MUSCULO-SKELETAL SYSTEM: Adult Health Nsg.pptx

this topic contains musculoskeletal trauma, musculoskeletal infections, musculoskeletal inflammation, musculoskeletal special therapies, orthopedic modalities, metabolic bone disorder, spinal column defect.

1. MUSCULO-SKELETAL SYSTEM PREPARED BY: Sonali Kujur

2. Musculoskeletal trauma: Dislocation Sprain Strain Fracture Amputation

3. Dislocation A dislocation occurs when the articulating surfaces of a joint come out of position.

4. CAUSES Trauma Disease that affects the joint Congenital weakness

5. SIGN AND SYMPTOMS Pain Loss of movement Pulselessness Paresthesia

6. DIAGNOSTIC EVALUATION History collection Physical examination X-rays

7. MANAGEMENT Open(surgical) or closed reduction (non-surgical) Immobilization and elevate the affected joint, apply ice Pain relief(analgesics) Assess neurovascular status before and after reduction Including sensation, strength of pulse, capillary refill time, and color of skin.

8. SPRAIN A sprain is excessive stretching of one or more ligaments that usually results from twisting movements during a sports activity, exercise, or fall. Like strains, sprains also vary in severity.

9. CAUSES Mild sprain (tearing of few ligament fibers) Moderate sprain (more ligament fibers are torn, but stability of joint is not affected) Severe pain (causes instability of the joint and requires surgical interventions)

10. MANAGEMENT RICE(rest, ice, compression, elevation) is used for several days until swelling and pain diminish. Anti-inflammatory drugs (decrease inflammation and control pain) Moderate sprains may need immobilization with a brace or cast until healing occurs.

11. STRAIN A strain is a soft tissue injury that occurs when a muscle or tendon is excessively stretched

12. CAUSES Fall Twisting or getting hit can force to joint out its position Ligament and joints tears and stretching

13. SIGN AND SYMPTOMS Pain and inability to move the affected body part result. The most severe strain occurs when a muscle or tendon is ruptured, with separation of muscle from muscle, tendon from muscle, or tendon from bone. Severe pain and disability result from this injury.

14. DIAGNOSTIC EVALUATION History collection Physical examination

15. MANAGEMENT RICE is an acronym for rest, ice, compression, and elevation. These four components are the basis of therapy for strain injuries. Immediately after a strain, ice should be applied to decrease pain, swelling, and inflammation.

16. FRACTURE

17. Osteogenesis imperfecta:

18. Rickets :

19. Osteomalacia :

20. Open reduction

21. Simple (closed) fracture

22. Compound (closed)fracture

23. Comminuted fracture

24. Impacted fracture

25. Angulated fracture

26. AMPUTATION Amputation: Is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected. Amputation: The surgical removal of a part of the body, a limb or part of a limb.

27. INDICATIONS Long-standing infections of bone and tissue that prohibit restoration of function Extensive trauma to an extremity Peripheral vascular disease Uncontrolled or wide thermal injuries Malignant tumours Spread infection of extremities ( e.g gas gangrene, osteomyelitis) Congenital disease Life threatening disorders, such as arterial thrombosis and gas bacillus infections

28. TYPES Amputated finger Amputated thumb Amputated arm Amputated toe Amputated leg Amputated lower leg

29. AMPUTATION METHODS Open amputation Closed amputation

30. Open amputation In open amputation (guillotine amputation) the end of the residual limb, or stump is temporarily open with no skin covering the sumps. Open amputation are usually performed in the presence of infection. Skin traction is applied, and the infected area allowed to drain. The traction must be continuous. The surgeon may arrange the traction so that the client turns over in bed.

31. Closed amputation In this type of amputation, skin flaps cover the several done end. They usually return from a surgery with either a soft compression dressing or rigid plaster shell covering the residual limb. The compression dressing consist of a gauze over which elastic roller bandages are warped to create pressure to control bleeding.

32. ANESTHESIA:

33. MUSCULOSKELETAL INFECTIONS AND TUMORS

34. Osteomyelitis Osteomyelitis is an acute infection of the bone caused by bacteria, although fungi and viruses may play a main role. It may be chronic and acute.

35. Etiology Trauma, surgery Infection originating from other body part Kidney dialysis (hemodialysis lead to bactremia) IV drug users Organism (Staphylococcus aureus, Streptococcus pyogones , Pneumococcus species, Escherichia coli)

36. Clinical features Fever Chills Malaise Pain on movement of the infected extremities Localized redness, tenderness and edema Drainage of pus

37. Diagnostic evaluation History collection Physical examination Blood test (WBC, ESR and blood culture) CT scan and MRI bone scan bone tissue aspiration joint fluid aspiration

38. Medical management Antibiotic therapy (ciprofloxacin, vancomycin) Antifungal medication (amphotercin, itraconazole) Analgesics (acetaminophen) Immobilization Incision and drainage (drain abscess in bone)

39. Bone tumors Bone tumors may be malignant or benign. Malignant tumors are primary, originating in the bone or originating from else ware in the body. Benign bone tumors have the potential to cause fractures of bone. ETIOLOGY: unknown

40. Clinical features Pain that worsens when bearing weight Bone appears deformed and swelling is seen Movement is decreased

41. Diagnostic features History collection Xray Bone scan Bone biopsy

42. Management Treatment for pain management Surgical excision of tumors

43. MALIGNANT TUMORS are abnormal osteoblast or myoblast that exhibit rapid and uncontrolled growth. ETIOLOGY : Due to exposure of radiation Toxic chemicals Genetic CLINICAL FEATURES : Abnormal gait Persistent pain and swelling In late stage, tumor rises to other site

44. DIAGNOSTIC EVALUATION : History collection Xray MRI Bone scan Bone biopsy SURGICAL MANAGEMENT: Surgical removal of tumor and amputation

45. Cast:

46. Splint:

47. traction:

48. METABOLIC BONE DISORDER

49. Osteomalacia Rare condition Associated with vitamin d deficiency Decalcification and softening of bone This disease is same as rickets in children

50. Etiology Lack of exposure sun rays GI malabsorption Extensive burns Chronic diarrhoea Pregnancy Kidney disease Drugs such as phenytion

51. Clinical features Low back and bone pain Progressive muscular weakness Especially in the pelvic region Weight loss Kyphosis Bowing of the legs, occurs as the disease advances Risk of fractures

52. Diagnostic features History collection Physical examination X- ray Blood test: Calcium and phosphate Medical management

53. Medical management Correcting the underlying the causes Supplementation of vitamin D, adequate nutr Exposure of sunlight and progressive exercise Early ambulation surgical correction of bone deformity

54. OSTEOPOROSIS Osteoporosis or porous bone (fragile bone disease) is a chronic progregressive metabolic bone disease characterised by: low bone mass structural deterioration of the bone tissue leading to increased fragility.

55. Risk factor Advanced age Female gender Thin, small framed Family history of osteoporosis Diet low in calcium Excessive use of alcohol Cigrette smoking Inactive life style Excess caffeine levels

56. clinical features bons becomes so weak that a sudden strain, bump or fall cause a hip,vertical or wrist fracture collapsed vertebrae may initially be manifested as a beck pain loss of weight spinal deformities

57. diagnostic evaluation history collection physical examination serum calcium, phosphorus, alkaline phosphatise and vit D levels bone menieral densitometry dual energy X-ray absorptimoetry (DEXA) USG

58. management diet high in calcium calcium supplement vit D supplement exercise program estrogen replacement

59. Paget’s Disease Paget's disease, is a slowly progressive bone disease characterized by accelerated patterns of bone remodeling. An initial phase of excessive bone resorption (osteoclastic phase) is followed by a reactive phase of excessive abnormal bone formation (osteoblastic phase). Chronic accelerated remodeling eventually enlarges and softens the affected bones. The new bone structure, which is chaotic, fragile, and weak, causes painful deformities of both external contour and internal structure. Paget's disease usually localizes in one or several areas of the skeleton (most frequently the lumbosacral spine, skull, pelvis, femur, and tibia

60. Etiology Unknown Infections Benign or malignant bone tumors Vitamin D deficiency during the bone-developing years of childhood Autoimmune disease Estrogen deficiency

61. clinical features usually severe and persistent pain cranial enlargement over frontal and occipital area sensory abnormalities and impaired motor function kyphosis barrel chest asymmetric bowing of the tibia and femur waddling gait slow and incomplete healing of fractures

62. diagnostic evaluation history collection physical examination X-rays, CT scan and MRI bone biopsy radionuclide bone scan

63. management Analgesics such as aspirin or NSAID Antibiotics (mithramycin) Physical therapy

64. MUSCULOSKELTAL INFLAMMATION: Bursitis, Synovitis, Arthritis

65. Bursitis an inflammation of the bursa common site of bursitis is elbow, shoulder and knee .

66. Etiology infections secondary effect to gout rheumatic arthritis

67. clinical manifestations painful movements of a joint edematous , warmth and tenderness in joint part

68. diagnostic evaluation history collection physical examination x-ray biopsy

69. management proper rest NSAID ( ibuprofen ) corticosteriod ( methylprednisolone ) injected in joint ROM

70. ARTHRITIS it is the inflammation of a joint.

71. TYPES OSTEOARTHRITIS RHEUMATOIDARTHRITIS

72. OSTEOARTHRITIS it is a inflammation of a joint.

73. Causes Trauma mechanical stress inflammation joint instability neurological disorder skeletal deformities haematological/endocrine disorder

74. Clinical Manifestation joints which are majorly affected are weight bearing joints (hips and knee) and small joint in fingers. the joint involvement is very slow, progressive and irreversible. the cartilage fails and there is increased pressure on articular bone, joint pain increases with exercise and releived with rest.

75. Diagnostic evaluation history collection physical examination blood test xrays

76. management maintaing proper body posture weight reduction physical therapy drug therapy (NSAIDs)

77. Rheumatic arthritis it is an inflammatory disease that affects primarily synovial lined joints but can affect the cardiac, nervous, pulmonary, reticuloendothelial and integumetry systems.

78. Causes unknown autoimmunine disease genetic factor

79. Clinical manifestation Articular and periarticular manifestation: morning stiffness is often the initial symptom, lastly longer than osteoarthritis joint involved in patients are metacarpophalangeal, metatarsophalangeal, proximal interphalangeal, wrist, knee, ankle, shoulder, and hip. however, any joint in the body can be affected joint swelling and tenderness with significant limited range of motion swan neck deformity boutonniere deformity

80. Extra-articular manifestation Pulmonary involment: pulmonary nodules pleural effusion pulmonary vasculitis pleuritis Ocular involvement: scleritis Sjogren syndrome

81. Hematologic involvement: normochromic normocytic or microcytic anemia granulocytopenia Cardiac involvement: pericarditis myocarditis Skin: subcutaneous nodules Constitutional symptoms : fever, weight loss, malaise Others: osteoporosis myositis compressive neuropathy

82. Diagnostic evaluation History collection Physical examination X-ray CT scan and MRI Synovial fluid aspiration

83. Management Local application of heat and cold NSAIDs (indomethacin or aspirin) Corticosteroid (prednisone) Arthroscopy or reconstructive of the joint (artifical joint)

84. SPINAL CORD DEFECT Kyphosis Lordosis Scoliosis

85. Kyphosis kyphosis is an exaggerated convex curvature of the thoracic spine. kyphosis is referred to as hunchback it is found in children.

86. Diagnostic evaluation: if kyphosis is suspected, a complete X-ray is done Management: physical therapy 5% of patient will undergo surgery (severe kyphosis)

87. LORDOSIS An exaggerated forward curve of the lumbar spine.

88. Causes Genetic predisposition Weak abdomen, gluteal and hamstrings Tight lower back muscles Management: Physical therapy To maintain proper alignment of pelvic

89. SCOLIOSIS Scoliosis is an abnormal lateral curvature of the spine, which is very common, especially among adolescent girls.

90. Causes Idiopathic Loss of control of the nerves that support the spine Breakdown of disc Congenital

91. Clinical features Lateral deviation of the spine

92. Management Massage and exercise