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Final

NURS 202 Final: OSCE- Musculoskeletal System


Department
Nursing
Course Code
NURS 202
Professor
Shelly Peacock
Study Guide
Final

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Musculoskeletal System:
Inspection Palpation ROM Muscle
Testing
Rand
om
Temporomandibular Joint
-inspect area
anterior to ear
-Palpate using tips of rst
two ngers, asking pt to
open and close mouth
-drop ngers into
depressed area over joint
(smooth movement of
mandible, audible or
palpable snap in many
healthy pts)
-instruct pt to clench
teeth, palpate contracted
temporalis and masseter
muscles
(compare right and left sides
for size, rmness, strength)
-open mouth maximally
(vertical motion you can
measure between upper and
lower incisors, normal space is
3-6cm or 3 ngers inserted
sideways)
-partially open mouth,
thrust lower jaw and move
side to side
(lateral motion, normal extent
is 1-2 cm)
-stick out lower jaw
(protrusion without deviation)
-move jaw
forward and
laterally against
your resistance,
and to open
mouth against
your resistance
(should be able to
resist your
resistance)
-muscle
test is
also a
test of
integrity
of
cranial
nerve V
or the
trigemin
al nerve
Cervical Spine
-inspect
alignment of
head and neck
(spine should be
straight and head
erect)
-palpate the spinus
processes and
sternomastoid, trapezius
and paravertebral
muscles
(feel rm, no muscle spasm
or tenderness)
-touch chin to chest
(#exion of 45)
-lift chin towards ceiling
(hyperextension of 55)
-move ear towards
corresponding shoulder, do
NOT lift up shoulder
(lateral bending of 40)
-turn chin towards each
shoulder
-ask patient to
repeat ROM
activities while
you apply
opposing force
(pt should be able
to maintain #exion
against your
resistance)
-muscle
testing
is also a
test of
cranial
nerve XI
(spinal
nerve)

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(rotation of 70)
Shoulders
-compare both
shoulders
posteriorly and
anteriorly
-check size and
contour of joint
-compare
shoulders for
equality of bony
landmarks
(normally no
redness, muscle
atrophy, or
deformity or
swelling is present)
-check anterior
aspect of joint
capsule and the
subacromial
bursa for
abnormal
swelling
-stand in front of pt!
-palpate both shoulders
(note any muscle spasm,
atrophy, swelling, heat or
tenderness)
Start at clavical, and
explore:
-Acromeioclavicular joint
-scapula
-greater tubercle of the
humerus
-area of the subacromial
bursa
-biceps groove
-anterior aspect of the
glenohumeral joint
-palpate pyramid shaped
axilla
(no masses should be
present)
-WITH ALL: cup hand over
shoulder during ROM to note
any crepitation
(none should be present)
-arms at side and elbows
extended, move both arms
forward and up in wide
vertical arcs and
backwards
(#exion of 180, hyperextension
of 50)
-rotate arms internally
behind back, placing back
of hands as high as
possible towards the
scapulae
(internal rotation of 90)
-arms at side and elbows
extended, raise both arms
in a wide arc in the coronal
place, touching arms
together above head
(abduction of 180, adduction
of 50)
-touch both hands behind
head with elbows +exed
and rotate posteriorly
(external rotation of 90)
-ask patient to
shrug shoulders,
+exing forward
and up, and
abducting them
against your
resistance
(should be able to
maintain #exion
against your
resistance)
-
shoulder
shrug is
also test
of
cranial
nerve XI
(spinal
nerve)
Elbow
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-inspect size and
contour of elbow
in both +exed
and extended
positions
(look for any
deformity,
redness, or
swelling)
-check olecranon
bursa and
normally present
hollows on
either side of
olecranon
process
(should be no
swelling)
-palpating with pt’s elbow
at 70 degrees and as
relaxed as possible
-use left hand to support
pt’s left forearm,
palpating extensor
surface of elbow with
right thumb and ngers
-with thumb in lateral
groove and index in
medial groove, palpate
either side of olecranon
process
(normally tissues and fat
pads feel solid, should be no
synovial thickening, nodules,
or tenderness)
-bend and then straighten
elbow
(#exion of 150-160, extension
at 0)
-hold hand midway, then
touch front and back sides
of hand to table
(90 in pronation, 90 in
supination)
-stabilize pt’s
arm with one
hand, apply
resistance just
proximal to wrist
and instruct pt to
+ex and extend
elbow against
resistant
(should be able to
maintain #exion
against your
resistance)
Wrist and Hand
-inspect hands
and wrists on
dorsal and
palmar sides
(noting position,
contour, and
shape)
(in normal
functional position
of hand, wrist is in
slight extension
and ngers lie
straight in same
axis as forearm)
(normally no
swelling, redness,
-FACE PT and support pt’s
hands with your ngers
underneath
-palpate wrist rmly with
both your thumbs on it’s
dorsum
(make sure pt’s wrist is
relaxed and in straight
alignment)
-move your palpating
thumbs side to side to
identify normal depressed
areas that overlIE joint
space
(normally joint surface feels
-bend hand up at wrist
(hyperextension of 70)
-bend hand down at wrist
(palmar #exion of 90)
-bend ngers up and down
at metacarpophalangeal
joints
(#exion of 90, hyperextension
of 30)
-with palms +at on table,
turn them outward and in
(ulnar deviation of 50-60,
radial deviation of 20)
-position pt’s
forearm
supinated and
resting on a
table, stabile pt’s
arm by holding
your hand at mid
forearm, ask pt
to +ex wrist
against
resistance at
palm
(should be able to
maintain #exion
against your
resistance)
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