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Problems of the Musculoskeletal System

Mona Garrett NURS 210

Review of Skeletal System
Functions of bone Structure of bone Cancellous (spongy) or cortical (compact) Haversian system Bone remodeling Osteoblasts and osteoclasts Long bones and short bones Joints

ROM Abduction and adduction Flexion and extension Effects of aging and disuse . muscle size.Review of Muscular System Function Assessment Muscle strength.

hip.Osteoporosis Most common metabolic bone disease Rate of resorption > rate of bone formation Primary versus secondary Affects 50% of women. 20% of all men S/S: Loss of height Progressive curvature of spine Low back pain Fractures especially wrist. vetebral .

lean body build Long term use of steroids Calcium deficiency Estrogen deficiency Androgen deficiency Smoking High caffeine intake High alcohol intake Sedentary life style or prolonged immobility .Risk Factors of Osteoporosis Increasing age Family history of osteoporosis Female Postmenopausal Caucasian or Asian Thin.

phosphorous. ALP MRI. vit D. Ultrasound .Diagnosis of Osteoporosis History and physical exam Xrays CT scan Dual-Energy Xray Absorptiometry (DEXA) Bone biopsy Serum calcium.

Actonel) Calcitonin SERMs: Evista (Raloxifene) . Boniva.Treatment of Osteoporosis Diet: Foods high in calcium and Vit D Medications Hormone Replacement Therapy Parathyroid Hormone (Forteo) Calcium Vit D Biphosponates (Fosamax.

prevention of falls. exercise. diet.Treatment of Osteoporosis Prevention of falls Weight bearing exercise Pain management Orthotics Health teaching: Medications. psychosocial support . disease process.

inadequate mineralization of bone matrix Patients at risk: Elderly Strict vegetarians Vitamin D deficiencies Limited exposure to sunlight Meds that increase degradation of Vit D Impaired intestinal absorption of Ca & P Renal or liver disease .Osteomalacia Reversible metabolic bone disorder.

waddling gait. low Ca and P. elevated parathyroid and alkaline phosphase (ALP) Treatment: Vitamin D supplements Calcium and phosphorous supplements Sunlight at least 5 minutes/week Diet high in calcium and exercise .Osteomalacia S/S: Bone pain and tenderness. muscle weakness. pathologic fractures Diagnosis: Xrays.

hearing loss.Paget’s Disease Metabolic bone disease of unknown etiology. vertigo Neuro compromise. pathologic fracture CHF. men > women 3:2 S/S: 80% asymptomatic Bone pain of spine. hypertension. excessive osteoclastic activity Familial tendency. cranium. arteriosclerosis . pelvis Flushing and warmth of overlying skin Headache.

CT. elevated urinary Ca & hydroxyproline. bone scan.antineoplastic & antibiotic Other biphosphonates (Fosamax) Other pain relief measures Joint replacement or repair .Paget’s Disease Diagnosis: Xrays. bone biopsy Treatment NSAIDS and analgesics Calcitonin and Didronel Mithramycin . elevated serum alkaline phosphatase.

hematogenous. and swelling of affected area Diagnostic Tests: Blood & wound cultures. bone biopsy Elevated ESR & WBC if acute. redness. usually bacterial (primarily staph aureus) Can be exogenous. or extension from adjacent soft tissue infection S/S: Fever. normal if chronic . bone scan. MRI. Xrays. tenderness.Osteomyelitis Infection of the bone. warmth. bone pain.

impaired physical mobility.Treatment of Osteomyelitis Meds: Aggressive long term antibiotics Surgery: Needle biopsy or aspiration Surgical debridement Bone graft or muscle flap to replace deficit Hyperbaric oxygen therapy Nursing Diagnoses: Pain. anxiety & powerlessness Teaching: Home administration of antibiotics and dressing changes .

CBC.Bone Tumors Primary vs secondary tumors (metastasize from breast. MRI. kidney. chemo . thyroid. pain Diagnosis: Xrays. may have pathologic fracture. ESR. CT. prostate) Primary bone tumors are benign (most common osteochondroma) or malignant (most common osteosarcoma) S/S: Usually associated with fall or injury. Chems Rx: Removal of tumor. lung. Needle biopsy. radiation.

most frequent bone cancer in children. usually head and neck especially orbit. usually 10-25 yrs old Rx: Amputation or limb salvage. children under 5 Treatment: Surgery. chemo Rhabdomyosarcoma .affects ages 4-25 yrs old Treatment: Radiation. radiation . chemo Prognosis: 50% expect long term survival Ewing Sarcoma .Bone and Soft Tissue Tumors in Children Osteosarcoma .most common soft tissue sarcoma in children. chemo.

ice. splinting rest. surgery as last resort . NSAIDS. corticosteroid injections. tingling. pain at night Dupuytren’s Contracture – progressive contracture of palmar fascia Ganglion – cyst on tendon or wrist joint Treatment: Immobilization.Hand Disorders Carpal Tunnel Syndrome – compression of median nerve as a result of inflammation Repetitive use injury or R/T other disorder S/S: Numbness.

Foot Disorders Hallux Valgus . surgery. usually due to footwear Hammertoe .dorsiflexion of big toe with plantar flexion of 2nd and 3rd toes Morton’s Neuroma .tumor like mass. usually only in one foot and 3rd web space Diagnosis: Inspection and xrays Rx: Orthotics. casts . analgesics.enlargement and lateral displacement of first metatarsal (bunion) Can be congenital.

stretching exercises.compressed posterior tibial nerve in ankle. pain in arch of foot and/or heel Affects runners. cortisone injection. cortisone injections. OR Plantar Fasciitis . NSAIDS. adults over 40 Treatment: Rest.inflammation of plantar fascia. ice. obese.Foot Disorders Tarsal Tunnel . orthotics . causes numbness & pain Rx: NSAIDS.

Congenital Clubfoot Common deformity with foot twisted from normal shape and position Talipes equinovarus most common Treatment Serial casting begun after birth. casted every 1-3 weeks for 3 months Surgery a possibility if casting not working Reverse last shoes Surgery at 4 months to 1 year old .

casting OR: Spinal fusion and instrumentation .Inspection.Spinal Disorders Scoliosis . xrays Conservative treatment: Braces.lateral curvature of the spine Kyphosis – excessive angulation of normal posterior curve of thoracic spine (hunchback) Lordosis – lumbar curvature (swayback) Diagnosis . curvature > 5o by scoliometer. weight reduction. traction. exercises.

electromyogram (EMG) Treatment: None available to cure Goal is to preserve and promote mobility . can involve cardiac and endocrine systems. muscle biopsy.Muscular Dystrophy Group of inherited muscular disorders that cause progressive muscle degeneration Duchenne’s dystrophy most common S/S: Progressive muscle weakness. mental retardation Diagnosis: Serum creatine phosphokinase.