musculoskeletal disorder islamic university nursing college

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Health of Newborns & Infants (MW 412)

Musculoskeletal disorder

Islamic University Nursing College

1Musculoskeletal The main organs and tissues that are part of the musculoskeletal system in humans arethe cartilagesthe bonesthe muscles

2Musculoskeletal Main functions of MS are:To support & protect vital organs (the brain, heart and lungs)To keep structure and maintenance of the body spatial conformation. Allows the body to move (walking, standing, bending). Because soft tissues are resilient (flexible) in children, dislocations and sprains are less common than in adults

Nutrient storage (glycogen in muscles, calcium and phosphorus in bones)

3Musculoskeletal: Physical Assessment Inspect child undressedObserve child walkingSpinal alignmentROM (range of movement)Muscle strengthReflexesAssessment of concerns4Musculoskeletal: Physical Assessment Assessment of concerns: Pain or tenderness & Muscle spasm Masses Soft tissue swellingFractures in children younger than 1 year are unusual because a large amount of force is necessary to fracture their bones. A child younger than 1 year with a fracture should be evaluated for possible physical abuse or an underlying musculoskeletal disorder that would cause spontaneous bone injury

assess injury site at the last

5Musculoskeletal: Neurovascular Assessment Neurovascular checks should be done at least every 1 to 2 hours during the first 48 hours, and usually for as long as the child is in traction

Pain: (location, alleviated and aggravating factors; Does the pain become worse when fingers or toes are flexed) Sensation: Can the child feel/ touch on the affected extremity Motion: Can the child move fingers or toes below area of injury / nerve injury Temperature: Is the extremity warm or cool to touchCapillary refill; Color; Pulses (distal to injury or cast)

6Musculoskeletal: Diagnostic proceduresX-ray & Bone scan Alkaline phosphatase (ALP): ALP is an enzyme found mainly in bone, liver, placenta, and kidney; levels may be elevated in bone disease, fractures, trauma, or liver disease and during periods of rapid growth.Electromyography (EMG): studies the electrical activity of skeletal muscle and nerve conduction.

Muscle or bone biopsyArthoscopy: direct visualization of a joint with a fiberoptic instrument.

7FractureCauses of fracture:Birth trauma, child abuse & injury.Vehicle accident for children and rare in infantsFracture line can be transverse, oblique, or spiral, compound

8Fracture: Clinical ManifestationsSwelling, pain or tendernessDiminished functional use of the affected part; inability to bear weight.Bruising, severe muscular rigiditySometimes crepitus.Less frequent neurological and vascular damage (ischemia), which can be assessed using 5 Ps.PainPallorPulselessnessParasthesiaParalysis9Fracture: Therapeutic ManagementCast: fiberglass or plaster application to immobilize affected body part

Tractions :Is the direct application of force to produce equilibrium at the fracture site

Distraction: involves the use of an external device to separate opposing bones to encourage regeneration of new bone & used to immobilize fractures or correct defects when the bone is rotated or angled

10Fracture: Therapeutic Management Internal Fixation External Fixation

11Fracture: CastRisk for altered tissue perfusion R/F pressure from castKeep extremity elevated to decrease edema.assess circulation Q 15 minutes after applying the cast then hourlyassess skin warmth and 5 Ps

Risk for impaired skin integrity R/F pressure from castCast edges must smoothed/covered Cast remains in place for 4-8 weeksDiscourage itching under the cast

12Fracture: CastPossible concerns:

Unusual odor under the castDrainage from castTingling, numbness and swelling in the casted body partLoose or cracked castUnexplained feverUnusual fussiness (carefulness) or irritability and painDiscoloration of finger or toes13Fracture: TractionIs the direct application of force to produce equilibrium at the fracture site

Types of tractions Manual traction: applied by hand is used during cast Skin traction: pull applied directly to the skin surface and indirectly to the skeletal structure Skeletal traction: pull applied directly to the skeletal structure by a pin, wire, or tongs

14Fracture: TractionPurposesTo realign bone fragments & treat dislocationTo provide rest for an extremity & help prevent or improve contracture deformity. To allow preoperative or postoperative positioning and alignment.To provide immobilization of affected body partTo fatigue the involved muscle and reduce muscle spasm so that bones can be realigned (Fatiguing of muscle is accomplished by applying constant stress to the muscle so that the buildup of lactic acid will produce muscle relaxation)15Fracture: TractionNursing CareRegular assessment of 5 Ps Skeletal traction is never released by the nurse (do not move the weights)Assess blood pressure Skin care for the childs back, elbows and heels.

16Fracture: ComplicationsCirculatory impairment: Careful assessment of the pulses, skin color, and temperature is crucial

Nerve compression syndromes (e.g., carpal tunnel syndrome, tarsal tunnel syndrome)Sensory testing with touch and pinprick evaluating motor strength by asking the child to move the unaffected joint distal to the injury

17Fracture: ComplicationsCompartment syndromesis a tissue ischemia due to a compression of nerves, blood vessels, and muscle inside a closed space (compartment) within the body due to increased pressure in that part The most frequent causes are: tight dressings or casts, hemorrhage, trauma, burns, and surgery Signs & symptoms include:motor weakness and pain that does not decrease with medication the muscle may feel tight or full Burning sensation

18Fracture: ComplicationsEpiphyseal damage: leads to unequal growth Infection: osteomyelitis (potential problem in open fractures, from pressure ulcers, or when bone surgery)Pulmonary emboli: blood, air, or fat emboli may produce a life-threatening vascular obstruction and ischemia. Primary symptom is shortness of breath and chest pain. Interventions should include:Place patient in high fowlersAdminister O2 and check chest X-ray19Sprained ankle A soft tissue injuryManagement ( in the first 6 to 12 hours) controlling the swelling and reducing muscle damage by RICE Rest Ice Compression Elevation20KyphosisIs an abnormally increased convex angulation in the curvature of the thoracic spine

It can occur secondary to disease process such as tuberculosis, chronic arthritis

Treatment Postural exercises Bracing (Milwaukee) for more marked deformity

21LordosisIs an accentuation (stress) of the lumbar curvature beyond physiologic limits

It may be a complication of a disease process, the result of trauma or idiopathic

Lordosis is a normal observation in toddlers

In older children is often seen in association with flexion contractures of the hip, obesity, congenital dislocated hip and slipped femoral capital epiphysis.

22ScoliosisIs a spinal deformity which may involve lateral curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis. It is the most common spinal deformity. It can be congenital, or it can develop during infancy or childhood, but it is most common during adolescence (peaks between 8-15 years) It may be genetic and transmitted as an autosomal dominant traitIt may be multifactorial

23Scoliosis: TypesFunctional scoliosiscaused by a secondary problem such as unequal leg length. The curve tends to be a C-shaped curve can be treated by treating the primary cause first

Structural scoliosisthe cause is idiopathic with a positive family history in some casesIt involves a permanent curvature of spine accompanied by damage to the vertebral.The curve tends to be S-shaped curve.24Scoliosis: Clinical ManifestationFrom standing position ( feet together and arms at sided)Unequal shoulders levelCurved spinal columnUneven level of the elbowsFrom bending position ( child bends and touch his toes):Rotation of the spine becomes more prominent.Hump (bulge) in the backOne shoulder blade is more prominent than other isIn some cases there are back pain, fatigue and dyspnea

25Scoliosis: Management Non-surgical management aimed to :promoting self-esteem and positive body image maintain spinal stability prevent further progression of deformity until bone growth is complete and surgical repair can be performed

mild cases (less than 20%), observation and exercises- swimming is advised & Long-term monitoring.Moderate (20-40%), exercises, traction, bracing. Bracing (Milwaukee brace) is successful in halting or slowing the progression of curvatures Severe (more than 40%), bracing until the skeletal system mature and then surgical interventionSurgery includes realignment and straightening of the spine with internal fixation

26Developmental/congenital hip dysplasia/dislocation (DDH/CHD)Improper formation and function of the hip socket. Cause of DDH is unknown, but there are predisposing factors such as:Genetic factors & birth orderPhysiologic factors: maternal hormoneMechanical factors: intrauterine position (breech), oligohydraminos, twining and fetus size, delivery type, postnatal positioning DDH occurs more commonly in females.

27 DDH/CHD: DegreesAcetabular dysplasia (or preluxation)

Subluxation

Dislocation

28 DDH/CHD: DegreesAcetabular dysplasia (or preluxation)The mildest form The femoral head remains in the acetabulum

29 DDH/CHD: DegreesSubluxationAccounts for the largest percentage of DDH. It implies incomplete dislocation The femoral head remains in contac

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