Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 24
NURSING CARE OF
THE CLIENT:
MUSCULO-SKELETAL
SYSTEM
Orthopedics
The branch of medicine that deals with
the prevention and correction of the
disorders and diseases of the musculoskeletal system.
 Involves the muscles, skeleton, joints, and
supporting structures such as ligaments
and tendons.

Orthopedic Nursing

The primary goal of the nurse caring for a
client with locomotor disorders is the
prevention of contractures (permanent
shortening of a muscle) or deformities.
Skeletal Functions
To provide the body with a structural
framework.
 To act as a protective casing for internal
organs ( the brain, heart, lungs,etc.).
 To allow movement by muscles attached
to the skeleton.
 To store calcium, phosphorus, and
magnesium.
 To manufacture blood cells in the red
bone marrow.

Types of Bones

Two types of bone:
 Cancellous, which resembles a sponge
with spaces.
 Cortical, which is compact bone found
in the shaft of long bones.
Muscle Characteristics
Muscles act as motors controlled by nerve
fibers from the cerebral cortex.
 Muscles and skeleton work together to
permit movement.
 Muscles are attached to bones by
tendons.
 Movement of the muscles may be
voluntary or involuntary.

Joints
A joint is a junction of two or more bones.
 Three types:

Diarthosis: freely movable such as hinge
(elbow, knee); ball and socket (hip, shoulder),
pivot (skull, first vertebrae), gliding (wrist) and
saddle (thumb).
 Synarthosis: joints are immovable.
 Amphiarthosis: slightly movable (vertebrae
and pelvic bones).

Assessment of the Bony
Skeleton
Notation on any deformities.
 Body alignment.
 Abnormal growths due to bone tumors.
 Shortened extremities.
 Amputations.
 Abnormal angulation other than at joints.
 Crepitus (a grating or crackling sensation
or sound).

Assessment of Spine
Three common spinal curvatures:
Scoliosis (crooked back; lateral curving
deviation).
 Kyphosis (hump back; increased
roundness of the thoracic spinal curve).
 Lordosis (sway back; exaggeration of the
lumbar spine curvature as seen in
pregnancy).

Musculoskeletal Trauma
Strains.
 Sprains.
 Dislocations.
 Fractures.
 Compartment Syndrome.

Strain
An injury to a muscle or tendon due to
overuse or overstretching.
 May be acute or chronic.

Sprain
An injury to ligaments surrounding a joint
caused by a sudden twist, wrench, or fall.
 Symptoms include pain, edema, loss of
motion, and ecchymosis.

Dislocation

What occurs when articular surfaces of a
joint are no longer in contact. The bones
are literally “out of joint.”
Fracture
A break in the continuity of a bone.
 More than 90 different classifications.
Most common are:

Greenstick, or incomplete.
 Simple, or closed.
 Compound, or open.
 Impacted, or telescoped.
 Spiral.
 Comminuted.

Compartment Syndrome

A form of neurovascular impairment that
may lead to permanent injury of an
affected limb caused by the progressive
constriction of blood vessels and nerves.
Casts





Since plaster casts dry from the inside out, they
should not be covered or dried with a hairdryer
or heat lamp.
Moisture and heat from the drying cast should
be allowed to evaporate naturally.
To avoid indentation, a drying cast should be
placed on pillows and not on a hard surface.
When handling the cast, only the palms of the
hands should be used.
Synthetic casts dry in minutes.
Traction
The principle of traction is to have two
forces pulling in opposite directions.
Traction consists of weights and
counterweights.
 Traction may be used to reduce a
fracture, immobilize an extremity, lessen
muscle spasms, or correct or prevent a
deformity.

Rehabilitation
Physical Therapy.
 Learning the proper use of equipment
such as crutches, canes, or walkers.

Surgical Methods:
Open Reduction
A surgical procedure that enables the
surgeon to reduce (repair) the fracture
under direct visualization.
 Major disadvantage is chance of infection.

Circulation, Movement, and Sensation
Assessments: The Five P’s
Pain.
 Pallor (slow capillary return).
 Paresthesia (unrelieved tingling or
numbness).
 Puffiness (edema).
 Pulselessness.

Inflammatory Diseases
Rheumatoid Arthritis.
 Bursitis (an inflammation of the bursa, a
sac filled with synovial fluid that facilitates
joint movement. Major bursae are found
in the shoulder, knee, hip, and elbow).
 Polymyositis (involves striated muscle).
 Osteomyelitis (inflammation of the bone
and bone marrow).

Degenerative Disorders
Osteoporosis.
 Degenerative joint disease.
 Total joint arthoplasty.

Osteoporosis
An increase in the porosity of bones
causing an increased susceptibility to
fractures of the hip, spine, and wrist.
 Of those affected, 80% are women.

Degenerative Joint Disease
Also called osteoarthritis.
 Considered a “wear and tear” disease,
characterized by slow and steady
progressive destructive changes of the
joint.
 The most common type of arthritis.

Total Joint Arthroplasty
Joint replacement or arthroplasty is the
replacement of both articular surfaces
within a joint capsule.
 The hip, knee, shoulder, and fingers are
the joints most frequently replaced.
 Joint replacement is usually an elective
procedure and clients may wish to have
autologous blood transfusions.

Musculoskeletal Disorders
Amputations.
 Temporomandibular joint
disease/disorder.
 Carpal Tunnel syndrome.

Amputations
Removal of all or part of an extremity.
 Done in response to injuries resulting in
extensive laceration of arteries or nerves,
or diseases such as malignant tumors,
infections, and peripheral vascular
disorders.

Temperomandibular Joint
Disease/Disorder (TMD)



Commonly referred to as TMJ by general
population, this is a collection of conditions
affecting the temperomandibular joint and/or the
muscles of mastication.
Causes include trauma, stress, teeth clenching
or grinding (bruxism), and joint diseases such
as arthritis.
Common symptoms include limited jaw
movement, clicking or crepitus when jaw
moves, popping when chewing or talking, and
radiating pain in the face, neck, or shoulders.
Carpal Tunnel Syndrome
Occurs when the median nerve in the
wrist is compressed by inflamed,
edemetous flexor tendons.
 Symptoms include pain, paresthesia, and
weakness of the thumb, index finger,
middle and part of the ring finger but
never the pinky.
 Caused by repetitive motion.

Systemic Disorders with
Musculoskeletal Manifestations
Gout.
 Lyme Disease.

Gout
A metabolic disease of ineffective purine
metabolism resulting from deposits of
needlelike crystals of uric acid in
connective tissue, join spaces, or both.
 Attack generally begins with severe
constant pain.
 Clients should avoid foods high in purine
(e.g. liver, sardines, sweetbreads,
anchovies, gravies, and asparagus).

Lyme Disease
Caused by a spirochete Borrelia
burgdorferi carried by deer ticks.
 First symptom in most cases is a red
rash. Other symptoms include headache,
neck stiffness, fever, and pain.
 Untreated Lyme Disease can result in
arthritis, fatigue, facial palsy, meningitis,
and encephalitis.
