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The Musculoskeletal System
 Structure
and functions of bones
 Structure and functions of muscles
 Age-related changes
Elsevier items and derived items © 2013, 2009 by Saunders, an imprint of Elsevier Inc.
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 The
musculoskeletal systems consists of the
bones, cartilage, ligaments, tendons, and
muscles.
 There are two distinct groups of bones cells
that are transformed into mature cells.
These cells form Cartilage
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 There
are 206 bones that make up the
Human Skeleton
 Bone is either compact or spongy
 Spongy bone is made up of red bone marrow.
 Bones are classified as long, short, flat or
irregular
 Each bone has markings on it that make it
unique See Table 32-1 Bone Markings
 The haversian system is a canal system that
runs through the bone and contains the blood
and lymph vessels
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 Bones
provide shape to the body
 Provides a ridged framework that supports
and protects the internal organs of the body
 Provides attachments for the tendons and
ligaments and contribute to the movement of
the body
 The red bone marrow in the spongy bones
forms red blood cells, white blood cells, and
platelets.
 Store and release minerals such as calcium
and phosphorous
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Joint Articulation point between two or more
bones of the skeleton



Immovable EX: The skull
Slightly moveable EX: Vertebrae
And freely moveable EX” Knee, elbow
Ligaments : Join the bones of a joint together
Tendons: Connective tissues that provide joint
movement
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Cartilage Connective : tissue in which fibers
and cells are embedded in a semisolid gel
material. Serves as a cushion
Example is the meniscus in the knee
Bursa : Fluid filled sac that provides
cushioning at friction points in a freely
moveable joint .
Skeletal muscle is made up of hundreds of
muscle fibers bundled together surrounded
by connective tissue.
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 Fascia
is connective tissue that surrounds and
separates the muscles
 The muscle coverings contain blood vessels
and and nerves
 Muscles have properties that allow it to be
electrically excites causing it to contract,
extend or stretch, and provide elasticity.
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 Contraction
of the skeletal muscle produces
synchronized contraction of many muscle
fibers
 Skeletal muscles contract, thereby producing
movement and joint stability, maintaining
posture, and producing body heat.
 Muscles provide movement of the joints
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 Ossification
occurs which is the replacement
of cartilage by more boney tissue
 Bone density decreases because of resorption
of minerals
 The loss of bone mass or osteoporosis, more
common in women
 Bone injury or fracture takes longer to heal
 Bones in the elderly are more brittle and
break easily
 Thinning of the intervertebral cartilage
causes a collapse of the vertebrae creating a
kyphosis (hump)
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 Joint
cartilage thins and erodes resulting in
stiffness and grating of the joints
 Joint motion may decrease, causing limited
mobility and swelling
 Los of muscle mass and less strength
 Muscle cramping especially at night increase
due to impaired circulation
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 Safety
Measures
 Using proper body mechanics when moving or
lifting objects. (large muscle groups)
 Using seat belts when riding in cars
 If riding bicycles or motorcycles use helmets
 Calcium and Vitamin D throughout life span
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Disease, trauma, malnutrition, and aging all
contribute to musculoskeletal problems
 Trauma may cause bruising, strain, sprain, or
fracture
 Poor nutrition may deprive the body of
sufficient nutrients such as calcium and
phosphorous to build strong bones
 Inadequate protein can cause muscle wasting
 Malignant tumors can invade bone either as a
primary cancer or a metastatic disease
 Decreased Estrogen after menopause can
lead to osteoporosis
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Preservation of motion and mobility are
important to prevent long term orthopedic
problems
 Weight-training and exercise throughout life
to maintain bone mass and contribute to
increase muscle strength, improved
coordination and balance all decrease
incidence of falls
 Nutrition for bone growth and density
 No Smoking contributes to musculoskeletal
health
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 Diagnostic
Tests evaluate for Autoimmune
disorders
 Blood
counts
 Blood Culture
 Erythrocyte sedimentation rate (ESR)
 Serum protein electrophoresis
 See
charts 32-2 pgs 740-741
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
Calcium

Phosphorous

AlP (Alkaline
phosphotase)

CPK
Needed for bone
formation
 Needed for bone
formation
 Useful in determining
if primary or
metastatic cancer
present
 Used to test for
skeletal muscle
trauma or disease

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Uric Acid
 Rheumatoid Factor


ANA (Anti nuclear
Antibody)
Used to detect gout
 To detect antibodies,
indicating rheumatoid
arthritis, lupus or
scleroderma
 Useful to diagnosis
rheumatoid arthritis,
lupus, and other
connective tissue
disorders

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 Imaging
and use of contrasts to diagnose
musculoskeletal disorders
 MRI
 CAT scan
 X-rays of joints or bones
 Goniometry and range of motion
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

DEXA Scan
Measures bone
density
 To detect bone
injury/tumor
 To detect bone
problems especially
tumor
 Provides pictures of
the joint cavity and
soft tissue structures

Bone Scan

Gallium/Thallium
Scan

Arthrogram
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
Arthroscopy

Arthrocentesis
To inspect the interior
aspect of a joint,
usually knee with a
fiberoptic scope to
diagnoses problems
with the meniscus, or
arthritis
 To extract synovial
fluid for analysis or to
reduce swelling

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Arthrocentesis
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
The measurement of
a joint. Each joint is
evaluated in terms of
degrees it can be
moved from the 0
degrees position
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Nursing Care post arthroscopy/ Arthrocentesis
 Observe for signs of bleeding or swelling: ice
packs may be used post procedure
 Assess for swelling, circulation, sensation,
pulses, and color of extremity.
 Apply ice packs post procedure
 Wrap with elastic bandage if ordered
 Instruct patient not to overuse joint until
pain and selling decrease
 Analgesics as ordered.
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Bone marrow biopsy
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
Biopsy

EMG
Done to detect tumor
cells. Muscle biopsy
may be done to
diagnose several
muscles disorders
To determine abnormal
nerve transmission to
the muscle and
abnormal muscle
function.

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 Family
history may be significant for
musculoskeletal problems osteoporosis,
rheumatoid arthritis
 Assess pain. What makes it worse
precipitating factors
 Pain in wrists, knees, hips or feet?
 Note problems of movement and changes in
facial expression related to activities of daily
living
 Family members’ and patient’s ability to
perform the activities of daily living
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History Taking/Nursing Assessment
When reviewing the patient history the nurse
needs to keep in mind the significance of
disorders that affect other systems but
secondarily affect bones and muscles.
Example: psoriasis is sometimes the first sign
of psoriatic arthritis.
Nutritional deficiencies can affect the
nutritional composition of bone and muscle
Example: Osteoporosis (Risk for falls/fracture.
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 Has
the patient experienced any sensory
changes? Sensation in feet, hands or
elsewhere?
 Any trouble sleeping because of muscle or
joint pain?
 Any restriction in movement?
 Does the [patient have any joint deformity?
Example: Bunion, Hammertoe, Swan neck
deformity
 Any previous injury to the bone?
 Have any problems with ADL’s
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 Posture,
gait, and balance
 Mobility, range of motion, and strength
 Spine
 Appearance of joints
 Skeletal muscle appearance in arms and legs
 Ability to perform activities of daily living
 Elder considerations
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 HAMMERTOE
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 Rheumatoid
Arthritis Swan Neck Deformity
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 All
movements need to be
gentle and firm movements
 Sufficient help and adequately trained
personnel
 If the patient can help without damaging the
diseased joint or limb, he should be
to do so
 If the patient is not able to help, explain the
procedure to him and instruct him to relax
completely during the procedure
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 Within
a few days, the structures of
immobilized muscles and joints begin to
undergo changes
 The forming of contractures, loss of muscle
tone, and the fixation of joints can be
prevented in most cases by consistent
nursing intervention:
 The major components of this intervention:
 Gradual mobilization
 Exercise program
 Proper positioning
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 Patient and family teaching
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 The
major components of this intervention:
 Gradual
mobilization
 Exercise program
 Proper positioning
 Instruction of the patient and family
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 Preventing
contractures: When muscles are
not regularly stretched and contracted they
attempt to adapted them selves and become
shorter


“Adaptive shortening” Can begin in 3 7 days
after immobilization of a body part.
Most common: “footdrop,” knee and hip flexion
contractures, “wrist drop,” and contractures of
the fingers and arms
 Loss
of muscle tone
 ROM exercises important in preventing this
and must begin as soon as possible .
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 Prevent
ankylosis –Result of injury the tissues
of the joint are replaced by a bony
overgrowth that completely obliterates the
joint Proper positioning and movement of the
joint can help prevent this
 Gradual mobilization


Nursing responsibility: Recognize patients who
are at risk for falls while they are learning to
regain their mobility
Set goals for progressive mobilization. Must take
into account the pathological condition or cause
for immobilization
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 Caring
for immobile patients requires careful
planning.
 Making beds for the bed confined orthopedic
patient is best done by two people.
 Bathing and grooming are more time
consuming when a patient has an
immobilized limb, or a immobilizing device
 Planning for toileting at regular Intervals for
the patient who can’t get out of bed by self.
 Repositioning the patient is important q 2
hours and for comfort.
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 ROM
exercises 3-4 times a day
 Physical/Occupational Therapy needs to be
involved as soon as possible for evaluation
and treat.
 Patients experiencing intense pain need to
be assess and proper analgesics and anti
inflammatory drugs administered before
their exercises. 30-60 minutes before
 CPM –Post joint surgery. This machine
provides passive motion of the joint
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 CPM
machine passive exercise
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 Exercise



and ROM exercises
Isometric exercises
Administration of analgesic and antiinflammatory drugs
Continuous passive motion
 Positioning


and special beds
Foot drop (Footboard may be appropriate) for
flaccid paralysis
Foot Cradle may be appropriate for patients with
specific paralysis (Relieves the pressure of bed
sheets and blankets)
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 Foot
Board and Bed Cradle
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 Speciality
Beds Use Often use for patient in
cervical traction Beds turn the patient 300
times a day. Allows access to all areas of te
body.
 Use of slings and splints
 Teaching ambulation with assistive devices


Crutch safety see page 730-731
Special maneuvers on crutches
 Psychosocial
care
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Psychosocial Care
Many orthopedic conditions require prolonged
periods of confinement to bed,
immobilization, and restricted physical
activity
This can lead to frustration and depression due
to the dependence on others for care.
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 Determine
effectiveness of interventions
 Be alert to nuances of body language
 Observe patient’s ability to accomplish ADLs
 Check x-rays and laboratory tests
 Collaborate among all health professionals
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