MUSCULOSKELETAL

DISORDERS
DEVELOPMENT HIP DYSPLASIA
• Abnormal development of hip—Preluxation, Subluxation, Dislocation
• Neonate—Laxity –ligaments—hip
• Infant—Galeazzi/Allis sign(Knee shortening), Restricted abduction mvt,
Unequal gluteal folds, Ortalani’s Sign (abduct –click), Barlow’s Sign (adduct—
slips),
• Older—Short affected leg, Trendelenburg’s test—Weight on affected hip, pelvis
tilts on normal side, Marked Lordosis, waddling gait
• MGT: 1. <6months—Pavlik harness Splint, 2. 6-18months– Reduction—Bryants,
modified bryants traction, Hip Spica cast (2-4 months), Flexion abduction brace
(3months), 3. Neurovascular, Skin care, 4. ABDUCTION POSITION
MAINTAINED
Bryants and Modified Bryants Traction
Congenital club foot
• Ankle and foot deformity,--Congenital
• Talipes Equinus, Talipes Calcaneous, Talipes Varus, Talipes Valgus
• MGT: 1. Manipulation (Closed Reduction), Casting, --8-12 weeks, Splint
2. Open Reduction, Cast after 12weeks , Cast, 3. Neurovascular and skin care
IDIOPATHIC SCOLIOSIS:
• Spinal deformity—lateral curvature, spinal rotation, rib asymmetry, hypokyphosis of
thorax—preadolescent
• Asymmetry(shoulder,ribs, hips), ADAM’S TEST– Asymmetry- ribs, flanks—bending
down, Leg discrepancy,
• MGT: 1. Back brace, 2. Spinal Fusion—Log roll position, Avoid twisting, activity
restrictions, 3. Check NVS, skin care, 4. Post op comp-Superior mesenteric artery Sx—
G.I Disturbance as Paralytic ileus, 5. Psychological support—Body image disturbance
Scoliosis Brace
MARFAN SYNDROME
• Genetic—Fibrillin I gene–blocking connective tissue—skeletal, CVS, eyes
• No cure—tall, thin , slender fingers, arms, legs, Visual disturbances, Cardiac
dysfunction,
• MGT: 1. Safety, Visual examination, 2. B blockers---lol—HR decrease, 3. Avoid
strenuous activities, contact sports, 4. Antibiotics—dental procedure---
endocarditis, 5. Aortic valve replacement
• LEGG-CALVE-PERTHES DISEASE:
• Blood supply interrupted – hip socket--- femur begins to dies
• Limping, Pain, stiffness –hip, groin, thigh, knee, ROM – limited
• MGT: 1. Stretching exercises, 2. Avoid weight bearing—AFF. Leg---Crutches, 3.
Bed rest, 4. Pelvic Traction, 5. Hip Spica cast—Femur in socket, 6. Night brace,
7. Hip arthroplasty----Maintain abduction, Avoid hip flexion, avoid weight
bearing, Check NVS, Skin Care
SPORTS RELATED INJURIES
• Strains—muscle/tendon over stretching– cold/heat application,
limit activity, anti inflammatory, muscle relaxant---- surgery

• Sprain---Ligament—over stretching– PRICE therapy, casting,

Surgery

• Rotattor cuff injury--- musculotendinous joint tear—NSAIDS,

Physical therapy, Sling support, Ice / heat application, Surgery
FRACTURE:
• Break in bone---injury
• TYPES: 1. Simple/Closed, 2. Compound/Open, 3. comminuted/multiple, 4.
complete, 5. incomplete, 6. compression,7. depressed, 8. impacted, 9.
greenstick, 10. oblique, 11. spiral, 12. transverse,13. pathological
• Pain, tenderness, swelling, redness, Limited movement, bone deformity,
crepitation, edema, NV impairement
• MGT: 1. Immobilise—splint, cast, 2. Check—NVS, 3. Reduction—Closed and
open, 4. Fixation –External and Internal, 5. Traction– Skin and skeletal, 6. Cast,
7. Assess NVS and Skin Care,
• Complication:
• 1. Fat embolism, 2. Compartment syndrome, 3. Pulmonary embolism, 4.
Osteomyelitis, 5.Avascular necrosis
Bucks Traction and Knee Sling (Double Sling )
Pelvic Traction
Balanced Suspension Traction
Skeletal Skull Traction Gardner Well tongs and Halo Vest
Fixation Device
Dunlop and 90 - 90 Traction
Perkins and Agnes Hunt Traction
CRUTCH WALKING
CRUTCH GAITS

From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
SINGLE- AND QUAD-FOOT CANES

From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
WALKERS
FRACTURED HIP

• Femur fracture—1. intracapsular , 2. extracapsular

• MGT: ICHF--- Skin traction, Total Hip replacement, ORIF, ---Prevent Hip dislocation
—avoid extreme hip flexion, abduction posture

• ECHF---Balanced suspension, Skin traction, ORIF, --Prevent internal and external

rotation, avoid extreme hip flexion > 90 (operated leg extended, elevated), Avoid
low seats/chairs, turning to unaffected side, HOB elevated 30-45 (only for food),
avoid weight bearing on affected leg(walker)—ORIF not for THR, Avoid crossing
legs, bending over, Wear Antiembolism stocking (flex and extend feet)

• Antibiotics, NVS, Skin care,

TOTAL KNEE REPLACEMENT:
• Analgesics before CPM—Post operative,
• Avoid leg dangling
• No Weight bearing—assistive device
• Blood salvage
• Antibiotics
• JOINT DISLOCATION AND SUBLUXATION:
• Dislocation—displacement ---socket
• Subluxation—incomplete displacement
• Asymmetry, pain, tenderness, swelling,
• MGT: 1. Open /Closed Reduction, 2. Activity restrictions,
INTERVERTEBRAL DISK HERNIATION

• Cervical herniation (C5-C7)

• Shoulder, arms, hands, scapula, pectoral muscles Pain, Paresthesia,
numbness, weakness—UE
• MGT: 1.Bed rest, 2. Immobilize, 3. Cervical collar/brace, 4. Apply heat, 5.
Head and spine alignment, 6. Analgesics, sedatives, anti-inflammatory,
corticosteroids, 7.Cervical Traction, 8. Avoid—flexing, extending, rotating
neck, prone position, sitting, --Maintain neutral position
• Lumbar herniation (L 4 –S1)
• Muscle weakness, pain lower back, radiation –hip, leg, Sciatica pain,
aggravated –activity, coughing, lifting
• MGT: 1. Heat / cold application, 2. side lying position with knee , hip
flexed, pillow btw legs, 3. Pelvic traction, 4. Analgesics, sedatives, anti-
inflammatory, corticosteroids, 5. Corset / brace, 6. Body mechanics, 7.
Weight control
POST OP CARE:
• Cervical disk surgery:
• Check—resp distress, --encourage
cough, deep breathing, early
ambulation
• Check laryngeal nerve damage
• Check surgical dressing
• Soft diet
• Neck collar
• If pain returns sudden —notify
Surgeon—cervical spine
instability
• Log roll techniques
• Lumbar disk surgery
• Check—B/B dysfunction
• Check Surgical Dressing
• High fibre diet, increased fluid diet,
stool softners
• Back brace, corset, cotton
underwear
• Lie supine, pillow under neck ,
slightly flex knees, activity
restrictions,
• Avoid spinal flexion, twisting,
straight alignment, minimal sitting,
extreme hip flexion when lying side
• Log roll techniques
 LOWER EXTREMITY AMPUTATION

• Surgical removal of limb

• Post op Care:
• Check and mark bleeding and drainage---dressing
• Phantom limb sensation and pain
• Prevent Hip flexion contractures—No elevation—residual limb—pillow
• < 24 hrs—Elevate FOB—edema , Bed flat –prevent—Hip flexion
contractures
• 24-48hrs—Prone, --prevent hip flexion contractures
• Elastic compression wrap, elastic stump shrinker –mould
• Massage ---Sutureline, ---prevent adherence to bone
• Wash –mild soap , lots of water, dry completely
• Progressive assistive techniques---Push residual limb against pillow
 Below knee amputation Above knee amputation
• Prevent edema • Prevent Internal/external rotation
• No dangling of knee • Sand bag , rolled towel, tronchater
• Avoid long periods of sitting roll--- outside the thigh
• Avoid knee flexion • Prone Position
• Place prone position throughout day
IMMEDIATE TRAUMATIC CARE---
• Call emergency
• Apply direct pressure—clotting
• Elevate extremity—above heart
• If finger—water tight, sealed plastic
bag, keep in ice bag, move to
emergency
OSTEOARTHRITIS (DEGENERATIVE JOINT DISEASE)

• Progressive deterioration- articular cartilage---weight bearing joints---hips,

knees, lower vertebral column and hands
• Joint pain– even at rest, climate aggravate, tenderness, Heberden’s nodes,
Bouchard’s Nodes, Crepitus, Limited in range, Difficulty getting up, inability to
perform daily living, compression of spine---radiating pain, stiffness, ---both
extremities
• Pain—acetaminophen, , NSAIDS, Muscle relaxants, moist heat, hot packs,
compresses, paraffin dips, cold , adequate rest,
• Physical mobility ----active, ----limit if pain exists
• Avoid large pillows under head and knee
• Osteotomy—resected --- correct joint deformity
• Arthroplasty---- joint replacement, ---infection time contraindicated
OSTEOPOROSIS
• Metabolic disease----bone demineralization—loss of calcium
from bones
• Bone Resorption--- bone formation slows—wrist, hips, vertebral
column
• Back pain—activity, palpation, weight bearing, decline in height,
Dowagers hump, Balance problem, Degeneration of vertebral
column, Osteoporosis
• MGT: 1. Safety, 2. ROM exercises, 3. Back Brace, 4. Exercises, 5.
Diet high in protein, calcium, vitamin C , vitamin D and iron
• Avoid alcohol, coffee, tea,
• Adequate fluid in take(calculi)
• Calcitonin for bone strength
GOUT: M-- 4.5 – 8mg/dl; F– 2.5 to 6.2mg/dl

• Systemic disease—urate crystals –joints, body tissues, cartilages

• Excruciating pain, joints inflammation, great toe, urate crystals within

organs, organ dysfunction, TOPHI– urate in skin (chalky nodules), renal
stones

• MGT---1. Low purine diet, 2. High fluid diet, 3. Weight reduction, 4.

Avoid alcohol, starvations diet,  gout attack, 5. Eat alkaline ash foods,
(green, beans, broccoli) > alkaline, 6. Bed rest, Mild flexion, 7. Protect
Joints, Bed cradles, 8. Heat and cold application , 9. Analgesics, anti
inflammatory, uricosuric agents—allopurinol