Musculoskeletal System

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Musculoskeletal System
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Musculoskeletal System

• Anatomy Physiology
• Bones
• Short bones
• Fingers toes
• Long bones
• Femur ulna
• Flat bones
• Sternum
• Irregular bones
• Vertebrae

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Musculoskeletal System

• Anatomy Physiology (cont)
• Bony tissue
• Cancellous bone
• Spongy
• Found at the rounded, irregular ends (epiphyses)
  or long bones
• Cortical bone
• Dense hard
• Found chiefly in the long shafts (diaphyses) of
  bones in the arms and legs

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Musculoskeletal System

• Anatomy Physiology (cont)
• Bone
• Osteoblasts
• Cells that build bones
• Secrete bone matrix (mostly collagen) which
  inorganic minerals (calcium salts) are deposited
• This process of ossification calcification
  transforms the blast cells into mature bone
  cells
• Osteocytes
• Maintain bone tissue
• Osteoclasts
• Involved in destruction, resorption and
  remodeling of bone

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Musculoskeletal System

• Anatomy Physiology (cont)
• Bone (cont)
• Periosteum
• Covers the bones (not joints)
• Inner layer contains osteoblasts necessary for
  bone formation
• Inside bones are 2 type of bone marrow
• Red bone marrow
• Found primarily in sternum, ileum, vertebrae,
  ribs
• Manufactures blood cells hgb
• Yellow bone marrow
• Fat connective tissue
• May begin the task of the red bone marrow during
  blood cell compromization

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Musculoskeletal System

• Anatomy Physiology (cont)
• Muscles
• Skeletal
• Voluntary
• Promote movement of bones of the skeleton
• Composed of muscle fibers that contain several
  myofibers
• Sliding filaments called sarcomeres make up
  myofibers
• Contractile units of skeletal muscle
• Smooth Cardiac muscles are involuntary muscles
  their activity is controlled by mechanisms in
  their tissue of origin

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Musculoskeletal System

• Anatomy Physiology (cont)
• Joints
• The junction between two or more bones (Table
  66-2)
• Free moving joints, diarthrodial joints, make up
  most skeletal joints (Box 66-1)
• The surfaces of diarthrodial joints are covered
  with hyaline cartilage
• Reduces the friction during joint movement
• The space between is the joint cavity
• Enclosed by a fibrous capsule lined with synovial
  membrane, which produces synovial fluid
  (lubricant)

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Musculoskeletal System

• Anatomy Physiology (cont)
• Tendons
• Cordlike structures
• Attach muscles to the periosteum of the bone
• Muscles have two or more attachments
• Origin
• More fixed
• Insertion
• More movable
• When a muscle contracts, both attachments are
  pulled, and the insertion is drawn closer to the
  origin
• Example Biceps of arm which has two origin
  tendons, attached to the scapula, and one
  insertion tendon, attached to the radius. When
  the biceps contracts, the lower arm moves toward
  the upper arm

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Musculoskeletal System

• Anatomy Physiology (cont)
• Ligaments
• Fibrous tissue connecting tow adjacent, freely
  movable bones.
• Help protect joints by stabilizing their surfaces
  keeping them in proper alignment
• Sometimes ligaments completely enclose a joint

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Musculoskeletal System

• Anatomy Physiology (cont)
• Cartilage
• Firm, dense type of connective tissue
• Consists of cells embedded in a substance called
  the matrix
• Matrix is firm compact
• Enables it to withstand pressure and torsion
• Primary functions of the cartilage
• Reduce friction between articular surfaces
• Absorb shocks
• Reduce stress on joint surfaces

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Musculoskeletal System

• Anatomy Physiology (cont)
• Cartilage
• Hyaline (articular) cartilage
• Covers the surface of movable joints
• Protects the surface of these joints
• Other types of cartilage include
• Costal cartilage
• Connects ribs sternum
• Semi-lunar cartilage
• One of the cartilages of the knee joint
• Fibrous cartilage
• Found between the vertebrae
• Elastic cartilage
• Larynx, epiglottis, outer ear

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Musculoskeletal System

• Anatomy Physiology (cont)
• Bursae
• A small sac filled with synovial fluid
• Reduce friction between areas
• Such as tendon and bone
• Such as tendon and ligament
• Inflammation of these sacs is called bursitis

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Musculoskeletal System

• Assessment
• If chronic disorder
• Obtain a thorough medical, drug and allergy
  history
• If the pt is injured
• Obtain how and when the trauma occurred
• Compile a list of symptoms assoc. with
  discomfort/pain
• Onset
• Duration
• Location

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Musculoskeletal System

• Assessment (cont)
• Determine whether activity makes the symptoms
  better or worse
• Identify associated symptoms ask if these
  interfere with ADLs
• Such as muscle cramping
• Such as skin lesions
• If there is an open wound
• Obtain when patient last received a tetanus
  immunization
• Obtain past medical history
• ie DM, whether family members have had similar
  symptoms

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Musculoskeletal System

• Physical Examination
• General assessment
• Ambulation, sitting, standing
• Activities requiring fine motor skills
• Look for symmetry, size contour of extremities
  and random movements
• A spinal inspection identifies spinal curvatures
• Kyphosis
• Exaggerated convex curvature of the thoracic
  spine - Humpback
• Lordosis
• Excessive concave curvature of the lumbar spine -
  Swayback
• Scoliosis
• Lateral curvature of the spine

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Musculoskeletal System

• Physical Examination (cont)
• Palpation
• Muscles joints
• For swelling, degree of firmness, local warm
  areas
• Muscle strength
• Neurovascular assessment (Table 66-3)
• Circulation
• Sensation
• Mobililty
• Pain
• Note spasms or tremors

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Musculoskeletal System

• Physical Examination (cont)
• If injury
• V/S
• Depends on type and area of injury
• May need to cut clothing off to inspect the area
• Be thorough
• Be gentle
• Maintain standard precautions
• The MD must examine the pt. Before the nurse
  touches, cleans, or disturbs open wounds and
  before moving the injured extremity

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Musculoskeletal System

• Diagnostic Tests
• Radiography
• CT scan
• MRI
• Arthroscopy
• Internal inspection of a joint using an
  arthroscope
• Inserts a large-bore needle into the joint
  injects sterile NS solution to distend the joint
• Inserts the arthroscope inspects joint for signs
  of injury or deterioration
• MD can use the scope to remove bits of torn or
  floating cartilage

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Musculoskeletal System

• Diagnostic Tests (cont)
• Arthrocentesis
• Aspiration of synovial fluid
• Used to relieve discomfort caused by an excessive
  accumulation of fluid in the joint space
• Used also to inject a drug, such as cortiosteroid
• Arthrogram
• A radiographic exam of a joint
• Fluoroscopy may be used to determine proper
  placement of the needle
• A contrast medium is injected X-Rays are taken

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Musculoskeletal System

• Diagnostic Tests (cont)
• Synovial fluid analysis
• To diagnose disorders
• Traumatic arthritis
• Septic arthritis (caused by microorganism)
• Gout
• Rheumatic fever
• Systemic lupus erythmatosis
• Normally the fluid is clear and nearly colorless
• Check for blood cells, crystals, formed debris

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Musculoskeletal System

• Diagnostic Tests (cont)
• Bone Densitometry
• Estimates bone density
• X-Ray of wrist, hip or spine
• Bone sonometry or U/S
• Bone Scan
• IV injection of radionuclide
• To detect the uptake of the radioactive substance
  by the bone
• To detect metastatic bone lesions, fractures,
  certain types of jnflammatory disorders

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Musculoskeletal System

• Diagnostic Tests (cont)
• Electromyography
• Tests the electric potential of the muscles and
  nerves leading to the muscles
• Evaluates muscle weakness or deterioration, pain,
  disability
• MD inserts needle electrodes and uses electrical
  current to stimulate the muscles
• An oscilloscope records responses
• Biopsy
• To identify the composition of bone, muscle, or
  synovium
• Removed with a needle or surgically

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Musculoskeletal System

• Diagnostic Tests (cont)
• Blood Tests
• CBC
• RBC, Hgb, WBC, differential
• Alkaline Phosphatase level Serum phosphorus
  level
• Up May indicate bone tumors healing fractures
• Acid Phosphatase level
• Up May indicate Pagets disease and metastatic
  CA
• Serum calcium level
• Down May indicate osteomalacia, osteoporosis,
  bone tumors
• Serum uric acid level
• Up May indicate gout
• Antinuclear antibody level
• Up May indicate lupus erthematosus

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Musculoskeletal System

• Diagnostic Tests (cont)
• Urine Tests
• 24-Hour urine collection
• To determine levels of uric acid and calcium
  excretion
• In gout uric acid is elevated
• Elevated calcium levels metastatic bone lesions
  prolonged immobilitly

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Musculoskeletal System

• Nursing Management
• Implement protocols necessary to prepare the pt
  for a diagnostic procedure
• Identify send collected specimens to lab
• Manage the pts safe recovery after invasive
  procedures
• Chronic Disorder
• General history
• Description of current symptoms
• Allergies to food meds (shellfish, iodine)
• Invasive Joint Exam
• Inspect area for swelling, bleeding, serous
  drainage
• Change/reinforce dressings prn, give pain meds,
  apply ice prn

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Musculoskeletal System

• Nursing Management (cont)
• Traumatic Injury
• Obtain information regarding the injury
• Take v/s, initially at frequent intervals until
  stable
• Check neurovascular status
• Keep pt. Calm
• Promote comfort