Musculo-Skeletal System – Study Unit 1.9

Spinal Curvature Abnormalities

Scoliosis

• Lateral curvature of the spine.

• May present as an “S” or “C” curve when viewed posteriorly.

• Normal spine ≠ scoliosis; visual deviation is diagnostic clue.

Lordosis

• Exaggerated curve of the lumbar vertebral column.

• Forms a pronounced inward arch at the lower back.

• Cervical lordosis may coexist but lumbar distortion is clinically relevant.

Kyphosis

• Exaggerated curve of the thoracic vertebral column.

• Produces “humpback” appearance.

  

Fascia & Fasciotomy

• Fascia: fibrous connective membrane that covers, supports & separates muscles; variable in fat, collagen, elastin & tissue fluid content.

• Fasciotomy: surgical cutting/removal of fascia to relieve pressure (e.g., in compartment syndrome).

Summative Explanations of Core Medical Conditions

Osteoporosis

• Metabolic bone disorder marked by significant loss of bone mass & strength ➔ fracture risk.

• Pathogenesis: \text{Bone resorption rate} > \text{Bone formation rate}.

• Common sites: hip, vertebrae, wrist.

• Risk factors: age, menopause, corticosteroid use, low Ca/ Vit D intake, sedentary lifestyle.

Acute Infective Osteomyelitis

• Pyogenic bone infection; common in children/adolescents but also in poorly-nourished or immunocompromised adults.

• Sudden onset → may become chronic/debilitating if poorly managed.

• Usually secondary to existing infection (haematogenous or contiguous spread).

Tuberculosis of Bone

• Mycobacterium tuberculosis spreads haematogenously from lungs/lymph nodes.

• Prefers vertebrae & long-bone metaphyses (rich vascular supply).

• Incidence ↑ in developing countries & with AIDS.

• Early painless; late presentation with severe back pain, swelling, abscesses, deformities, neurological compromise (paraplegia).

• Systemic TB signs may be absent; latency common.

• Treatment: 6–18 months chemotherapeutic regimen (rifampicin, isoniazid, ethambutol, pyrazinamide) ± surgery (e.g., laminectomy).

Carpal Tunnel Syndrome

• Median nerve entrapment at wrist within carpal tunnel.

• Etiology: repetitive hand motions, vibration, fluid retention.

• Presents with numbness, tingling, night pain, thenar weakness.

Muscular Dystrophy

• Group of inherited progressive myopathies → muscle fibre degeneration, weakness & replacement by connective/fatty tissue.

• Pathology: fibre size variation, phagocytosis, regeneration failure.

• Clinical picture (e.g., Duchenne): swayback, weak hip extensors, tip-toe gait, pseudohypertrophic calves, frequent falls.

• Differences among types: pattern of inheritance, involved muscles, age of onset, progression rate.

Conditions Presented with Study Framework

Hallux Valgus

• Definition

  • Deformity of big toe (first metatarsophalangeal joint) causing lateral deviation.

• Causes/Risk Factors

  • Narrow-toed, high-heeled footwear.

  • Genetic predisposition.

  • Intrinsic biomechanical issues (flat foot, ligament laxity, neurologic disorders).

• Pathophysiology

  • Failure of tendons/ligaments supporting first metatarsal → misalignment.

  • Progressive bunion formation & medial soft-tissue thickening.

• Clinical Manifestations

  • Red, thickened medial skin; bony bump; pain worsened by shoes; decreased toe ROM; overlapping digits with corns/calluses; shoe-fit difficulty.

• Diagnostic Tests

  • Inspection.

  • Foot X-ray.

• Medical Treatment

  • Analgesics; corticosteroid injections; corrective surgery.

• Basic Nursing Care

  • Post-op wound & neurovascular checks; pain control; mobilisation protocols.

• Health Education

  • Proper shoe fit; daily foot hygiene/massage; elevation & rest.

Fractures

• Definition

  • Break in bone due to force, trauma or disease.

• Causes/Risk Factors

  • Direct/indirect trauma, sports, occupational hazards, degenerative disorders.

• Pathophysiology

  • Periosteum stripping & vascular disruption ➔ bleeding, haematoma, soft-tissue damage.

• Clinical Manifestations

  • Oedema, pain, loss of function, deformity, discoloration.

• Diagnostic Tests (List Only)

  • X-ray, CT, MRI, bone scan.

• Medical Treatment

  • Reduction (closed/open); immobilisation (cast, traction, ORIF); pain management.

• Basic Nursing Care

  • Neurovascular assessment (5 P’s: pain, pallor, pulselessness, paraesthesia, paralysis).

  • Elevation, ice, skin integrity monitoring.

• Health Education

  • Cast care; signs of complications (compartment syndrome, infection); nutrition for bone healing.

Types of Fractures (Learning Activity 2)

• Greenstick – incomplete break in children (e.g., fall on outstretched arm).

• Transverse – perpendicular to bone axis (direct blow).

• Oblique – diagonal line (twisting injury).

• Comminuted – bone splinters (>2 fragments) (high-energy trauma, e.g., MVC).

• Compound/Open – skin breach (gunshot wound).

Compartment Syndrome

• Definition

  • Raised pressure within closed muscle compartment leading to impaired perfusion & nerve damage.

• Causes

  • Fracture, crush injury, severe contusion, re-perfusion, anabolic steroid-induced hypertrophy, tight casts/bandages.

• Pathophysiology

  • Non-distensible fascia encloses muscles/nerves/vessels.

  • Swelling ↑ intracompartmental pressure > capillary perfusion pressure.

  • Ischaemia → muscle/nerve necrosis; potential limb loss.

• Clinical Manifestations

  • Severe out-of-proportion pain esp. on passive stretch, tense swollen limb, paresthesia, pallor, pulselessness (late), paralysis (late).

• Diagnostic Tests

  • Physical exam; X-ray to identify underlying fracture; compartment pressure monitoring (if available).

• Medical Treatment

  • Emergent fasciotomy (two-incision four-compartment release in leg) to decompress.

• Basic Nursing Care

  • Pre-op: loosen constrictive dressings, keep limb level with heart (no elevation above heart pre-decompression).

  • Post-op: sterile dressing, wound VAC, neurovascular checks.

• Health Education

  • Early reporting of escalating pain; care of fasciotomy wounds; avoidance of tight casts or intense repetitive exercise until cleared.

Immediate Care of Acute Compartment Syndrome (Learning Activity 4)

• Recognise 5 P’s promptly(Pain, Pallor, Pulselessness, Paraesthesia, and Paralysis).

• Remove/loosen casts & dressings.

• Keep limb at heart level.

• Notify surgical team – time-critical (<6 h optimal).

• Prepare for fasciotomy: consent, IV access, analgesia.