MUSKULOSKELETAL

SYSTEM
Perlin Zellaine T. Licas RN, PhD, MAN
The musculoskeletal system
is made up of bones, cartilage,
ligaments, tendons and
muscles, which form a
framework for the body.
Tendons, ligaments and fibrous
tissue bind the structures
together to create stability, with
ligaments connecting bone to
bone, and tendons connecting
muscle to bone.
01 BONES
03 TENDONS

02 CARTILAGE
04 LEGAMENTS

FUNCTIONS
SUPPORT
PROTECTION
MOVEMENT
Mineral Homeostasis
Blood Cell Production
Triglyceride Storage
Once an osteoblast becomes surrounded by bone matrix,
it is reoffered to as an OSTEOCYTE.
Your Picture Here
Factors affecting Bone Growth
Factors affecting Bone Growth
Factors affecting Bone Growth
Factors affecting Bone Growth
Factors affecting Bone Growth
Factors affecting Bone Growth
MUSCULAR SYSTEM
3 TYPES OF MUSCLE TISSUE:
SKELETAL | SMOOTH | CARDIAC

FUNCTIONS:
Movement of the body
Maintenance of posture
respiration
Production of body heat
Communication
Constriction of organs and vessels
Contraction of the heart
MUSCULAR SYSTEM
The major characteristic of muscle tissue are:
MUSCULAR SYSTEM
The major characteristic of muscle tissue are:
MUSCULAR SYSTEM
Properties of Muscular Tissue
MUSCULAR SYSTEM
Skeletal Muscle Structure
MUSCULAR SYSTEM
Skeletal Muscle Structure
MUSCULAR SYSTEM
Parts of Muscle
MUSCULAR SYSTEM
Anatomy and Physiology
Functional Classification of Joints
SKELETAL SYSTEM

Your Picture Here

FEMUR
The femur is the longest, heaviest, and
strongest bone in the human body. The main
function of the femur is weight bearing and
stability of gait. An essential component of the
lower kinetic chain.
 Various Tests to Assess Musculoskeletal Integrity
Radiography

- Most commonly used procedure

to diagnose disorders of the
musculoskeletal system.
 Various Tests to Assess Musculoskeletal Integrity
Arthrocentesis
- Involves aspirating synovial fluid, blood, or pus
via a needle inserted into a joint cavity.
- Medications are sometimes instilled into the joint
to alleviate inflammation.
Various Tests to Assess Musculoskeletal Integrity
Myelogram

- Injection of a dye or air into the subarachnoid

space followed by radiography to detect any
abnormalities of the spinal cord and vertebra.
Various Tests to Assess Musculoskeletal Integrity
Myelogram

- Injection of a dye or air into the subarachnoid

space followed by radiography to detect any
abnormalities of the spinal cord and vertebra.
Common Orthopedic Disorders
Sprain and Strain
• Sprain - tear in the ligament surrounding a
joint (overuse, misuse or excessive twisting
• Strain - stretching injury to a muscle
(mechanical overloading, forcible
stretching or unusual muscle contractions)
Common Orthopedic Disorders
Dislocations
- Displacement of bone from its correct
position within a joint
(Subluxation - partial dislocation)
Common Orthopedic Disorders
Fractures
- A break in the continuity of the margins of a bone
- When a force exceeds the compressive or tensile
strength of the bone, fracture occurs
- Maybe due to stress, trauma, overuse, repeated
wear
Types and Causes of Fractures
Avulsion
- Fracture that pulls bones and other tissues from
their usual attachments
- Direct force with resisted extension of the
bone joint
Types and Causes of Fractures
Closed
- Skin closed but bone is fracture
- Minor force
Types and Causes of Fractures
Compression
- Fracture in which the bone is squeezed or
wedged together at one side
- Compressive, axial force applied
directly to the distal fragment
Types and Causes of Fractures
Greenstick
- Break in only one cortex of bone
- Minor direct or indirect force
Types and Causes of Fractures
Impacted
- Fracture with one end wedged into the
opposite end or into the fractured fragment
- Compressive, axial force applied
directly to the distal fragment
Types and Causes of Fractures
Linear
- Fracture line runs parallel to bone’s axis
- Minor or moderate direct force applied
to the bone
Types and Causes of Fractures
Oblique
- Fracture at an oblique angle across both
cortices
- Direct or indirect force with angulation
and some compression
Types and Causes of Fractures
Open
- Skin is open, bone is fractured, and soft
tissue trauma may occur
- Moderate to severe force that is
continuous and exceeds tissue
tolerances
Types and Causes of Fractures
Pathologic
- Transverse, oblique or spinal fracture of a
bone weakened by tumor
- Minor or indirect force
Types and Causes of Fractures
Spiral
- Fracture curves around both cortices
- Direct or indirect twisting force, with the
distal part of the bone held or unable to
move
Types and Causes of Fractures
Stress
- Crack in one cortex of a bone
- Repetitive direct force as from jogging,
running or osteoporosis
Types and Causes of Fractures
Transverse
- Horizontal break through the bone
- Direct or indirect force toward the bone
Diagnosis
- History of traumatic injury and results of
physical exam
- X-rays of suspected fracture
Nursing Interventions and Treatment
- Fracture injury is then assessed. Cut the clothing from the affected side of
the fracture for best visualization. Control the bleeding by applying direct
pressure on the area and digital pressure over the proximal artery nearest
the fracture.
- To prevent further damage, reduce pain and increase circulation, the
emergency team immobilizes the area of the fracture by splinting.
Nursing Interventions and Treatment
- With an open fracture, the wound is covered with a clean (sterile) dressing
to prevent contamination of deeper tissues.
- Splints are used to support, immobilize and protect parts with injuries such
as known or suspected fractures, dislocations or severe sprains When in
doubt, treat the injury as a fracture and splint it
Closed Reduction involves:
 Manual manipulation of the extremity to align the fractured fragments
 Traction - exertion of a pulling force applied in 2 direction to reduce
muscle spasm and immobilize a fracture
 Type of Traction:
• Skin traction - elastic bandaged and coverings are used to attach the
traction device to the patient’s skin
Closed Reduction involves:
• Skeletal traction - a pin or wire is inserted through the bone distal to
the fracture and attached to a weight, allowing a more prolonged
traction
Closed Reduction involves:
 Purposes of Traction
 Maintain proper body alignment
 Reduce pain and muscle spasms
 Provide support  Principles of Traction
 To reduce fracture  Position in supine or dorsal recumbent position
 Ensure that the weights are hanging freely
 Maintain continuous traction
 There should be a counter
 Ensure that the ropes are in the groove of the pulley
and moving freely
 There should be no knots in the pulley
 Check the ropes for fraying
Open Reduction involves:
 Surgical intervention and fractures may be treated with internal fixation devices
 Patient may be placed in traction or cast following the procedure
Fixation
 Involves the application of screws, plates, pins or nails to hold the fragments
in alignment
 Provided immediate bone strength
 External Fixation
 An external frame is used with multiple pins applied through the bone
 Provides more freedom of movement than with traction
Nursing Consideration for Patients in Skeletal or Skin Traction
Casting
 Application of plaster of paris or fiberglass for the purpose of stabilizing a
fracture site while bony union occursFixation
 Plaster type
 - can be used for severely displaced fractures
 - easily molded and inexpensive
 - slow drying, heavy and easily weakened by moisture
 Synthetic type
 lightweight, dries quickly and moisture resistant
 increase chance of skin maceration, if not dried properly
 expensive
Nursing Consideration for Patients in Skeletal or Skin Traction
Crutch Walking
 Used to aid the client in ambulation
 Accurate measurement is important to avoid damage to the brachial plexus
 The distance between the axial and the arm pieces on the crutches should be
two finger widths in the axilla space
 The elbows should be slightly flexed, 20-30 degrees when the client is walking
 Instruct to stop ambulation if numbness or tingling in the hands or arms occur
 When ambulating with the client, stand on the affected side
 Instruct the client to look upward and outward when ambulating and to place
the crutches 6-10 inches diagonally in front of the foot.
Nursing Consideration for Patients in Skeletal or Skin Traction

Crutch Walking
Nursing Consideration for Patients in Skeletal or Skin Traction
Crutch Gaits
 When only one leg can bear weight
- Swing to gait: crutches forward; swing body to crutches
- Swing through gait: crutches forward; swing through body crutches
- 3 point gait: crutches and affected extremity forward; swing forward; placing non-affected foot ahead or
between crutches
 When both legs can move separately and bear some weight
- 4 point gait: right crutch forward, left foot forward; swing weight to right side while bringing left crutch
forward, left foot forward; stimulated normal walking
- 2 point gait: same as 4 point gait but faster; leg moving one crutch and opposite leg moving forward at
the same tine
 Going up and down the stairs
- Up the stairs - unaffected leg first then moves the affected leg and crutches up- Going down the stairs -
affected leg and crutches down first then unaffected leg
BONE HEALING
BONE HEALING
1. Hematoma formation

 Occurs during the first 48-72 hours after

fracture
 Develops as blood from the torn blood
vessels in the bone fragments and
surrounding soft tissue leaks between
and around the fragment of the fractured
bone
 Clotting factors remain in the injured area
to initiate the formation of a fibrin
meshwork
BONE HEALING
2. Cellular Proliferation
 Osteoblasts or bone-forming cells multiply into a fibro-
cartilaginous callus begins distal to the fracture
 Fibro-cartilage “collar” becomes evident around the fracture
site- collar edges on either site of the fracture eventually unite to
form a bridge, which connects the bone fragments
BONE HEALING
3. Callus formation
 Fracture becomes “sticky” as osteoblasts continue to move in
and through the fibrin bridge to keep it firm; bone calcifies as
mineral salts are deposited
 Usually occurs during the 3rd to 4th week of fracture healing
BONE HEALING

3. Callus formation

 Fracture becomes “sticky” as osteoblasts

continue to move in and through the
fibrin bridge to keep it firm; bone calcifies
as mineral salts are deposited
 Usually occurs during the 3rd to 4th
week of fracture healing
BONE HEALING

4. Ossification

 Final laying down of bone; fracture has

been bridged and the fracture fragments
are firmly united
 Mature bone replaces the callus; excess
callus is gradually reabsorbed by the
osteoclasts
 Fracture site feels firm and immovable;
safe to remove the cast
BONE HEALING

5. Remodeling

 Resorption of the excess bony callus in

the marrow space and encircles the
external aspect of the fracture site
 Directed by mechanical stress and
direction of weight bearing
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