MSK

Musculoskeletal System Overview

  • Presenter: Ashley Jamison, RN, BScN, BCCN, MAED

  • Source adaptation: Allison Hall RN, BSCN, MN (2018)

Functions of Bones

  • Support: Provides structural framework for the body.

  • Protection: Safeguards vital internal organs.

  • Voluntary Movement: Facilitates movement through attachment to muscles.

  • RBC Production: Hematopoiesis occurs in the bone marrow, producing red blood cells.

  • Mineral Storage: Stores essential minerals such as calcium and phosphorus.

Classifications of Bone

  • Cancellous (Spongy) Bone: Less dense, found in the interior of bones.

  • Cortical (Compact & Dense) Bone: Strong, dense outer layer.

Bone Cells

  • Osteoclasts: Cells responsible for bone resorption.

  • Osteoblasts: Cells that build new bone.

  • Osteocytes: Mature bone cells that maintain bone tissue.

Periosteum

  • Definition: A membrane lining the outer surface of bones that contains blood vessels and nerves.

Soft Tissue Injuries

  • Types:

    • Strains and Sprains

    • Dislocations and Subluxations

    • Repetitive Strain Injuries

    • Rotator Cuff Injury

    • Meniscus Injury

Case Studies Overview

Case Study A: Don

  • Age: 51

  • Symptoms: Right shoulder pain and stiffness; unable to lift arm.

  • History: Symptoms worsening over years; received corticosteroid injection.

Case Study B: Andy

  • Age: 83

  • Symptoms: Severe pain (9/10) in left shoulder; visibly misaligned shoulder joint after fall.

  • Immediate Care: Morphine IV prescribed; follow-up for realignment planned.

Case Study C: Alex

  • Age: 28

  • Symptoms: Knee pain (8/10) after volleyball; audible click; unable to weight bear.

  • Assessment: Positive McMurray's test; prescribed naproxen and knee scope.

Case Study D: Blake

  • Age: 17

  • Injury: Ankle pain (7/10) while playing soccer; partial tearing of posterior tibialis tendon.

  • Healing: Expected to heal in approximately 3 weeks.

Case Study E: Vivian

  • Age: 74

  • Symptoms: Numbness, tingling, inconsistent pain in wrist from crocheting; positive Tinel's and Phalen’s signs.

  • Care Plan: Prescribed naproxen.

Repetitive Strain Injuries (RSI)

  • Causes: Poor ergonomics, awkward postures, and excessive force during movements.

  • Common Occupations at Risk: Office workers, musicians, athletes, laborers.

Strains and Sprains

Strains

  • Definition: Injury to a muscle or tendon from twisting or pulling.

  • Grades:

    • 1st Degree: Mild pull.

    • 2nd Degree: Moderate pull.

    • 3rd Degree: Severe tear.

Sprains

  • Definition: Stretching or tearing of ligaments surrounding a joint.

  • Grades:

    • 1st Degree: Mild, minimal fiber tears.

    • 2nd Degree: Moderate, partial disruption.

    • 3rd Degree: Complete tearing of the ligament, extremely painful.

Symptoms of Sprains/Strains

  • Pain, edema, altered movement.

  • Minor cases usually resolve in 3-6 weeks; severe cases may lead to avulsion fractures or dislocations.

Nursing Management/Treatment for Strains & Sprains

  • RICE Protocol:

    • Rest

    • Ice

    • Compression

    • Elevation

  • Preventive Measures: Stretching warm-ups, wrapping joints, rehabilitation exercises.

Dislocation and Subluxation

  • Dislocation: Complete separation of joint surfaces.

  • Subluxation: Partial separation; minor displacement.

  • Signs and Symptoms: Pain, swelling, loss of mobility, contour changes.

Complications of Dislocation/Subluxation

  • Traumatic Implications: Distorted blood supply and nerves leads to potential avascular necrosis.

  • Initial Management: Immobilization, reduction, and NSAIDs.

Complications of Fractures

Healing Phases

  1. Hematoma Formation

  2. Granulation Tissue

  3. Callus Formation

  4. Ossification

  5. Consolidation

  6. Remodeling

Common Causes of Fractures

  • Trauma (falls), osteoporosis, repetitive action.

Complications Influencing Healing Time

  • Factors affecting healing: Age, blood supply, infection risk, hormonal levels.

Surgical and Non-Surgical Management of Fractures

Reduction Techniques

  • Closed Reduction: Non-invasive realignment of bone.

  • Open Reduction: Requires surgical incision; better outcomes for healing.

Immobilization Strategies

  • Casts: Support healing, pain management, facilitate function.

  • Assessments: Peripheral nerve and circulation status.

Nursing Considerations with Fractures

  • Pain management, risk assessments, mobilization protocols, patient teaching, and discharge planning.

Complications Related to Fractures

  1. Infection: May require surgical intervention.

  2. Compartment Syndrome: High pressure within a muscle compartment that reduces blood flow.

    • Symptoms: Unrelenting pain, paresthesia, immobility; can lead to irreversible damage.

  3. Deep Vein Thrombosis (DVT): Major post-fracture complication requiring vigilance in assessment.

  4. Fat Embolism: Fat globules from bone trauma that can lead to serious respiratory complications post-accident.