understanding musculoskeletal system

8/2/2019 Understanding Musculoskeletal System

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Congratulations for

making your 3 years innursing GREAT!!!



Rules

Punctuality in Attending

ClassessLate comers will enter the room

after one hour

No ID no entry



Prayer Leader

Starting from no.1

onwardsSame person before

and after



Attendance

The door will be closed exactly

1pm Checking of attendance is by

number

Seat plan will be provided

Stay in your place or else you

will be marked absent



Cellphones NO CELPHONES ALLOWED



EATING IS NOT ALLOWED



QUIZZES Either announced,unannouced

Can be before,at the middle of discussion or after

Late comers who entered the roomafter 1 hour will not be given specialexams meaning youve missed 1 exam



No borrowing and lending of

papers Always have a paper with you.

( ¼,1/2,1 whole)



Cheating

Once caught in the act

automatic deduction of 5 pointsfrom the total score



Grooming

A. Female

1. All female students shouldwear their complete properuniform with ID

2. Hair should be neatly tied upinto a bun with black hairnet

and hair clip



GroomingB. Male

1. All male students should also

wear their complete uniformswith ID

2. Hair should be properlytrimmed according to theCollege of nursing required

haircut



Major Exams

No Permit ,No Exam policy



Requirements: Case study per group

Case will not be taken from PCGH,but other tertiary Hospital

Musculoskeletal case to be presentedduring the class

Exposure at Orthopedic Hospitalstarting June 27



Assignment

Either by group

Individual Must be submitted on time



Grading System Quiz - 40%

Requirement - 20% Att/Att - 10%

Major Exam - 30%

100%



Recitation

Perfect points is 5

Recited but not related to the topic1

No recitation 0



References

Any medical and surgical book



Film Analysis

Questions will be provided

based on the film



My consultation dayMonday: 1pm-5pm

Tuesday: 8am-5pmWednesday: 8am-5pm

Thursday: ipm-5pm



ANY QUESTION?

REACTIONS?



UnderstandingThe Musculoskeletal System

Prof. Gina T. Vierne



Objectives:

On completion of this chapter,you will be able to:

Describe the basic structureand function of themusculoskeletal system



Discuss the significance of

the health history of theassessment of the

musculoskeletal health



Identify the risk factors

associated withmusculoskeletal disorders



Describe the significance of

the health history of theassessment of musculoskeletal dysfunction



Specify the diagnostic tests for

assessment of musculoskeletalfunction

Identify medications applicableto musculoskeletal problems



Identify medical and surgical

management withmusculoskeletal problems

Define terms used inmusculoskeletal function



Chapter Overview Caring for patient with

musculoskeletal disordersrequires a sound understandingof musculoskeletal anatomy and

physiology as well as bodymechanics



Overview Thorough assessment

Assessment includes:

Complete history Physical examination

diagnostic testing

Risk factors Informations r/t psychosocial impact of the

disorder on the pt and his family



overview Nursing diagnoses focus:

impaired physical mobility Altered peripheral tissue

perfusion



overview Nursing interventions :

designed to maintain orimprove the pts ability to carryout ADLs and prevent further

injury



overview

Patient teaching:Crucial

nursing activityWhy?



Anatomy and

physiology review



Video clip presentation



The musculoskeletal system

include 206 bones which areconnected at joints.

The joints are held together byligaments and cushioned bycartilages

Tendons attach muscles to thebones



The Bones-bodys frameworkFunctions:

Support

Protection

Movement

Storage

Blood Cell Formation



protection Bones provide a hard

framework that support and

anchors all soft organs of thebody.The bones of the legs act as pillars to support the bodytrunk when we stand,and therib cage supports the thorax

wall



Protection The fused bone of the skull

provide a snug enclosure forthe brain. The vertebraesurround the spinal cord,and

the rib cage helps protect thevital organs of the thorax.



Movements Skeletal muscles, attached to bones by

tendons ,use the bones as levers to

move the body and its parts.As a result,we can walk,grasp and breathe.Thearrangement of bones and the design of

joints determine the types of movement possible



Example: Saddle joint

Hinge joint

plane joint

Condyloid joint

Ball and socket joint Pivot joint



Storage Bone matrix itself serves as a

storehouse, a reservoir for minerals, the

most important being calcium andphosphorous, although K, Ca,Na,Sulfurmagnesium and copper are also stored.



Blood Cell Formation The bulk of blood cell formation, or

hematopoiesis, occurs within the

marrow cavities of certain bones.



DIVISIONS1. Axials upright structure with

80 bones

22 bones in skull 6 middle ear

1 hyoid bone 26 vertebral column

25 thoracic cage



Axial- green Appen - golden



2. Appendicular-bodys

appendages with 126 bones4- pectoral girdle

60 upper limbs60 lower limbs

2 pelvic girdle



Types of Bones1. Long bones

2. Short bones3. Flat bones

4. Irregular bones



Long bonesHumerus of arms

Short bonesCarpals of wrist

Flat Parietal bone of skull

Irregular

vertebra



Assignment

How an individual bone is

structured? Please read



skeleton Consist of 206 bones(long,

short, flat, irregular) Store calcium, magnesium,

phosporous,and carbonate,

marrow produces RBCs



skeletonKey facts:

206 bones Stores

calcium,magnesium,phosporous

and carbonate



Skeletal muscles Provide body movemetn and

posture

Attach to bones by tendons

Begin contracting with the

stimulus of a muscle fiber Retain some contraction to

maintain muscle tone



Key facts about skeletal

muscle Provide body movement and

posture Attach to bones by tendons

Retain some contraction for

muscle tone



ligaments Tough bands of collagen fibers

that connect bones Encircle a joint to add strength

and stability



tendonsNonelastic collagen cords

Connect muscle to bones



joints Articulation of two bone

structures Provide stabilization and permit

locomotion;degree of joint

movement is called ROM



Key facts about joints Articulation of two bones

surfaces Provide stabilization permit

locomotion

ROM is degree of joint movement



synovium Membrane that line a joints

inner surfaces Secrete synovial fluid and

antibodies

Reduces friction in joints( inconjunction with cartilage)



Key facts about synovium Lines a joints inner surfaces

Secretes synovial fluid Reduces friction



CARTILAGES

Contains a firm gel

substance in its matrix,which gives it more

flexibility than bone



cartilage Serves as a smooth surface for

articulating bones Absorb shock to joints

Atrophies with limited ROM or

in the absence of weight bearing



TYPES1. Fibrocartilage

Greatest tensile Occurs in the invertebral

discs and in the symphysispubis



2. Elastic CartilagePossesses firmness and

elasticityOccurs in the external earand the eustachian tube



3. Hyaline CArtilageMost common cartilage type

Cushions most of the jointsto help soften any impact

Firm yet slightly flexible

Occurs also in part of thenasal bronchial rings



Key facts about cartilage Composed of fibers embedded

in firm gel Smooth surface for articulating

bones

Absorbs shocks to joints



bursa Fluid filled sac

Serves as padding to reducefriction

Facilitates the motion of body

structures that rub against eachother



Key facts about the bursa Fluid filed sac

Serves as padding Facilitates motion of body

structures



Jingle( the bonedance)



Understanding skeletal muscle

movement Skeletal muscles contract to

move bone, while jointsallow this movement tooccur



To contract, all skeletal

muscles require some formof stimulation either internalfrom motor neurons or

external from stimuli such aselectricity, heat or injury



8 ways of muscle contraction

isotonic Isometric

twitch contraction

Tetanic contraction Treppe or staircase phenomenon

Fasciculation

Fibrillation

convulsion



isotonic contraction- shorten muscle

length while maintaining muscletension, generating movement

Isometric contraction-tighten a muscle

by increasing muscle tension without shortening the muscle

Twitch contraction- are quick, jerky

reactions to a single stimulus



Tetanic contraction- serial, continuous

contractions,in which individualcontractions cant be distinguish

Treppe( staircase) phenomenon-series

of increasingly stronger twitchcontraction occuring in response torepeated stimuli

Fibrillation- abnormal contraction inwhich individual fibers contact in anunsynchronized way



Fasciculation- abnormal contraction

visible through the skin as a slight ripple

Convulsions- abnormal, violent rhythmic contractions andrelaxations of muscle groups



Joint Motion Terminology Flexion

Extension

Hyperextension

Abduction/Adduction

Rotation

Circumduction

Inversion



Eversion

Pronation

Supination

Protraction

Retraction

Flexion Decreases the angle between



Flexion-Decreases the angle betweenthe anterior surfaces of articulating

bones Extension-increases the angle between

the anterior surfaces of articulatingbones

Hyperextension-continues the act of extension beyond the original anatmicalposition

Abduction-when seen from the front,moves a bone in the appendicularskeleton away from the bodys midline

Add ti h f th f t



Adduction-when seen from the front, movesa bone in the appendicular skeleton towards

the bodys midline Rotation- pivots the bone on its axis

Internal

External; Circumduction-combines a number of

movements to cause the distal end of a bone

to describe a circle.360 degrees to completefull circle

Inversion-turns an extremity or part of anextremity inward towerd the bodys midline

Eversion turns an extremity or part of an



Eversion-turns an extremity or part of anextremity outward from the bodys midline

Pronation-turns the palm of bodys front toward the floor

Supination-turns the palm, foot, or bodys

front toward the ceiling Protraction-moves the mandible forward

Retraction-moves the protracted mandible

back into its neutral anatomical position



Musculoskeletal Terminology Atrophy

Causalgia

Contracture

Deformity

Leg length discrepancy

Dislocation



Musculoskeletal Terminology Dorsiflexion

Dysplasia

Kyphosi

Lateral

Lordosis



Musculoskeletal Terminology Palsy

Range of Motion

Recurvatum Subluxation

Valgus

varus



Atrophy-wasting away



causalgia A severe burning pain produced

by several nerves that havemalfunctioning nerve endings,touch can often produce this

pain



Causalgia



circumduction



contracture The absence of full range of

motions of any joint. Most common is flexion contracture,the lack of full extension



contracture



deformity Malformation or defect of any

part of the body



deformity



Leg length discrepancy (anisomelia)an inequality

between corresponding limbs



Leg length discrepancy



dislocation Musculo skeletal, traumatic

injury resulting in disruption of the continuity of jointsconfiguration and articulation

causing the loss of contact between the joint surfaces



dislocation



dorsiflexion



dysplasia Abnormality of movement



dysplasia



eversion



inversion



kyphosis Posterior convexity of thoracic portion

of vertebral column, normal curvature

of spine, but becomes pathologic if excessive



kyphosis



lordosis Concavity of the vertebral

column, normal curvatureexisting in cervical and lumbarareas, which may become

pathologic if accentuated



Lordosis



scoliosisLateral curvature of the

spine



scoliosis

P l l i



Palsy- paralysis

Range of motion- the full motion of joint can assume



palsy



recurvatum

Hyperextension( beyond neutralposition)

Subluxation-partial or complete

dislocation of joint surfaces

Valgus-angular deformity denoting



Valgus angular deformity denotingangulation away from the midline

of the body distal to the anatomicpart named

Ex. Knock knee. Varus- angular deformity denoting

angulation toward the midline of

the body distal to the anatomicpart named

Ex. bowlegged



Assessment FindingsHealth History

Pain

Numbness, tingling Joint stiffness

Swelling

Fatigue Fever

Difficulty with movement

Key assessment findings in



Key assessment findings indisorders of MS

Pain

Numbness, tingling Joint stiffness

Difficulty with movement



Physical examination

Abnormal vital signs

Inflammation Edema

Skin breakdown

Skeletal deformity




Limited ROM

Poor posture Muscle weakness

Muscle stiffness and rigidity

Abnormal skin color andtemperature




Paresthesia

Nodules

Erythema

Tophi

Abnormal peripheral pulses Tremors

Gait abnormalities(how to assess?)



P.E. bone integrity

Compare the left and right sidesof the body,take note anydeformities and anatomicalmisalignment



joints

Evaluate ROM,defprmities,stabilty and nodularformation

Active

passive



muscles

Note ptss ability to changeposition,presence of atrophy or

hypertrophy Check carefully the origin of muscle

weakness because pts fear,

unwillingness, or malingering might givefalse positive results(muscle strength)



muscles

Note for muscle tone: sensation of resistance felt as one manipulates a

joint through it ROM Measure the muscle girth at the bulkiest

portion of the extremity: location and

position must be the same on bothextremities

Key physical findings in



Key physical findings indisorders of the MS

Skeletal deformity

Limited ROM Inflammation

edema

understanding musculoskeletal system

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