Musculoskeletal System
Chapter 41-43
Musculoskeletal System
FUNCTION!
•
•
•
•
Protection
Framework
Mobility
Reservoir
– Blood cells
– Minerals
• Ca
• Ph
Anatomy & Physiology
SKELETAL SYSTEM
How many bones are in the human body?
A. 206
B. 1,245
C. 847
D. 145
E. 666
Bone Types
•
•
•
•
Long bones
Short bones
Flat bones
Irregular bones
Which of the following are formed in
the bone marrow?
A. Red blood cells
B. White blood cells
C. Platelets
D. Hemoglobin
E. All of the above
Bone structure
• Types of bone tissue
– Compact bone
• Dense
– Spongy bone
• Bone marrow
Bone Marrow
Red
• Locations
– Flat bones
• Contents
–
–
–
–
RBC
WBC
Platelets
Hgb
Yellow
• Location
– Long bones
• Contents
– Fat
Bone Cells
• Osteoblasts
– Form matrix
• Osteocytes
– Maintenance
• Osteoclasts
– Dissolving & resorbing
Bone Maintenance
• Modeling
– Childhood
• Remodeling
– Adulthood
Cool Fact!
Complete skeletal turnover
occurs every 10 years
Joints
• AKA:
– Articulations
• Defined
– Where two or more
bones meet
Synovial joints
• Cavity filled with
synovial fluid
Ligaments
• Defined
– Connects bones to
bones
• Function
– Joint stability
Tendon
• Define
– Connects muscles to
bone
• Function
– Joint movement
Muscles
• Types of muscles
– Skeletal muscles
• Voluntary movement
– Smooth muscles
• Internal organs
• Involuntary
– Cardiac muscles
• Heart muscle
• Involuntary
Muscle structure
• Muscle thick bundles of
parallel fibers
Muscle contraction
• EACH muscle cell is
“excitable”
– Receive and respond to
stimuli
• Skeletal muscle cells
contract when motor
neurons release
acetylcholine
(neurotransmitter)
Muscle contraction
•
•
•
•
Motor neuron 
Acetylcholine 
Muscle cells 
Contraction
Muscle extension
• Muscles extend when
they relax
Muscle Tone
• Nerve impulses
maintain muscle tone.
• Lack of muscle use 
atrophy
– Muscle wasting
M/S system of the older adult
• i in bone mass
• Joint & disc dehydrate 
i height
• i flexibility
• Hips & knees flex
• Head tilted backward 
• Alt. center of gravity 
• h risk of falls
Assessment
• Chief complaint
– Pain
– Limited mobility
Physical assessment
• Gait
• Movements
• Posture
Physical Examination
• Posture
– What is this?
– Kyphosis
• h curve of the thoracic
spine
Physical Examination
• Posture
– What is this?
– Lordosis
• h Curve of the lumbar
spine
Physical Examination
• Posture
– What is this?
– Scoliosis
• Lateral curve of the spine
Physical assessment
• Inspect & palpate
Physical assessment
• Crepitus
– Grating sound or
sensation during ROM
Neurovascular status
• CMS
– Circulation
• Color
• Temp
• Cap. refill
– Motion
• Weak / paralysis
– Sensation
• Paresthesia
• Pain
Range of Motion
• Flexion
– Bend a joint
• Extension
– Straighten joint
• Abduction
– Move away from midline
• Adduction
– Move towards midline
Range of Motion
Passive
• Total assist
Active
• Independent
Clinical Alert!
• Never attempt to move a joint past
its normal range of motion for the
client or past the point at which pain
is experienced.
Erythrocyte Sedimentation Rate (ESR)
• What does an elevated ESR indicate?
A. Bone cancer
B. Osteoporosis
C. Inflammation
D. Anemia
E. Auto-immune disease
C-reactive Protein
• What does an positive CRP indicate?
A. Bone cancer
B. Osteoporosis
C. Inflammation
D. Anemia
E. Auto-immune disease
Dx Tests
• Ca+
– Calcium
• Ph
– Phosphate
Dx Test - imaging
• X-ray
– No special prep
• CT – scan
– No special prep
• CT-scan with contrast
– Assess for allergies
• MRI
Dx tests
• Bone density scan
– Used to diagnosis
osteoporosis
– No special prep
Dx Test
• Arthroscopy
– Flexible fiberoptic
endoscope to visualize
joint
• Arthroscopy
– Pre-procedure
• √ Consent
• NPO 8 hours
– Post-procedure
• Assess neurovascular
status
• Arthroscopy
– Pain management
– Assess bleeding,
swelling
– Elevated
– Ice
• Dr Behl show – Knee
arthroscopy
•
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• Shoulder Arthroscopy
•
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Soft Tissue Injury: Sprain
• Ligament injury
Soft Tissue injury: Strain
• Tear in the muscle
IDT care: Sprain / Strain
• X-ray
– To rule out fx
IDT care: Sprain / Strain
• Rest
• Ice
– First 48 hours
• Compression dressing
• Elevate
– Above level of the heart
Crutches
• Requirement for use
– Good balance
– Strong upper body
– Erect posture
Crutches: Adjust
• Length
– 5 cm below axilla
• Hand grip
– 20 – 30o elbow flexion
Crutches
• Down Stairs
1. Crutches
2. Affected leg
3. Unaffected leg
Crutches
• Up stairs
1. Unaffected leg
2. Crutches & affected
•
•
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Medications: Sprains & Strains
• NSAID’s
• Analgesics
– narcotics
Fracture
• Defined
– Break in the continuity
of the bone
Fracture S&S
•
•
•
•
Deformity
Pain
Immobility
Crepitus
Fractures: IDT care
• Emergency care
–Immobilization
–Open wounds
• Cover with
sterile dressing
– Assess
• Pulse
–CMS
• X-ray to confirm FX
Fracture reduction: IDT care
• Reduction
– Restore alignment
• Immobilization
Cast Care
• Frequently assess
– CMS
• Promptly report
– Changes in CMS
– h or severe pain
– Drainage
• Read text book on cast
care
• Ch. 42
Medications: fracture
• Analgesics & NSAIDs
• Stool softeners
• Antibiotics
Dislocation
• Separation of contact
between two bones of a
joint.
Dislocation
• Most common
– Shoulder
– Knee
S&S of dislocation
•
•
•
•
Pain
Deformity
Length change
Immobility
Dislocation: Tx
• Reduced
Dislocation: Tx
• Immobilized
Amputation
• Partial or total removal
of a body part
Amputation: WHY?!
• Bone Cancer
• Infection
• Trauma
What’s your biggest problem?
• You’ve been in an automobile accident and your right
leg was crushed. You wake up from surgery to find
that your leg had to be amputated, they could not
save it. How do you feel? What are you most
worried about.
• Remembering that nurses deal with patient’s
responses to illnesses and injury – what would be
your priority nursing diagnosis for yourself?
Amputation: Affect
• Physical
• Mental
• Social
Amputation: Complications
• Infection
• Contractures
• Phantom leg pain
Contractures
• Permanent shortening
of the muscle  flexion
Contracture prevention
• ROM
– Extension
IDT care
• Compression
dressing
• Limited weight
bearing 2wks postop
Osteoporosis
• Porous bones
– i Bone mass
– h fragile
– h risk of fractures
– Assoc. with age
Osteoporosis: Pathophysiology
• Bone is constantly
being remodeled
• h Age 
• More bone is lost
than gained 
• i Bone mass
Osteoporosis: S&S
• Asymptomatic
– Loss of height
– Progressive
curvature of the
spine
– Low back pain
– Fx
Which of the following is a
complication of osteoporosis
A.
B.
C.
D.
Lordosis
Kyphosis
Scoliosis
Barrel chest
Osteoporosis: complications
• Pathological fx
IDT: diagnosis
• Bone mineral density
(BMD)
• X-ray
IDT: Nutrition
• Calcium
• Vitamin D
– Needed for Ca+
absorption
Osteomyelitis
• Infection of the bone
Osteomyelitis
• Pathophysiology
– Usually D/T open wound
Osteomyelitis
• Dx
–
–
–
–
WBC
ESR
Blood/tissue cultures
Imaging
• MRI
• CT scan
Osteomyelitis: Rx
• What do they need?
– Antibiotics
Arthritis
• Inflammation of the
joint
Osteoarthritis
• Degenerative joint
disease
• Progressive loss of joint
cartilage
Osteoarthritis
• Affect entire joint
Osteoarthritis:S&S
• Gradual
• Arthalgia
IDT:Dx
• S&S
• X-ray
IDT:care
• Lose weight
• Exercise
• Heat
Osteoarthritis: Rx
• Mild analgesics
– Aspirin
– Acetaminophen
– NSAIDs
Osteoarthritis: Surgery
• Arthroplasty
– Reconstruction of the
joint