Musculoskeletal Orthopaedic Assessment

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.
• 理疗师是想访问病人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 ofmovements(ROM- Range of Motion),muscle strengthandmuscle tone.^[3][4][5]a.Standing Position:矢状面,正面图(冠),transverse plane. b.Sitting Position:矢状面,正面图(冠),transverse plane. c.Lying down Position:矢状面,正面图(冠),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 onsetor 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]