Musculoskeletal Assessment

A patient says their hip pain is a 3 out of 10, but they can't bear weight. The musculoskeletal exam tells you what the pain scale won't — whether structure and function are intact.

Musculoskeletal assessment evaluates bones, joints, muscles, tendons, and ligaments for strength, mobility, symmetry, and structural integrity. Use a systematic bilateral comparison approach: always assess the unaffected side first to establish the patient's baseline. Inspect for deformity, swelling, ecchymosis, atrophy, and asymmetry. Palpate joints and surrounding tissue for warmth, crepitus, tenderness, and nodules. Assess active range of motion (ROM) first — the patient moves the joint voluntarily — then passive ROM only if active is limited, stopping immediately at pain. Muscle strength is graded on a 0–5 scale: 0 = no contraction, 1 = trace contraction (visible or palpable without movement), 2 = movement with gravity eliminated, 3 = movement against gravity, 4 = movement against some resistance, 5 = full strength against resistance. Document grade and side. Gait assessment includes observing stance width, arm swing, stride symmetry, and use of assistive devices. Always evaluate neurovascular status distal to any injury — the 5 P's (pain, pallor, pulselessness, paresthesia, paralysis) — because compromised circulation from fractures or casts is a medical emergency.

Key Distinctions

Don't confuse crepitus (grating sensation within a joint, assessed during ROM) with subcutaneous emphysema (crackling under the skin, assessed during integumentary or respiratory exam). Students often test passive ROM before active ROM — always let the patient move first to avoid worsening an injury. The 5 P's belong here when assessing an extremity injury, not in peripheral vascular assessment, which addresses chronic circulation.

Clinical Pearl

"Compare, don't assume." Always assess the unaffected side first — bilateral comparison is the fastest way to spot abnormal findings you'd otherwise miss.