MUSCULOSKELETAL DISORDERS 3.

Pain
FRACTURE 4. Bleeding/Bruisinng
CAUSES OF FRACTURE 5. Loss of function
1. Trauma. 6. Shortening of affected extremity
A.) Violence as domestic. 7. Crepitus – sound of bone friction (grating
B.) Accidents- sports. sound)
*NEVER ELICIT CREPITUS!!
2. Pathological STAGES OF BONE HEALING
A.) Infections of bone. 1. Hematoma or inflammatory stage
B.) Metabolic Disorders.  1-3 days
C.) Malignancy. 2. Fibrocartilage Stage
3.  3-14 days
3. Callous formation
Classification of Fracture  2-6 weeks
1. Closed or dimple fracture 4. Ossification stage
- Has intact skin over sit of injury.  3-6 months
2. Open or Compound 5. Consolidation and remodeling
- Has skin break over injured site  6 weeks-1 year
- issue damage may be extensive

TISSUE DAMAGE ACCORDING TO SEVERITY

A. Grade 1
 Wound smaller than 1cm with minimal FRACTURE
contamination
B. Grade 2
 Wound larger than 1cm
C. Grade 3
Periosteum BV Bleeding Hematoma
 Wound exceeds 6-8cm with extensive damage
to soft tissue, nerve, and tendon.

TYPES OF FRUCTURE Fibrolastic Act.

 SIMPLE
 complete separation of the bone
 COMPOUND
 GREENSTICK/INCOMPLETE FRUCTURE
 THERE WAS A BREAK BUT NO SEPARATION. Gra. tissue
Commonly seen among children. Periosteum
 COMMINUTED- Break ups into pcs.
 Impacted- Similar to simple type.
 Depressed Fracture
Proc. Callus
DIRECTION OF FRACTURE
 OBLIQUE
 Diagonal
 COMMINUTED
 SPIRAL Prov Callus
 pinakamarte (sturdy& more strength)
 COMPOUND

CLINICAL MANIFESTATION
1. Deformity
2. Swelling
FACTORS AFFECTING BONE HEALING
1. Adequate circulation and proper immobilization TYPES OF CAST
-Very Crucial 1. Short arm cast- before the elbow
- To promote proper alignment 2. Long arm cast- below axilla
2. Presence of systemic or bone disease 3. Arm cylinder cast- whole hand not included
3. Age and general health of client 4. Hanging arm case- with sling to support
4. Type of fracture 5. Short leg cast- below the knee
5. Immediate treatment 6. Leg cylinder cast- whole foot not included in the
cast
COMPLICATION OF FRACTURE HEALING 7. Long leg cast- above the knee
1. Infection 8. Booth cast/walking cast-
2. Non-union- There is no healing process took 9. Spica cast- includes main part of the body plus
place in 6 months (poor immobilization) extremity
3. Mal union- there is union, but the end process is - Shoulder spica cast
bad (deformity) - Hip spica cast
4. Delayed union- healing is taking over a long  Bilateral long leg hip spica cast
period of time  One and a half hip spica cast
10. Body cast- fracture of vertebral column
MANAGEMENT 11. Minerva cast- fracture of neck
1. First aid 12. Risser cast or body jacket
a. Immobilization- Splint
b. CARE OF CLIENT IN CAST
*Splint them where they lie* 1. Before application
c. Transportation  Explain procedure
- Above and below joint
DEFINITE MANAGEMENT - 4-6 weeks
1. Reduction -restoration back to anatomical  Skin care
alignment -source of infection
a. Close or manual  Assist in application
– no direct visualization - stockinette several inches longer; pulled
– Incomplete, greenstick fractures over
b. Open or surgical- direct visualization - Padding or web roll- surrounding
- Open, comminuted, compound fracture site;
fractures  Moreover, bony prominences
- Internal fixation  1st layer- no stretching
 Plates and screws inside the  2nd layer- more tightly
bone - Cast – encircle injured part
- External fixation  Support with palms not fingers
 Screws and plates outside the  Not rest on hard surface
skin  After care
 Indications: - Clean skin
 Maintain position for - Plaster laden water- not emptied on
unstable fractures ordinary sink
 Allow use of joints with 2. After the application
immobilization  Drying of the cast
 Nonunion fracture  30 minutes- set in completely
healing  48 hours or longer- completely dry
2. Immobilization  No weight bearing till completely dry
a. Cast  Drying generates hear
- Or gypsum, plaster of Paris, anhydrous *Don’t cover - burn
(no water) calcium sulfate, fiber glass
- Rigid immobilizing device molded to
contour of body
 Assess the 5ps
 Pallor- pale skin or poor capillary
refill (vein)
 Pain- on palpation, movement and
constant
 Pulselessness- diminished or absent
pulse (artery)
 Paresthesia- “pins and needles”
(numbness)
 Paralysis- cannot move
 Assessment of pain
 Assess regularly; ask the client
 Progressing pain and unrelieved
by analgesic means
 Dose not enough
 Compartment syndrome
 IF UNRELIEVED REPORT
IMMEDIATELY!
 Assess for bleeding
 Encircle the area
 Refer
*Doctor will perform
windowing- opening or area of
the cast with bleeding
 Assessment of complications
1. Compartment syndrome
- Due to bleeding and swelling
that produces high pressure
inside an enclosed muscle-
impedes blood flow to
affected part
- Swelling- evident on 1st 24
hours
2. Fat emboli
- Common in long bone
fractures
- Due to trauma resulting:
a. Release of bone
marrow fat in
circulation particularly
lung
b. Altered lipid
metabolism
- J
- Signs and symptoms:
a. Pulmonary
insufficiency
(dyspnea, tachypnea)
b. Neurologic symptoms
c. Anemia
d. Thrombocytopenia
3. Deep vein thrombosis (DVT)
- Pain
- Swelling
- Redness
- Warmth
- Leg cramps often starting
- Bluish/whitish skin discolor
- Leg pain worsens when bending foot
- Unilateral edema below site of
thrombosis
- Pain and tenderness (Homans’ sign
50%)
MANIFESTATION DUE TO HYPOXEMIA
1. Apprehension and anxiety
2. Agitation and acute confusion
3. Petechiae on chest, abdomen, axilla
4. Fever
5. Dyspnea
4. Infection
Manifested by:
a. New pain or increasing pain
b. Increased warmth
c. Fever and chills
d. Odor
e. Purulent discharge
5. Cast Syndrome (Superior
mesenteric artery syndrome
Management:
1. Create window/bivalving
2. NGT to decompress
intestine
3. NPO
4. Anti-emetic
GENERAL CARE:
a. Relieve swelling
-Elevate extremity higher than heart for 1 st 24-
48 hrs
b. Change position every 2 hrs
c. Safety of client
d. Instruction on itchiness
-Not put anything on the cast
Characteristics of dry cast
 Order less
 White and shiny
 Light in weight
 Resonant when percussed
 Feel close to room temperature when touched
b. Traction
 -Pulling force applied to a part of the body
Countertraction- Pull at the opposite direction
TYPES OF TRACTION
1. Manual- temporary
2. Skin- pull/force is directly applied on the skin of
the patient
*FREE FROM FRICTION
*THERE DOULD BE CONTERTRACTION  Thomas splint traction
*NO KNOTS
*NO WEIGHTS TOUCHING THE FLOOR
 Bryant traction- the butt is off the bed

 Skeletal traction- force is directly

applied in the bone
 Dunlop traction *crutchfield thong

 Head halter traction

 Balance suspension skeletal traction

 Halo Traction

 Buck’s extension traction-lower

extremities

 Pelvic traction 

PRINCIPLE OF CARE:
1. Always a counter traction
a. Weights
-Maximum for skin traction- 15lbs or 6.5 kilos
(10% of BW)
- Skeletal 25-40lbs (11-18kg)
b. Elevation of bed (1inch/lb)
2. Continuous and uninterrupted unless interrupted
traction was prescribed
3. Follow a line of pull
4. Free of friction
5. Proper position

 Hammock traction
 3. Rehabilitation -Joint surfaces are in partial contact, but relationship is
-Regain back normal functioning abnormal
 Physical Therapy
 Exercise -Partial dislocation
 Gadgets
THERE’S STILL AN ABNORMAL RELATIONSHIP AND HAS
- Crutches (axillary, elbow, gutter)
A PARTIAL CONNECTION
 Gaits in crutch walking
-2point CAUSES
-3point
-4point -Acute deforming forces applied to ligaments of
-Swing through tendons
 GOOD GOES TO HEAVEN
BAD GOES TO HELL 1. fall
- Cane (Cane + Bad leg) 2. Blow
- Purpose of cane
 Aid in walking 3. Strong muscle contraction
 Provide postural stability
 PSupport and assist in - Holding to siderails
maintaining good posture MANIFESTATIONS (DISLOCATION)
 Self defense
 Fashion accessory -Severe pain that increases attempted movement
- Principle of using cane
1. Proper size -Swelling around or below the joint
2. Correct use -Complete or nearly complete loss of function (Total or
- Wheelchair, walker and stroller Partial)
CONTUSION
 Soft tissue injury due to blunt object, kick, or fall -Visible deformity-may alter length of extremity
 Small blood vessels rupture into soft tissue
Signs and symptoms MANIFESTATIONS (SUBLUXATION)
1. Pain -Pain – Varies
2. Swelling
-Increases with attempted movement
STRAIN OR PULLED MUSCLES
Cause: Overstrecthing or excessive stress on muscle -Swelling

-Feeling that joints were out of position

SPRAIN
-Injury to ligaments and supporting muscle fibers that -Joints feel weak
surrounds the joints
-X-Ray Result: Normal
MANAGEMENT FOR STRAIN AND SPRAIN: (RICE)
MANAGEMENT (DISLOCATION)
R- Rest affect part
I- Ice or cold compress -Immediate reduction – before inflammation and spasm
- 20-30 minutes for 24-48 hours becomes significant
- Vasoconstriction
C- Compression (Elastic bandage) -Ice pack
E- Elevate affected part
-Analgesics and muscle relaxant – before attempt to
DISLOCATION reduce

-Opposing joint surfaces are no longer in contact -Splint, harness or padding for 4-8 weeks

(immobilize part affected in order to maintain normal

anatomical position)
SUBLUXATION
MANAGEMENT (SUBLUXATION)
Neuromuscular condition
-Joint restrictive support

-RICE (Rest, Ice, Compression and Elevation) -Spinal deformities as poliomyelitis, spinal cord tumors,
trauma and cerebral palsy.

TYPES OF SCOLIOSIS
SPINAL COLUMN DISORDERS 1. According to etiology
33 VERTEBRA A. Congenital
-gene called CHD7 (Chromodomain-
7 CERVICA delicase-DNA-binding-protein 7)
B. Idiopathic
12 THORACIC – according to onset
5 LUMBAR -most common form
-appears in growing children with no
5 SACRAL apparent health problems

4 COCCYGEAL Infantile – less than 3 years

Juvenile – 3-10 years
Adolescent – over 10 years
Why it is S- MOST COMMON
SHAPED? For even Adult
distribution of weight
and stability of movement. Functional
-Spine is normal
CURVES OF THE SPINE -Cause
1.) one leg is shorter
Normal lordosis – two forward curves – concave 2.) Muscle spasm at the back
Neck-cervical spine
Lowback – Lumbar spine Neuromuscular
-Failure of spines to form or separate completely
SCOLIOSIS -Associated with birth defect

-Lateral curvature of the spine B. According to origin

-Cervical, thoracic, thoraco-lumbar or lumbar area A. Structural origin
- cannot correct itself on force bending against
INCIDENCE the curvature
- Vertebral rotation is demonstrates
-primarily a problem in girls
-with screening studies, equal to both girls and boys B. Non structural origin
-Less than 20 degrees associated on both male and - Is easily
females corrected on
-most common over 10 years force bending
- Rotation – not
ETIOLOGY demonstrated

Congenital

-Malformation of body segments of spine because of

failure of:
DIAGNOSIS
Formation – mixing formation of spine (SCOLIOSIS)
Failure of segmentation –
 1. Adams forward test If greater than 45 degrees
If conservative management failed
- Used as screening test
1. Spinal function
2. X-RAY - Ultimate goal in most cases

3. COBB ANGLE – to assess curve qualitatively SPINAL FUSION

MANAGEMENT (SCOLIOSIS) KYPHOSIS

-Curve is considered significant if greater than 25-30
degrees
-Curves exceeding 45-50 degrees are considered severe
and requires more aggressive treatment
-Consists of:
-humpback
-posterior rounding of thoracixc or sacral region
-more than 45 degrees needs evaluation
- Hyperkyphosis “more than 50 degrees”

NON SURGICAL TREATMENT

1.Observation
2. Bracing
- Not curve, prevents progression of curve
-Boston brace- Most utilized brace
-number of hours: 12-20 hours CAUSES:
-Poor posture
-Secondary to disease
-Degenerative disc diseases
-Developmental problems
-Trauma
-`Osteoporosis with fracture of vertebrate

TYPES OF CLASSIFICATION
1.Congenital
-spinal column not fully developed correctly in the
3.Exercise womb
 Cat-Cow exercise -Vertebra may be malformed or fused together
-Can disappear in teenage years

2. Postural
-Most common
-Due to slouching
-Younger- slouching kyphosis; reversible
-Adult – dowager’s hump or hyperkyphosis

SURGICAL MANAGEMENT 3.Nutritional

-From nutritional deficiency in childhood
-As vitamin D deficiency – soften bones
-curving of spines and limbs

4.Post traumatic kyphosis

-From untreated or ineffectively
Treated vertebral fractures

5.Gibbus deformity
-Form of structural kyphosis, often a sequala to
tuberculosis

MANAGEMENT (KYPHOSIS)

Orthosis – use of Milwaukee brace

surgery or kyphoplasty
-may arrest deformity and relieve pain
A. osteotomy- Bone is cut to correct deformity
B. Spinal fusion – to stabilize after osteotomy

LORDOSIS
-Excessive inwards curvature of lumbar spine

CAUSES (LORDOSIS)
-Tight low back muscles
-Excessive visceral fats or obese
-Pregnancy
-Congenital hip dislocation
-Large abdominal tumors
-Dancer gymnasts

MANIFESTATIONS (LORDOSIS)

MANAGEMENT (LORDOSIS)
-Loss of weight
-Use of Brace
-Surgery – spinal fusion