Muscular System and Skeletal System

Bone types

  • Bone structure

  • Bone function

  • Bone growth and metabolism are affected by calcium and phosphorus, calcitonin, vitamin D, parathyroid hormone, growth hormone, glucocorticoids, estrogens and androgens, thyroxine, and insulin.

Joints

  • Types include synarthrodial, amphiarthrodial, and diarthrodial.

  • Structure of a synovial joint.

  • Subtyped by anatomic structure:

- Ball-and-socket

- Hinge

- Condylar

- Biaxial

- Pivot

Muscular System Assessment

  • Patient history

  • Nutritional history

  • Family history and genetic risk

  • General inspection:

    • Posture and gait

Specific Assessments

  • Face and neck

  • Spine

  • Hand

  • Hip

  • Ankles, feet

  • Neurovascular assessment

  • Psychosocial assessment

Diagnostic Assessments

  • Laboratory tests: serum calcium and phosphorus, alkaline phosphatase, serum muscle enzymes

  • Radiographic examinations standard radiography, bone density, tomography, xeroradiography, myelography, arthrography, and CT

  • Other diagnostic tests bone and muscle biopsy

Electromyography

  • EMG aids in the diagnosis of neuromuscular, lower motor neuron, and peripheral nerve disorders, usually with nerve conduction studies.

  • Low electrical currents are passed through flat electrodes placed along the nerve.

  • If needles are used, inspect needle sites for hematoma formation.

Arthroscopy

  • A fiberoptic tube is inserted into a joint for direct visualization.

  • Patient must be able to flex the knee; exercises are prescribed for ROM.

  • Evaluate the neurovascular status of the affected limb frequently.

  • Analgesics are prescribed.

  • Monitor for complications.

Osteoporosis

  • Chronic metabolic disease, in which bone loss causes decreased density and possible fracture

  • Osteopenia (low bone mass), which occurs when osteoclastic activity is greater than osteoblastic activity

  • Stiology and genetic risk

  • genetic considerations

  • incidence/prevalence

  • Cultural considerations

Classification of Osteoporosis

  • Generalized osteoporosis occurs most commonly in postmenopausal women and men in their 60s and 70s.

  • Secondary osteoporosis results from an associated medical condition such as hyperparathyroidism, long-term drug therapy, or long-term immobility.

  • Regional osteoporosis occurs when a limb is immobilized.

Osteoporosis Interventions

  • Nutrition therapy

  • Exercise

  • Other lifestyle changes

Osteoarthritis: Drug Treatment

  • Calcium and vitamin D supplements

  • Estrogen or hormone therapy

  • Bisphosphonates

  • Selective estrogen receptor modulators

  • Calcitonin

  • Other agents used with varying results

Osteomalacia

  • Loss of bone related to vitamin D deficiency

  • Bone softens because of inadequate deposits of calcium and phosphorus in the bone matrix

  • Rickets

Collaborative Care

  • Assessment

  • The major treatment for osteomalacia is vitamin D

Paget’s Disease of the Bone

  • A chronic metabolic disorder in which bone is excessively broken down and reformed

  • Genetic considerations

  • Collaborative care

    • Physical assessment

    • Diagnostic assessment

Paget’s Disease: Nonsurgical Management

  • Analgesics

  • Decrease bone resorption

  • Selected bisphosphonates

  • Calcitonin

  • Plicamycin

  • Diet therapy

  • Nonpharmacologic pain-relief measures

Paget’s Disease: Surgical Management

  • Tibial osteotomy

  • Partial or total joint replacement

  • Surgical decompression and stabilization of the spine

Osteomyelitis

  • Infection in bony tissue

Osteomyelitis: Collaborative Care

  • Assessment

  • Antibiotic therapy

  • Hyperbaric oxygen therapy

  • Surgical management:

    • Sequestrectomy

    • Microvascular bone transfers