Care of the Patient with a Musculoskeletal Disorder PN 135

1. Care of the Patient with a Musculoskeletal DisorderPN 135

2. Overview of Anatomy and Physiology • Divisions of the skeleton • Axial- • Cranium (skull, face, and ears), vertebrae, ribs • Appendicular • Limbs, shoulders, pelvis, hips

3. Divisions of Skeleton • 206 bones total • Axial skeleton • 80 bones • Head & trunk • Appendicular skeleton • 126 bones • Extemeties, shoulders, hips

4. Figure 44-2 (From Thibodeau, G.A., Patton, K.T. [1997]. The human body in health and disease. [2nd ed.]. St. Louis: Mosby.) Skeleton, anterior view.

5. Figure 44-3 (From Thibodeau, G.A., Patton, K.T. [1997]. The human body in health and disease. [2nd ed.]. St. Louis: Mosby.) Skeleton, posterior view.

7. Overview of Anatomy and Physiology • Functions of the skeletal system • Support • Protection • Mineral storage-calcium/phosphorus • Movement • Hemopoiesis • Structure of bones • Long, short, flat, and irregular

8. Functions of the Skeletal System • Support • Rigid framework • Supports against pull of gravity • “hanger” for our muscles!

9. Functions of the Skeletal System • Protection • Soft body parts • Brain • Heart • Lungs • Vascular system

10. Functions of the Skeletal System • Movement • Provide sites for muscle attachment • Bones and muscles work together as simple mechanical lever systems to produce body movements.

11. Functions of the Skeletal System • Mineral Storage • The bones serve as a storage specifically for 2 minerals—calcium and phosphorus • Intercellular matrix of bone contains large amounts of… • Calcium • When blood calcium levels drop • Calcium is released from the bones • Excess Calcium is stored in the bone

12. Functions of the Skeletal System • Storage • Bone tissue contains smaller amounts of… • Sodium • Magnesium • Potassium • Carbonate

13. Functions of the Skeletal System • Hematopoesis • Blood cell formation • Takes place in red marrow of bones • Infants primarily have red marrow • As we age red marrow changes to yellow marrow for fat storage

14. Functions of the Skeletal System • Hematopoesis (cont.) • Adults • Red marrow is limited to the spongy bone • Skull • Ribs • Sternum • Clavicles • Vertebrae • Pelvis

15. Functions of the Skeletal System • Red Marrow Functions • Formation of… • Red Blood Cells • White Blood Cells • Blood Platelets

16. Functions of the Skeletal System • Red Marrow (summary) • Manufactures blood cells • Found in ends of long bones • Center of other bones • Yellow Marrow (summary) • Shaft of long bones • Composed largely of fat

17. Bones • Bones stop growing in length by late teens, early 20’s • Children- bone repair is much faster • Elderly- past active phase, repair takes longer, bones more fragile

18. Types of Bone • Types of Osseous/Bone Tissue • Cancellous • Spongy • Epiphysis, end of long bone & center or others • Filed with red marrow • Cortical • Compact • Diaphysis, shaft of long bone • Outer layer of other bones • Haversion canal contains nerves and blood vessels

19. Types of Bones • Short bones and flat bones • Cancellous/spongy covered by Cortical/compact • Irregular – e.g. vertebrae • Long bones • Ends are Cancellous/Spongy • Shafts are Cortical/Compact

20. Types of Bone • Four classifications based on form and shape: • 1. Long – eg. Humerus • 2. Short – eg. Phalanges of the fingers • 3. Flat – eg. Occipital, sternum • 4. Irregular - eg. Vertebrae

22. Classification • Long Bones: longer than they are wide • Short Bones: • roughly cube-shaped • Vertical and horizontal dimensions approx. = • E.g. Wrist, ankle

23. Classification • Flat bones: • Thin, flattened, usually curved • Made like sandwich with a middle layer of spongey bone called diploӫ. The diploӫ is covered on each side by a layer of compact bone. • E.g. Cranium

24. Classification • Irregular Bones • One of a group of bones having peculiar or complex forms • E.g vertebrae

25. Structure of Bones

27. Bone Membranes • Periosteum • Membrane on outside of bone • Contain osteoblasts • Endosteum • Lines marrow cavity • Cells aid in growth and repair

28. Bone Cells and Actions • Osteoblasts- build bone • Osteocytes- are mature bone cells • Osteoclasts- break bone down

29. Projections • Head- rounded knob • At end of bone • E.g. ____________________ • Process- large projection • E.g. Spinous process on vertabrae • Crest- border or ridge • E.g. __________________ • Spine- sharp projection • E.g. spine of scapula

31. Depressions or Holes • Foramen- hole allows vessel or nerve to pass through • Sinus- air space in some skull bones • Fossa- depression • Meatus- short channel or passage • E.g. Passage to inner ear

32. 12 Ribs • True Ribs • First seven pair • Attach to sternum by costal cartilage • False Ribs • Next five pair • 8th, 9th, & 10th attach to rib above • 11th& 12th have no anterior attachment (Floating ribs)

33. Vertebral Column • Cervical vertebrae- 7, support & move head • Thoracic vertebrae- 12, ribs attached here • Lumbar vertebrae- 5, support weight • Sacral vertebrae- 5, fuse to single bone • Coccyx • 4-5 in child • Fuse to 1 in adult

34. Bones and Joints

35. Bones and Joints • Bursa • Fluid-filled sacs • Joint movement • Fascia • Connective tissue • Includes tendons, ligaments, and aponeuroses • Tendons • Attach muscle to bones • Ligaments • Bind joints together

36. Overview of Articulations • Articulations (joints) Connect bones and allow movement • Three types according to degree of movement • Synarthrosis—no movement • Amphiarthrosis—slight movement • Diarthrosis—free movement

37. Joints • Diarthrosis-freely moveable • Hinge: elbow, knee • Ball and socket: hip and shoulder • Pivot: skull and 1st vertabrae • Synarthrosis-immovable • Sutures • Amphiarthrosis-slightly movable • Vertebrae and pelvis

38. Diarthrosis • Hinge: permitting only flexion and extension as in the elbow and knee joints. • Gliding: Flat or slightly flat surfaces move against each other allowing sliding or twisting. This happens in the carpals in the wrist and the tarsals in the ankle.

39. Diarthrosis • Ball-and-Socket: The ball-shaped end of one bone fits into a cup shaped socket on the other bone allowing the widest range of motion including rotation. Examples include the shoulder and hip. • Pivot: An example is the joint between the axis and atlas in the neck.

40. Diarthrosis • Articulating Joints • Covered with articular cartilage • Have joint capsules • Outer layer-fibrous • Inner layer- synovial, secretes synovial fluid to lubricate joints

41. Types of Joints

42. Structure of a freely movable (diarthrotic) joint.

43. Synovial Joint Movement • Flexion-decreases angle between bones (close fingers) • Extension-increases angle between bone (open fingers) • Abduction-movement away from midline • Adduction-movement toward midline

45. Joint Movement • Rotation-twisting or turning • Supination-turn up • Pronation-turn down • Inversion-turning inward • Eversion-turning outward

46. Synarthrosis and Amphiarthrosis • Fibrous joint • Fibrous connective tissue • E.g. sutures in skull • Immovable, synarthrosis • Cartilaginous joint • Connected by cartilage • E.g. vertebrae and ribs connecting to sternum • Slightly movable, amphiarthrosis