musculoskeletal system assessment, an evaluation of the condition and functioning of the patient’s muscles, joints, and bones and of factors that may contribute to abnormalities in these body structures. ▪ METHOD: The patient is questioned about any pain and edema in muscles, joints, and bones; weakness in extremities; limitations in movements and activities; unsteadiness on the feet; fatigability; insomnia; anorexia; and weight loss. The individual’s general appearance, age, blood pressure, pulse, respirations, body alignment, ability or inability to move in bed, gait, need for assistance in walking, handgrip, range of motion, and internal and external rotation of extremities are observed. The presence of contractures, deformities, paralysis, contusions, lacerations, wounds, footdrop, wristdrop, paralysis, crutches, brace, cast, prosthesis, cane, walker, pressure ulcers, allergies, skin rash, or tenseness is noted. It is ascertained whether the patient can perform activities of daily living and is able to sit up and turn, whether constipation is a complaint, and whether the individual is independent or dependent. Concurrent diseases or conditions investigated include injury to the spinal cord, nerve impairment, cerebrovascular accident, rheumatoid arthritis, osteoarthritis, bursitis, polyneuritis, multiple sclerosis, muscular dystrophy, myasthenia gravis, fracture, ruptured disk, Ménière’s disease, and labyrinthitis. It is determined whether the patient previously had orthopedic or spinal surgery, poliomyelitis, hemiplegia, cerebral palsy, parkinsonism, a cerebrovascular accident, ataxia, syphilis, hyperparathyroidism, osteoporosis, rickets, osteomalacia, tuberculosis, alcoholism, and impaired vision or hearing. A family history of carcinoma, diabetes, or tuberculosis and the patient’s involvement in a hazardous job or recreation, history of previous accidents, and use of tobacco or medications such as steroids, sedatives, tranquilizers, analgesics, antimalarials, acetylsalicylic acid, or indomethacin are determined. Laboratory studies important for the assessment are assays of serum and urine calcium and phosphorus and of alkaline phosphatase serum level. Diagnostic procedures that may be required include x-ray films of bones, arthrograms, myelograms, arteriograms, arthroscopy, biopsies of bone or muscle, incision and drainage of joints, and electromyograms of muscles. ▪ INTERVENTIONS: Health care providers conduct the interview to obtain subjective data, make the necessary observations of the patient, and assemble the information on concurrent and previous disorders, the family history, the patient’s social and medication background, and the results of laboratory studies and diagnostic procedures. ▪ OUTCOME CRITERIA: A meticulous assessment of the patient’s musculoskeletal system is a valuable aid in making the diagnosis, planning the course of therapy, predicting the prognosis, and ensuring the patient’s safety.
