Complex Concepts in Musculoskeletal Function and Alterations

musculoskeletal system

• Protects vital organs

• Provides body support & structure

• Allows movement

• Holds bones together at joints

• Produces heat (though contractions)

• Helps blood return to the heart

• Stores important minerals (calcium, phosphorus, magnesium, fluoride in bone)

• Acts as a reservoir for immature blood cells

• Produces blood cells in the bone marrow 

cancellous (trabecular) and cortical (compact)

What are the two primary tissue types of bones?

osteoprogenitor cells

Stem cells that replace needed bone cells

osteoblasts

Cells responsible for building new bone tissue

osteocytes

Mature cells that maintain bone tissue.

osteoclasts

Cells that break down old bone tissue

calcitriol, parathyroid hormone, and calcitonin

What are hormones involved with bones?

active vitamin D (calcitriol)

increases calcium in the blood by helping the small intestine absorb more calcium from food for the body. Also helps calcium and phosphate get deposited into the bone matrix to which maintains bone density and strength.

parathyroid hormone (PTH)

is released when blood calcium is low

• it does this by:

  • Pulling calcium out the the bones

  • Helping the kidneys keep calcium

  • Increase calcium absorption in the intestines 

  • Lowering phosphate levels (by secretion of kidneys)

calcitonin

lowers blood calcium by:

• inhibiting osteoclasts, reducing bone breakdown and calcium release from bone

• Helps the kidneys to reabsorb more calcium in the urine

• Moves calcium into the bone

joints

Definition

• Point between two or more bones.

Primary Function

• Permits mobility, allows fluid skeletal movement, and provides structural support.

Key Components

• Ligaments: Fibrous connective tissue bands that hold bone to bone.

• Bursae: Fluid-filled sacs that facilitate movement and reduce friction.

synarthroses (solid)

a type of joint that is immovable structural connections securely joined by solid cartilage or fibrous connective tissue (e.g., skull sutures).

diarthrodial (synovial)

Highly movable types of joints encapsulated with a fluid-filled synovial cavity and protected by smooth articular cartilage.

ligaments

Fibrous connective tissue bands that hold bone to bone.

bursae

Fluid-filled sacs that facilitate movement and reduce friction.

tendons

A strong band of connective tissue that attaches muscle to bone. When a muscle contracts, the tendon pulls on the bone to create movement at a joint.

aponeurosis

A wide, flat sheet of connective tissue. It works similarly to a tendon but is not cord-like. Connects muscle to bone or muscle to muscle. Example: abdominal muscles

isometric movement

Constant Length

• The length of the muscles remains constant but the force generated is increased

Example

• Pushing against an immovable wall

isotonic movement

Shortening Muscle

• Characterized by shortening of the muscle with no increase in tension within the muscle

Example

• Flexing the forearm

flaccid, spastic, and atonic

When issues occur, muscle tone presents as: ______________________

circulation, sensation, movement

Neurovascular status is important for the nurse to perform frequent neurovascular assessments of patients with musculoskeletal disorders. It is usually called CSM (___________, ______________, ____________)

pain, pallor, poikilothermia, pulses (includes capillary refill), paresthesia, paralysis

What are the 3 P’s of a neurovascular assessment?

x-ray, CT scan, ca, vit. d, phosphorus, hormones, cbc, esr, ck, myoglobin

Name diagnostic studies for musculoskeletal alterations.

bursitis

is the inflammation of a bursa—a small, fluid-filled sac that acts as a cushion to reduce friction between bones, tendons, and muscles near joints.

tendonitis

is the irritation or inflammation of a tendon—the thick fibrous cords that attach muscle to bone, often caused by repetitive strain or overuse.

localized pain, swelling and redness, stiffness

clinical manifestations of bursitis and tendonitis?

RICE, NSAIDs, corticosteroid injectiosn

treatment and care of bursitis and tendonitis?

rest, ice, compression, elevation

RICE

carpal tunnel syndrome (CTS)

An entrapment neuropathy where the median nerve at the wrist is compressed. Causes include: thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue mass.

forearm movement; feeling

median nerve function

repetitive movement, pregnancy, obesity, hypothyroidism, age + trauma

risk factors of carpal tunnel syndrome

numbness/tingling, wrist and hand pain, loss of control, burning sensation

signs and symptoms of carpal tunnel syndrome

aponeurosis

Wide, flat connective tissue sheet that attaches muscle to bone or muscle to muscle.

DEXA scan

Bone-density test used to evaluate bone strength.

tinel’s sign and phalen’s sign tests

What are clinical tests used to evaluate for carpal tunnel syndrome?

contusion

Bruising caused by blunt-force injury and bleeding into soft tissue.

strain

Injury to a muscle or musculotendinous structure caused by overstretching or overuse.

sprain

Ligament injury commonly caused by twisting or wrenching.

POLICE

Protect, Optimal Loading, Ice, Compression, and Elevation; a movement-based approach to some acute injuries.

fracture

A break in the continuity of a bone.

open fracture

Fracture in which the skin is broken, increasing infection risk.

closed fracture

Fracture in which the skin remains intact.

comminuted fracture

Fracture in which the bone breaks into multiple fragments.

greenstick fracture

An incomplete fracture in which the bone is only partially broken.

closed reduction

Setting a broken bone back into position without surgery.

open reduction and internal fixation (ORIF)

surgery using hardware such as plates and screws to stabilize a fracture.

compartment syndrome

Increased pressure within a muscle compartment that can damage nerves and tissue; a key sign is severe pain out of proportion to the injury.

fat embolism syndrome

Release of fat from bone marrow, especially after long-bone fractures, causing respiratory distress, altered mental status, petechiae, and hypotension.

traction

Pulling force used to reduce muscle spasms and help align or immobilize fractures.

skeletal traction

Traction attached directly to bone using pins, wires, screws, or tongs.

buck’s traction

Skin traction using a boot or harness with weights.

amputation

Surgical removal of a limb or part of a limb; may be caused by disease, ischemia, infection, tumor, or trauma.

phantom limb pain

Pain felt in the area of a limb that has been amputated.

NSAIDs

Medications such as ibuprofen, naproxen, and celecoxib that reduce prostaglandin production and help decrease pain and inflammation.

corticosteroids

Anti-inflammatory medications such as prednisone and methylprednisolone used for severe inflammatory episodes.

acetaminophen

Analgesic used for mild to moderate pain when anti-inflammatory action is not required.