Musculoskeletal System Assessment of the Musculoskeletal System 2015 - 2016 L / Hanaa Eisa

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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.

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

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

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

Upper and lower extremity cast

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

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

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.

Nursing Management Positioning Strengthening Exercises Potential Complications

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

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

Thank you