Care of Clients with Problems Related

to the Musculoskeletal System

Diagnostic Procedures
1. Radiologic studies
a. X-rays
b. Computed tomography or CT scan
• Non- invasive procedure where a body part can be acanned from different
angles with an x-raybeam and a computer calculates varrying tissue
densities and records a cross section image on paper done to determine
extent of fracture in difficult to define areas
Diagnostic Procedures
c. Myelography
 Injection of radioopaque dye into subarachnoid space at posterior spine to
determine level of disc herniation or site of tumor
Diagnostic Procedures
2. Arthrography
 Radioopaque or air injected into joint cavity- outines soft tissue structure
and contour of joint
3. Bone scanning
 Parenteral injection of bone seeking radioactive isotope
4. Electromyography
 Graphic presentation of the electrical potential of muscles
Diagnostic Procedures
5. Magnetic Resonance Imaging
 Noninvasive scanning technique that uses magnetism and radiofrequency
waves to produce cross-sectional images of body tissues on computer
screen
6. Arthroscopy
 Endoscopic direct visualization of joint, especially knee
Diagnostic Procedures
7. Arthrocentesis
 Needle aspiration of synovial fluid
8. Bone Biopsy or Muscle biopsy
9. Laboratory
a. Uric acid
b. Antinuclear antibody (ANA) for systemic Lupus Erythematosus
c. Complement fixation (CF) for Rheumatoid Arthritis
d. Calcium, Alkaline Phosphate, Phosphorus
Musculo-Skeletal Therapeutic Modalities
1. Reduction
 Realigning an extremity into anatomical position

a. Open- use of surgical methods

b. Closed- use of non-surgical methods; manipulation
Musculo-Skeletal Therapeutic Modalities
2. Immobilization
 Manual
 Skin- adhesive- plaster or adhesive is applied longitudinally on the lower
extremeties and an elastic bamndage applied in an spiral motion
Musculo-Skeletal Therapeutic Modalities
2.Bryant’s traction- indicated for children aged 0-3 year’s not more than
40 lbs.
1.Traction is always applied on both ends

• Nursing Responsibility
• Nurse should be able to pass hand between the patient’s buttocks and
mattress
Bryant traction

Knee slightly flexed

Buttocks sightly
elevetated and
clear of bed
Musculo-Skeletal Therapeutic Modalities
Buck’s Extension Traction
Indicated for older patients to those weighing over 40 lbs.

Nursing Responsibility
Only the affected extremity is placed on traction
Buck’s Extension Traction
Musculo-Skeletal Therapeutic Modalities
Dunlop Traction
Used in affectations of the upper extremities
Dunlop Traction
Nursing Care of Clients with Adhesive Traction
1. Unwrap and wrap and elastic bandage at least once a shift
2. Check skin integrity for allergic reactions to plaster
3. Note circulation, sensation and mobility of the affected extremities
Skin- non adhesive
Uses canvass or cloth that is applied on the patient’s skin
• Pelvic girdle traction
Applied like a girdle and connected to two ropes with weights that hangs at
the foot part of the bed
Indicated for low back pain
• Head Halter Traction
Applied on chin and occipital region connected to a hanger with weights that
hangs at the head part of the bed
Usually indicated for cervical spine affectations
Skin- non adhesive traction
• Cotrel Traction
Combination of the head halter and pelvic traction used in scoliosis
• Russell Traction
Permits patient to move freely in bed and permits flexion of the knee and
hip joint
Buck’s extension and the knee is suspended in a sling to which a rope is
attached
Russell Traction
Nursing Care of Clients with non-adhesive
traction
• Rest period are provided
Skeletal Traction
Applied into a bone
• Crutchfield Skeletal Traction
Applied into the parietal; bones
• Indicated for cervical spine affectations
Crutchfield Tong
Skeletal Traction
• Balanced Skeletal Traction
Applied alone or with skeletal traction to promote patient mobility
Balanced Skeletal Traction
Principles of Care
1. The patient should always be on either supine or dorsal recumbent
position
2. The should always be an counteraction (patient’s weight)
3. The line of deformity should be in line with the traction
4. Traction should be continuous
5. There should be no friction within the line of traction
b. Cast- ComparisonPlaster
of Cast Materials
Synthetic
Material Plastc of Paris, comprised Polyester and cotton,
of powdered calcium fiberglass or plastic.
sulfate crystals Polyester and cotton is
impregnated into the impregnated with water-
bandages activated polyurethane
resin

Drying time 24-48 hours 7-15 mins of setting

15-30 mins for weight
bearing
Advantages Less costly Less likely to indent into
More effective for skin
immobilizing severely Lighter in weight
displaced bones Less restrictive
Smooth surface Does not crumble
Does not require Nonabsorbent
expensive equipment for Can be immersed in water
application
c. Braces
• Knight-taylors
For thoraco-lumbar affectations
• Milwaukee
For scoliosis

Nursing Care
Use cotton clothing as barrier
d. Fixators
RAEF
Roger Anderson External Fixator
Ilizarov device
Indicated for comminuted fractures
3. Rehabilitation
Active or dynamic program aimed at enabling an ill or disabled to
achieve the highest level of physical, mental, social, and economic
self-sufficiency of which he is capable
Members of the Rehabilitation team
a. Patient
 Key member of health team
b. Rehabilitation nurse
 Develops plan of patient care
c. Physician
 Makes medical diagnosis; directs team
d. Physiatrist
 Physician specialist in physical medicine
e. Physical Therapist
 Teaches or supervises patient in prescribed exercise program
Members of the Rehabilitation team
f. Psychologist
 Helps patient or family explore feelings
g. Occupational Therapist
 Helps develop skills for home and work situations
h. Social Worker
 Assists patient and family adjust socio-economically
i. Vocational Counselor
 Tests patient’s interest and aptitudes
j. Rehabilitation Engineer
 Uses technology in designing or constructing devices to help the
handicapped
Transfer and Assistive Devices
1. transferring a client from bed to stretcher
 stretcher must be perpendicular to bed
2. transferring a client from bed to wheelchair
 the wheelchair must be parallel to the head of the bed
3. Canes
 Height of cane is from floor to waist level
 Cane is held by opposite the affected extremity
Transfer and Assistive Devices
4. Crutches
 Height of crutch is from floor to axilla minus 2 inches
 Patient’s weight is borne by the palm, of the hand and not on the axilla
 When going upstairs, unaffected leg first
 When going upstairs, affected leg first
Crutch-walking techniques
Two point gait (two alternate gait)
Three point gait
Four point gait
Swinging crutch gaits
Both legs are lifted off the ground simultaneously and swung forward while
patient pushes up on crutches
Swing-to gait
Lift and swing body up to crutches
Swing-through gait
Lift swing body beyond crutches
Exercises
a. Isometric
 Alternate contraction and relaxation of the muscle without moving the
joint
a. Done on the affected extremity
b. Isotonic
 Range of motion exercises
 Done on the unaffected extremity
Heat or Cold Application in Trauma
Cold Application • Heat Application
first 24 hours • After 24 hours
To decrease • To relieve pain from
hemorrhage muscle spasms
To relieve pain • To reduce swelling by
To reduce inflammation increasing circulation
• To promote healing by
increasing oxygenation
4. Orthopedic Operative Procedures
a. Arthrotomy
• Surgical opening into a joint
b. Arthrodesis
• Fixation of a joint
c. Spinal fusion
• Surgical removal of 1 or more vertebra and fusing
them together
4. Orthopedic Operative Procedures
d. Hip replacement
• Placement of prosthesis on the hip joint
• Indication
• Hip fracture
• Inability to move leg voluntarily
• Shortening and external rotation of the leg
Nursing Management on Hip Replacement
• Avoid positioning on the operative site
• Maintain abduction of hip
• Pillows between legs
• Provide chair with firm, non-reclining seat and arms
Nursing Management on Hip Replacement
• Avoid hip flexion beyond 60 degrees for 10 days
• Avoid hip flexion beyond 90 degrees from day 10 to 2
months
• Avoid adduction of the affected leg beyond midline
for 2 months
• Partial weight bearing status for 2 months
Trauma
• Contusion
• Injury to the soft tissue produced by blunt force
• Sprain
• Injury to the ligamentous structures caused by wrenching
or twisting
• Forcible hyperextension of a joint with tissue damage like
whiplash injury
Trauma
• Strain
• Tearing of musculotendenous unit caused excessive stretching
• Dislocation
• Joint articulating surfaces are partially separated
• No longer in anatomical contact
• Fractures
• Break on continuity of bone
Nursing Assessment
1. Pain
• Increasing until immobilized
2. Loss of function
3. Localized swelling or discoloration
4. Deformity
5. Crepitus
• Grating sound
General Classifications of Fractures
1. Simple or closed
• Skin is intact over fracture site
2. Compound or open
• With an external wound in contact with the underlying fracture
3. Complete
• Entire cross section is displaced
4. Incomplete
• Portion of cross section undisplaced
General Classifications of Fractures
1. Greenstick
• One side broken and other bent
2. Transverse
• Straight across the bone
3. Oblique
• Angle or slanting across the bone
4. Spiral
• Twisting or coils around shaft
5. Comminuted
• Splintered into several fragments
General Classifications of Fractures
• Depressed
• Fragments are drived-in; facial or skull
• Compression
• Fractured bone compressed by another bone; vertebra
• Impacted
• Fractured bones are pushed into each other (telescoped)
• Displaced
• Fragments are separated from fracture line
• Linear
• Fracture parallel with long axis
 COMPARING ARTHRITIS
Rheumatoid Osteoarthritis Gouty
Etiology Autoimmune Degenerative Metabolic or
+ Rh factor senescence familial purine
metabolism

Incidence 35-45 women Men or more in Men over 40

women

Signs and Subcutaneaous Heberdens nodule Tophi

symptoms nodules
Morning stiffness
Swan neck deformity
Areas Joints of hands Weight bearing joint Great toe
affected
Management Aspirin, NSAIDs Symptomatic Colchicine
Paraffin bath Avoid purine
diet
Allopuyrinol