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MUSCULOSKELETAL SYSTEM OUTLINE: A. Fxn bones= support, voluntary movement, protect underlying organs, production blood, storage minerals.

B. BONE CELLS: a. Osteoblasts- build bone b. Osteoclasts- break down bone- remodelling c. Osteocyte- mature bone cell C. TYPES BONES: a. Long bones- bear weight ex. Femur o Epiphysis- consist spongy cancellous bone-o Metaphysic- resp longitudinal growth of bone o Diaphysis- compact bone- yellow & red marrowtrabeccaspongy, haversinian system

In adults, flat & irregular bones of skull, shoulder, pelvis ribs and sternum produce blood cells.

b. Short-ex. Phalanges c. Flat-ex. Scapula D. GROWTH & METABOLISM IS AFFECTED BY a. Ca2+ & phosphorus, Vit D-necessary for absorption Ca2+, insulin, gluccorticoidsprotein metabolism, calcitonin-decreases serum Ca2+, parathyroid hormone-increases serum Ca2+, estrogens & androgens stimulate osteoblast activity, thyroxine protein synthesis, growth hormone-increase length bone. E. JOINTS- articulation for movement & flexibility a. Synarthroidal - immovable joint ex skull b. Amphiarthroidal- slightly moveable ex. Pelvis c. Dyarthroidal (synovial)- freely moveable-flexion, extension, ab/adduction rotation, circumduction F. BURSAE-sacs filled with synovial fluid which decrease friction between moving joints

G. ISOMETRIC CONTRACTIONS- squeezing muscledont move, ISOTONIC CONTRACTIONmoves muscle H. MUSCULOSKELETAL CHANGES ON OLDER PERSON: a. Loss motor neurons b. Muscle atrophy and weakness c. Increased bone re-absorption w/ decreased bone production oteopenia & osteoporosis d. Degeneration cartilage e. Loss flexibility tendons & ligaments I. ILLNESSESS AFFECTING MUSCULOSKELETAL SYSTEM: a. DM, poliomyelitis, tuberculosis, parathyroid problems, rickets, scurvy, soft tissue infection, neuromuscular disabilities. o Ask if had vaccination for polio & tetanus, what are results for TB test J. MEDICATIONS THAT AFFECT MUSCULOSKELETAL SYSTEM a. Anti-seizure, corticosteroids, potassium depleting diuretics o Ask if bouts amenorrheaosteoporosis, ask postmenopausal women about HRT,

both sexes about Ca2+, Vit D supps

K. LABS & DIAGNOSTIC TESTS: a. RADIOGRAPHIC TESTS: o Standard x-ray- eval. Structure & fxn bone

Explain procedure, avoid excessive exposure, remove Radiopaque objects, verify not pregnant

o Myelogram (myelpgraphy)- injection Radiopaque dye into subarachoid space of vertebral column after removal sm. Amt CSF

NPO after liquid breakfast, Check iodine allergy, Informed consent If oil based dielie flat for12hrs, water dye- HOB 30-45 & institute seizure precautions Inform spinal headache should HCP resolve 1-2dys w/ rest & fluids & notify

o MRI- views soft tissue, Gadolinum may be injected to better view structures

Contraindicated those with pacemaker, shrapnel, hearing aid, electronic devices aneurism clips or metal implants Remove al jewellery & cloths w/ metal, Instruct to lie still & may have s/s/ claustrophobia, Admin anti-anxiety meds

b. ENDOSCOPY o ARTHROSCOPY- insert arthroscope into joint, removes loose bodies 7 biopsy

Inform outpt. Procedure w/ strict asepsis, under local or general anesthesia After cover wound w/ P-dressing 24hrs, limit activity

c. INVASIVE PROCEDURES o ARTHROCENTESIS- puncture of joint capsule to obtain synovial fluid or remove excess fluid. Local anesthetic & asepsis

Inform done @ bedside or exam room, pressure dressing, observe blood or fluid

d. ELECTROMYELOGRAM (EMG)- records electrical activity of muscle by inserting smallgauge needles attached to leads dx lower motor dysfxn

Inform perform in electromyelogram lab while supine on a table, discomfort from needle insertion must stay awake to respond to commands from movement

Avoid stimulants ex. Caffeine & sedatives 24hrs

e. BLOOD STUDIES o RHEUMATOID FACTOR N<1:20 or negative o URIC ACID-end product purine metabolism & excreted in urine. N-men=4.56.5mg/dL, N-women=2.5-5.5mg/dL.