Chapter 9 – Musculoskeletal System Assessment
Brief Scan: MSK System
A brief scan provides a quick overview of the MSK system. It can be performed when the client enters the room. Your observations provide insight into how the client may need to be supported during the assessment, ways you may need to modify the assessment, and cues that require further investigation.
Steps involved in the brief scan are:
- Assess the type of footwear and the presence of and mobility aids such as canes, walkers, braces, splints, or wheelchairs.
- If aids are present, you should ask further questions. You need to understand the need for the aid and should assess whether it is being used properly.
- Assess the client’s posture and balance when they enter the room and their ability to sit or stand upright and maintain this position.
- Normal findings may include an upright posture and no issues with balance.
- Abnormal findings may include hunched over, unequal weight bearing, and lateral lean.
- Assess for the presence of or obvious deformities.
- Normal findings include no tremors or deformities.
- Abnormal findings may include deformities, which could include fractures, or unilateral or bilateral tremors in head/neck region, upper or lower limbs.
- Assess the client’s symmetry of limbs in terms of length and . This can be done informally when the client walks in the room from the waiting room. Otherwise, you can ask them to walk about 10 feet. This may not be required if a client is in a wheelchair, particularly if they are unable to stand up.
- Normally, limbs are symmetrical, and gait is balanced.
- Abnormal findings include asymmetrical limbs and difficulties with balance. Cues of asymmetry and a gait that is not balanced should be probed further.
- Note the findings.
- Normal findings might be documented as: “Client’s body is symmetrical, no deformities, posture straight, steady gait and balance. No mobility aids used.”
- Abnormal findings might be documented as: “Client has a slow and unsteady gait. Left arm hangs lower than the right arm.”
Contextualizing Inclusivity
Use a person-centred and systematic approach to assessment. The initial MSK brief scan will help guide your questioning and facilitate a non-discriminatory, anti-ableist assessment. For example, if a client uses a mobility aid, always ask for permission/consent to touch or handle the equipment.
Priorities of Care
During the brief scan, any fractures or suspected fractures should take priority. The fracture may have caused internal damage that is not visible upon inspection, such as a punctured lung, severed cranial nerve, perforated organ, bone fragments, or vascular or peripheral nerve damage.
A primary survey approach should be performed before beginning a focused MSK assessment. If there are no life-threatening injuries, you can begin the MSK assessment. Safety should be prioritized, including prevention of falls when assessing a client’s movement, balance, strength, and gait.
are artificial devices that replace a missing body part such as an artificial limb
are involuntary rhythmic twitching-like movements.
refers to balance and movement of limbs while walking.
