Introduction to the
Musculoskeletal System
Anatomy and Physiology
Musculoskeletal System
Bones
Bursae
Cartilage
Muscles
Musculoskeletal
System
Ligaments
Tendons
Joints
Anatomy and Physiology
Bones
206 bones in the human body
Classification
Short bones; long bones
Flat bones; irregular bones
Two types of bony tissue ( spongy, dense)
Composition of bones (calcium and
phosphorus
Types of bone cells
Bone marrow
Types of bone cells
Osteogenic cells respond to traumas, such as fractures, by
giving rise to bone-forming cells and bone-destroying cells.
Osteoblasts (bone-forming cells) synthesize and secrete
unmineralized ground substance and are found in areas of
high metabolism within the bone.
Osteocytes are mature bone cells made from osteoblasts that
have made bone tissue around themselves. These cells
maintain healthy bone tissue by secreting enzymes and
controlling the bone mineral content; they also control the
calcium release from the bone tissue to the blood.
Osteoclasts are large cells that break down bone tissue. They
are very important to bone growth, healing, and remodeling.
Bone-lining cells -made from osteoblasts along the surface
of most bones in an adult. Bone-lining cells are thought to
regulate the movement of calcium and phosphate into and
out of the bone.
Anatomy and Physiology
Muscles
Skeletal, smooth, and cardiac
Joints
The junction between two or more bones
Free-moving or diarthrodial joints
Tendons
Cord-like structures that attach muscles to
the periosteum of the bone
Attachments of the muscle
Origin and insertion
Anatomy and Physiology
Ligaments
Fibrous tissue connecting two adjacent,
freely movable bones
Cartilage
Firm, dense type of connective tissue
Types: Hyaline or articular; costal;
semilunar; fibrous; elastic
Bursae
Small sac filled with synovial fluid
Reduces friction between areas
Assessment
History
Chronic disorder
Medical, drug, and allergy
Family and occupational
Recent injury
Occurrence of trauma
Open injury
Date of last tetanus immunization
Compilation of list of symptoms
Determining the effect of activity on
symptoms
Assessment
Physical Examination
Assessment
Musculoskeletal
Motor skills; muscle strength or
wasting
Symmetry; size; ROM; alignment
Pain; tenderness; swelling; redness
Spinal inspection: Kyphosis; lordosis;
scoliosis
Neurovascular: Spasms; tremors
Assessment
Physical Examination (Cont’d)
Tests
Abnormal size or alignment
Symmetry
Pain; tenderness
Swelling; redness
External bleeding; bruising
Degree of movement
Muscle strength and wasting
Assessment
Physical Examination (Cont’d)
Assessment for traumatic injury
Vital signs
Swelling, external bleeding, or bruising
Open wounds, debris, protrusion of bone
or tissue
Peripheral circulation and sensation
Malalignment of the injured limb
Injury beyond the original area
Pain: Type and location
Assessment
Diagnostic Tests
Blood and
urine tests
Biopsy
Electromyography
Imaging
procedures
Arthroscopy
Diagnostic
Tests
Bone scan and
densitometry
Arthrocentesis
Synovial
fluid
analysis
Nursing Management
Diagnostic Tests
Diagnostic examination protocols
Send specimens to the laboratory
Ensure safe recovery after procedure
Endoscopic Exam
Fine Needle Aspiration
Chronic Disorder
General medical history
Current symptoms
Compile drug and allergy histories
Nursing Management
Invasive Joint Examination
Inspect: Swelling, bleeding, or drainage
Change or reinforce dressings
Traumatic Injury
Information regarding injury
Monitor: Vital signs; neurovascular status
Provide comfort and support
Medical and Surgical Treatment
Modalities
Medications
Splinting and Casting
Skeletal Fixation (Traction)
Surgical Reduction
Surgical Fixation ( Pinning)
Joint Replacement
Nursing Process: The Client With a
Musculoskeletal Injury
Assessment
Location of injury, its nature, and effects
on mobility
Circulatory status of the injured area
Level of pain
Vital signs and signs of shock
Nursing Process: The Client With a
Musculoskeletal Injury
Diagnosis, Planning, and Interventions
Provide relevant information
Allow client to ask questions
Obtain signed consent form if required
Clarify the physician’s explanations
Provide written discharge instructions for
self-care
Nursing Process: The Client With a
Musculoskeletal Injury
Diagnosis, Planning, and Interventions
Additional interventions for
Pain related to tissue injury
Risk for impaired tissue perfusion
related to inflammation or inactivity
Anxiety and its treatment
Potential for altered mobility
Nursing Process: The Client With a
Musculoskeletal Injury
Evaluation of Expected Outcomes
Pain relief
Neurovascular status remains intact
Reduced anxiety and a calm demeanor
General Considerations
Nutritional Considerations
Calcium
Protects against bone loss
Adequate calcium intake
Maximizes peak bone mass
Vitamin D
Protects against bone loss and fractures
Without adequate vitamin D, calcium is
excreted
General Considerations
Pharmacologic Considerations
Oral calcium
Preparations containing vitamin D are
better absorbed
Avoid taking with other oral drugs
Take with meals
General Considerations
Gerontologic Considerations
Women older than 45 years have a 9% to
10% decrease in cortical bone per decade
Height loss with age
Active lifestyle delays decline in muscle
strength and bone mass
Osteoporosis among aging women
End of Presentation