During a musculoskeletal assessment, what would be the most appropriate action if unilateral swelling is noted in the shoulder?

Musculoskeletal assessment of the shoulder includes inspection, palpation, and evaluation of symmetry, swelling, pain, and joint integrity. Unilateral swelling is an abnormal finding that may indicate trauma, inflammation, infection, or joint effusion. When such a finding is identified, the nurse must proceed with a focused assessment to further characterize the abnormality before making conclusions or moving on. Palpation helps determine tissue involvement, tenderness, and structural changes such as crepitus. A. Documenting the swelling and proceeding to other systems prematurely may lead to missed or delayed diagnosis of an underlying musculoskeletal or inflammatory condition. Unilateral swelling requires further focused assessment to determine its cause before it is simply recorded and ignored. Proper nursing assessment prioritizes clarification of abnormal findings rather than immediate progression. B. Asking the client to perform active range of motion exercises is inappropriate when swelling is present, as it may worsen inflammation or underlying injury. Active movement without understanding the cause of swelling could exacerbate pain, tissue damage, or joint instability. Further assessment should precede any movement-based intervention. C. Performing a focused palpation of the area is the most appropriate next step because it allows the nurse to assess for tenderness, warmth, fluctuance, or crepitus. These findings help differentiate between causes such as inflammation, infection, trauma, or joint effusion. A structured palpation provides critical data needed for clinical decision-making and potential escalation of care. D. Continuing the assessment and reassessing the swelling later delays identification of potentially serious conditions such as infection, hemarthrosis, or acute injury. Abnormal findings require immediate focused evaluation rather than postponement. Early assessment ensures timely intervention and prevents progression of underlying pathology.