Assessment of the Musculoskeletal System

L / Hanaa Eisa 2015 - 2016

Learning outcome

At the end of this Lesson the study will be able to:1.Elicit a health history from a patient with a musculoskeletal ,chief complaint.2.Perform inspection and palpation of the musculoskeletal system.3.Describe the range of motion movements of the major joints.4. Measure range of joint motion with a goniometry5.Document the findings of the musculoskeletal assessment.6.Assess muscle strength of the arms and legs using the muscle strength grading scale

Human skeleton has

206 boneso Axial skeletono Appendicular

skeleton

Provide structure and support for soft tissue

Protect vital organs

Classification of bones by shape

Classification of bones cont’d

Compact bone

o Smooth and dense e.g. shaft of long bones and

outside layer of other bones

Spongy bone

o 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:

1. Synarthroses , Immovable (e.g., skull)

2. Amphiarthrosis ,Slightly movable e.g. vertebral joints

3. Diarthroses or synovial ,Freely movable e.g. shoulders, hips

Skeletal Muscle

Types of Muscles:

There are 600 skeletal muscles in deferent shapes

1. Skeletal voluntary, Allows voluntary movement

2. Smooth involuntary ,Muscle movement controlled by internal mechanism .e.g. muscles in bladder wall and GI system

3. 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

1. Either limit or enhance movement

2. Provide joint stability

3. Enhance joint strength

Bursae ,Fluid-filled sacs

Changes in older adult

1. Cause stooped posture, changing center of gravity

2. Elderly at greater risk for falls

3. Endocrine changes cause skeletal muscle atrophy

4. Muscle tone decreases

Diagnostic Tests

1. Blood tests

2. X-rays

3. Bone density scan

4. CT scan

5. MRI

6. Ultrasound

7. 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

1. first-degree: rest, ice for 24 to 48 hr, compression bandage, and elevation

2. second-degree: immobilization, partial weight bearing as tear heals

3. third-degree: immobilization for 4 to 6 weeks, possible surgery

Fractures

Fractures break in the continuity of bone

Classification of Fractures

1. Closed or simple

2. Open or compound

3. Complete or incomplete

4. Stable or unstable

Direction of the fracture lineo Obliqueo Spiralo Lengthwise plane (greenstick)

Fractures – emergency care

First aids:

1. Immobilize

2. Check pulse, color, movement, sensation

3. splinting

4. Sterile dressing for open wounds.

Fracture reduction

5. Closed—external manipulation

6. Open—surgery

Complications of fractures

1. Shock

2. Fat embolism .

3. Venous thromboembolism

4. Infection

5. Ischemic necrosis

6. Fracture blisters,

7. Delayed union, nonunion, and malunion

Musculoskeletal Assessment Fracture

1. Change in bone alignment

2. Alteration in length of extremity

3. Change in shape of bone

4. Pain upon movement

5. Decreased ROM

6. Ecchymotic skin

7. Subcutaneous emphysema with bubbles under the skin ,Swelling at the fracture site

Special assessment considerations

1. For fractures of the shoulder and upper arm, assess client in sitting or standing position.

2. Support the affected arm to promote comfort.

3. For distal areas of the arm, assess client in a supine position.

4. 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

1. Plaster

2. Fiberglass

3. Polyester-cotton

1. Arm Casts

2. Leg Casts

3. Body or Spica Casts

4. Splints and Braces

5. External Fixator

6. Traction

Types of casts

Cast complications:

1. Infection

2. Circulation impairment

3. Peripheral nerve damage

4. Complications of immobility

Cast care and client education

Upper and lower extremity cast

Nursing Care for patient with Casts

Neurovascular

1. Check color/capillary refill ,Temperature

2. Pulse , Movement , Sensation (5 P’s)

3. Elevate Extremity

4. Exercises – to unaffected side; isometric exercises to affected extremity

5. Keep heel off mattress

6. Handle with palms of hands if cast wet

7. Turn every two hours till dry

8. Do not place items under cast.

Traction

1. Application of a pulling force to the body to provide reduction, alignment, and rest at that site

2. Types of traction: skin, skeletal, plaster, brace, circumferential.

Traction care:

3. Maintain correct balance between traction pull and counter traction force

4. Care of weights

5. Skin inspection

6. Pin care

7. 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

1. Positioning

2. Strengthening Exercises

3. Potential Complications

Operative Procedures

oOpen reduction with internal fixation o External fixation

E.g . Orthopedic Surgeryo Joint Replacemento Total Hip Replacemento Total Knee Replacement

Extremity Fractures

1.In upper Extremity Fractures include :

Clavicle ,Scapula Humerus , Radius and ulna

Wrist and hand

2.In Lower Extremity Fractures include: o Femur ,Patella ,Tibia and fibula ,Ankle and foot

Thank you