Physical assessment of the musculoskeletal system evaluates bones, muscles, joints, and surrounding structures to detect deformities, functional limitations, or injury. Nurses use inspection, palpation, and movement testing to gather baseline data. This evaluation helps differentiate between acute injuries and chronic degenerative conditions common in clinical practice across Nigeria, such as osteoarthritis or post-traumatic joint stiffness.
A successful physical examination requires a quiet, well-lit room with adequate space for the patient to walk and move. Privacy is paramount, so screens or private examination bays must be used. Ensure the patient is appropriately gowned, exposing only the specific body parts under examination to maintain dignity and prevent chilling. Explain each step clearly before touching the patient to reduce anxiety and secure cooperation.
Inspection begins the moment the nurse first sees the patient. Observe standing posture from the front, back, and sides, checking for symmetry of body parts, spinal curves, and limb lengths. Watch the patient walk across the room to evaluate gait stability, stride length, and arm swing. Common abnormal findings include scoliosis, lordosis, kyphosis, or an antalgic limp resulting from joint pain.
Palpation assesses the temperature, texture, tenderness, and integrity of bones, joints, and muscles. Systematic touch helps identify swelling, crepitus, nodules, or fluid accumulation.
Range of motion (ROM) measures the maximum movement possible for a specific joint.
Stop movement immediately if the patient reports sharp pain or muscle spasm. Never force a joint beyond its natural resistance.
Muscle strength testing evaluates the force generated by specific muscle groups against resistance. The standard Medical Research Council scale grades strength from 0 to 5.
| Grade | Description |
|---|---|
| 0 | No muscle contraction detected |
| 1 | Trace contraction, no movement |
| 2 | Movement with gravity eliminated |
| 3 | Movement against gravity only |
| 4 | Movement against gravity with some resistance |
| 5 | Normal strength against full resistance |
When musculoskeletal injuries like fractures or severe sprains occur, nearby blood vessels and nerves face high risk of compression or laceration. Nurses perform systematic checks using the five Ps: Pain, Pallor, Pulses, Paresthesia, and Paralysis. Comparing the injured limb to the uninjured side helps identify deficits quickly. Early recognition of impaired circulation prevents permanent tissue necrosis or compartment syndrome.
Accurate documentation ensures continuity of care and provides a legal record of the patient's physical status. Record specific measurements, such as centimeters of swelling or degrees of joint flexion, rather than vague terms like 'normal' or 'bad.' Highlight asymmetric findings, neurological deficits, or severe pain responses. Clear notes protect the healthcare team and guide medical management.