Musculoskeletal System Disorders

This slide was presented to us in class by Ms. Dinah Hernandez.

1. Dinah Hernandez MSN, PHN, RN

2. Common Medical Treatments for MS
Application of hot and cold
Hot, cold compress or paraffin
Physical Therapy Tx (PROM, AROM)
External Immobilization
Braces, corsets, splints, casts, traction
Surgical Treatment
Joint- replacement surgery/ arthroplasty
Amputation

3. Data Collection
Skeletal deformity
posture, coordination, body build
assymetry, deformity
Muscle mass, swelling, deformity, tenderness
Assess musculoskeletal function
muscle strength, balance, gait
Assessment of immobilization device
pressure, infection, hemorrhage
Complications: neurovascular compromise

4. Complications of pressure
Wound infection
Infection to the bone
Hemorrhage
Diminished color
Tachycardia
Hypotension
Rapid respiration
Anxiety/panic/confusion
Diaphoresis
Oliguria

5. Planning and implementation
Preventing disorders of immobility
Skin breakdown
Contractures
Constipation
Thromboembolism
Providing comfortable positioning
Providing skin care
Adequate nutrition
Exercise
Evaluation

6. Musculoskeletal Disorders
◦Amputation – the absence or removal of all part or limb/ body
organ w/c can be congenital or as a result from an injury/ surgery
◦Reasons for surgical treatment:
Malignancy
Trauma
Gangrene
Amputation of any extremety is performed at the most distal part to
preserve joint and maximize limb length; prosthesis fitting is easier.
Amputation is classified
8.According to the affected limb
9.According to the level of amputation

7. Levels of Amputation
◦Below elbow amputation
◦Above elbow amputation
◦Below knee amputation
◦Above knee amputation
◦Phantom limb pain is an after effect of amputation. It refers
to the sensation of pressure, itching that occurs to the areas
of amputation, and the feeling as if the absent body part is
still present. The sensation is common and results from
damage to the nerves in the stump

8. Prosthesis – artificial device that replaces part or all
necessary extremity.
Clients are fitted w/ prosthesis asap after surgery
Nursing consideration:
Wound dressing twice daily
Preventing complication
Client teaching
Provide emotional support
Assisting in exercises
Replantation – is the re-attachment of a completely severed
body part back to the body.

9. Chronic back pain
Contributing factors
Combination of prolonged muscular and ligament strain,
pressure on the lumbosacral vertebrae, aging process
Causes:
Abnormal spinal column curvatures
Poor posture
Congenital disease
Malignancy
Compression fracture
Osteoarthritis
Rickets
Rheumatoid arthritis
aging

10. Intervertebral Disk (IVD) results when a small pad or
disk or cartilage ( nuclues pulposus) between two
vertebrae presses against the spinal nerve that radiate
out from the spinal cord.
Also known as herniated nucleus pulposus (HNP)
Also know as sciatica
Diagnostic Tests:
MRI
CT Scan combine with myelography/
Diskography

11. Medical Treatment of IVD
Physical therapy
Antispasmodic/analgesic
Ultrasound/intermittent traction. TENS therapy
Surgical Treatment
Surgical Treatment
Lumbosacral decompression
Laminectomy
Diskectomy
Microdiskectomy
Spinal fusion
Interbody fusion

12. Nursing consideration
Provide postoperative care
Assist with pain management
Wound care
Watch for s/s of bleeding, drainage
Evaluate pt for neurologic function
Follow physician’s orders
Lumbar Decompression
Observe for clients sensation/mobility
Observe for complications of spinal nerve damage/cord
Immediately report complaints of tingling, numbness or difficulty
moving legs
Check for edema due to trauma
Encourage pt to move to prevent respiratory complication

13. Postlumbar decompression concerns
Nerve damage
Edema
Changes in level of consciousness
Muscle spasm
Thrombophlebitis
Additional injury
Infection
Cervical decompression
Difficulty/changes in sensation in arms
Difficulty in moving arms
Difficulty in breathing

14. Nursing consideration
◦Log roll
◦Pain medicine (PCA)
◦Use of thoracic-lumbar-sacral orthosis (TLSO)
◦Use of fracture bed; advice pt not to reach/stretch for articles
◦Application of antiembolism stocking & pneumatic compression
devices
◦Use of cervical collar ( cervical diskectomy)
◦Teach pt to keep his neck in neutral pos’n & aligned pos’n
◦Teach pt for cervical collar care
◦Assist pt with sitting by supporting pt’s neck & shoulder

15. Temporomandibular Joint (TMJ) – painful, aching disorder
involving facial bones/ muscles around the joint between
mandible & temporal bones.
Causes:
◦Stress
◦Malocclusion of the upper and lower jaw
◦Poorly fitting dentures
◦Rheumatoid arthritis
◦Neoplasm
s/s: clicking sound during chewing
Tinnitus
Deafness
Treatment:
Identify the causative etiology
Physical therapy
Anti-inflammatory
Braces/surgery

16. Muscular Dystropathies -chronic degenerative dse of
the skeletal muscle often inherited; progressive
weakening and wasting of muscles.
Cause: unknown
Treatment:
Focus on support
Exercise programs
Splints to prevent deformities
Braces to permit ambulation
Inform pt need to prevent respiratory infection,
Maintain ideal weight
Strive for general good health

17. Osteoporosis- bone mass decrease, common to
postmenopausal women
Risk Factors
Advanced age
Family history
Early menopause
Low intake of dietary calcium
Excessive alcohol/caffeine intake
Sedentary life
Smoking
Treatment
Calcium supplements
Hormones (estrogen, progesterone)
Fosamax

18. Repetitive strain injuries-“overuse disorders”, occurs in
workplace because of the necessity of performing certain
motions repeatedly in some occupations.

19. Carpal Tunnel Syndrome – compression neuropathy of
the median nerve in the wrist.
◦S/S:
Weak grip
Paresthesia
Pain of the thumb & 1
st
3 fingers (Tinel’s sign)
◦Causes:
Repetitive movements
Arthritis
Trauma
Gout
Tumor
Treatment:
Wrist splinting NSAIDS
Rest Corticosteroid injection
Surgery

20. Lateral Epicondylitis – repeated forceful wrist and
finger movements that stress the origins of muscles.
S/S:
Pain along the outer aspect of elbow radiating to forearm
Pain increases on stretching & on resisted wrist and hand flexion
Treatment
Splinting
Analgesics
Rest
Corticosteroid injections

21. Rotator cuff injury
Injury to the rotator cuff in the shoulders due to the
repetitive injury or sudden trauma
S/S
Pain
Weakness
Loss of shoulder movement
Treatment:
Physical Therapy to increase ROM arm muscle strength
Surgical intervention

22. Inflammatory Disorders
Bursitis – inflm of bursa due to mechanical irritation,
bacterial infection, trauma, gout
Treatment : heating and resting affected part
Inflammatory agent
Corticosteroid injection/aspiration of fluid
Surgical drainage – infectious bursitis
Excision of bursa

23. Tenosynovitis – inflammation of tendon sheath that may
result from irritation or infection, typically affects the wrist/
ankle
◦S/S : pain and tenderness
◦Causes: non-infectious: strains
blows
prolonged use of tendons
◦Treatment:
Resting
Application of ice 1-2 days
NSAIDS
Surgery
Antibiotic
Elimination of activities

24. Arthritis – joint inflammation
Types of arthritis
Rheumatoid arthritis
Osteoarthritis, DJD, hypertrophic arthritis
Ankylosing spondylitis, rheumatoid spondylitis,
rheumatoid arthritis of the spine
Gouty arthritis
Systemic lupus erythematosus (SLE)
Scleroderma, progressive systemic sclerosis
Monoarticular arthritis – one joint
Polyarticular asrthritis- multiplt joints

25. Factors causing arthritis:
◦Infection by virus/microorganism
◦Direct injury to a joint ( traumatic arthritis)
◦DJD ( degeneration/deterioration of joint)
◦Metabolic disorder (gout)
◦Cause: unknown
◦Monocyclic arthritis: 35% cases
◦Polycyclic arthritis: 50% cases
◦Progressive arthritis: 15% cases

26. Clinical features of arthritis
◦Persistent pain/stiffness
◦Pain & tenderness of joints
◦Swelling in the joints
◦Recurrence of symptoms
◦Obvious redness and warmth in joint
◦Unexplained wt loss, fever, muscle weakness with joint pain
◦Bouchard’s nodes ( enlargement of proximal interphalangeal
joints)
◦Heberden’s nodes (grows in the terminal phalengeal joints)
with DJD

27. Rheumatoid arthritis –most painful & crippling., 3x
common in women
Cause: possibly virus that causes immune system
to become overactive
genetic predisposition
S/S: fatigue weakness
wt loss general body aches
painful/tender joints
stiff, swollen joints
Tendons/ligaments shorten- joint deformities such as
hyperextension, contractures, sublaxation (dislocation)

28. Medical Treatment of Rheumatoid arthritis
Goal: maintain function
Reduce inflammation before joints are permanently
damage
Multidisciplinary ( nursing, PT, OT)
Drug therapy
Patient education

29. Osteoarthritis
Believed to have a genetic cause or predisposition,
caused by wear & tear on a joint.
Treatment:
Synovectomy
Arthroscopic surgery
Total arthroplasty

30. Ankylosis spondylitis
Rheumatoid arthritis of the spine primarily affects the facet joints
& stabilizing ligaments of the spinal column
S/S:
Hip & lower back pain or stiffness
Wt loss
Fatigue
Fever
Conjunctivitis
Hip contracture & flexion of neck & back
Breathing impaired
Osteoporotic spine increases spinal fx
Spinal stiffening
Humpback
Chest curvature
Neck stiffness

31. Treatment of ankylosis spondylitis
Phenylbutazone
Teach pt to refrain from lying on one side to prevent
excess sideways spinal curvature
Light exercise
Brace