Musculoskeletal Notes

Musculoskeletal System

KYPHOSIS

 an anteroposterior curving of the spine causes a bowing of the back, usually at the thoracic level. Occurs in children and adults

Causes Congenital kyphosis leads to cosmetic deformity and reduced pulmonary function. Appear in adolescence or adulthood Adult kyphosis may result from aging and associated degeneration of intervertebral disks, atrophy, and osteoporotic collapse of the vertebrae; from endocrine disorders, such as hyperparathyroidism and Cushing’s disease; and from prolonged steroid therapy

Assessment findings Mild pain at the apex of the curve Fatigue Tenderness or stiffness in the involved area or along the entire spine Prominent vertebral spinous processes at the lower dorsal and upper lumbar levels Round back appearance associated with weakness of the back and generalized fatigue Disk lesions called Schmorl’s nodes develops in the anteroposterior curving of the spine

Diagnostic tests On PE: curvature of the spine in varying degrees of severity. X-ray: show vertebral wedging, Schmorl’s nodes, irregular end plates Mild scoliosis of 10 to 20 degrees

Treatment Therapeutic exercises Bed rest on firm mattress (with or without traction) Brace to straighten the kyphotic curve until spinal growth is complete Pelvic tilt to decrease lumbar lordosis Hamstring stretch to overcome muscle contractures Thoracic hyperextension to flatten the kyphotic curve Lateral X-rays taken every 4 months to evaluate correction Gradual weaning from the brace Surgery for spinal curve greater than 60 degrees or intractable and disabling back pain in a patient with full skeletal maturity.

ANKYLOSING SPONDYLITIS

 chronic, progressive inflammatory disease affects the sacroiliac, apophyseal, and costovertebral joints and adjacent soft tissue disease progresses unpredictably and can go into remission, exacerbation, or arrest at any stage

Causes unknown more than 90% of patient with this disease exhibit the histocompatibility antigen HLA-B27 Immunity activity by the presence of circulating immune complexes Familial tendency

Assessment findings Intermittent lower back pain, most severe in the morning or after a period of inactivity Stiffness and limited motion of the lumbar spine Pain and limited expansion of the chest Peripheral arthritis involving the shoulders, hips and knees Kyphosis, in advanced stages, caused by chronic stooping to relieve symptoms Hip deformity and limited range of motion Tenderness over sites of inflammation Tenderness over the sacroiliac joint Mild fatigue, fever, anorexia, or weight loss Occasional iritis Aortic regurgitation and cardiomegaly

Diagnostic tests X-ray findings: blurring of the bony margins of joints in the early stage, bilateral sacroiliac involvement, patchy sclerosis with superficial bony erosions, eventual squaring of the vertebral bodies, and “bamboo” spine with complete ankylosis?  confirms the diagnosis Slightly elevated ESR and alkaline phosphatase and creatine kinase levels

Treatment Management aims to delay further deformity by good posture, stretching and deep-breathing exercises Braces and lightweight supports Anti-inflammatory analgesics, such as aspirin, indomethacin, and sulindac, control pain and inflammation Surgery

Nursing interventions Promote patient comfort Administer medications as ordered Apply local heat and provide massage to relieve pain Assess mobility and degree of discomfort frequently.

CARPAL TUNNEL SYNDROME

 Most common nerve entrapment syndrome, results form compression of the median nerve at the wrist, within the carpal tunnel. The median nerve, along with blood vessels and flexor tendons, passes through this tunnel to the fingers and thumb. Occurs in women between ages 30 and 60 and poses a serious occupational health problem

Causes Some conditions can cause the contents or structure of the carpal tunnel to swell and press the median nerve against the transverse carpal ligament Conditions like: rheumatoid arthritis, flexor tenosynovitis, nerve compression, pregnancy, renal failure, menopause, diabetes mellitus, acromegaly, edema following Colle’s fracture, hypothyroidism, myxedema, benign tumors, and tuberculosis. Dislocation or acute sprain of the wrist

Assessment findings Weakness, pain, burning, numbness, or tingling in one or both hands This paresthesia affects the thumb, forefinger, middle finger, and half of the fourth finger Decreased sensation to light touch or pinpricks in the affected fingers Inability to clench the hand into a fist Nail atrophy Dry, shiny skin and pain

Diagnostic test

 (+) Tinel’s sign: tingling over the median nerve on light percussion (+) Phalen’s wrist-flexion test: holding the forearms vertically and allowing both hand to drop into complete flexion at the wrists for 1 minute Compression test: blood pressure cuff inflated above systolic pressure on the forearm for 1 to 2 minutes provokes pain and paresthesia along the distribution of the median nerve Electromyography: detects a median nerve motor conduction delay of more than 5 milliseconds

Treatment

 Resting the hands by splinting the wrist in neutral extension for 1 to 2 weeks Correction of underlying disorder Surgical decompression of the nerve by sectioning the entire transverse carpal tunnel ligament

Nursing interventions

 Mild analgesics Apply splint. Perform range of motion exercises After surgery, monitor vital signs, and regularly check the color, sensation, and motion of the affected hand