The Musculoskeletal System

2. The Musculoskeletal System Nancy Bevill-Mathews RN, BSN, CNOR The University of AlabamaSpring 2011

3. Skeletal System Bone types Bone structure Bone function

4. Human Femur

5. Bones of the Hand

6. Human Scapula & Sternum

7. Structure

8. Joints of the Human Body • Types include synarthrodial, amphiarthrodial, diarthrodial. • ˜Structure synovial joint. • Subtyped by anatomic structure: • Ball-and-socket • Hinge • Condylar • Biaxial • Pivot

9. Structure of Synarthrodial Joint

10. Structure of Amphiarthrodial Joint

11. Structure of the Diarthrodial Joint

12. Look at the picture: Which classification of joint is found at each letter? A: ________________ B: ________________ C: ________________ D: ________________

13. Classification of Joints 2) Which of these three sports tends to rely most heavily on flexibility at the slightly moveable joints of the vertebrae? gymnastics, football or skiing? (http://www.teachpe.com/cloze/classification_of_joints.htm)

14. Classification of Joints 3) Which classification of joint can be found at the cranium as well as at the pelvis? (http://www.teachpe.com/cloze/classification_of_joints.htm)

15. Musculoskeletal changes associated with aging.

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

20. Face and neck • Hand • Ankles and Feet • Neurovascular assessment • Psychosocial assessment • Spine • Hip

21. Face and Neck

22. Spine

23. Hand

24. Hip

25. Ankle and Foot

26. Neuromuscular Assessment

27. Assessment of Neurovascular Status in Patientswith Musculoskeletal Injury

28. Psychosocial Assessment • Factor affecting psychosocial health: • Stress • Anxiety • Depression • Deformities

29. Musculoskeletal Problems • Osteoporosis • Paget’s Disease • Bone tumors • Bone Lesions • Deformities • Syndromes • Bone Cancer

30. Osteoporosis

31. 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. • Continue program of weight-bearing exercises. • Avoid sedentary lifestyle.

32. Assessment • Physical assessment • Psychosocial assessment • Laboratory assessment • Imaging assessment: • DXA • QCT • QUS

33. Osteoporosis: Interventions • Nutrition therapy • Exercise • Other lifestyle changes

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

35. Osteoporosis: Surgical Interventions • Vertebroplasty • Kyphoplasty

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

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

38. 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

39. Paget’s Disease: Non-surgical Management • Analgesics • Decrease bone resorption • Selected bisphosphonates • Calcitonin • Plicamycin • Diet therapy • Nonpharmacologic pain-relief measures

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

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

42. 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.

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

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

45. Bone Cancer: Surgical Management • Preoperative care • Operative procedure • Postoperative care

46. 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. • Ganglion: A round, benign cyst often found on a wrist, joint, or tendon.

47. Disorders of the Foot

48. Scoliosis

49. Progressive Muscular Dystrophies • Pathophysiology • Genetic considerations • Diagnosis • Management • Nursing interventions

50. Tyrone Prothro