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Musculoskeletal Disorders

Musculoskeletal Disorders. Psych Rehab Nursing. Outline. Overview of anatomy and physiology Diagnostic tests Musculoskeletal trauma Problems of the musculoskeletal system Osteoporosis Osteoarthritis Rheumatoid arthritis Gout Other musculoskeletal problems. Review.

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Musculoskeletal Disorders

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  1. Musculoskeletal Disorders Psych Rehab Nursing

  2. Outline • Overview of anatomy and physiology • Diagnostic tests • Musculoskeletal trauma • Problems of the musculoskeletal system • Osteoporosis • Osteoarthritis • Rheumatoid arthritis • Gout • Other musculoskeletal problems

  3. 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)

  4. 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

  5. Bones • Blood cells are produced in bone marrow (see below) • 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)

  6. Bones 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) Ligaments (fibrous connective tissue connecting bone to bone)

  7. Bones: Types • Long bones • Short bones • Flat bones • Irregular bones • Sesamoid (or round) bones • Sutural or Wormian bones

  8. 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

  9. Long Bones • Examples of long bones • MetacarpalsPhalanges • 9 14 • 10 15 • 11 16 • 12 • 13

  10. Red and Yellow Bone Marrow • 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 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)

  11. 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)

  12. 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

  13. Long Bones • ??

  14. 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

  15. 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.

  16. 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)

  17. 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.

  18. 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

  19. Bones: Types • Long Bones: weight bearing, strong, curved • Short bones: compact on surface, spongy center & cuboidal (metatarsals) • Flat bones: parallel surfaces of the body, protecitvefunciton, 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)

  20. Joints • A diarthrosis joint is a freely moveable joint – always a synovial joint • Types of synovial joints • Gliding (Two sliding surfaces) (Example - between carpals) • Hinge (Concave surface with convex surface) (Example – between humerus and ulna) • Pivot (Rounded end fits into ring of bone and ligament (Example – between atlas (C1) and axia (C2) vertebrae

  21. Joints Synovial Joint Diarthrosis Joint (all are synovial joints)

  22. Joints, Synovial types, cont. • Ball and socket joint (Ball-shaped head with cup-shaped socket) (Example – Between femur and pelvis) • Condyloid joint (Oval condyle with oval cavity) (Example – between metacarpals and phalanges) • Saddle joint (Each surface is both concave and convex) (Example – Between carpus and the first metacarpal) • Hinge joint (interphalangeal joints) • Pivot joint (able to rotate – neck, forearm, knees)

  23. Muscles • Source of power and movement • Three types… • Skeletal Muscle • Cardiac Muscle • Smooth Muscle

  24. 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)

  25. 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.

  26. 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)

  27. 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.

  28. Diagnostic Tests forMusculoskeletal • 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

  29. 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.

  30. Soft Tissue Injuries • Sprains/Strains • Sports-related • Dislocation/Subluxation • Carpal Tunnel Syndrome • Rotator cuff • Repetitive Strain • Meniscus Injury • Bursitis • Muscle spasms

  31. Dislocation / Subluxation • Dislocation of joint • Subluxation (partial dislocation of joint) • Candidate joints are shoulders, fingers, kneecaps

  32. Trauma to Bone • Highest incidence • MALES 15-24 years of age or elderly females 65 years of age, or older • Why are females in this age group affected? • A result of a blow to the body, a fall, or another accident

  33. Rotator Cuff Injury A rotator cuff injury includes any type of irritation or damage to the rotator cuff muscles or tendons. Causes of a rotator cuff injury may include falling, lifting and repetitive arm activities — especially those done overhead, such as throwing a baseball or placing items on overhead shelves (Mayo Clinic, 2008)

  34. Meniscus Injury • Symptoms of medial meniscus tear • A history of trauma or twisting of the knee • Pain on the inner surface of the knee joint • Swelling of the knee within 24-48 hours of injury • Inability to bend knee fully- this may be associated with pain or a clicking noise • A positive sign (pain and/or clicking noise) during a "McMurrays test" • Pain when rotating and pressing down on the knee in prone position (video). • "Locking" of the knee • Inability to weight bear on the affected side (SIC, 2008)

  35. Muscle Spasm • Inflammation that occurs when a muscle is over-stretched or torn • The back is a common area for inflammation to occur • Why? Poor body mechanics • (cold or heat might be effective, reduce inflammation & relax muscles)

  36. Bursitis:Inflammation of the Bursa(Pain, fluid build up, calcium deposits & loss of motion in the joint. Prevention is to build up activity gradually. Treatment: avoid what is causing the problem, NSAIDS, steroids, ice. In some cases surgery might be necessary.

  37. Types of Complete Fractures • Closed (Simple) • Open (Compound): riskiest due to infection, bone breaks through skin. • Transverse • Oblique • Spiral • Comminuted • Colles’ fracture: fracture of wrist on inside portion of wrist. Treatment is reduce it & cast it. (happens when someone falls down). Responds well to cast.

  38. Fractures • Fractures commonly tear blood vessels, producing a hematoma • This area of hematoma is commonly used as an area to anesthetize the periosteum because thisis where the blood vessels are located. • Reduction usually requires anesthesia

  39. Healing stages • After several weeks the periosteum is beginning to heal & lay down scar tissue. Trabecular cone has begun to grow over the break. There is callus formation w/ the osteoblasts • After several months…..

  40. Healing stages, cont • Remodeling: over the next months or years, the bone shape returns to normal as osteoclasts absorb extra cells and osteoblsats generate new cells and bone. The bone will be thickened somewhat at the fracture… • Fully healed fractures in children are indistinguishable from the original bone b/c the growth plates are open. However, multiple fxs in various stages of healing are a strong indicator of child abuse

  41. Closed Simple Fracture • Only bone damage • Little or no soft tissue damage • Does not penetrate skin

  42. Open Fracture • Probably need surgery… lot of time spent cleaning the wound • Wound may be left open for a while…

  43. Transverse Bone Fracture • Often caused by direct traumatic injury • Bone has been broken giving rise to a transverse break or fissure within the bone at a right angle to the long portion of the bone

  44. Oblique Bone Fracture • Extremely rare type of break • An oblique break in the bone which is very unstable (break at an angle) • Bone still together…

  45. Spiral Fractures • Bone is broken due to twisting-type motion • Unstable fracture • Looks like corkscrew – runs parallel with the axis of the broken bone

  46. Comminuted (crushed) Fracture • More than two fragments of bone have been broken off • Highly unstable with many bone fragments • (Fixed w/ rods & screws after taking all the pieces out)

  47. Types of Incomplete Fractures • Greenstick • Torus (closed) (side of the bone bends but does not break) • Bowing • Stress

  48. Greenstick fracture • Usually seen in children • Bone is usually “bent” and broken on the outside of the bend • If kept straight, heals quickly • (sometimes doesn’t need a cast… sometimes overtreated)

  49. Stress Fracture • Incomplete fracture • Caused by “unusual or repeated” stress – this in contrast to other type fractures resulting from trauma • Common sports injury and among soldiers from marching • Tiny hairline fractures • Most common symptom is pain • Most are not associated with swelling or redness, but tenderness to palpation • Tibia (shin splints-runners) and metatarsal bones affected in runners

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