Assessment of Musculoskeletal Function

Introduction to Musculoskeletal Assessment in Midwifery

Assessing the musculoskeletal system is an essential part of comprehensive maternal care. During pregnancy, a woman's body undergoes dramatic biomechanical shifts to accommodate the growing uterus and prepare for childbirth. Midwives must understand these normal anatomical changes to distinguish them from pathological conditions. A thorough evaluation helps identify pre-existing orthopedic issues, joint instability, or gestational complications like symphysis pubis dysfunction early in antenatal care.

Patient History and Subjective Data Collection

Gathering subjective data starts with a detailed client history. Ask about localized pain, joint swelling, stiffness, and any history of trauma or previous bone fractures. In pregnant clients, specifically inquire about back pain, pelvic girdle discomfort, and how these symptoms affect daily activities. Reviewing past medical history uncovers chronic conditions like rheumatoid arthritis or osteoporosis that directly impact pregnancy and mobility.

Systematic Physical Examination Techniques

Physical assessment of the musculoskeletal system relies on a logical sequence: inspection, palpation, and percussion where applicable.

• Inspection: Observe posture, gait, skin color over joints, and obvious deformities or asymmetry.
• Palpation: Feel along muscles, bones, and joints to check for tenderness, swelling, abnormal warmth, and crepitus.
• Comparison: Always compare one side of the body with the contralateral side to establish a reliable baseline.

Evaluating Joint Range of Motion and Muscle Strength

Evaluating movement confirms joint functionality. Assess both active range of motion (where the client moves the joint themselves) and passive range of motion (where the midwife gently moves the joint). Test muscle strength against resistance and grade it using the standard Medical Research Council scale from zero to five, where five represents normal power.

Common Musculoskeletal Changes During Pregnancy

Hormones like relaxin loosen joint capsules and ligaments, particularly in the pelvis, preparing the birth canal. This laxity, combined with weight gain, shifts the mother's center of gravity forward. Consequently, pregnant women frequently develop lordosis—an inward curvature of the lower spine—which contributes to lower back strain.

Documentation and Clinical Decision-Making

Accurate recording ensures safe continuity of care. Document all findings using clear, descriptive terminology regarding swelling, tenderness grades, and precise angles of restricted movement. A well-documented assessment guides timely referrals to physiotherapists or orthopedic specialists when a client's musculoskeletal pain exceeds normal gestational expectations.