1. Musculoskeletal System
Assessment of the
Musculoskeletal System
L / Hanaa Eisa

2. Learning outcome At the end of this Lesson the study will be able to:
Elicit a health history from a patient with a
musculoskeletal ,chief complaint.
Perform inspection and palpation of the
musculoskeletal system.
Describe the range of motion movements of the major
joints.
Measure range of joint motion with a goniometry
Document the findings of the musculoskeletal
assessment.
Assess muscle strength of the arms and legs using the
muscle strength grading scale

3. Classification of bones by shape
Human skeleton has
206 bones
Axial skeleton
Appendicular skeleton
Provide structure and support for soft tissue
Protect vital organs

4. Classification of bones cont’d
Compact bone
Smooth and dense e.g. shaft of long bones and outside layer of other bones
Spongy bone
Contains spaces , Spongy sections contain bone marrow

5. Joints (articulations)
Area where two or more bones meet. Holds skeleton together while allowing body to move, there are many types:
Synarthroses , Immovable (e.g., skull)
Amphiarthrosis ,Slightly movable e.g. vertebral joints
Diarthroses or synovial ,Freely movable e.g. shoulders, hips

6. Skeletal Muscle Tendons:
Types of Muscles:
There are 600 skeletal muscles in deferent shapes
Skeletal voluntary, Allows voluntary movement
Smooth involuntary ,Muscle movement controlled by internal mechanism .e.g. muscles in bladder wall and GI system
Cardiac involuntary ,Found in heart.
Tendons:
Fibrous connective tissue bands that connect bone to muscles , Enable bones to move when muscles contract

7. Anatomy and Physiology cont’d
Ligaments: Bands of connective tissue that connect bone to bone
Either limit or enhance movement
Provide joint stability
Enhance joint strength
Bursae ,Fluid-filled sacs

8. Changes in older adult
Cause stooped posture, changing center of gravity
Elderly at greater risk for falls
Endocrine changes cause skeletal muscle atrophy
Muscle tone decreases

10. Diagnostic Tests
Blood tests
X-rays
Bone density scan
CT scan
MRI
Ultrasound
Bone scan

11. Soft tissue trauma
Contusion : Bleeding into soft tissue ,can cause a hematoma , Swelling and discoloration (bruise)
Sprain: ligament injury , excessive stretching of a ligament due to , twisting motion ,overstretching or tear.
Strain: Microscopic tear in the muscle, may cause bleeding, pulled muscle

12. Treatment of sprains
first-degree: rest, ice for 24 to 48 hr, compression bandage, and elevation
second-degree: immobilization, partial weight bearing as tear heals
third-degree: immobilization for 4 to 6 weeks, possible surgery

14. Fractures Fractures break in the continuity of bone
Classification of Fractures
Closed or simple
Open or compound
Complete or incomplete
Stable or unstable
Direction of the fracture line
Oblique
Spiral
Lengthwise plane (greenstick)

15. Fractures – emergency care
First aids:
Immobilize
Check pulse, color, movement, sensation
splinting
Sterile dressing for open wounds.
Fracture reduction
Closed—external manipulation
Open—surgery

16. Complications of fractures
Shock
Fat embolism .
Venous thromboembolism
Infection
Ischemic necrosis
Fracture blisters,
Delayed union, nonunion, and malunion

17. Musculoskeletal Assessment Fracture
Change in bone alignment
Alteration in length of extremity
Change in shape of bone
Pain upon movement
Decreased ROM
Ecchymotic skin
Subcutaneous emphysema with bubbles under the skin ,Swelling at the fracture site

18. Special assessment considerations
For fractures of the shoulder and upper arm, assess client in sitting or standing position.
Support the affected arm to promote comfort.
For distal areas of the arm, assess client in a supine position.
For fracture of lower extremities and pelvis, client is in supine position.

19. Casts
Rigid device that immobilizes the affected body part while allowing other body parts to move
Cast materials
Plaster
Fiberglass
Polyester-cotton

20. Types of casts Arm Casts Leg Casts Body or Spica Casts
Splints and Braces
External Fixator
Traction

21. Cast care and client education
Cast complications:
Infection
Circulation impairment
Peripheral nerve damage
Complications of immobility

22. Upper and lower extremity cast

27. Nursing Care for patient with Casts
Neurovascular
Check color/capillary refill ,Temperature
Pulse , Movement , Sensation (5 P’s)
Elevate Extremity
Exercises – to unaffected side; isometric exercises to affected extremity
Keep heel off mattress
Handle with palms of hands if cast wet
Turn every two hours till dry
Do not place items under cast.
Traction – skin or skeletal
Countertraction – counteracts the pull of traction; Suspension – use of traction equipment, such as frames, splints, ropes, pulleys and weights- not pull suspends
Balanced suspension – allow patient to move freely and easy in bed.
Buck’s extension – common skin traction.
Skeletal - Kirschner wire or Steinmann pin , covered with cork or metal protectives, nurse applies small sterile dressings, cleaned, antibiotic oint. Check for infection
Balanced suspension with Thomas splint and Pearson attachment

28. Traction
Application of a pulling force to the body to provide reduction, alignment, and rest at that site
Types of traction: skin, skeletal, plaster, brace, circumferential.
Traction care:
Maintain correct balance between traction pull and counter traction force
Care of weights
Skin inspection
Pin care
Assessment of neurovascular status

30. Musculoskeletal – Fractures Treatment
Immobilize ,medications ,closed reduction manual and cast; external fixation device ,traction; splints; braces Surgery. Nursing Care Elevate extremity to decrease swelling / ice pack ,Teach skin care, cast care, diet, complications. Promote comfort , Vital Signs, Assess infection Promote mobility , Teach safety , Monitor elimination.

31. Nursing Management Positioning Strengthening Exercises
Potential Complications

32. Operative Procedures Open reduction with internal fixation
External fixation
E.g . Orthopedic Surgery
Joint Replacement
Total Hip Replacement
Total Knee Replacement

33. Extremity Fractures In upper Extremity Fractures include :
Clavicle ,Scapula Humerus , Radius and ulna
Wrist and hand
In Lower Extremity Fractures include:
Femur ,Patella ,Tibia and fibula ,Ankle and foot

34. Thank you