(1) Observe the patient's general appearance, body symmetry, gait, posture,
and coordination. Inspect and palpate his muscles, joints, and bones. Evaluate muscle
and joint function of each body area as you proceed with the examination. Compare both
sides of the body for size, strength, movement, and complaints of pain.
(2) Position the patient to allow full range of motion (ROM), but avoid tiring the
patient by allowing him to sit whenever possible.
(3) Inspect spinal curvature. Have the patient stand as straight as possible
and inspect the spine for alignment and the shoulders, iliac crests, and scapulae for
symmetry of position and height. Normally, the thoracic spine is characterized by convex
curvature and the lumbar spine is characterized by concave curvature in a standing
patient. Have the patient bend forward from the waist with arms relaxed and dangling.
Stand behind him and inspect the straightness of the spine, noting flank and thorax
position and symmetry.
(4) Have the patient stand with his feet together. Note the relation of one
knee to the other. The knees should be symmetrical and located at the same height in a
forward-facing position.
(5) Ask the patient to walk away, turn around, and walk back. If the patient is
elderly or infirmed, remain close and ready to help if he should stumble or start to fall.
Observe and evaluate his posture, pace and length of stride, foot position, coordination,
and balance. Normal findings include smooth, coordinated movements, erect posture, and
2 to 4 inches between the feet. Abnormal findings include a wide support base, arms held
out to the side or in front, jerky or shuffling motions, toeing in or out, and the ball of the
foot, rather than the heel, striking the floor first.
(6) To assess gross motor skills, have the patient perform range-of-motion
(ROM) exercises (see Nursing Fundamentals I, figure 5-1). To assess fine motor
coordination, have the patient pick up a small object from a flat surface.
(7) Assess muscle tone. Muscle tone is the tension in the resting muscle.
Palpate the muscle at rest and during passive ROM from the muscle attachment at the
bone to the edge of the muscle. A relaxed muscle should feel soft and pliable. A
contracted muscle should feel firm.
(8) Assess muscle mass. Muscle mass is the actual size of a muscle.
Assessment involves measuring the circumference of the thigh, the calf, and the upper
arm. Measure at the same location on each area. Abnormal findings include
circumferential differences of more than inch between opposite thighs, calves and upper
arms, decreased muscle size (atrophy), excessive muscle size (hypertrophy) without a
history of muscle building exercises, flaccidity (atony), weakness (hypotonicity), spasticity
(hypertonicity), and involuntary twitching of muscle fibers (fasciculations).
MD0906
6-19
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