Module 10: Altered Musculoskeletal Function

Where is the pain located?

The pain location refers to the specific area or areas where the patient feels discomfort or pain.

How would you describe the quality of the pain?

Is the pain sharp, stabbing, dull, throbbing, or continuous?

When did the pain start?

Time frame refers to when the pain first occurred and how long it has been present.

What makes the pain better or worse?

Aggravating/Relieving factors refer to any activities, movements, or treatments that affect the intensity of the pain.

Is there swelling present?

Swelling refers to any noticeable increase in size or puffiness of the affected area.

When was the swelling first observed?

The time of first observation helps determine how quickly the swelling occurred and provides insight into its development.

Has the swelling increased or decreased?

Progression of swelling can indicate how the injury or condition is evolving over time.

Where is the stiffness located?

Stiffness refers to areas of the body that feel tight or restricted in movement.

How long does the stiffness last?

Duration refers to the length of time the stiffness persists during or after an injury

How severe is the stiffness?

Degree of stiffness refers to the intensity of the restricted movement, often rated on a scale.

Has there been any noticeable change in the affected area compared to the uninjured state?

Deformity refers to any visible changes, such as swelling, misalignment, or abnormal positioning of the affected area.

Is weakness present in the affected area?

Weakness refers to a decrease in muscle strength, making the affected area less functional.

How severe is the weakness?

Degree of weakness refers to how much muscle strength is compromised, often rated on a scale.

Has the weakness increased or improved since the injury?

Progression of weakness can indicate whether the condition is worsening or improving.

Is there instability in the affected area?

Instability refers to a feeling that the affected area may give way, or is unable to maintain its normal function.

How is the current level of functioning affected?

This refers to the impact the injury has on the patient’s ability to perform regular activities or movements.

Is the affected area unable to function as it did previously?

Loss of function refers to a decrease in the normal ability to move or use the affected body part.

Are there noticeable changes in skin color or temperature over the affected area?

Changes in color or temperature could indicate poor circulation, inflammation, or infection.

Is there any numbness or tingling present?

Altered sensation, such as numbness or tingling, can indicate nerve involvement.

Are there any other symptoms related to the injury?

Associated symptoms could include dizziness, headaches, or other signs related to the injury.

Is there any relevant past medical history that could impact the injury?

A patient's past medical history could affect the injury's healing process or complicate recovery.

Is there significant family medical history related to this condition?

Family history could provide insights into genetic conditions or predispositions that may affect the injury.

Has any treatment been attempted for the injury?

This refers to any treatments or interventions that have already been provided and their effectiveness.

How would you assess the patient's normal walking gait?

A normal walking gait assessment helps identify any limping, abnormal movements, or difficulties while walking.

What is involved in a physical assessment for injuries?

Physical assessment includes evaluating the affected area for swelling, deformity, strength, and range of motion.

How is sensation assessed in the injured area?

Sensation is assessed by testing responsiveness to stimuli, such as pinprick, light touch, or temperature changes.

How should pulses be assessed in an injured area?

Pulses should be assessed for rate, rhythm, depth, and symmetry, ensuring blood flow to the extremities.

How do you assess muscle tone and strength?

Muscle tone is assessed by feeling resistance in the muscles, and strength is assessed by testing the ability to move the affected area against resistance.

Why is the evaluation of sensation important in skeletal bone function?

Evaluation of sensation is a critical indicator of skeletal bone function, and abnormal sensation (e.g., numbness or tingling) may indicate nerve damage due to pressure, fracture, or injury.

What could abnormal sensation like numbness or tingling indicate?

Abnormal sensation could indicate nerve damage caused by pressure, fracture, or injury.

What is the expected outcome after treatment for paresthesia?

Paresthesia often resolves after treatment is initiated.

What is the procedure for the pinprick test in sensation assessment?

The pinprick test involves using a paper clip or specialized instrument to apply a stimulus to the suspected injury area.

Why is symmetry and equality important in sensation assessment?

Symmetry and equality of sensation are key indicators of normal nerve function.

What might it indicate if the patient is unable to feel the stimulus during the pinprick test?

Inability to feel the stimulus may signal sensory nerve damage.

Why is pulse assessment important after an injury?

Pulse assessment indicates the adequacy of blood flow to the extremities, particularly after injury.

What is the proper technique for pulse assessment?

Use two fingers (avoid the thumb) to assess pulse rate, rhythm, depth, and symmetry.

Why should you avoid using your thumb when assessing pulses?

The thumb has its own pulse, which could interfere with accurately assessing the patient's pulse.

What is muscle tone and why is it important?

Muscle tone refers to the normal degree of tension or contraction in relaxed, voluntary muscles, and abnormal tone may indicate neurological or musculoskeletal issues.

What is the procedure for assessing muscle tone?

Ask the patient to relax completely or "go limp," then move the extremity through full range of motion (ROM).

What is the expected finding during muscle tone assessment?

A mild, even resistance to movement is expected.

What should you note during muscle tone assessment?

Note any abnormal or involuntary movements during the assessment.

What is the purpose of muscle strength testing?

Muscle strength testing assesses the ability of muscles to resist force and indicates overall muscle function, especially useful when assessing weakness.

How is muscle strength tested?

Ask the patient to resist force as you attempt to move their body part against the direction of pull.

What is the grading scale for muscle strength?

The grading scale ranges from 0 to 5:

• 0: No muscle contraction

• 1: Trace of muscle contraction

• 2: Muscle can move without gravity

• 3: Muscle can move against gravity but not resistance

• 4: Muscle can move against some resistance

• 5: Full ROM against resistance (normal strength)

Why is it important to compare muscle strength bilaterally?

Comparing bilaterally helps detect muscle weakness and differences between the two sides of the body.

Why is bone health important in relation to calcium, phosphorus, and vitamin D?

Bone health is essential because bones are the major source of calcium in the body, and adequate levels of calcium, phosphorus, and vitamin D are critical for bone health and integrity.

What happens when calcium levels are low?

Low calcium levels increase the risk of fractures and may negatively impact bone health.

Why are calcium levels important for bone health?

Calcium is essential for maintaining bone density and overall bone health. Low levels of calcium are associated with increased fracture risk.

How do phosphorus levels relate to calcium?

Phosphorus has an inverse relationship with calcium: as calcium levels rise, phosphorus levels decrease in a healthy individual. Both are necessary for bone integrity.

How does vitamin D contribute to bone health?

Vitamin D promotes the gastrointestinal absorption of calcium and phosphorus, which is essential for proper calcium and phosphorus metabolism.

How do calcitonin and parathyroid hormone (PTH) regulate calcium and phosphorus?

Calcitonin and PTH work together to maintain the equilibrium of calcium and phosphorus in the body, regulating their levels to ensure bone health.

What role does estrogen play in bone health?

Estrogens stimulate osteoblast activity (bone-forming cells). After menopause, decreased estrogen levels increase fracture risk.

How are estrogen levels assessed?

Estrogen levels can primarily be assessed through urine analysis.

Why are calcium, phosphorus, vitamin D, and estrogen levels important in clinical practice?

These levels are crucial for evaluating bone health, identifying potential fracture risk, and preventing complications related to osteoporosis and other bone-related disorders.

How can monitoring calcium, phosphorus, vitamin D, and estrogen levels help prevent bone-related disorders?

Regular monitoring helps assess bone health, prevent fractures, and identify early signs of osteoporosis or other bone conditions, enabling timely intervention.

What is the purpose of an X-ray in musculoskeletal health?

X-rays are commonly used to visualize injuries or abnormalities in the musculoskeletal system, helping practitioners assess the extent of the injury or abnormality for appropriate treatment.

Why is X-ray an important diagnostic tool?

It is quick, efficient, non-invasive, and often the first step in diagnosing musculoskeletal issues.

What is the purpose of a CT scan in musculoskeletal health?

A CT scan combines multiple x-ray views to create cross-sectional images of bones and soft tissues, and can use contrast material to highlight blockages or blood vessel abnormalities.

Why is a CT scan useful in diagnosing musculoskeletal issues?

It provides detailed images for better assessment of soft tissue and bone abnormalities and is useful for detecting complex fractures or conditions not clearly visible in a regular x-ray.

How does MRI help in musculoskeletal health assessments?

MRI uses magnetic fields and radio waves to produce high-detail images of internal structures, including muscles, ligaments, and tendons.

Why is MRI particularly useful in musculoskeletal health?

MRI often provides greater detail than X-rays or CT scans, especially for soft tissues, making it ideal for assessing soft tissue damage or joint issues.

What is the purpose of an arthrogram in musculoskeletal health?

An arthrogram is used to evaluate joint pain or progression of joint disease by injecting a contrast agent into the joint cavity to enhance visualization of joint structures.

Why is the contrast agent used in arthrography?

The contrast agent (radiopaque dye or air) enhances the visualization of joint structures (ligaments, cartilage, tendons, joint capsule). If there's a tear in the joint, the contrast agent will leak out, which can be seen on the X-ray.

What is the purpose of a DEXA scan?

DEXA is used for bone densitometry to evaluate bone mineral density (BMD), which helps predict fracture risk and monitor changes in bone density, particularly in osteoporosis patients.

Why is DEXA important in musculoskeletal health?

It is an accurate method for monitoring bone density, especially for osteoporosis treatment, and can evaluate bone density in the spine, hip, wrist, and total body.

What is the difference between DEXA and peripheral DEXA (pDXA)?

Peripheral DEXA (pDXA) can be used for the forearm, finger, or heel but is less accurate for predicting hip or spine fracture risk compared to standard DEXA.

At what age does bone density begin to diminish?

Bone density begins to diminish around age 30.

How does menopause affect bone density in women?

After menopause, bone density loss accelerates in women due to the loss of estrogen.

What happens to joint cartilage as people age?

Joint cartilage decreases in mass due to reduced bone mineral content, leading to thinner joints and an increased fracture risk.

How do joints change with age?

Joints become stiffer and less flexible due to decreased fluid in the joint spaces.

What happens to connective tissues in ligaments as people age?

Connective tissues within ligaments lose water content and become more rigid with age.

What is important to teach older adults to maintain musculoskeletal health?

Teach older adults to engage in regular weight-bearing exercises, ensure adequate vitamin D intake, and have routine follow-ups with their primary care provider.

What is the purpose of arthrocentesis?

Arthrocentesis is performed to obtain synovial fluid for diagnostic examination or to relieve pain due to joint effusion (excess fluid in the joint).

How can the examination of synovial fluid help diagnose musculoskeletal conditions?

Examining synovial fluid is helpful in diagnosing conditions like septic arthritis and other inflammatory arthropathies.

What additional purposes can arthrocentesis serve?

Arthrocentesis can help diagnose hemarthrosis (bleeding into the joint cavity) and relieve pain by removing excess fluid from the joint.

What is the normal appearance of synovial fluid?

Synovial fluid is normally clear, pale, and straw-colored with a scanty volume.

How is arthrocentesis performed?

The procedure is done under aseptic conditions, where a needle is inserted into the affected joint to aspirate synovial fluid for analysis. Anti-inflammatory medications may also be injected into the joint if needed.

Why is aseptic technique important in arthrocentesis?

Aseptic technique is crucial to prevent infection during the procedure.

What happens after the synovial fluid is aspirated during arthrocentesis?

A sterile dressing is applied after the procedure to minimize the risk of infection, and anti-inflammatory medications may be injected into the joint to reduce inflammation and pain.

What does synovial fluid analysis help identify?

Synovial fluid analysis helps identify infections, such as septic arthritis, and can reveal hemarthrosis, indicating bleeding disorders or trauma.

What factors influence the development of acute and chronic osteomyelitis?

The development of osteomyelitis is influenced by factors such as the virulence of the bacteria, the immune status of the patient, underlying health conditions, and the type, location, and vascularity of the bone.

What is the initial process in the development of osteomyelitis?

The process begins with an invasion of the bone and surrounding tissue by bacterial pathogens, leading to inflammation, increased vascularity, and edema.

What happens after thrombus formation in osteomyelitis?

Thrombus formation in the vessels leads to ischemia, slow necrosis of the affected bone, and delays the healing process, increasing the likelihood of superimposed infections or abscesses.

What is the cycle that occurs in osteomyelitis once necrotic bone is present?

The cycle of inflammation and infection continues due to the presence of necrotic bone, which prevents healing and prolongs the infection.

What is the clinical hallmark of osteomyelitis?

The clinical hallmark of osteomyelitis is bone necrosis and the development of sinus tracts that connect the bone and skin

What is exogenous osteomyelitis and how does it occur?

Exogenous osteomyelitis is caused by trauma or surgery, where the infection spreads through direct inoculation from a fracture or open wound, or via contagious spread from a nearby wound.

What is endogenous osteomyelitis and how does it occur?

Endogenous osteomyelitis results from the spread of infection from another part of the body, often originating in adjacent soft tissues or joints, and spreading to the bone through indirect inoculation.

Who is most commonly affected by contiguous osteomyelitis?

Older adults are more commonly affected by contiguous osteomyelitis, which often results from skin infections that spread to the bone.

What are the common pathogens in contiguous osteomyelitis?

Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, aerobic gram-negative bacilli, and both polymicrobial and monomicrobial infections.

What are common scenarios for osteomyelitis in older adults?

Common scenarios include decubitus ulcers, affected total joint arthroplasties, and vascular insufficiencies.

What percentage of osteomyelitis cases are contiguous osteomyelitis?

Contiguous osteomyelitis accounts for approximately 34% of all documented osteomyelitis cases.

What happens when osteomyelitis develops?

Osteomyelitis begins with the invasion of bone and surrounding tissue by bacterial pathogens, leading to inflammation, increased vascularity, and edema.

What are the two primary types of osteomyelitis based on infection spread?

The two types are hematogenous (infection spreads via bloodstream, common in children <1 year) and contiguous (occurs from open fractures or trauma, common in adults).

What occurs after thrombus formation in osteomyelitis?

Thrombus formation within days to weeks leads to ischemia and necrosis, with necrotic bone delaying healing and increasing the risk of infection or abscess formation.

How does necrotic bone affect healing in osteomyelitis?

Necrotic bone delays healing and increases the likelihood of infection or abscess formation, which perpetuates inflammation and infection.

What laboratory test is used to detect infection in osteomyelitis?

WBC count (white blood cell count) is elevated in infection.

What does the Erythrocyte Sedimentation Rate (ESR) indicate in osteomyelitis diagnosis?

The ESR indicates inflammation in the body.

What does the C-reactive protein (CRP) test measure in osteomyelitis?

CRP is a marker of acute infection.

How are blood cultures used in osteomyelitis diagnosis?

Blood cultures help identify the causative organism of the infection

What imaging study is used to detect acute osteomyelitis?

A Bone Scan is used to detect acute osteomyelitis.