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Chapter 52. Assessment of the Musculoskeletal System. Skeletal System. Bone types Bone structure Bone function

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chapter 52

Chapter 52

Assessment of the Musculoskeletal System

skeletal system
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
  • Types include synarthrodial, amphiarthrodial, diarthrodial.
  • Structure synovial joint.
  • Subtyped by anatomic structure:
    • Ball-and-socket
    • Hinge
    • Condylar
    • Biaxial
    • Pivot
muscular system assessment
Muscular System Assessment
  • Patient history
  • Nutritional history
  • Family history and genetic risk
  • General inspection:
    • Posture and gait
specific assessments
Specific Assessments
  • Face and neck
  • Spine
  • Hand
  • Hip
  • Ankles, feet
  • Neurovascular assessment
  • Psychosocial assessment
diagnostic assessment
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
  • 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.
  • 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.
other tests
Other Tests
  • Bone scan
  • Gallium or thallium scan
  • Magnetic resonance imaging
  • Ultrasonography
chapter 53

Chapter 53

Care of Patients with Musculoskeletal Problems

  • 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
osteoporosis cont d1
Osteoporosis (Cont’d)
  • Etiology and genetic risk
  • Genetic considerations
  • Incidence/prevalence
  • Cultural considerations
classification of osteoporosis
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.
health promotion illness prevention
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.
  • Physical assessment
  • Psychosocial assessment
  • Laboratory assessment
  • Imaging assessment:
    • DXA
    • QCT
    • QUS
osteoporosis interventions
Osteoporosis: Interventions
  • Nutrition therapy
  • Exercise
  • Other lifestyle changes
osteoporosis drug therapy
Osteoporosis: Drug Therapy
  • Calcium and vitamin D supplements
  • Estrogen or hormone therapy
  • Bisphosphonates
  • Selective estrogen receptor modulators
  • Calcitonin
  • Other agents used with varying results
osteoporosis surgical interventions
Osteoporosis: Surgical Interventions
  • Vertebroplasty
  • Kyphoplasty
  • Loss of bone related to vitamin D deficiency
  • Bone softens because of inadequate deposits of calcium and phosphorus in the bone matrix
  • Rickets
collaborative care
Collaborative Care
  • Assessment
  • The major treatment for osteomalacia is vitamin D
paget s disease of the bone
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
paget s disease nonsurgical management
Paget’s Disease: Nonsurgical Management
  • Analgesics
  • Decrease bone resorption
  • Selected bisphosphonates
  • Calcitonin
  • Plicamycin
  • Diet therapy
  • Nonpharmacologic pain-relief measures
paget s disease surgical management
Paget’s Disease: Surgical Management
  • Tibial osteotomy
  • Partial or total joint replacement
  • Surgical decompression and stabilization of the spine
  • Infection in bony tissue
osteomyelitis collaborative care
Osteomyelitis: Collaborative Care
  • Assessment
  • Antibiotic therapy
  • Hyperbaric oxygen therapy
  • Surgical management:
    • Sequestrectomy
    • Microvascular bone transfers
benign bone tumors
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
  • Non-drug pain-relief measures
  • Drug therapy—analgesics, NSAIDs
  • Surgical therapy—curettage (simple excision of the tumor tissue), joint replacement, or arthrodesis
bone cancer
Bone Cancer
  • Primary tumors
  • Metastatic lesions
  • Pathophysiology
  • Assessment
  • Nonsurgical management:
    • Drug therapy
    • Radiation therapy
bone cancer surgical management
Bone Cancer: Surgical Management
  • Preoperative care
  • Operative procedure
  • Postoperative care
bone cancer community based care
Bone Cancer: Community-Based Care
  • Home care management
  • Health teaching
  • Health care resources
disorders of the hand
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
  • Round, benign cyst often found on a wrist or foot joint or tendon
disorders of the foot
Disorders of the Foot
  • Hallux valgus
  • Hammertoe
  • Morton’s neuroma
  • Tarsal tunnel syndrome
  • Plantar fasciitis
  • Other problems of the foot
  • Changes in muscles and ligaments on the concave side of the spinal column
scoliosis cont d
Scoliosis (Cont’d)
  • Pathophysiology
  • History
  • Treatment of children
  • Treatment of adults
progressive muscular dystrophies
Progressive Muscular Dystrophies
  • Pathophysiology
  • Genetic considerations
  • Diagnosis
  • Management
  • Nursing interventions