Musculoskeletal Medsurge

Joint types

Diarthrodial (synovial) most common.

Cartilage types

Hyaline, elastic, fibrous

Tendons

Muscle to bone

Ligaments

Bone to bone.

Fascia

Layers support muscle.

Bursae

Fluid-filled sacs; reduce friction

Soft tissue injury

damage to the muscles, ligaments, tendons, and other nonbony structures in the body.

Sprain

injury to ligaments around a joint by wrenching or twisting motion

First degree Sprain

few fiber tears; mild tenderness and swelling

Second degree Sprain

partial disruption of tissue; increased swelling and tenderness

Third degree Sprain

complete tear with moderate to severe swelling

Strain

excessive stretching of muscle and fascia; may involve tendon

First degree Strain

mild or slightly pulled

Second degree Strain

moderately torn muscle

Third degree Strain

severely torn or ruptured muscle

RICE

rest, ice, compression, and elevation

Rest: Stop activity and limit movement

Ice: 24 to 28 hours; 20 to 30 minutes at a time

Compression: elastic bandage; apply distal to proximal to immobilize

Elevate: above the heart 24-48hr

Dislocation

complete displacement or separation of the articular surfaces of the joint

Subluxation

partial of incomplete displacement of the joint surface; symptoms less severe • Symptoms—deformity, pain, tenderness, loss of function, swelling • Complications—intraarticular fractures and avascular necrosis • Diagnosis—x-ray and/or aspiration

Carpal Tunnel Syndrome

Caused by compression of the median nerve. Associated with activities that require continuous wrist movement

Osteomyelitis

Severe infection of bone, bone marrow, and surrounding soft tissue.

Direct Entry (80% of Cases):Infection enters the bone directly, often through an open wound, fracture, or surgery.

• Indirect Entry: Infection spreads to the bone from the bloodstream, commonly occurring in areas with rich blood supply, such as the spine or pelvis

Amputation

Traumatic or surgical removal of an extremity

Closed amputation

creates weight-bearing residual limb

Open amputation

guillotine amputation

Disarticulation

amputation through a joint • Syme’s amputation done at the ankle • Left open then closed later, done to control infection

Key Diagnostic Imaging Tests for muscle skeletal system

X-ray (first-line), DEXA (osteoporosis), MRI/CT (soft tissue), EMG (nerve/muscle).

Heat

can be introduced cautiously after 48 hours

Increasing blood flow to the area, which can promote healing. • Relaxing tight muscles and reducing muscle spasms. • Alleviating stiffness in the affected area.

Sequestrum (Dead part of Bone)

WBCs and antibiotics can’t reach through the blood • Becomes a reservoir for microorganisms that can spread to other sites. • If not resolved or surgically debrided, a sinus tract may develop with chronic, purulent cutaneous drainage

Below-Knee Amputee

Key Risk: Knee flexion contracture.

• Prevention Tips:

• Avoid prolonged knee bending: • Do not sit with knees bent for long periods. • Avoid placing pillows under the residual limb when lying down.

• Stretching and positioning: • Lie flat with the residual limb straightened (e.g., prone positioning for 20–30 minutes daily).

• Active range-of-motion (ROM) exercises: • Perform knee extension exercises to maintain flexibility and strength

Above-Knee Amputee

•Key Risk: Hip flexion contracture.

•Prevention Tips:

•Avoid sitting for long periods: •Limit time sitting with the hip bent. Avoid reclining chairs that elevate the knees and hips.

•Prone positioning: •Lie on your abdomen for 30 minutes, 3–4 times a day, to stretch hip flexor muscles.

•Active ROM exercises: •Perform hip extension exercises to prevent shortening of hip flexors.

•Standing and weight-bearing: •When medically cleared, practice standing upright to promote normal hip alignment.

Upper-Extremity Amputee:

Key Risks: Elbow flexion and shoulder contractures.

• Prevention Tips:

• Avoid prolonged elbow bending: • Do not rest the residual limb bent on the chest or abdomen for extended periods. • Use proper arm positioning with support to keep the elbow extended when lying or sitting

. • Active ROM exercises: • Stretch the shoulder and elbow joints by performing arm raises and elbow extensions. •

Engage in functional activities: • Encourage activities like reaching forward or overhead to maintain full joint mobility.

involucrum

Periosteum with blood supply forms new bone (new bone formation)

Ischemia

results in bone death