-to check range,
motion effect on symptoms, end feel
pattern
 END FEEL
 The feeling which is experienced by the
examiner as resistance or barrier to further
motion
 Normal (physiological)/abnormal (pathological)
 Normal –soft, firm ,hard
 Soft end feel (tissue approximation)-gradual
increase in resistance
 Firm end feel (tissue stretch)-abrupt increase in
rubbery resistance
 Hard end feel (bone to bone) –abrupt ,stoppage
of motion
 Abnormal end feel

Soft Firm
hard empty
 ACCESSORY JOINT MOTION
 Arthrokinematics: done when PROM is found to
be effected
 AJMG (accessory joint motion grades)
0-ankylosed
1-considerable hypomobile
2-slightly hypomobile
3-normal
4-slightly hypermobile
5-considerable hypermobile
6-unstable
 Indication of AJMG
 0 and 6 grade: joint mobilization not
indicated
 1&2 mobilization indicated
 4&5 mobilization not indicated (taping,
strengthening, bracing indicated)
 MUSCLE PERFORMANCE
 Resisted isometric testing
 MMT
 Resisted isometric testing (can suggest a
lesion in contractile tissue ,inert tissues.)

Pain during contraction No pain during contraction

(contractile tissues involved) (inert tissues involved)
Resisted isometrics to determine the type of
pathology (Cyriax)
 Strong and painless: no lesion or
neurological deficit of the tested muscle
 Strong and painful: minor lesion of the
tested muscle and tendon
 Weak and painless: indicate complete
rupture of tested muscle or tendon, disuse
atrophy
 Weak and painful: indicate fracture or
neoplasm, partial rupture of muscle or
tendon,
 MMT
 Break test methods

 make test methods

 Neurological examination
 Myotomes
 Dermatomes
 Reflexes
 Special tests
 To confirm a tentative diagnosis
 To differentiate between structures
 To make a differential diagnosis
 Functional ability
 Barthel index
 Evaluation of findings
 All the subjective & physical findings are
evaluated to establish the diagnosis
 When no identifiable diagnosis can be
reached, provisional diagnosis is given
 investigations
 diagnosis
 Treatment plan
 Objective
 Goals: short term goals
Long term goals
 treatment plan
THANK YOU