Chapter 66

Assessment of Musculoskeletal Function

Orthopedics

The branch of medicine that deals with the prevention and correction of the disorders and diseases of the musculo-skeletal system.

The primary goal of the nurse caring for a client with locomotor disorders is the prevention of contractures (permanent shortening of a muscle) or deformities.

Skeletal Functions To provide the body with a structural

framework. To act as a protective casing for internal

organs ( the brain, heart, lungs, etc.). To allow movement by muscles attached

to the skeleton. To store calcium, phosphorus, and

magnesium. To manufacture blood cells in the red

bone marrow.

Structure

206 Bones in the body Long bones Short bones Flat bones Irregular bones

Joints Muscles

Bone Cells

Osteoblasts Function in bone formation

Osteocytes Mature bone cells that function in bone

maintenance Osteoclasts

Multinuclear cells function in destroying, resorbing, and remodeling bone

Bone Formation and Maintenance

Osteogenesis: process of bone formation Ossification: the process of formation of the bone

matrix and deposition of minerals Bone is in constant state of turnover Regulating factors

Stress and weight-bearing Vitamin D Parathyroid hormone and calcitonin Blood supply

Role of calcium

Bone Healing

Hematoma and inflammation Angiogenesis and cartilage formation Cartilage calcification Cartilage removal Bone formation Remodeling

Joints A joint is a junction of two or more bones. Three types:

Diarthosis: freely movable such as hinge (elbow, knee); ball and socket (hip, shoulder), pivot (skull, first vertebrae), gliding (wrist) and saddle (thumb).

Synarthosis: joints are immovable (skull sutures).

Amphiarthosis: slightly movable (vertebrae and pelvic bones).

Hinge Joint of the Knee

Muscles

Attached to bones and other structures by tendons

Encased in a fibrous tissue—fascia Contraction of muscle causes movement Contraction utilizes energy in the form of ATP Anaerobic pathways using glucose metabolized

from stored glycogen provide energy for more strenuous muscle activity

Movement of the muscles may be voluntary or involuntary.

Assessment of the Musculoskeletal System

Include data related to function ability; ADLs and ability to perform various activities. Note any problems related to mobility.

Health history: family history, general health maintenance, nutrition, occupation, learning needs, socioeconomic factors, and medications—include OTC

Assessment of pain and altered sensations Physical assessment: posture, gait, bone integrity, joint

function, muscle strength and size, skin, neurovascular status

Assessment of the Bony Skeleton Notation on any deformities. Body alignment. Abnormal growths due to bone tumors. Shortened extremities, symetry. Amputations. Abnormal angulation other than at joints. Crepitus (a grating or crackling sensation

or sound). posture

Assessment of Spine

Scoliosis (crooked back; lateral curving deviation).

Kyphosis (hump back; increased roundness of the thoracic spinal curve).

Lordosis (sway back; exaggeration of the lumbar spine curvature as seen in pregnancy).

Three common spinal curvatures:

Normal Spine and 3 Abnormalities

Range of Motion (ROM)

Active person does the moving Have person move joint through each of its

various ROM movements Note the angle of each joint movement Note any pain, tenderness, or crepitus

Range of Motion (ROM)

Passive person relaxes and allows you to move the

joints Done if person is unable to do active ROM

• ALWAYS stop if the person complains of pain• NEVER push a joint beyond its anatomic angle

Muscle Strength

As you are testing ROM Test muscle strength

Ability to perform the ROM against resistance• Symmetry• Involuntary movements

Detecting Fluid in the Knee

Rheumatoid Arthritis—Ulnar Deviation and “Swan-Neck” Deformity

Diagnostic Evaluation X-rays Computed tomography MRI Arthrography Bone densitometry Bone scan Arthroscopy Arthrocentesis Electromyography Biopsy Laboratory studies