musculoskeletal disorders psych rehab nursing fall 2009

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  • Musculoskeletal Disorders Psych Rehab Nursing Fall 2009
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  • Outline Overview of anatomy and physiology Diagnostic tests Musculoskeletal trauma Problems of the musculoskeletal system Osteoporosis Osteoarthritis Rheumatoid arthritis Gout Other musculoskeletal problems
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  • Review Purpose of the musculoskeletal system - Supporting framework for attachment of muscles and other tissues - Protects vital organs and soft tissues - Joints, bones, cartilage make up the skeletal system - Bones enable movement of the body by acting as levers and points of muscle attachments (muscles ONLY contract: opposing muscles allow flexion & extension. Muscles are conductors of electrical energy)
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  • Bones Function Framework for the attachment of muscles and other tissues Protection Production of blood cells in the red marrow - Which bones are involved in the process? - Facilitate movement by contracting muscles - Storage area for calcium and phosphorus - Lipids (energy sources) are stored in adipose cells of the yellow marrow
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  • Bones Blood cells are produced in bone marrow (see below) Red marrow Red marrow in flat bones (sternum, scapulae, skull, ribs, vertebrae, pelvis, epiphyseal ends of long bones, i.e., femur and humerus (marrow runs all the way through the bone, but the cells are released from the epiphyseal ends) Femur head; view of cortex; view of red bone marrow; view of yellow bone marrow (2009)
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  • Bones Ligaments Ligaments (fibrous connective tissue connecting bone to bone) Tendons Tendons (connect muscle to bone) Example: Achilles tendon attaches calf muscles to the ankle bone while a ligament holds the calf and thigh bones together at the knee joint (Pollick, 2008)
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  • Bones: Types Long bones Short bones Flat bones Irregular bones Sesamoid (or round) bones Sutural or Wormian bones
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  • Long Bones Long bones Longer than they are wide A shaft with two ends - the shaft widens at the end of the bone Contain yellow bone marrow and red bone marrow Humerus (proximal) ; radius and ulna (distal) of the upper extremity; femur (proximal), tibia (anterior/distal) and fibula (posterior/distal) of the lower extremity
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  • Long Bones Examples of long bones Examples of long bones Metacarpals Phalanges 9 14 10 15 11 16 12 13
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  • Red and Yellow Bone Marrow red Half of the bone marrow is red (in adults) Red marrow is found mainly in the flat bones (hip bone, sternum, skull, ribs, vertebrae and shoulder blades) Also found in the spongy material in the proximal ends of the long bones femur and humerus Yellow Yellow marrow is found in the hollow interior of the middle portion of long bones Femur head; view of cortex; view of red bone marrow; view of yellow bone marrow (2009)
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  • Bone Marrow Hematopoesis (blood formation) RBC storage Production of WBCs Platelets (formed in bone marrow; aid in clotting) High fat content (long bones) fat embolus Fat embolism syndrome, a condition characterized by hypoxia, bilateral pulmonary infiltrates, and mental status change, is commonly thought of in association with long-bone trauma. Although studies suggest that embolization events infrequently result in clinically apparent fat embolism syndrome, clinicians should be vigilant in considering fat embolism as a causative agent for postoperative respiratory distress. (Glazer & Onion, 2001)
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  • Short Bones Short bones Cube-like; about as long as they are wide Contain mostly spongy bone Outside surface consists of a thin layer of compact bone Located in the hands and feet (metacarpals) Patella
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  • Long Bones ??
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  • Flat Bones Flat bones Thin and flat Found where the need is for a broad surface area for muscular attachment or where extra protection is needed Examples: Skull; Pelvis; Sternum; Rib cage; Scapula In adults most RBCs are formed in flat bones
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  • Bones: Microscopic Anatomy Osteoprogenitor cells are multipotential skeletal cells; the stem cells for the skeletal system. Osteoblasts are bone forming cells; they lay down the bond tissue. Can be stimulated in cancer. Osteocytes are mature bone cells that become trapped at maturity in a matrix; they maintain the bone Osteoclasts are bone reabsorbing cells that destroy old bone. Slow process. Inc cancer, these cells are destroyed and not replaced (osteoporosis). Collagen is soft, strong connective tissue that supports and reinforces the mineralized matrix stronger than steel.
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  • Irregular Bones Examples are the vertebrae; sacrum; coccyx; temporal; sphenoid; ethmoid (in skull); zygomatic (cheek bone); maxilla; mandible; palatine; inferior nasal concha; and hyoid Serve as protection (example: vertebrae protects spinal cord) Allowing multiple anchor points for skeletal muscle (example: sacrum)
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  • Bones Ligaments (bone to bone): fibrous connective tissue connecting bone to bone Tendons: (connect muscle to bone) Example: achilles tendon attaches calf muscles to the ankle bone while a ligament holds the calf and thigh bones together at the knee joint.
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  • Sesamoid (Round) Bones Sutural, or Wormian bones An example of a Sesamoid bone is the patella Sesamoid bones are embedded within tendons; Act to protect tendons Sutural or Wormian bones occur between the sutures of the cranial bones
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  • Bones: Types Long Bones: weight bearing, strong, curved Short bones: compact on surface, spongy center & cuboidal (metatarsals) Flat bones: parallel surfaces of the body, protecitve funciton, broad attachment surface (ribs, pelvis, skull, ilium) Irregular bones: various functions: vertebrae & some facial bones Sesamoid (or round) bones: embedded in tendons, allow change of direction of movement, like a pulley (patella) Sutural or Wormian bones: between sutures of skull (between large flat bones of skull)
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  • Joints diarthrosis A diarthrosis joint is a freely moveable joint always a synovial joint Types of synovial joints Types of synovial joints Gliding Gliding (Two sliding surfaces) (Example - between carpals) Hinge Hinge (Concave surface with convex surface) (Example between humerus and ulna) Pivot Pivot (Rounded end fits into ring of bone and ligament (Example between atlas (C1) and axia (C2) vertebrae
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  • Joints Synovial Joint Diarthrosis Joint (all are synovial joints)
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  • Joints, Synovial types, cont. 1.Ball and socket joint 1.Ball and socket joint (Ball-shaped head with cup-shaped socket) (Example Between femur and pelvis) 2.Condyloid joint 2.Condyloid joint (Oval condyle with oval cavity) (Example between metacarpals and phalanges) 3.Saddle joint 3.Saddle joint (Each surface is both concave and convex) (Example Between carpus and the first metacarpal) 4.Hinge joint 4.Hinge joint (interphalangeal joints) 5.Pivot joint 5.Pivot joint (able to rotate neck, forearm, knees)
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  • Muscles Source of power and movement Three types Skeletal Muscle Cardiac Muscle Smooth Muscle
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  • Skeletal Muscle Skeletal Muscle Skeletal Muscle Attached to bones and causes movements of the body. Also called striated muscle (actin &??) because of its banding pattern, or voluntary muscle (because muscle contraction can be consciously controlled)
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  • Cardiac Muscle Cardiac muscle Cardiac muscle Responsible for the rhythmic contractions of the heart Muscle is involuntary Generates its own stimuli to initiate muscle contraction Microscopically striated like skeletal muscle Striations join together in bundles to allow coordinated action Involuntary and autorhythmic. Some cardiac muscles function as built in pacemakers.
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  • Smooth Muscle Smooth Muscle Smooth Muscle Lines the walls of hollow organs (Example: lines the walls of blood vessels and of the digestive tract where it functions to advance the movement of substances. Contraction is relatively slow and involuntary Microscopically smooth (not striated)
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  • Basic components Muscles are stimulated by motor neurons. Richly supplied w/ arteries and veins and have intimate contact w/a rich capillary network b/c of high energy demands.
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  • Diagnostic Tests for Musculoskeletal X-ray Electromyogram (EMG) Arthroscopy Arthrogram Computerized Axial Tomography (CT) Magnetic Resonance Imaging (MRI) Bone Scan Arthrocentesis Laboratory Testing Antinuclear Antibodies (ANA) Ca+, P Rheumatoid Factor (RF) Erythrocyte Sedimentation Rate (ESR) Uric Acid
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  • Chemical action in muscle ATP ADP energy cycle. Critical to muscles ability to get energy they need to do the work they need to do.
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  • Soft Tissue Injuries Sprains/Strains Sports-related Dislocation/Subluxation Carpal Tunnel Syndrome Rotator cuff Repetitive Strain Meniscus Injury Bursitis Muscle spasms
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  • Dislocation / Subluxation Dislocation of joint Subluxation (partial dislocation of joint) Candidate joints are shoulders, fingers, kneecaps
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