12th edition brunner & suddarth's unit 15

8/12/2019 12th edition brunner & suddarth's unit 15

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Assessment of Musculoskeletal function

Anatomic and physiologic overview

The musculoskeletal system includes the bones, joints, muscles, tendons,

ligaments, and bursae of the body. The bony structure provides protection for vital organs, including the brain, heart,

and lungs.

The bony skeleton provides a sturdy framework to support body structures.

The bone matrix stores calcium, phosphorus, magnesium and fluoride.

The red bone marrow located within bone cavities produces red and white blood

cells in a process called hematopoiesis.

Joints hold the bones together and allow the body to move.

The muscles attached to the skeleton contract, moving the bones and producing

heat, which helps to maintain body temperature.

tructure and function of the skeletal system

There are !"# bones in the human body, divided into four categories$

%ong bones &femur'

hort bones &metacarpals'

(lat bones &sternum'

)rregular bones &vertebrae'

*ones are constructed of cancellous &trabecular' or cortical &compact' bone

tissue.

+iaphysis shaft of long bones

-piphysis ends of long bones -piphyseal plate separates the epiphyses from the diaphysis and is the center

for longitudinal growth in children.

artilage tough,

elastic, avasculartissue.

%ong bones are

designed for weightbearing andmovement.

hort bones

cancellous bonecovered by a layer ofcompact bone.

(lat bones important

sites forhematopoiesis.


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*one is composed of cells, protein matrix, and mineral deposits. The cells are of

three basic types$

/steoblasts function in bone formation by secreting bone matrix.

/steocytes mature bone cells.

/steoclasts multinuclear cells involved in destroying, resorbing and

remolding bone. /steon microscopic functioning unit of mature cortical bone.

%amellae minerali0ed bone matrix.

1eriosteum dense, fibrous membrane covering the bone.

-ndosteum thin, vascular membrane that covers the marrow cavity of long

bones and the spaces in cancellous bone.

*one marrow vascular tissue located in the medullary cavity of long bones and

in flat bones. 2esponsible for producing red and white blood cells.

*one formation &osteogenesis'

/ssification process by which the bone matrix is formed and hardeningmaterials are deposited on the collagen fibers.

Two basic process of ossification$

-ndochondral a cartilage3like tissue &osteoid' is formed, resorbed, andreplaced by bone.

)ntramembranous occurs when bone develops within membrane, as inthe bones of the face and skull.

*one maintenance

*one is a dynamic tissue in a constant state of turnover

+uring childhood bones grow 4 form by a process called modeling

-arly adulthood &early !"s' remodeling is the primary process5 remodelingmaintains bone structure 4 function through simultaneous resportion 4osteogenesis5 complete skeletal turnover occurs 67" years

*alance between bone resoprtion 4 formation is8

o 1hysical activity

9eight bearing activity acts to stimulate bone formation 4remodeling5 tend to be thick 4 strong

1pl who are unable to engage in regular weigh bearing haveincreased resorption from calcium loss 4 their bones becomeosteopenic 4 weak

o +ietary intake of certain nutrients esp. calcium

7"""3!""" mg calcium daily is essential in maintain adult bonemass

7#3!: ounces of milk dailyo several hormones

calcitriol functions to increase the amt of calcium in the blood bypromoting absorption of calcium from the ;) tract5 also facilitatesminerali0ation of osteoid tissue

a deficiency of


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1T= 4 calcitonin are major hormonal regulators of calciumhomeostasis5 1T= regulates the concentration of calcium in theblood, in part by promoting mvmt of calcium from the bone5 lowcalcium levels cause increased levels of 1T=>deminerali0ation ofbone> formation of bone cysts5 alcitonin &secreted by thyroid dueto increase of calcium' inhibits bone resorption 4 increases

deposit of calcium in bone thyroid hormone 4 cortisol excessive thyroid hormone

production in adults &graves?' can result in increased boneresorption 4 decreased bone formation5 increased levels ofcortisol have the same effects5 pts receiving long3term syntheticcortisol or corticosteroids are at increased risk for steroid inducedosteopenia 4 fractures

growth hormone has direct 4 indirect effects on skeletal growth4 remodeling5 stimulates liver 4 to produce insulin like growthfactor37 &);(37' which accelerates bone modeling in children 4adolescents5 ;= also directly stimulates skeletal growth inchildren 4 adolescents &believed that low levels of of ;= 4 );(37

that occur w> aging may be responsible for decreased boneformation 4 resultant osteopenia'

sex hormones

estrogen stimulates osteoblast 4 inhibits osteoclast

therefore bone formation is enhanced 4 resorption isinhibited

testosterone directly causes skeletal growth in

adolescence 4 has continued effects on skeletal musclegrowth throughout the lifespan5 testosterone converts toestrogen in adipose tissue providing an additional sourceof bone preserving estrogen for men

bone remodeling &1%-A- 2-


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-xternal soft tissue where bridging callus forms that provides ability tothe fractured bones

D phases of fracture healing$

2eactive phase

There is a bleeding into the injured tissue and formation of a

fracture hematoma. cytokines are released that initiate the fracture healing process by

causing proliferation of fibroblast 4 that cause angiogenesis tooccur &growth of new blood vessels'

granulation tissue begins to form w> in the clot 4 becomes dense

)nflammation, swelling, and pain are present.

2eparative phase

;ranulation tissue initially replaced w> callus precursor, procallus

(ibroblast invade the procallus 4 produce a denser type of callus

that is composed mostly of fibrocartilage

(ibrocartilaginous callus is replaced w> denser bony callus w> in

approx. D3: weeks post3injury

%amellar bone then forms as the bony callus calcifies months

post3injury

2emodeling

The final stage of fracture repair.

2emodeling is the new bone into its former structural

arrangement.

May take months to years depending on the extent of bone

modification needed, the function of the bone, 4 functionalstresses on the bone

ancellous bone heals and remodels more rapidly than does

compact cortical bone.

serial x3rays are used to monitor the progress of bone healinga. type of bone fracture, the ade6uacy of blood supply, the surface contact

of the fragments, the immobility of the fracture site, the age 4 generalhealth of the person influence the rate of fracture healing

b. ade6uate immobili0ation is essential until after there is x3ray evidence ofbone formation w> ossification

fractures treated w> open rigid compression plate fixation techni6ues, bony

fragments can be placed in direct contact

primary bone healing occurs through cortical bone &haversian' remodeling5 little

or no cartilaginous callus develops5 immature bone develops from theendosteum5 intensive regeneration of new osteons &which develop the fracture

line by a process similar to normal bone maintainance fracture strength is obtained when the new osteons have become established

tructure and function of the articular system

Joint &articulation' the junction of two or more bones. Three basic kinds of

joints$

ynarthrosis immovable joints


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Amphiarthrosis limited motion of joints

+iarthrosis freely movable joints

Types of diarthrosis joints$

*all and socket joints permit full freedom of movement

=inge joints permit bending in one direction only

addle joints allow movement in two planes at right angles toeach other

1ivot joints permit rotation for such activities as turning adoorknob

;liding joints allow for limited movement in all directions

joint capsule tough, fibrous sheath that surrounds the articulating bones.

ynovium secretes the lubricating and shock absorbing synovial fluid into the

joint capsule.

%igaments fibrous connective tissue bands that bind the articulating bones

together.

*ursa a sac filled with synovial fluid that cushions the movement of tendons,

ligaments, and bones at a point of friction.

tructure and function of the skeletal muscle system

Tendons cords of fibrous connective tissue that attach muscles to bones,

connective tissue, other muscles, soft tissue or skin.

(asciculi parallel groups of muscle cells

(ascia fibrous tissue encasing fasciculi

keletal muscle contraction

-ach muscle cell &also referred to as a muscle fiber' contains myofibrils.

arcomeres contain thick and thin actin filaments. Muscle fibers contract in response to electrical stimulation delivered by an

effector nerve cell at the motor end plate. 9hen stimulated, the muscle celldepolari0e and generates an action potential manner similar to that described fornerve cells. These actions potentials propagate along the muscle cell membraneand lead to the release of calcium ions that are stored in speciali0ed organellescalled arcoplasmic reticulum.

alcium is rapidly removed from the sacromeres by active reaccumulation in the

sarcoplasmic reticulum. 9hen calcium concentration in the sacromeredecreases, the myosin and actin filaments cease to interact, and the sarcomerereturns to oits original resting length &relaxation'. Actin and myosin do not interactin the absence of calcium.

The primary source of energy for the muscle cells is adenosine triphosphate

&AT1', which is generated through the cellular oxidative metabolism.

At low levels of activity &eg, sedentary activity', the skeletal muscle synthesi0es

AT1 from the oxidation of glucose to water and carbon dioxide. +uring strenuousactivity, when sufficient oxygen may not be available, glucose is metaboli0edprimarily to lactic acid.


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+uring isometric contraction, almost all of the energy is released in the form of

heat5 during isotonic contraction, some of the energy is expended in mechanicalwork.

)n some situations, such as shivering because of cold, the need to generate heat

is the primary stimulus for muscle contraction.

Types of muscle contractions

)sometric contraction the length of the muscles remain constant but the force

generated by the muscles are increased.

)sotonic contraction shortening of the muscle with no increase in tension within

the muscle.

-x. +uring walking, isotonic contraction results in shortening of the leg and isometriccontraction causes the stiff leg to push against the floor.

Myoglobulin is a hemoglobin3like protein pigment present in striated muscle cells

that transports oxygen. Muscles containing large 6uantities og myoglobulin &red muscles' have been

observed to contract slowly and powerfully &eg, respiratory and postural muscles'

Muscles containing little myoglobulin &white muscles' contract 6uickly &eg,extraocular eye muscles'.

Muscle tone

Tone &tonus' state of readiness

(laccid muscle that is limp and without tone

pastic 3 muscle with greater3than3normal tone

Atonic soft and flabby muscles

Muscle actions

ynergists muscles assisting the prime mover

Antagonists muscles causing movement opposite to that of the prime mover.

-xercise, disuse, and repair

Muscles need to be exercised to maintain function and strength.

=ypertrophy increase in si0e of individual muscle fibers without an increase in

the number of muscle fibers. Atrophy decrease in the si0e of the muscle.

*ed rest and immobility cause loss of muscle mass and strength.

*ody movements produced by muscle contraction

(exion bending at a joint &eg, elbow'

-xtension straightening at a joint


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Abduction moving away from midline

Adduction moving toward midline

2otation turning around a specific axis &eg, shoulder joint'

ircumduction cone3like movement

upination turning upward

1ronation turning downward )nversion turning inward

-version turning outward

1rotraction pushing forward

2etraction pulling backward

1hysical assessment$

1osture

The normal curvature of the spine is convex through the thoracic portion and

concave through the cervical and lumbar portions.

ommon deformities of the spine include$ yphosis increased forward curvature of the thoracic spine

%ordosis or sway back, an exaggerated curvature of the lumbar spine

coliosis lateral curving deviation of the spine

;ait

;ait is assessed by having the patient walk away from the examiner for a short

distance.

The examiner observes the patient?s gait for smoothness and rhythm.

Any unsteadiness or irregular movements are considered abnormal.

*one integrity The bony skeleton is assessed for deformities and alignment.

ymmetric parts of the body are compared.

Joint function

The articular system is evaluated by noting the range of motion, deformity,

stability, and nodular formation.

2ange of motion is evaluated both actively and passively.

;oniometer a protractor designed for evaluating joint motion.

Muscle strength and si0e

The muscular system is assessed by noting the patient?s ability to changeposition, muscular strength and coordination, and the si0e of individual muscles.

kin

The nurse inspects the skin for edema, temperature, and color

@eurovascular tatus

1erform fre6uently b>c of risk for tissue 4 nerve damage


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ompartment syndrome caused by pressure w>in a muscle compartment

that increases to such an extent that microcirculation diminishes leading tonerve 4 muscle anoxia and necrosis5 function can be permanently lost if theanoxic situation continues for longer than # hours

@erve Test of sensation Test of movement

1eroneal nerve 1rick the skin centeredbetween the great andsecond toe

Ask the patient to dorsiflexthe ankle and extend thetoes.

Tibial nerve 1rick the medial and lateralsurface of the sole

Ask the patient toplantarflex toes and ankle.

2adial nerve 1rick the skin centeredbetween the thumb andsecond finger

Ask the patient to stretchout the thumb, then the

wrist, and then the fingersat the metacarpal joints.

Clnar nerve 1rick the fat pad at the topof the small finger.

Ask the patient to spread allfingers.

Median nerve 1rick the top or distalsurface of the index finger.

Ask the patient to touch thethumb to the little finger.Also observe whether thepatient can flex the wrist.

+iagnostic evaluation

)maging procedures

E3ray studies

*one x3rays determine bone density, texture, erosion, and changes in bonerelationships.

Multiple x3ray are needed for full assessment of the structure beingexamined.

E3ray study of the cortex of the bone reveals any widening, narrowing, orsigns of irregularity.

Joint x3ray reveal fluid, irregularity, spur formation, narrowing, and changes inthe joint structure.

omputed tomography

T scan shows in detail a specific plane of involved bone and can revealtumors of the soft tissue or injuries to the ligaments or tendons.

)dentify the location and extent of fractures in areas that are difficult toevaluate &eg, acetabulum'. T studies, which may be performed with or

without the use of contrast agents, last about 7 hour.

Magnetic resonance imaging

Jewelry, hair clips, hearing aids, credit cards with magnetic strips, and othermetal3containing objects must be removed before the M2) is done5 otherwisethey can become dangerous projectile objects.

Arthrography


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)s useful in identifying acute or chronic tears of the joint capsule or supportingligaments of the knee, shoulder, ankle, hip or wrist.

A radiopa6ue substance or air is injected into the joint cavity to outline softtissue structures and the contour of the joint.

*one densitometry

)s used to estimate bone mineral density &*M+'. This can be done throughthe use of x3rays or ultrasound.

+ual3energy x3ray absorptiometry &+-EA' determines bone mineral density atthe wrist, hip or spine to estimate the extent of osteopososis and to monitor apatient?s response to treatment for osteoporosis.

*one sonometry &ultrasound' measures heel bone 6uantity and 6uality and isused to estimate *M+ and the risk of fracture for people with osteoporosis.

*one density sonography is a cost3effective, readily available screening toolfor disgnosing osteoporosis and predicting a person?s risk for fracture.

@ursing interventions $

*efore the patient undergoes an imaging study, the nurse should assess forconditions that may re6uire special considerations during the study or that maybe contraindications to the study.

)t is essential that the patient remove all jewelry, hair clips, hearing aids, and

other metal before having an M2).

)f contrast agent will be used, the nurse should carefully assess the patient for

possible allergy.

*one scan

)s performed to detect metastatic and primary bone tumors, osteomyelitis,certain faractures, and aseptic necrosis.

@ursing interventions $

*efore a bone scan, the nurse should ask about possible allergy to radioisotope.

Assess for any condition that would contraindicate performing the procedure.

-ncourage the patient to drink plenty of fluids.

Ask the patient to empty the bladder before the procedure.

Arthroscopy

)s a procedure that allows direct visuali0ation of a joint to diagnose jointdisorders.

The procedure is carried out in the operating room under sterile conditions5injection of a local anesthetic into the joint or general anesthesia is used.

A large3bore needle is inserted, and the joint is distended with saline.

The arthroscope is introduced, and joint structures, synovium and articularsurfaces are visuali0ed.

After the procedure, the puncture wound is closed with adhesive strips orsutures and covered with a sterile dressing.

@ursing interventions$

9rap the joint with a compression dressing to control swelling.


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carry out movements of the body. D Types$

7. M//T=

This type of muscle is also called visceral, plain and involuntary muscles.

This muscle is present as sheets in the walls of the blood vessels, the

gastrointestinal tract, urinary bladder, ducts of the reproductive system,ureters, respiratory passages, lymphatic vessels, capsule of the spleen,around hair follicles, within connective tissue of the skin and within theeyeball.

)t is not under voluntary control.

!. A2+)A MC%-

This type of muscle is also called striated involuntary or heart muscle.

)t beats spontaneously and in rhythm.

D. -%-TA% MC%-

This type of muscle is striated voluntary and attached to bones.

)t is composed of parallel bundles of fibers which are the units of histologicalorgani0ation.

keletal muscles are attached to the skeleton and permit movements.

The are excitable and capable of contraction or extension.

Arrangement of the skeleton is usually in antagonistic pairs so that one

muscle is extended while the other contracts. After a force that has beenapplied to a muscle is released, the muscle will return to its normal lengthbecause of the characteristics of elasticity. The muscles are attached to thebones at points of insertion by strong fibrous tendons. -ach muscle also hasa point of origin, which is usually more fixed than the point of insertion.

Muscle contraction is initiated by a nerve impulse that reaches the muscle

fiber at the myoneural junction. The nerves are located in the middle of thefiber so that the impulse spread out toward both ends, allowing for morecoincident contraction of all sacromeres. -nergy for contraction is supplied bythe breakdown of AT1. /xygen and glucose are also needed for thisreaction.

keletal muscles are divided according to the following$

7. According to locationa. )ntercostal muscle between ribsb. (emoris muscle in the femurc. *rachii muscle in the arm

!. According to direction of fibersa. 2ectus straightb. Transverse acrossc. /bli6ue obli6ue, diagonal

D. According to the type of action performeda. Abductor muscle which move limb &or other part' away from the midline

of body.


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b. (lexor muscle which bend a limb at a jointc. %evator muscle which lift a part eg, eyelidd. -xtensor muscle which straighten a limb at a jointe. Adductor muscle which move a limb &or other part' towards the midline.

:. According to the shape or si0e

a. +eltoid from greek letter FdeltaGb. Trape0ius four3sidedc. Maximus largestd. %ongus longeste. Minimus smallestf. *revis shortg. (usiform spindle shapedh. 2homboid 6uadrilateral

H. According to the number of the heads or origina. *iceps muscle with ! headsb. Triceps muscle with D heads

c. Iuadriceps muscle with : heads

A skeletal muscle has D parts namely$

7. /rigin, the end which is the more fixed point of attachment!. )nsertion, the end which is freely movable.D. *ody or *elly, the portion between the origin and insertion.

Attachment of skeletal muscle may either be tendons or fasciae.

7. Tendons attach muscle to bone. *road sheats of tendons are termedaponeurosis.

!. (asciae &singular fascia' are tough fibrous connective tissues which separatemuscles from one another and hold them in position.

Muscles are also named according to movement

7. 1rime mover or agonist muscle which execute actual movement e.g., thebiceps in flexion of elbow

!. Antagonist muscle that acts against the prime mover, e.g., the triceps in flexionD. ynergist muscle that enables prime mover e.g., perform the action efficiently

and smoothly.:. (ixator muscle which studies the bone giving origin to the prime mover so that

the insertion will move.

-%-T/@

The bone consist of cells, fibers and ground substances.

)t is calcified, making it hard substance suited for supportive and protective

functions.

*one tissue is nourished by the haversian system. i.e., a network of minute

canals traversed with blood vessels.

*one tissue is constantly crerated and reabsorbed.

These ! processes$ i.e., bone creation &deposition' by osteoblasts and bone

reabsorption, determine skeletal bone si0e and strength.


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). -%-TA% (C@T)/@7. 1rovides attachment of muscles, tendons and ligaments!. 1rotects delicate: organs of the body &e.g., brain, heart, lungs and other soft

tissue'D. tores minerals salts, e.g., calcium, phosphorous and release them whenever

necessary.

:. -ncloses bone marrow which is responsible for production of blood corpuscles.H. Assists with movement by providing leverage and attachment for muscles.

)). */@- =)T/%/;B

=istologically, bones consist of ! types7. ompact bone i.e., strong and dense with closely spaced lamellae &concentric

layers of mineral depositions'.!. ancellous i.e., spongy appearance with more widely spaced lamellae.

*etween layers of lamellae are small cavities called lacunae. uspended in tisuuefluid within each lacuna is an osteocyte &mature bone forming cells'. Tiny canals&canaliculi' connects the lacunae and hence the osteocytes.

2ed bone marrow has a hematopoietic function &manufactures red and white blood

cells' and is located in cancellous bone spaces.

Bellow marrow occurs in the shaft of long bones and extends into the haversiansystems. Bellow marrow is connective tissue composed of fat cells. *lood supply tobone comes$

&a' via arterioles through the haversian canals,&b' via vessels in the periosteum that center bone through the minute


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:. )rregular bones are bones of no definite shape. The thinner part consist of twoplates of compact bone with cancellous bone between them while the bulky partconsist of cancellous bone surrounded by a layer of compact bone.

-xample$ skull and vertebraeH. esamoid bones are rounded, bones which develop in the capsules of joints or

in tendons. The function of this bone is to eliminate friction and increase leverage

of muscle.-xample$ patella, knee cap

)


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!.' kull bones

- the facial bones consist of 7 mandible 7 vomer, ! maxillary, ! xygomatic.! nasal, ! lacrimal, ! inferior nasal conchae and ! palatine.

a. Mandile the strongest and the longest bone of the face. )t is the bone ofthe lower jaw.

b. Maxilla the upper jaw is formed by the fusion of two maxillae which

articulate with the frontal bone.c. @asal bone paired nasal bones join to form the bridge of the nose.d. 1alatine bone two bones forming the posterior of the roof of the mouth

or hard palate.e. Lygomatic bone the two bones forming the prominence of the cheek

called malar bones and rest upon the maxillae articulating with their0ygomatic processes.

f. %acrimal bone the paired bone make up part of the orbit at the innerangle of the eye.

g. @asal onchae or )nferior Turbinae bones lies immediately below eachnostril on the lateral side.

h.


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c. (ree or floating ribs last ! pairs and are attached in front.

- The spaces between the ribs are called intercostals spaces and are filledwith muscle.

*. A11-@+)C%A2 -%-T/@- The appendicular skeleton is composed of bones of the upper and lower

extremities including the shoulder and pelvic girdles.

. !ones o" the #pper E$tre%it&a. houlder girdle this is made of clavicle and scapula on each side of the

body. )t serves to attach the bones of the upper extremities to the axialdivision of the skeleton and provides places for muscle attachments.

7.' lavicle known as the collar bone located at the root of the neck andanterior to the first rib.

!.' capula a large flat triangular bone located on the dorsal portion of thethorax covering the area from the !ndrib to the thrib. )t serves as theorigin for some muscles that move the arm.

b. =umerus long bone of the upper arm

c. 2adium lies on the lateral thumb side of the forearmd. Clna lies on the medial side of the forearme. arpals there are in each extremityf. Metacarpals the palm of the hand consist of H metacarpal bones, each

with a base, shaft and head.'. !ones o" the Lower E$tre%it&

a.1elvic ;irdle supports the trunk and provides attachment for the legs. )t is madeup of hip bone or os coxae on each side of the body. This is the broadest bone ofthe body.

)lium uppermost and largest portion of the pelvic bone

)schium lowest and strongest portion of the pelvic bone

1ubic lies superior and slightly anterior to the ischium. *etween the pubis and

the ischium is an obturator foramen.b.(emur form the bone of the thigh. )t is the heartiest, largest and strongest bonein the body. )t transmits the entire weight of the trunk from the hip to the tibia.

c.1atella or knee cap largest seasamoid bone in the body and is embedded in thetendon of the 6uadriceps femoris. )t is movable and serves to increase leverage ofmuscles that straighten the knee.

d.!ones o" the le(

Tibia medial and larger bone of the leg also known as skin bone

(ibula a long, slender bone on the lateral side of the leg.

e. !ones o" the "oot

Tarsal bone in each foot are arranged in the hindfoot and forefoot.

Metatarsals bases of the inner three five metatarsals articular with the D

cuneiform bones and those of the outer teo warticulates with the cuboid.

1halanges there are 7: in each foot, ! of which are in the great toes and D in

each of the other toes.


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+)A;@/T) A-M-@T

. )adiolo(ic Studiesa. 2oentgenograms &E3ray films' to establish presence of musculo3skeletal

problems, follow its progress and evaluate treatment effectiveness.

1lain E3ray film is common usually from antero3posterior &A1'

and>or lateral view.b. Arthrography injection of a dye or air in the joint for x3ray studyc. Myelography examines the spinal cord after introduction of the contrast

medium.d. T can useful is assessing some bone and soft tissue tumors and

some spinal fractures.

'. !lood Studiesa. -2 non3specific test for inflammationb. Cric Acid usually elevated in goutc. Antinuclear antibody assess presence of antibodies capable of

destroying cell nuclei.

-positive in about K:N of clients with %-

d. Anti +@A detects serum antibodies that react with +@A- most specific test for %-e. Test of Mineral Metabolism

alcium decreased levels found in osteomalacia, hypoparathyroidism.

- increased levels found in bone tumors, acute osteoporosis,hyperparathyroidism.

1hosphorus increased levels found in healing fractures, chronic

renal disease.f. Muscle -n0yme tests

reatine 1hosphorus highest concentration found in skeletal

muscle.3 increased levels found in traumatic injuries, progressive musculardystrophy

Adolase useful in monitoring muscular dystrophy and

dermatomyositisD. Arthroscop& direct visuali0ation of a joint usong an arthroscope after injection of

local anesthesia.

:. Arthrocentesis method of aspirating synovial fluid, blood or pus via a needleinserted into the joint cavity.

H. E*+ , Electro%&elo(raph& non3invasive test that graphically records the

electrical activity of the muscle at rest and during contraction.

#. !one scannin( radio isotope that are Ftaken upG by bones are injectedintravenous &usually @a pertechnetae KK MTc'.

Musculoskeletal care modalities

Managing care of the patient in a cast


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c. =anging ast fracture of radius ulnar with callus

D.' %/9-2 -ET2-M)TB )2C%A2 ATa. hort leg circular cast &boot cast' affections of ankle and toesb. 9alking ast affections of the ankle with callus formationc. 1T* 1atellar Tendon *earing ast fracture of the tibia fibula with callus

d. %ong %eg ircular ast fracture of tibia fibulae. Iuadrilateral ast fracture of the shaft femur with good callus formationf. ylinder ast fracture of patella

/*-2


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7 4 O hip spica

+ouble hip spica

(rog ast congenital hip dislocation

1anatalon ase fracture of the pelvis

/bservations on patients in spica type7. igns of respiratory distress!. igns of cast syndromeD. igns of impaired circulation on toes:. signs of urinary bowel disturbanceH. signs of infection tissue necrosis#. pressure around edge of cast below nipple axillary, iliac crest, buttocks, sacral,

groin, knee and metatarsals.

asting materials

@on plaster

2eferred to as fiberglass casts, these water3activated polyurethane materials

have the versatility of plaster but are lighter in weight, stronger, water resistant,and durable.

They are used for non displaced fractures with minimal swelling and for long

term wear.

1laster

The traditional cast is made of plaster. 2olls of plaster bandage are wet in cool

water and applied smoothly to the body.

A crystalli0ing reaction occurs, and heat is given off.

1%)@T /2 1/T-2)/2 M/%+

). C11-2 -ET2-M)TB

a. hort arm posterior mold affections of the wrist and infection, open woundsb. %ong arm, posterior mold infections of the forearm, open woundsc. ugar tong affections of the shoulder, upper portion of humerus with infections,

open wounds.d. Abduction plint fracture of the neck of humeruse. ock3up3splint fracture of the neck of humerusf. *anjo splint brachial nerve paralysisg. +ennis *rowne splint congenital clubfoot

)). %/9-2 -ET2-M)TBa. hort leg posterior mold affections of the ankle and toes with infections, openwounds.

b. %ong leg posterior mold affections of the knees, tibia fibula with infections,open wounds

c. @ight splint post polio with residual paralysis of lower extremityd. pica Mold affections of the hip, femur3like septic hip, osteomyelitis

@/T-$ /bservations same as in a circular type of cast for upper and lower extremity.


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*2A-

Types$a. Milwaukee brace scoliosisb. Taylor body brace 1otts disease on thoracic vertebraec. Jawet brace compression fracture of vertebral bodyd. hant0 collar cervical spine affection

e. /M) sterno occipito madibular immobili0er cervical spine affectionf. (orester cervico thoraco3lumbar affectionsg. hair back dorso3lumbar affections

T2AT)/@

is an act pulling and drawing which is associated with counter traction.

1C21/->)@+)AT)/@

(or immobili0ation

To prevent and correct deformity

To maintain good alignment To give support to reduce pain and muscle spasm

To reduce fracture

12)@)1%- /( T2AT)/@

7. eep body alignment at normal position the client in dorsal recumbent!. (or every traction, there is always a counter traction

use shock blocks

use half ring Thomas splint

D. (or traction to be effective, it must be applied continuously:. The line of pull must be in line with deformityH. (riction should be eliminated

9eights should be hanging freely

2ope of sash cord runs freely along the pulley

nots should be away from the pulley

9eights should not be resting on the floor

/bserve the rope and bag weights for signs of wear and tear.

TB1- /( T2AT)/@ according to manner of application

7. Manual Traction traction applied to the body by the hand of operator!. kin Traction traction applied at the surface of the skin and soft tissue and

indirectly to the bone using adhesive elastic bandage and spreaderE$a%ples$ *ryant Traction, 2ussell Traction

D. keletal Traction traction applied directly to the bone using pin, wires, tongs-xample$ =alo pelvic traction, rutchfiels tong traction:. (illed or adjustable traction traction applied to the body using devices like

canvass, laces, buckles, leathers used according to the side of the patient.E$a%ples$ Anklet Traction 1elvic trap Traction

=ead =alter Traction


22/43

@C2)@; +)A;@/) (/2 %)-@T )@ T2AT)/@

7. 1otential for immobility related to therapy3 provide for active motion of the unaffected joints3 deep breathing coughing exercise

!. 1otential for neurovascular compromise related to tractionD. 1otential for skin breakdown related to pressure on soft tissues.

:. 1otential for complication like )nfection at the pin>wire site inspect insertion sites carefully every shift, cleanse

sites with saline, peroxide or betadine, use antibiotic ointments and dry steriledressing if ordered.

1neumonia, atelectasis

ontractures

onstipation

*edstore

H. 1otential for boredorm#. ocial isolation. 1artial self3care deficit

ommon musculoskeletal problems$

Acute lower back pain

Acute low back pain refers to patients who have a problem with their back that

occurred within hours to 7 month.

)s the recent onset of back pain in the lumbar region.

1ain in this area can derive from any of the regionPs structures, including the

spinal bones, the discs between the vertebrae, the ligaments around the spine,the spinal cord and nerves, muscles of the low back, internal organs of the pelvis

and abdomen, and the skin covering the lumbar area.

*ack pain is classified into three categories based on the duration of symptoms $

Acute back pain is arbitrarily defined as pain that has been present for six weeks

or less.

ubacute back pain has a six3 to 7!3week duration.

hronic back pain lasts longer than 7! weeks.

linical manifestations$

ondition$ linical clues$

@onspecific back pain &mechanicalback pain, facet joint pain,osteoarthritis, muscle sprains,spasms'

@o nerve root compromise,locali0ed pain over lumbosacralarea

ciatica &herniated disc' *ack3related lower extremitysymptoms and spasm in radicularpattern, positive straight leg raising


23/43

test

pine fracture &compressionfracture'

=istory of trauma, osteoporosis,locali0ed pain over spine

pondylolysis Affects young athletes&gymnastics, football, weight

lifting'5 pain with spine extension5obli6ue radiographs show defect ofpars interarticularis

Malignant disease &multiplemyeloma', metastatic disease

Cnexplained weight loss, fever,abnormal serum proteinelectrophoresis pattern, history ofmalignant disease

onnective tissue disease&systemic lupus erythematosus'

(ever, increased erythrocytesedimentation rate, positive forantinuclear antibodies,scleroderma, rheumatoid arthritis

)nfection &disc space, spinal

tuberculosis'

(ever, parenteral drug abuse,

history of tuberculosis or positivetuberculin test

Abdominal aortic aneurysm )nability to find position of comfort,back pain not relieved by rest,pulsatile mass in abdomen

auda e6uina syndrome &spinalstenosis'

Crinary retention, bladder or bowelincontinence, saddle anesthesia,severe and progressive weaknessof lower extremities

=yperparathyroidism )nsidious, associated withhypercalcemia, renal stones,constipation

Ankylosing spondylitis &morningstiffness'

ostly men in their early !"s,positive for =%A3*! antigen,positive family history, increasederythrocyte sedimentation rate

ommon problems of the upper extremity$

*ursitis

9hether youPre at work or at play, if you overuse or repetitively stress your bodyPs

joints, you may eventually develop a painful inflammation called bursitis.

Bou have more than 7H" bursae in your body. These small, fluid3filled sacs

lubricate and cushion pressure points between your bones and the tendons andmuscles near your joints. They help your joints move with ease.

*ursitis occurs when a bursa becomes inflamed. 9hen inflammation occurs,

movement or pressure is painful.


24/43

*ursitis often affects the joints in your shoulders, elbows or hips. *ut you can

also have bursitis by your knee, heel and the base of your big toe.

*ursitis pain usually goes away within a few weeks or so with proper treatment,

but recurrent flare3ups of bursitis are common.

igns and symptoms

)f you have bursitis, you may notice$

A dull ache or stiffness in the area around your elbow, hip, knee, shoulder, big

toe or other joints A worsening of pain with movement or pressure

An area that feels swollen or warm to the touch

/ccasional skin redness in the area of the inflamed bursa

Tendinitis

Tendinitis is inflammation or irritation of a tendon Q any one of the thick fibrous

cords that attach muscles to bones.

The condition, which causes pain and tenderness just outside a joint, can occur

in any of your bodyPs tendons.

Tendinitis is common around your shoulders, elbows, wrists and heels.

igns and ymptoms

Tendinitis that is produced near a joint aggravated by movement include the following$

1ain

Tenderness

Mild swelling, in some cases

Tendinitis in various locations in your body produces these specific types of pain$

Tennis elbow. This type causes pain on the outer side of your forearm near your

elbow when you rotate your forearm or grip an object. ;olferPs elbow causes painon the inner part of your elbow. Achilles tendinitis. This form causes pain just above your heel.

Adductor tendinitis. This type leads to pain in your groin.

1atellar tendinitis. )n this type, you experience pain just below your kneecap.

2otator cuff tendinitis. This tendinitis leads to shoulder pain.

arpal tunnel syndrome


25/43


26/43

Though they are fixed in one place, they may RgiveR a little when you push

against them.

+upuytrenPs contracture

+upuytrenPs contracture is a rare hand deformity in which the connective tissue

&fascia' under the skin of the palm thickens and scars. nots &nodes' and cords of tissue form under the skin, often pulling one or more

of the fingers into a bent &contracted' position.

Though the fingers affected by +upuytrenPs contracture bend normally, they canPt

be straightened, making it difficult to use your hand.

igns and symptoms

+upuytrenPs contracture usually begins as a thickening of the skin on the palm of

your hand. As +upuytrenPs contracture progresses, the skin on the palm of yourhand may appear dimpled.

A firm lump of tissue may form on your palm. This lump may be sensitive to the

touch, but usually isnPt painful.

)n later stages of +upuytrenPs contracture, cords of tissue form under the skin on

your palm. ords may extend up to your fingers. As these cords tighten, yourfingers may be pulled toward your palm, sometimes severely.

The ring finger and the little finger are most commonly affected, though the

middle finger may also be involved. /nly rarely are the thumb and index fingeraffected.

+upuytrenPs contracture often affects both hands, though one hand is usually

affected more severely than the other.

+upuytrenPs contracture usually progresses slowly, over several years.

/ccasionally it can develop over weeks or months. )n some people it progressessteadily and in others it may start and stop. =owever, +upuytrenPs contracturenever regresses.

ommon foot problems$

1lantar fasciitis

Most commonly, heel pain is caused by inflammation of the plantar fascia Q the

tissue along the bottom of your foot that connects your heel bone to your toes.

1lantar fasciitis causes stabbing or burning pain thatPs usually worse in the

morning because the fascia tightens &contracts' overnight. /nce your footlimbers up, the pain of plantar fasciitis normally decreases, but it may return afterlong periods of standing or after getting up from a seated position.


27/43

igns and symptoms

harp pain in the inside part of the bottom of your heel, which may feel like a knife

sticking in the bottom of your foot

=eel pain that tends to be worse with the first few steps after awakening, when

climbing stairs or when standing on tiptoe

=eel pain after long periods of standing or after getting up from a seated position

=eel pain after, but not usually during, exercise

Mild swelling in your heel

orns and calluses

Bour skin often protects itself by building up corns and calluses Q thick,

hardened layers of skin.

Although corns and calluses can be unsightly, you need treatment only if they

cause discomfort.

)f you have diabetes or another condition that causes poor circulation to your

feet, youPre at greater risk of complications.

igns and symptoms

Bou may have a corn or callus if you notice$

A thick, rough area of skin A hardened, raised bump Tenderness or pain under your skin (laky, dry or waxy skin

orns and calluses are often confused, but theyPre not the same thing.

orns

Are smaller than calluses and have a hard center surrounded by inflamed

skin.

orns usually develop on parts of your feet that donPt bear weight, such

as the tops and sides of your toes.

orns can be painful when pushed or may cause a dull ache.

alluses

Csually develop on the soles of the feet, especially under the heels or

balls, on the palms, or on the knees.

alluses are rarely painful and vary in si0e and shape.

They can be more than an inch in diameter, making them larger than

corns.


28/43

)ngrown toenails

An ingrown toenail is a common condition in which the corner or side of one of

your toenails grows into the soft flesh of that toe.

The result is pain, redness, swelling and, sometimes, an infection. An ingrown

toenail usually affects your big toe.

igns and symptoms

1ain and tenderness in your toe along one or both sides of the nail

2edness around your toenail

welling of your toe around the nail )nfection of the tissue around your toenail

=ammertoe and mallet toe

A hammertoe is a toe thatPs curled due to a bend in the middle joint of a toe.

Mallet toe is similar, but affects the upper joint of a toe.

*oth conditions are commonly caused by shoes that are too short or heels that

are too high. Cnder these conditions, your toe may be forced against the front of

your shoe, resulting in an unnatural bending of your toe.

igns and symptoms

A hammer3like or claw3like appearance of a toe

)n mallet toe, a deformity at the end of the toe, giving the toe a mallet3like

appearance

1ain and difficulty moving the toe

orns and calluses resulting from the toe rubbing against the inside of your

footwear

*unions > hallux valgus

A bunion is an abnormal, bony bump that forms on the joint at the base of your

big toe.

Bour big toe joint becomes enlarged, forcing the toe to crowd against your other

toes. This puts pressure on your big toe joint, pushing it outward beyond thenormal profile of your foot, and resulting in pain.


29/43

*unions can also occur on the joint of your little toe &bunionette'.

*unions can occur for a number of reasons, but a common cause is wearing

shoes that fit too tightly. They can also develop as a result of inherited structuraldefect, injury, stress on your foot or another medical condition.

igns and symptoms

A bulging bump on the outside of the base of your big toe

welling, redness or soreness around your big toe joint

Thickening of the skin at the base of your big toe

orns or calluses Q these develop where the first and second toes overlap

1ersistent or intermittent pain

2estricted movement of your big toe

MortonPs neuroma

A neuroma is a noncancerous &benign' growth of nerve tissue that can develop in

various parts of your body.

MortonPs neuroma occurs in a nerve in your foot, often between your third and

fourth toes.

The condition isnPt a true tumor, but instead involves a thickening of the tissue

around one of the digital nerves leading to your toes.

MortonPs neuroma causes a sharp, burning pain in the ball of your foot. Bour toes

also may sting, burn or feel numb if you have MortonPs neuroma.

Also called plantar neuroma or intermetatarsal neuroma, MortonPs neuroma may

occur in response to irritation, injury or pressure Q such as from wearingtightfitting shoes.

igns and symptoms

A burning pain in the ball of your foot that may radiate into your toes

Tingling or numbness in your toes

At first, the pain may worsen when you wear tight or narrow shoes or engage in

activities that place pressure on your foot.

(latfeet > pes planus

)f you have flatfeet, the arch on the inside of your feet is flattened.

(latfeet usually doesnPt cause a problem. =owever, flatfeet can contribute to

problems in your feet, ankles and knees.


30/43

igns and symptoms

A flat look to one or both of your feet

Cneven shoe wear and collapse of your shoe toward the inside of your flat foot

%ower leg pain or weakness

1ain on the inside of your ankle

welling along the inside of your ankle

(oot pain

)@(%AMMAT/2B /@+)T)/@$

TB1-

7. Arthritis rheumatic disease involving joint symptoms and abnormalities!. @on3articular rhematic diseases involves pathologic changes in structures

related to joints but not within joint themselves.

a. (ibrositis connective tissue inflammation in any location especially aroundthe joints, and in or near the tendons, muscle sheats or other fasciae layers.

b. *ursitin inflammation of the bursa major. *ursa are located in shoulder,elbow, hips, knees

c. Tendinitis inflammation of the tendons.d. Myositis inflammation of voluntary musclese. 1eritendinitis inflammation of tendon sheatsf. ynovitis inflammation of synovial membraneg. Tenosinovitis inflammation of tendon, tendon sheats, and synovial

membrane commonly in hands, wrists, ankle and feet.

);@ A@+ BM1T/M

%imited movement

%oss of function

1ain

welling

2edness

ACT/3)MMC@- +)/2+-2$

2=-CMAT/)+ A2T=2)T)

)t is a connective tissue disease characteri0ed by chronic inflammatory changes

in the synovial membrane and other structure.

)s a chronic systemic disease although most prominent as a non suppurative

inflammation in the diarthroidal joints, may also be manifested by lesion of thevasculature, lungs, nervous system, and other major organs of the body.


31/43

-tiology

-xact cause is unknown

=ereditary

)nfection

tress

Metabolic disorder Auto3immune

Allergic phenomenon

1athology

- sta(es o" rheu%atoid arthritis

TA;- 7 )@/


32/43

D. -levated body temperature:. Morning stiffnessH. 1aresthesias of hands and feet#. plenomegaly. -nlarged lymph nodes. igns of anemia

%A) 2A S even or more criteria observed

+-()@)T- 2A S H criteria with joint signs or symptoms continues for at least #

weeks

12/*A*%- 2A S D criteria with joint signs or symptoms continuous for at least #

weeks

1/)*%- 2A S ! criteria with joint signs or symptoms continuous for at least #

weeks.

%aboratory +iagnosis

-levated -2 %eukocytes

Anemia

%atex fixation test presence of rheumatoid factor

@arrowing of the joint spaces and crosion of articular surfaces on E3ray

examination

)nflammatory changes in synovial tissue obtained by biopsy

@ursing )nterventions

7. 1rovide rest keep joints as straight as possible. 1revent flexion deformities firm

mattress, no pillows under his knees use footboard and trochanter roll to preventexternal rotation.!. 2elieve pain by analgesics and @A)+, provide heat therapy as ordered 3 warm compresses. 3 heat paraffin to 7!H to 7!K ( &H!3H: 'D. +iet should be well balanced:. Anemia should be treatedH. Maitain mobility exercises are done slowly, increased gradually and not carried

past the point of being painful.

1assive exercises

)sometric -xercises client exerts force without changing the length of themuscle setting exercises, & alternating tightening and relaxing the muscle',

gluteal muscles setting by contracting and relaxing the buttocks, 6uadricepssetting pressing the popliteal space against the mattress.

2esistive -xercises those actively done by the client with manual ormechanical resistance. To develop muscle strength.

Treatment

7. Analgesic aspirin!. @on3steroidal anti3inflammatory drugs &@A)+' )ndocin )ndomethacinD. ;old compounds myochrysine sodium thiomalate


33/43

:. Antimalaria drugshloro6uine

=ydroxychloro6uineH. orticosteroids#. Antacids. 1araffin dips of affected extremity for relief of joint pain by providing uniform heat.

. urgery when medical therapy fails to reduce inflammation ynovectomy to remove access synovial fluid and tissue in order to

prevent recurrence of inflammation.

Arthrotomy opening in the joints to remove damaged tissue or calcium

deposits.

Arthrodesis fusion of the joint to give stability, correct deformity and

relieve pain.

Arthroplasty plastic reconstruction of a joint to permit mobility and weight

bearing and alleviate pain.

BT-M) %C1C -2BT=-MAT/C %-

hronic connective tissue disease involving multiple organ system.

)s a chronic inflammatory disease of autoimmune origin that affects primarily the

skin, joints and kidneys, although it may affect virtually every organ of the body.

linical features

7. etiology not clearly understood but believed to be auto3immune, hereditary andviral cause, drug3induced

!. most fre6uently found in young woman with signs and symptoms referable tojoints and skin

D. remissions and exacerbation

:. very difficult to validate diagnosis

D major areas are currently being researched as possible causes of %-$7. +enetic Factors family members of persons with %- have an increased chance ofdeveloping the disease.!. En/iron%ental Factors ultraviolet light is known to cause exacerbations.D.Alteration in the I%%une )esponse cause immune complexes containing antibodiesto be deposited in tissue, causing tissue damage.

@ecrosis of the glomerular capillaries, inflammation of cerebral and ocular bloodvessels, necrosis of lymph nodes, vasculitis of the ;) tract and pleura, anddegeneration of the basal layer of the skin.

igns and ymptoms$

. Sub0ecti/e

Malaise

1hotosensitivity

Joint pain

'. Ob0ecti/e

(ever


34/43

*utterfly erythema on the face

1ositive %- prep.

+iagnostic Tests

linically documented multiorgan damage

1ositive fluorescent anti nuclear antibody test &A@A' )ncrease -2

-levated serum rheumatoid factor

)ncreased 9*

+ecreased 2* and hemoglobin

2enal function test is elevated

1ositive %- cell test

Treatment

orticosteroids and analgesics to reduce pain and inflammation

upportive therapy as major organs become affected &heart, kidneys, @, ;)'

@ursing are

7. Administer medications and observe for side effects .!. =elp the clients and family code with severity of the disease as well as its poor

prognosis.D. )mprove and maintain nutritional status.

M-TA*/%) /@+)T)/@

;/CTB A2T=2)T)

)nflammation of the joints secondary to abnormal metabolism of uric acid.

Csually affects the big toe

)s ametabolic disorder that develops as a result of prolonged hyperuricemia

&elevated serum uric acid ' caused by problems in synthesi0ing purines or bypoor renal excretion of uric acid.

)ncidence highest in males, a familial tendency has been demonstrated.

May have deposition of uric acid crystal &tophi' in tissue or renal urate lithiasis

&kidney stone' may result from precipitation of uric acid in the presence of a lowurinary p=.

-tiology ;enetic defect in purine metabolism overproduction of uric acid

+ecreased uric acid excretion 2(

+iet high in purine

+iagnostic Test

-levated -2, 9*

)ncrease serum uric acid levels


35/43

ynovial fluid reveal urate crystals

igns and ymptoms

2edness, swelling joints

Joint pain

%imited movement Tophi urate crystals deposited in great toe, ankle, or increase wherein there is

dimished blood flow.

Management

Administration of anti3inflammatory and &A@T) ;/CT' agents to decrease

synthesis of uric acid- 1urinase- %lanol- ynol- yloprim- Allopurinol

alicytes @A)+

alkaline3ash diet to increase the p= of urine to discourage precipitation of uric

acid and enhance the action of drugs &C2)/C2) A;-@T' increase excretionof uric acid

*enemid 3 1robenecid

olsalide 3 olchicine

elimination of foods high in purines

weight loss is encouraged if indicated

+iet low purine diet, alkaline ash diet avoid shellfish, sardines, liver, kidneys,

internal organs

@ursing are$

7. Assess joint pain, motion and appearance!. Administer anti3 inflammatory agents such as *uta0olicin, oxypheabuta0one

&Tandearil', or endomethacin &)ndocin' with antacids or milk to prevent pepticulcers. /bserve therapeutic response.

D. areful align joints so they are slightly flexed during acute stage, encourageregular exercise, which is important for long term management.

:. Cse a bed cradle during the acute phase to keep pressue of sheets off joints.H. )ncrease fluid intake to !""" to D""" ml > day to prevent formation of calculi#. )nstruct client to avoid high3purine foods suchs as organ meats, anchovies,

sardines and shellfish diet.

/T-/A2T=2)T)

+egenerative joint disease also known as osteoarthritis is an extremely common

disease that is probably as old as civili0ation.

9omen are more severely affected by the disease, although the incidence rates

are the same for males and females


36/43

1rimary joint disease is the most common type of noninflammatory joint disease.

1rimary degenerative joint disease is distributed throughout the central andperipheral joints of the body, usually affecting the joints of the hand, wrist, neck,lumbar spine, hips, knees and ankle.

The etiology is unknown, but age is an important factor in the development of the

disease.

The 6uantity and 6uality of proteoglycans decrease with the aging process and

predispose the cartilage to breakdown and degenerate.

linical Manifestations

7. 1ain worse with weight bearing, improves with rest.!. welling and joint enlargement$a. =eberden?s @odes bony protuberances occurring on the dorsal surface of the

distal interphalangeal joints of the finger.b. *ouchard?s @odes bony protuberance occurring on the proximal

interphalangeal joints of the fingerc. oxachrosis &+egenerative Joint +isease of the hip' pain in the hip on weight

bearing, with pain progressing to include groin and medial knee pain.D. Muscular Atrophy from disuse, joint instability and deformity:. +ecreased 2ange of Motion depends on amount of destroyed cartilageH. Join stiffness worse in the morning and after a period of rest or disuse.

=A2AT-2)T) 1AT=/%/;) =A@;- A((-T)@; T=- A2T)C%A2

A2T)%A;-7. -rosion of articular cartilage!. Thickening of underneath the cartilageD. Medications to reduce symptoms such as analgesics, anti3inflammatory agents,

and steroids.:. -xercise of affected extremities.

H. urgical interventiona. ynovectomy removal of the enlarged synovial membrane before bone andcartilage destruction occurs.

b. Arthrodeseis fusion of a joint performed when the joint surfaces are severelydamaged, this leaves the client with no range of motion of the affected joint.

c. 2econstructive urgery replacement of a badly damaged joint with a prostheticdevice.

/T-/1/2/)

A clinical condition in which there is a decrease in total amount of bone to the

point that factures occur with minor trauma. alcium in the bone is depleted and the bone matrix fails to produce replacement

bone. The result is a weakening of the structure.

auses

-xact cause is not known

@utritional deficiency


37/43

-ndocrine disease hyperthyroidism, hyperparathyroidism, cushing?s syndrome,

women past menopause

1rolonged immobility due to lack of normal stresses and strains.

igns and ymptoms

%ow back pain or musculo3skeletal aching 1athological fracture

)ncrease in urinary calcium especially at night as calcium withdrawal increase.

Management

-xercise with fre6uent rest periods

Avoidance of severe fatigue

pinal support corset or light brace in upright position

Analgesic

Muscle relaxants

Ade6uate intake of protein,


38/43

*AT-2)A% A2T=2)T)

-tiology

invasion of the synovial membrane by microorganism, most often ;onocossi,

meningococci, coliforms, salmonellae and =aemophilus )nfluen0ae.

-pidemiology

susceptible to patient who had recent joint surgery and trauma, intraarticular

injections and rheumatoid arthritis.

1athophysiology

synovial tissue respond to bacterial invasion by becoming inflamed. The joint

cavity may become involved, and pus will be present in the synovial membraneand synovial fluid.

patient complain of pain, swelling, and tenderness of the joint

joint aspiration is helpful in making the diagnosisi if the presence of organism can

be demonstrated in the synovial fluid. 9hite blood cell will be high, and glucosecontent of fluid may be reduced.

Medical Management

7. Appropriate antibiotic therapy.!. 2est or immobili0ation of the joint.D. urgical drainage if infection does not respond to antibiotic therapy:. 2esumption of active range of motion when infection subsides and motion can be

tolerated.

@ursing Management

7. 1romoting rest of the affected joint.!. Administering antibiotics and pain medication as prescribed.D. -ncouraging the patient to participate within restriction of prescribed rest for joint.:. 1atient teaching$

a. -ncouraging active joint motion when motion is permitted.b. )nstructing in proper administration of antibiotics if theraphy is to be continued

after discharge.c. Assuring that patient is aware of plans for follow up with physician.

/T-/MB-%)T)

*one infection from pyrogenic microorganism i.e., taphylococcus Aureus K"N of cases

treptococcus

almonella

although the development of osteomyelitis is often precipitated by a traumatic

event or is a complication of trauma. )t is included with the degenerativedisorders because of its chronic and debilitating aspect.


39/43

! Types

a. E$o(enous Osteo%&elitis caused by pathogen from outside the body, such asfrom an open fracture or surgical procedure.

b. 1e%ate(enous Osteo%&elitis caused by blood3borne pathogen originating frominfectious site within the body. E$a%plesinclude sinus, ear, dental, respiratory

and genitourinary infectious.

1athophysiology

- )n hematogenous /steomyelitis, the organism reach the bone through thecirculatory and lymphatic system. The bacteria lodge in the small vesselsof the bone, triggering an inflammatory response.

- The femur, tibia, humerus and radius are commonly affectede.- *one inflammation is marked by edema, increased vasculature and

leukocyte activity. The infectious process weakens the cortex, therebyincreasing the risk of pathologic fracture.

- *rodie?s Abcesses are characteristic of chronic osteomyelitis.

-)n cases of exogenous esteomyelitis, the infections begin in the softtissue and eventually forming abscess.

- hronic /steomyelitis is difficult to treat. 2ecurrent infections, areas ofdead bone &se6uestrum', and scar tissues are contributing factors to itsresistance to treatment.

- 1atient may report fever, malaise, anorexia and headache. The affectedbody part maybe erythematous, tender and edematous. There maybe anopening in the skin, draining purulent material.

igns and ymptoms

1ain

=eat, redness, swelling, tenderness %imited movement

2ise in temperature, chills

;eneral body malaise and weakness

Marked leukocytosis

-levated -2

1ossibly, positive blood cultures

Management

Analgesic

Anti3inflammatory

Antibiotic especially 1enicillin9ound )rrigation

)ncision and drainage

+ebridement

omplete removal of dead bone and soft tissue

ontrol of infection

-limination of dead space &after removal of necrotic bone'

e6uestrectomy surgical removal of the dead infected bone and cartilage


40/43

@ursing are

Cse surgical aseptic techni6ue when changing dressings

Maintain functional body augment and promote comfort.

Allow the client ample time to express feelings about long term hospitali0ation.

Ctili0e room deori0er is a foul odor is apparent-ncourage nutrient dense diet to compensate for antibiotic impact on nutritional

status.

T* of the pine 1/TT? +isease

- bone infection caused by invasion in the body by ock?s bacillus

igns and ymptoms

Muscle spasm

tiffness

Tendency to reach things on the floor by bending the knees rather than the back.

-ffects usually the lower dorsal spine and upper lumbar spine.

;ibbus formation angulation or pronounce antero3posterior curve of the spine as in

hunchback due to collapse of the vertebrae

1aralysis occasionally

Afternoon fever

omplications abscess formation

7. ervical region pharynx respiratory problems.!. +orsal region mediastinum and may rupture into the lungs.

D. %umbar spine lumbar muscles or gluteal region or may follow the course ofilopsoas muscles and point in the groin &psoas abscess' 3 most common.

Management

7. Anti T* drugs- 2ifampicin- 1LA- )@=

!. )mmobili0ation Taylor body braceD. (resh air, sunshine and proper diet

+B1%A)A /( T=- =)1

ondition in which the head of the femur is improperly seated in the acetabulum,or hip socket, of the pelvis

ongenital or develop after birth

Neonate3 due to laxity of ligament around the hip, allowing the femoral head tobe displaced from the acetabulum upon manipulation.


41/43

I%ple%entation$ splinting of the hips with 1avlik harness to maintain flesion andabduction and external rotation &neonatal period'

Assess%ent 3 infacnts has asymmetry of the gluteal and thigh skin folds whenthe child is placed prone and the legs are extended against the examining table.

%imited range of motion in the affected hip.

Asymmetric abduction of the affected hip when the child is placed supine with theknees and hips flexed.

Apparent short femur on the affected side.

/@;-@)TA% =)1 +B1A)A

Traction and surgery to release muscles and tendons

Maintain abduction and external rotation & application of double diapers whenchanging the infant '.

(ollowing surgery, positioning and immobili0ation in a spica cast until healing isachieved.

9alking child has minimal to pronounced variation in gait with lurching toward theaffected side.

1ositive Trendelenburg sign

1ositive *arlow or /rtolani?s maneuver.

+-


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!. train injury to muscle or tendons. Treatment same as contusion

D. prain injury to ligamentous structures surrounding a joint, caused by wrenching ortwisting

:. +islocation a condition in which the articular surfaces of the bones forming the joints

are no longer in anatomic contact with one another.

linical Manifestations

hange in contour of the joint

hange in length of extremity

%oss of normal movement

hange in axis of dislocated bones.

H.(racture a break in the continuity of a bone

;eneral lassificationa. omplete (racture fracture involving the entire cross3section of the bonesb. )ncomplete (racture a fracture involving only a portion of the cross section of

the bone.c. /pen (racture &compound' break in the bone, skin and there?s communication

between the fracture site and the external air.d. losed (racture &simple' break in the bone, skin and there?s communication

between the fracture site and the external air.

pecific types of fracture

a. ;reenstick (racture fracture in which one side of a bone is broken, the otherside is being beat.

b. omminuted a fracture in which bone has splintered into fragments.c. +epressed a fracture in which a fragment is driven inward &fracture of skull,

facial bones'd. Transverse a break straight across the bonee. piral with the fracture lines partially encircling the bonef. piral with the line of fracture at an obli6ue angle to the bone shaft.

igns and ymptoms

7. igns of local trauma &injury to soft tissue'

pain

tenderness

swelling

bruising

muscle spasm

redness

!. +ue to damage to blood vessels

bleeding

D. repitus sound grafting sound produced as bones rub against each other:. hortening of extremityH. 1resence of deformity


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#. %imited function>loss of function. @umbness if with injury to the nerves

omplication of (racture

7. )mmediate3 shock

3 fat embolism3 injury to skin, muscle, blood vessels and nerves!. -arly3 infection gas gangrene, tetanus, osteomyelitisD. %ate3 non3union3 delayed union3 mal3union3 avascular necrosis of the bone

MA@A;-M-@T /( (2ATC2- &- )2s3

7. )ECO+NITION of presence of fracture

!. )E4#CTIONa. losed 2eduction done by manipulationb. /pen 2eductionc. Traction

D. )ETENTIONa. astb. Tractionc. *races and splintsd. *andage

:. )E1A!ILITATION restoration to normal function

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12th edition brunner & suddarth's unit 15

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