Assessment of the Musculoskeletal System

1. Chapter 52 Assessment of the Musculoskeletal System

2. Skeletal System Bone types Bone structure Bone function Bone growth and metabolism affected by calcium and phosphorus, calcitonin, vitamin D, parathyroid hormone, growth hormone, glucocorticoids, estrogens and androgens, thyroxine, and insulin

3. Bone Structure

4. Joints Types include synarthrodial, amphiarthrodial, diarthrodial. Structure synovial joint. Subtyped by anatomic structure: Ball-and-socket Hinge Condylar Biaxial Pivot

5. Structure Diarthrodial Joint

6. Muscular System Assessment Patient history Nutritional history Family history and genetic risk General inspection: Posture and gait

7. Muscular System Assessment (Cont.)

8. Specific Assessments Face and neck Spine Hand Hip Ankles, feet Neurovascular assessment Psychosocial assessment

9. Diagnostic Assessment Laboratory tests�serum calcium and phosphorus, alkaline phosphatase, serum muscle enzymes Radiographic examinations�standard radiography, bone density, tomography and xeroradiography, myelography, arthrography, and CT Other diagnostic tests�bone and muscle biopsy

10. Electromyography EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders; usually with nerve conduction studies. Low electrical currents are passed through flat electrodes placed along the nerve. If needles are used, inspect needle sites for hematoma formation.

11. Arthroscopy Fiberoptic tube is inserted into a joint for direct visualization. Patient must be able to flex the knee; exercises are prescribed for ROM. Evaluate the neurovascular status of the affected limb frequently. Analgesics are prescribed. Monitor for complications.

12. Arthroscopy (Cont�d)

13. Other Tests Bone scan Gallium or thallium scan Magnetic resonance imaging Ultrasonography

14. Chapter 53 Care of Patients with Musculoskeletal Problems

15. Osteoporosis Chronic metabolic disease, in which bone loss causes decreased density and possible fracture Osteopenia (low bone mass), which occurs when osteoclastic activity is greater than osteoblastic activity

16. Osteoporosis (Cont�d)

17. Osteoporosis (Cont�d) Etiology and genetic risk Genetic considerations Incidence/prevalence Cultural considerations

18. Classification of Osteoporosis Generalized osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s. Secondary osteoporosis results from an associated medical condition such as hyperparathyroidism, long-term drug therapy, long-term immobility. Regional osteoporosis occurs when a limb is immobilized.

19. Health Promotion/Illness Prevention Teaching should begin with young women who begin to lose bone after 30 years of age. The focus of osteoporosis prevention is to decrease modifiable risk factors. Ensure adequate calcium intake. Avoid sedentary lifestyle. Continue program of weight-bearing exercises.

20. Assessment Physical assessment Psychosocial assessment Laboratory assessment Imaging assessment: DXA QCT QUS

21. Osteoporosis: Interventions Nutrition therapy Exercise Other lifestyle changes

22. Osteoporosis: Drug Therapy Calcium and vitamin D supplements Estrogen or hormone therapy Bisphosphonates Selective estrogen receptor modulators Calcitonin Other agents used with varying results

23. Osteoporosis: Surgical Interventions Vertebroplasty Kyphoplasty

24. Osteomalacia Loss of bone related to vitamin D deficiency Bone softens because of inadequate deposits of calcium and phosphorus in the bone matrix Rickets

25. Collaborative Care Assessment The major treatment for osteomalacia is vitamin D

26. Paget�s Disease of the Bone Chronic metabolic disorder in which bone is excessively broken down and reformed Genetic considerations Collaborative care: Physical assessment Diagnostic assessment

27. Paget�s Disease: Nonsurgical Management Analgesics Decrease bone resorption Selected bisphosphonates Calcitonin Plicamycin Diet therapy Nonpharmacologic pain-relief measures

28. Paget�s Disease: Surgical Management Tibial osteotomy Partial or total joint replacement Surgical decompression and stabilization of the spine

29. Osteomyelitis Infection in bony tissue

30. Osteomyelitis: Collaborative Care Assessment Antibiotic therapy Hyperbaric oxygen therapy Surgical management: Sequestrectomy Microvascular bone transfers

31. Benign Bone Tumors Often asymptomatic and may be discovered on routine x-ray or as a cause of pathologic fracture: Chrondrogenic tumors�from cartilage Osteogenic tumors�from bone Fibrogenic tumors�from fibrous tissue; most commonly found in children

32. Interventions Non-drug pain-relief measures Drug therapy�analgesics, NSAIDs Surgical therapy�curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis

33. Bone Cancer Primary tumors Metastatic lesions Pathophysiology Assessment Nonsurgical management: Drug therapy Radiation therapy

34. Bone Cancer: Surgical Management Preoperative care Operative procedure Postoperative care

35. Bone Cancer: Community-Based Care Home care management Health teaching Health care resources

36. Disorders of the Hand Dupuytren's contracture�slowly progressive contracture of the palmar fascia resulting in flexion of the fourth or fifth digit of the hand

37. Ganglion Round, benign cyst often found on a wrist or foot joint or tendon

39. Disorders of the Foot Hallux valgus Hammertoe Morton�s neuroma Tarsal tunnel syndrome Plantar fasciitis Other problems of the foot

40. Foot

41. Scoliosis Changes in muscles and ligaments on the concave side of the spinal column

43. Scoliosis (Cont�d) Pathophysiology History Treatment of children Treatment of adults

44. Progressive Muscular Dystrophies Pathophysiology Genetic considerations Diagnosis Management Nursing interventions