Clinical Skills · Assessment of the Musculoskeletal System

Physical Assessment

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On this page 9 sections

In 30 seconds
Why this matters
The college version
Eli explains
Worked example
Key takeaway
Check yourself
Study tools
Sources & references

In 30 seconds

The musculoskeletal physical assessment systematically evaluates how a person's body moves and supports itself. Like every nursing assessment, it blends history with exam: questions about pain, stiffness, weakness, and daily function; then , , range of motion, muscle strength, and observation of and everyday activities. Because MSK problems are common and disabling, the assessment's real questions are practical: Can this person do what they need to do? Is there an injury or a change from their usual state? Are they safe from falling? Findings are documented and compared with baseline, and concerning findings — severe pain, obvious deformity, inability to bear weight, numbness — are reported promptly. Exact techniques and grading scales vary by facility, so this topic presents general principles rather than a universal protocol.

Scope and safety: This is an educational study guide, not clinical guidance. Never force a joint that resists movement, especially after injury. Findings suggesting a fracture or neurovascular problem must be reported promptly per facility policy. Diagnosis and treatment are provider responsibilities.

Why this matters

Mobility is independence, and musculoskeletal problems are among the most common causes of pain and disability. Falls are a leading cause of injury in older adults, and much of what a nurse does about falls begins with assessment: asking about past falls, watching a transfer, and noticing weakness before the fall happens. The assessment also establishes the baseline the whole team uses — the physical therapist plans mobility work, the provider interprets imaging, and the nurse tracks whether a patient is getting better or worse. Finally, the assessment is a safety act in itself: performed with a gait belt and good body mechanics, it protects the patient and the nurse.

The college version

Core Concepts

The history: start with function

Begin with pain: location, onset, quality, aggravating and relieving factors, and what the person was doing when it started. Ask about stiffness — when it occurs and how long it lasts in the morning — plus swelling, weakness, numbness or tingling, and joints that lock or give way. Record the mechanism of any injury (fall? twist? lifting?). Collect past history (fractures, arthritis, osteoporosis), occupation and activity level, use of assistive devices, and — always ask older adults directly — "Have you fallen in the past year?" Anchor the exam in function: Can you dress yourself? Climb stairs? Get in and out of a chair?

Inspection: look before you touch

Observe posture and alignment — standing, are the shoulders level and the spine's curves intact? Note symmetry of muscles and joints, obvious deformity, muscle bulk or wasting, skin changes (bruising, redness, scars, wounds), and swelling. If the person can walk, watch them: smoothness of gait, a limp, balance, and whether they steady themselves on walls or furniture. Watching someone walk often reveals more than asking them to describe how they walk.

Palpation: what the hands add

Gently feel joints, muscles, and surrounding tissue for tenderness, warmth, swelling, and muscle spasm or tone. If one side is painful, palpate the uninvolved side first, then compare sides. — a grating sensation felt or heard when a joint moves — can occur with changes in joint surfaces; it is a finding to document, not proof of any particular condition. Watch the patient's face: wincing is data.

Range of motion: active and passive

describes how far a joint moves through its arc: flexion (bending), extension (straightening), abduction (moving away from the midline), adduction (moving toward the midline), and rotation (turning). The key distinction is who does the moving:

— the patient moves the joint themselves.
— the nurse moves the joint while the patient relaxes.

Compare sides and note pain, stiffness, and limitations. A useful interpretive principle: if active ROM is limited but passive ROM is full and painless, the limitation often reflects weakness or pain; if both are limited, the joint or its surrounding structures may themselves be affected. Never force a joint that resists movement — especially after injury, forcing can worsen damage. Document and report instead.

Muscle strength

Strength is commonly graded on a 0–5 scale, where 0 means no visible contraction and 5 means full strength against resistance; exact criteria and grading conventions vary by facility, so learn your institution's scale. Test major muscle groups (shoulder, elbow, wrist, hip, knee, ankle) and compare sides. Distinguish weakness from pain-limited effort: a person may not push hard because it hurts, not because the muscle is weak. Document what you actually observe — "resisted weakly, grimacing" is not the same as "no contraction."

Functional assessment and falls risk

The exam ends where daily life begins. Observe transfers (lying to sitting, sitting to standing), balance, and gait; ask about dizziness when standing; and check whether assistive devices fit and are used correctly. Fall-risk screening tools vary by facility, but asking about falls in the past year and watching a transfer are universal starting points. Use a gait belt and stay close during balance testing per facility policy — the assessment itself should never cause a fall.

Common Confusions

Do Not Confuse	With	Difference
Active ROM	Passive ROM	Patient moves the joint vs. the nurse moves it
Weakness	Pain limiting effort	No contraction vs. "won't push because it hurts" — document what you observe
Sprain	Strain	Ligament injury vs. muscle/tendon injury
Atrophy	Contracture	Muscle wasting vs. a joint fixed in a bent position
Crepitus	Fracture	A grating sensation with movement vs. a broken bone; crepitus alone is not proof
Textbook "normal" ROM	This patient's normal	Normal varies with age, conditioning, and prior injury; compare with baseline

Eli explains

The same idea, in plain words

Explain it like I’m 10

Checking a bicycle before a ride: you look at it (inspection), squeeze the tires and feel the brakes (palpation), turn the pedals and handlebars (range of motion), push on the pedals (strength), and then watch it roll down the driveway (gait). Each check answers one question, and you always compare the left side of the bike with the right side.

Worked example

Mr. J., age 80, tells you, "I slipped on the rug and my right hip really hurts." You take the history: the mechanism (a fall), whether he can bear weight (he cannot), and any numbness or tingling. On inspection, the right leg appears shortened and turned outward, with bruising over the hip — a pattern consistent with a hip fracture. On palpation, gentle touch over the hip is very tender, and you do NOT force the leg to move. You keep him comfortable, avoid moving the limb, document what you found, and report immediately. The facility protocol for suspected fracture may include keeping the person NPO (nothing by mouth), preventing weight bearing, and urgent provider notification — you follow your institution's procedure. You have recognized an urgent pattern; you have not made the diagnosis. Imaging and treatment are provider decisions.

Key takeaways

Order: history → inspection → palpation → ROM → strength → function; inspect before you touch.
Compare left and right on every measurement.
Active ROM = patient moves the joint; passive ROM = nurse moves it.
Never force a joint that resists movement, especially after injury.
Strength grading scales (commonly 0–5) vary by facility — learn yours.
Pain-limited effort is not weakness; document what you observe.
Ask older adults about falls, watch transfers, and use a gait belt per policy.
Report promptly: severe pain, deformity, inability to bear weight, numbness, or open wounds.

Check yourself

5 review questions from the chapter. Try each one, then open the answer.

Why inspect before palpating, and why palpate before asking the patient to move?
Show answer
Inspection is non-invasive and gathers visible information first; palpation adds tenderness, warmth, and swelling; asking for movement comes last because painful or unstable joints should not be forced. The order also protects the patient from unnecessary discomfort.
What is the difference between active and passive range of motion?
Show answer
Active ROM is performed by the patient; passive ROM is performed by the nurse while the patient relaxes. If active is limited but passive is full, the limit is often weakness or pain; if both are limited, the joint itself may be affected.
A patient moves her shoulder through full range but pushes weakly against resistance and winces. What should you document?
Show answer
Document both parts honestly: "full active range of motion; resisted weakly against resistance with grimacing." That distinguishes pain-limited effort from true weakness, which changes how the finding is interpreted.
Why should a nurse never force a joint that resists movement after an injury?
Show answer
Because a joint that resists movement after injury may be fractured or unstable; forcing it can worsen the injury. Document the limitation and report it instead.
What two questions or observations are universal starting points for fall-risk screening?
Show answer
"Have you fallen in the past year?" and observing a transfer (e.g., sitting to standing) for balance, steadiness, and use of support.

Keep learning

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Study toolsKey vocabulary

Key vocabulary

Inspection: Looking at posture, symmetry, deformity, skin, and gait
Palpation: Feeling joints and muscles for tenderness, warmth, and swelling
Range of motion (ROM): How far a joint moves through its arc
Active ROM: The patient moves the joint themselves
Passive ROM: The nurse moves the joint while the patient relaxes
Flexion / extension: Bending / straightening a joint
Abduction / adduction: Moving away from / toward the midline
Crepitus: A grating sensation felt or heard with joint movement
Muscle strength grading: A scale (commonly 0–5) rating a muscle's contraction
Gait: The way a person walks
Atrophy: Wasting (decrease) of muscle bulk
Contracture: A joint fixed in a bent (flexed) position

Sources & references

openstax.org — Clinical Nursing Skills

This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.

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