nursing musculoskeletal

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Board review

Review of Anatomy and PhysiologyThe musculo-skeletal system consists of the muscles, tendons, bones and cartilage together with the joints The primary function of which is to produce skeletal movements

The MUSCULAR SYSTEMFUNCTIONSMovement Posture Support Protection of vital organs Storage of minerals Heat production Propulsion of blood Movement of food in GIT and urine in the ureters

MusclesThree types of muscles exist in the body 1. Skeletal MusclesVoluntary and striated

2. Cardiac musclesInvoluntary and striated

3. Smooth/Visceral musclesInvoluntary and NON-striated

Structure of the MuscleEpimysium outermost layer that surrounds the muscle. Perimysium separate the muscle tissueinto small sections.

Endomysium thin covering of a fascicle

Skeletal Muscles Actionsa.

PRIME MOVERS muscles whose contractions actually produces the movement. SYNERGISTS muscles that contract at the same time as the prime mover, helping it produce the movement so the prime mover can produce a more effective movement. ANTAGONISTS muscles that relax while the prime mover is contracting.



Different Contractions of the Skeletal Muscles1.

ISOTONIC CONTRACTIONS -- shorten muscle length while maintaining muscle tension generating movement.

2. ISOMETRIC CONTRACTIONS -- tighten the muscle by increasing muscle tension without shortening the muscle. -- does not usually produce direct movement.

Different Contractions of the Skeletal Muscles3. TWITCH CONTRACTIONS -- quick, jerky reactions to a single stimulus. -- muscle shortens for a fraction of a second. 4. TETANIC CONTRACTIONS -- serial, continuous contractions, in which individual contraction cant be distinguished.

Different Contractions of the Skeletal Muscles5. TROPPE (Staircase Phenomenon) -- series of increasingly stronger twitch contractions occurring in response to repeated stimuli of constant intensity. 6. FASCICULATION -- abnormal contraction visible through the skin as a slight ripple. -- occurs after neuron destruction

Different Contractions of the Skeletal Muscles7. CONVULSIONS -- abnormal, violent rhythmic contractions and relaxations of muscle groups.

TENDONSBands of fibrous connective tissue that tie bones to muscles

LIGAMENTSStrong, dense and flexible bands of fibrous tissue connecting bones to another bone

The SKELETAL SYSTEMVariously classified according to shape, location and size Functions 1. Locomotion 2. Protection 3. Support and lever 4. Blood production 5. Mineral deposition

BONESThere are two divisions of the skeleton AXIAL body upright structure with 80 bones -- consists of the: skull, vertebral column,and ribs

APPENDICULAR body appendages with 126bones

-- consists of the arms, hips and legs


Long bones length exceeds breadth andthickness

Short bones equal in main dimensions foundmainly on hands and feet

Flat bones primarily made up of cancellousbone tissue

Irregular bones irregular in shape

Difference between Male and Female SkeletonsMale skeletons are larger and heavier than female skeleton Male pelvis--deep and funnel shaped with narrow pubic arc; female pelvis shallow, broad, and flaring with wider pubic arc

JOINTSThe part of the Skeleton where two or more bones are connected

CARTILAGESA dense connective tissue that consists of fibers embedded in a strong gel-like substance

BURSAESac containing fluid that are located around the joints to prevent friction

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMThe nurse usually evaluates this small part of the over-all assessment and concentrates on the patients posture, body symmetry, gait and muscle and joint function

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEM1. HISTORY 2. Physical ExaminationPerform a head to toe assessment Nurses need to inspect and palpate The special procedure is the assessment of joint and muscle movement

ASSESSMENT OF THE MUSCULO-SKELETAL SYSTEMGait Posture Muscular palpation Joint palpation Range of motion Muscle strength

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES 1. BONE MARROW ASPIRATIONUsually involves aspiration of the marrow to diagnose diseases like leukemia, aplastic anemia Usual site is the sternum and iliac crest Pre-test: Consent Intratest: Needle puncture may be painful Post-test: maintain pressure dressing and watch out for bleeding

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES 2. Arthroscopy A direct visualization of the joint cavity Pre-test: consent, explanation of procedure, NPO Intra-test: Sedative, Anesthesia, incision will be made Post-test: maintain dressing, assist in ambulation as ordered, mild soreness of joint for 2 days, joint rest for a few days, ice application to relieve discomfort

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES 3. BONE SCAN Imaging study with the use of a contrast radioactive material Pre-test: Painless procedure, IV radioisotope is used, no special preparation, pregnancy is contraindicated Intra-test: IV injection, Waiting period of 2 hours before X-ray, Fluids allowed, Supine position for scanning Post-test: Increase fluid intake to flush out radioactive material

ASSESMENT OF THE MUSCULO-SKELETAL SYSTEMLABORATORY PROCEDURES 4. DXA- Dual-energy XRAY absorptiometry Assesses bone density to diagnose osteoporosis Uses LOW dose radiation to measure bone density Painless procedure, non-invasive, no special preparation Advise to remove jewelry

FractureA break in the continuity of the bone and is defined according to its type and extent

FractureSevere mechanical Stress to bone bone fracture Direct Blows Crushing forces Sudden twisting motion Extreme muscle contraction Pathologic conditions

FractureTYPES OF FRACTURE 1. Complete fractureInvolves a break across the entire crosssection

2. Incomplete fractureThe break occurs through only a part of the cross-section

FractureBROAD CLASSIFICATION OF FRACTURE: 1. Close or simple fractureThe fracture that does not cause a break in the skin

2. Open or compound fractureThe fracture that involves a break in the skin

FractureClassification of Fracture as to Pattern:

1. Transverse fractureThe break runs across the bone

2. Oblique fractureThe break runs in slanting direction 45 degrees angle

Fracture3. Spiral fractureThe break coils around the bone

4. Longitudinal fractureThe break runs parallel to the bone

FractureClassification as to Appearance:

Comminuted fractureBone splintered into fragments

Impacted fractureWhen fractured ends of the bone are pushed into each other

FractureCompressed fractureA condition in which a bone, particularly the vertebra collapses

Depressed fractureUsually occurs in the skull with the broken bone being driven inward

Greenstick fracture

FractureASSESSMENT FINDINGS 1. Pain or tenderness over the involved area 2. Loss of function 3. Deformity 4. Shortening 5. Crepitus 6. Swelling and discoloration

FractureASSESSMENT FINDINGS 1. Pain Continuous and increases in severity Muscle spasm accompanies the fracture as a reaction of the body to immobilize the fractured bone

FractureASSESSMENT FINDINGS 2. Loss of function Abnormal movement and pain can result to this manifestation

FractureASSESSMENT FINDINGS 3. Deformity Displacement, angulations or rotation of the fragments causes deformity

FractureASSESSMENT FINDINGS 4. Crepitus A grating sensation produced when the bone fragments rub each other


FractureEMERGENCY MANAGEMENT OF FRACTURE 1. Immobilize any suspected fracture 2. Support the extremity above and below when moving the affected part from a vehicle 3. Suggested temporary splints- hard board, stick, rolled sheets 4. Apply sling if forearm fracture is suspected or the suspected fractured arm may be bandaged to the chest

FractureEMERGENCY MANAGEMENT OF FRACTURE 5. Open fracture is managed by covering a clean/sterile gauze to prevent contamination 6. DO NOT attempt to reduce the fracture

Emergency First aid splinting

FractureMEDICAL MANAGEMENT 1. Principles of fracture treatmentReduction of fracture Maintenance of realignment by immobilization Restoration of function

Fracture2. ReductionClosed manipulation using casts or sling Open reduction External fixation Traction

3. Immobilizationthe most important phase in obtaining union of fracture fragments.

FractureGeneral Nursing MANAGEMENT For CLOSED FRACTURE 1. Assist in reduction and immobilization 2. Administer pain medication and muscle relaxants 3. teach patient to care for the cast 4. Teach patient about potential complication of fracture and to report infection, poor alignment and continuous pain

FractureGeneral Nursing MANAGEMENT For OPEN FRACTURE 1. Prevent wound and bone infection -Administer prescribed antibiotics -Administer tetanus prophylaxis -Assist in serial wound debridement 2. Elevate the extremity to prevent edema formation 3. Administer care of traction and cast

FractureStages of Bone Healing 1. Formation of hematomaWhen a bone is fractured, blood extravasates between and around the fragments and the bone marrow.

2. Cellular proliferationPeriostal elevation, granulation tissue containing blood vessels, fibroblasts and osteoblasts

Fracture3. Callus formationDifferentiated tissue bridging the fracture

4. OssificationFinal laying down of bone State in which the fracture ends have knit together

Fracture5. RemodelingWhen consolidation is completed, the excess cells are absorbed. Compact bone is being formed



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