MSK Test Review

Functions of the Musculoskeletal System

• Supports the body

• Facilitates movement

• Protects internal organs

• Produces blood cells

• Stores/releases minerals (calcium & phosphorus) and fat

Bone Cells

• Osteoblasts: Build new bone by producing collagen.

• Osteocytes: Mature bone cells that maintain bone.

• Osteoclasts: Break down (resorb) bone.

• Bone remodeling is a balance between osteoblasts and osteoclasts. Too much osteoclast activity = bone loss (osteoporosis).

Bone Functions

• Bones = levers

• Joints = hinges

• Muscles attach to bones.

• Skull protects the brain, vertebrae protect the spinal cord, ribs protect the heart and lungs.

Bone Marrow

• Yellow marrow: Stores fat (energy).

• Red marrow: Produces RBCs, WBCs, and platelets.

Hyperlordosis (Swayback)

• Excessive lumbar curve.

• Abdomen protrudes forward; buttocks project backward.

• Can cause neck and lower back pain.

Kyphosis (Roundback)

• Exaggerated thoracic curve.

• Causes: Congenital defects, arthritis, osteoporosis, trauma, muscular disorders.

Scoliosis

• Sideways curvature of the spine.

• Assessed with Adam's Forward Bend Test.

• Signs: Uneven shoulders/hips, rib prominence, uneven shoulder blades.

Osteoporosis

• Bones become thin, weak, and fragile.

• Common sites: Hip, spine, wrist.

• Risk factors: Older age, female, smoking, poor calcium intake.

• Prevention: Calcium, Vitamin D, weight-bearing exercise, smoking cessation.

• Treatment: Bisphosphonates and calcitonin.

Osteoarthritis (OA)

• Degeneration of joint cartilage with aging.

• Risk factors: Aging, obesity, joint injury/overuse, female >50, family history.

• Symptoms: Deep aching pain, morning stiffness, crepitus, swelling, altered gait, limited ROM, pain improves with rest.

• Common joints: Knees, hips, spine, fingers.

• Treatment: Weight loss, exercise, acetaminophen, NSAIDs, celecoxib, joint replacement.

Musculoskeletal Nursing Assessment

Assess:

• Pain

• Mobility

• CMS = Circulation, Movement, Sensation

• Follow weight-bearing orders and implement fall precautions.

Weight-Bearing Orders

• NWB: No weight.

• TTWB: Toes touch floor for balance only.

• PWB: Up to 50% body weight.

• WBAT: 50–100% as tolerated.

• FWB: 100% body weight.

Range of Motion (ROM)

• AROM: Patient moves independently.

• PROM: Nurse/therapist moves the joint.

• Decreased ROM may result from pain, inflammation, muscle spasm, contractures, neurological disorders, or braces/fixation.

Muscle Strength (MRC Scale)

• 0: No contraction

• 1: Muscle twitch

• 2: Movement without gravity

• 3: Movement against gravity

• 4: Movement against some resistance

• 5: Full strength against resistance

Upper body: Handgrips, pull, push.
Lower body: Hip flexion, knee flexion, dorsiflexion, plantar flexion.