Tags & Description
Musculoskeletal System
consists of:
bones
muscles
joints
tendons
ligaments
cartilages
bursae
supports the body & facilitates movement
Main Function of MS
storage site of calcium, phosphorus, magnesium, fluoride
production of blood cells in bone marrow
protection & support to organs: lungs, heart, brain
Other Functions of MS
can cause immobility, disability, & potentially affect quality of life
What happens if there are any injuries/diseases in the MS?
206 bones
How many bones are there in the body?
femur, humerus, radius
examples of a long bone
tarsals, carpals
examples of a short bone
skull, sternum, ribs, iliac
examples of a flat bone
patella
example of a sesamoid bone
Osteoblast
builds the bones where the minerals are deposited
calcification
ossification
Calcification
calcium builds up in body tissue = tissue hardens
Ossification
process of bone formation
Osteocytes
forms new bone cells
Osteoclasts
involved in destruction, reabsorption, remodeling
“carpentry work”
Skeletal Muscle
involuntary
nerve innervation/stimulation => movement
muscle tones
Flaccid (Muscle Tone)
muscle tone is absent
Spastic (Muscle Tone)
muscle that has greater nerve innervation
Atonic (Muscle Tone)
muscle that is not innervated; soft & flabby
Hypertrophy (Muscle Tone)
muscle that is enlarged due to repetitive exertion/movement
Atrophy (Muscle Tone)
muscle deterioration due to lack of use & movement
Smooth Muscle
found in the GIT
Cardiac Muscle
most dangerous & crucial
Joints
allow movement between bony structures
articulation
Synarthrosis
fixed (i.e. skull)
Amphiarthrosis
slightly movable (i.e. vertebral joints)
Diarthrosis
freely movable (i.e. hips, knees, wrists)
Tendons
cord-like structures
connects muscle - bone
Origin Tendon
fixed
Insertion Tendon
movable
Ligament
fibrous tissue
connects bone - bone
provides stability = proper alignment
Cartilage
connective tissue
withstands pressure
absorbs shock, pressure
joint surfaces
Bursae
small sac filled w/synovial fluid to prevent friction between bony structures
Pt’s present health problem
the nurse elicits this information
involves:
upright body alignment (posture)
bone discrepancies (contour, length, alignment, symmetry)
bone motion (difficulty, smoothness, ROM)
gait (coordination, rhythm, stride, balance)
joint alignment (4S: symmetry, size, shape, stability)
joint movement (range, smoothness, pain, crepitus)
muscle mass (shape & firmness)
muscle strength (resistance & contractility)
muscle discrepancies (hypertrophy, atrophy, fasciculation, spasms)
what should be included in the MS assessment during physical examinations?
Crepitus
a cracking sound when moving
pain
pallor
paresthesia
pulses
paralysis
pressure
what are the 6Ps in MS assessment?
Pain
pain on palpation & movement
Pallor
pale skin or poor capillary refill
Paresthesia
pins & needles sensation (numbness & tingling)
Pulses
diminished/absent
Paralysis
movement
Radiographic Studies
detects MS structures
Bone Scan/CT Scan
provides 3D, cross-sectional image of soft tissues, bone, & spinal cord
Magnetic Resonance Imaging (MRI)
imaging studies
allows study of soft tissue in multiple planes of the body
Specific Studies
Arthography
Myelography
Biopsy
Arthrocentesis
Arthography
used to look at a joint in the shoulders, knees, hips
may be done if standard x-ray does not show the needed details of the joint
evaluation & diagnosis of joint condition
Myelography
invasive dx test that uses x-rays to examine spinal canal
special dye is injected into spinal canal w/a hollow needle
can show conditions affecting spinal cord & nerves within spinal canal
Biopsy
procedure wherein a tissue or sample of cells is taken to be tested in a laboratory
can help determine if there is cancer/another condition
Arthrocentesis
joint aspiration
performed to diagnose & may treat some MS conditions
involves injecting medications (i.e. corticosteroid) to relieve pain
Electromyography (EMG)
assess health of muscles & nerve cells that control them (motor neurons)
may reveal nerve dysfunction, muscle dysfunction, problems w/nerve-muscle signal transmission
Relevant Laboratory Studies
alkaline phosphate
creatinine phosphokinase (CPK)
serum calcium
lactic dehydrogenase (LDH)
rheumatoid factor (RH factor)
Alkaline Phosphate
44-147 IU/L
screen/help diagnose diseases of liver/bones
Creatinine Phosphate (CPK)
10-120 mcg/L
if muscle tissue is damaged, CPK leaks into the blood
CPK indicate stress/injury to heart
specific for muscular dystrophy (MD)
elevated levels indicate muscle disease
Serum Calcium
8.5 - 10.2 mg/dL
measure amount of calcium in the blood
screens/monitors bone diseases/calcium regulation disorders
Lactic Dehydrogenase (LDH)
105 - 333 IU/L
help identify location & severity of tissue damage in the body
Rheumatoid Factor
<15 IU/L
help pinpoint diagnosis of rheumatoid arthritis
Bursitis (ID)
inflammation/irritation of bursa sac
bursa becomes irritated by overuse/excess pressure
pain from bursitis may be sudden/builds up overtime
common around major joints: shoulder, elbow, hip, knee
older age
jobs/hobbies that involve repetitive task (sports, manual labor, music)
arthritis, diabetes, gout, thyroid disease
what are the 3 main risk factors for Bursitis?
repetitive motion (i.e. pitcher throwing a baseball over & over)
spending time in positions that put pressure on specific parts of the body (kneeling may cause flare-ups)
sudden injury/infection (occasionally)
what are the causes of Bursitis?
carpentry
gardening/raking
poor posture/poorly positioned joint/bone (due to different leg lengths, bone spurs, or arthritis in a joint)
scrubbing
shoveling
sports (tennis, golf, baseball)
what are activities that can lead to Bursitis?
Median Nerve
provides sensation (ability to feel) to the thumb, index finger, long finger, & part of the ring finger
supplies impulse to muscle - thumb
Carpal Tunnel Syndrome (ID)
median nerve compression
pressure on the median nerve (which runs through the arm & goes through a passage in the wrist = carpal tunnel)
can occur in 1 or both hands
swelling inside the wrist causes compression in carpal tunnel syndrome = numbness, weakness, tingling on side of the hand
hand may “fall asleep” & drop objects
numbness
tingling
pain in the thumb & 1st 3 fingers of the hand
pain & burning that travels up the arm
wrist pain at night that interferes w/sleep
weakness in the muscles of the hand
what are the symptoms of carpal tunnel syndrome?
avoid positions that extends the wrist
wrist splints that hold the hand in a neutral position (especially at night)
mild pain medications & medications to reduce inflammation
treatment of any underlying conditions (arthritis or diabetes)
steroid injections into carpal tunnel to reduce inflammation
what are non-surgical options to treat carpal tunnel syndrome?
Osteomalacia (MBD)
softening of the bones caused by severe Vitamin D deficiency
can lead to bowing during growth (especially in weight-bearing bones of the legs)
may lead to fractures in older adults
Vitamin D
helps absorb calcium in the stomach
help maintain calcium & phosphate levels to help bones form properly
lack of vitamin D
problem with diet
lack of sun exposure
issue w/intestines
body cannot process calcium in the bones
what are the causes of osteomalacia?
bone fractures are easy to induce
muscle weakness
hard time walking/develop a waddling gait
bone pain (especially in the hips)
dull, aching pain (may spread from hips to lower back, pelvis, legs, ribs)
what are the symptoms of osteomalacia?
low levels of vitamin D, calcium, phosphorus
alkaline phosphatase isoenzymes
levels of parathyroid hormone
Looser’s transformation zones
what are the dx tests for osteomalacia?
Alkaline phosphatase isoenzymes
high levels indicate osteomalacia
Level of Parathyroid Hormone
high levels indicate insufficient vitamin D & other related problems
Looser’s Transformation Zones
fractures can begin in these zones even with small injuries
Osteoporosis (MBD)
body looses too much bone, makes too little bone or both = bones become weaker & may break down from a fall or minor bumps
causes loss of bone density = increased risk for fractures
“porous bones”
increases size of spaces = lose bone strength & density
more common in older adult women
most common affected areas: ribs, hip, bones in wrists & spine
receding gums
weakened grip strength
weak & brittle nails
fracture from a fall or even a strong sneeze/cough
back/neck pain
loss of height
what are the symptoms of osteoporosis?
Age
Menopause
Gender (Female)
Ethnicity (Caucasian/Asian)
Family History of Osteoporosis
Poor Nutrition
Physical Inactivity
Smoking
Low Body Weight
Small-Boned Frame
what are the risk factors of osteoporosis?
Age
biggest risk factor in osteoporosis
30s = body starts breaking down bone faster than its ability to replace it
leads to bones with less density & more fragile (prone to breaking)
Menopause
occurs in women aged around 45-55
due to change in hormone levels, it can cause a woman’s body to lose bone even more quickly
Bone Density Test
dx test for osteoporosis
bone densitometry/dual energy x-ray absorptiometry (DEXA)
measure density of bones in the wrist, hips, spine
painless & takes 10-30 mins.
Bisophosphonates
Lifestyle Changes
treatment for osteoporosis
Bisophosphonates
prevents loss of bone mass
orally/injected
includes:
Aldendronate = Fosamax
Ibandronate = Boniva
Risedronate = Actonel
Zoledronic Acid = Reclast
Lifestyle Changes
increased intake of calcium & Vitamin D
appropriate exercises
Osteoarthritis (DJD)
wear & tear of weight-bearing joints (hip, knee, ankle)
increasing age
obesity
heredity
decreased bone density
what are the risk factors of osteoarthritis?
weight bearing joints: hips, knees, and spine
what joints are involved in osteoarthritis?
Herberden’s Node (distal interphalangeal joint)
Bouchard’s Node (proximal interphalangeal joint)
what are the bone affectations in osteoarthritis?
Radiographic X-Rays
Arthroscopy
what are the dx tests for osteoarthritis?
Rheumatoid Arthritis (DJD)
autoimmune, systemic, inflammatory disorder of connective tissues/joint
chronic w/remissions & exacerbations
Acute
RH nodules develop or are evident in bony prominences.
onset of RH symptoms
Bilateral & Symmetric
joint involvement of rheumatoid arthritis
Swan Neck Deformity
Boutonniere Deformity
Ulnar Deviation
what are the bone affectations in rheumatoid arthritis?
(+) C-reactive Protein (CRP)
(+) Rheumatoid Factor (RF)
what are the dx of rheumatoid arthritis?
Gouty Arthritis
painful, metabolic inflammatory reaction in the joints
decreased renal excretion of uric acid
abnormal purine metabolism
Acute
Tends to be inherited.
Affects men more than women.
Presence of hyperuricemia.
onset of symptoms of gouty arthritis
feet (great toe), hands, elbows, ankles, knees
what are the joints involved in gouty arthritis?
Gout Tophi (uric acid accumulation in the joint)
bone affectation of gouty arthritis
High Uric Acid Blood Test
24-hour Urine Collection
dx tests involved in gouty arthritis
Inflammatory Symptoms
pain
swelling
redness
warmth
Systemic Symptoms
fever
malaise
anorexia
weight loss
Specific Symptoms
stiffness
movement limitation
Non-Pharmacologic Management for Degenerative Joint Diseases
local rest affected area
support devices: splints, braces, canes, crutches
exercises/physical therapy measures