Download - Chapter 66-musculoskeletal-system
Chapter 66
Assessment of Musculoskeletal Function
Orthopedics
The branch of medicine that deals with the prevention and correction of the disorders and diseases of the musculo-skeletal system.
The primary goal of the nurse caring for a client with locomotor disorders is the prevention of contractures (permanent shortening of a muscle) or deformities.
Skeletal Functions To provide the body with a structural
framework. To act as a protective casing for internal
organs ( the brain, heart, lungs, etc.). To allow movement by muscles attached
to the skeleton. To store calcium, phosphorus, and
magnesium. To manufacture blood cells in the red
bone marrow.
Structure
206 Bones in the body Long bones Short bones Flat bones Irregular bones
Joints Muscles
Bone Cells
Osteoblasts Function in bone formation
Osteocytes Mature bone cells that function in bone
maintenance Osteoclasts
Multinuclear cells function in destroying, resorbing, and remodeling bone
Bone Formation and Maintenance
Osteogenesis: process of bone formation Ossification: the process of formation of the bone
matrix and deposition of minerals Bone is in constant state of turnover Regulating factors
Stress and weight-bearing Vitamin D Parathyroid hormone and calcitonin Blood supply
Role of calcium
Bone Healing
Hematoma and inflammation Angiogenesis and cartilage formation Cartilage calcification Cartilage removal Bone formation Remodeling
Joints A joint is a junction of two or more bones. Three types:
Diarthosis: freely movable such as hinge (elbow, knee); ball and socket (hip, shoulder), pivot (skull, first vertebrae), gliding (wrist) and saddle (thumb).
Synarthosis: joints are immovable (skull sutures).
Amphiarthosis: slightly movable (vertebrae and pelvic bones).
Hinge Joint of the Knee
Muscles
Attached to bones and other structures by tendons
Encased in a fibrous tissue—fascia Contraction of muscle causes movement Contraction utilizes energy in the form of ATP Anaerobic pathways using glucose metabolized
from stored glycogen provide energy for more strenuous muscle activity
Movement of the muscles may be voluntary or involuntary.
Assessment of the Musculoskeletal System
Include data related to function ability; ADLs and ability to perform various activities. Note any problems related to mobility.
Health history: family history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications—include OTC
Assessment of pain and altered sensations Physical assessment: posture, gait, bone integrity, joint
function, muscle strength and size, skin, neurovascular status
Assessment of the Bony Skeleton Notation on any deformities. Body alignment. Abnormal growths due to bone tumors. Shortened extremities, symetry. Amputations. Abnormal angulation other than at joints. Crepitus (a grating or crackling sensation
or sound). posture
Assessment of Spine
Scoliosis (crooked back; lateral curving deviation).
Kyphosis (hump back; increased roundness of the thoracic spinal curve).
Lordosis (sway back; exaggeration of the lumbar spine curvature as seen in pregnancy).
Three common spinal curvatures:
Normal Spine and 3 Abnormalities
Range of Motion (ROM)
Active person does the moving Have person move joint through each of its
various ROM movements Note the angle of each joint movement Note any pain, tenderness, or crepitus
Range of Motion (ROM)
Passive person relaxes and allows you to move the
joints Done if person is unable to do active ROM
• ALWAYS stop if the person complains of pain• NEVER push a joint beyond its anatomic angle
Muscle Strength
As you are testing ROM Test muscle strength
Ability to perform the ROM against resistance• Symmetry• Involuntary movements
Detecting Fluid in the Knee
Rheumatoid Arthritis—Ulnar Deviation and “Swan-Neck” Deformity
Diagnostic Evaluation X-rays Computed tomography MRI Arthrography Bone densitometry Bone scan Arthroscopy Arthrocentesis Electromyography Biopsy Laboratory studies