THE MUSCULOSKELETAL SYSTEM

ANATOMY

PHYSIOLOGY

DISEASE PROCESS

Anatomy

• Bones – 206 total– Long– Short– Irregular– Flat

Anatomy

• Joints – union of bones– Ligaments – bones to bones– Tendons – muscles to bones

• Types of joints– Synarthroses – no movement– Amphiarthroses – little movement– Diarthroses – free movement

Anatomy

• Muscles– Smooth– Striated– Cardiac

Physiology

• Children’s bones more porous, thus less susceptible to fx

• Bone length growth occurs at epiphyseal plate – – Cartilage cells replced by osteocytes

• One end of bone grows more actively than the other

Physiology

• Bone growth to the diameter occurs by deposition of osteocytes directly onto bone surface

• Bone growth regulated by growth hormone

• Bone growth stops when epiphyseal plates replaced by bone– This occurs earlier in girls than boys

Physiology

• Children may require prolonged immobilization due to fx, congenital deformity, diseases

• Complications may include anemia, fatigue

• Feelings of isolation, withdrawal can occur

Sprains & Strains

• Pathophysiology– Strain – stretching of muscle or tendon– Sprain – tearing with ligament involvement

• Treatment– RICE

• Nursing Implications

Fractures

• Pathophysiology – Simple– Compound– Comminuted– See p 571

• Types of traction– Skeletal traction– Skin traction– See p 571

• Immobilization– Bryant’s traction– Buck’s traction– Russell traction

• Volkmann’s ischemia• Compartment syndrome

• Nursing Implications– See p 572 & 574

Osteomyelitis

• Pathophysiology– Infection of bone– s. aureus & h.

influenzae most common

• S/S– Infants – fever &

limited movement of affected area

– Children – fever, pain, swelling, redness, tenderness

Osteomyelitis

• Treatment– Antibiotic– Bedrest– I&D

• Nursing implications– Support affected area– Reduce pain– Give antibiotics

Duchenne’s Muscular Dystrophy

• Pathophysiology –most common– Genetic– Occurs in boys only– Lack of dystrophin, a protein found in muscle

cells

Duchenne’s Muscular Dystrophy

• S/S– Frequently diagnosed between 2 & 6 years because

child is slow to develop– Clumsiness – Gower’s maneuver– Hypertrophy of calf muscles (to overcome weakness

of gluteal & lumbar muscles)– Mental impairment– Weakness progresses; child usually confined to w/c

by adolescence

Duchenne’s Muscular Dystrophy

• Treatment – No cure– Palliative

• Nursing implications– Instructions– Prevent complications

Legg-Calve-Perthes Disease

• Pathophysiology– Necrosis occurs of femoral head due to

interruption of blood supply– Eventually replaced with live bone– Cause is unknown

Legg-Calve-Perthes Disease

• S/S– Limping– Limited ROM– No pain

• Treatment– NSAIDs– Restricted activity– Brace – Bedrest– Good prognosis

Osteosarcoma

• Pathophysiology– Usually in long bone

near epiphyseal growth plate

– Lungs common met site

• S/S – Pain – Swelling

• Treatment – Chemotherapy– Surgery

Ewing’s Sarcoma

• Pathophysiology– Commonly in marrow of long bones– Mets to lungs & other bones

• S/S – Pain

• Treatment– Chemotherapy– Surgery

Juvenile Rheumatoid Arthritis

• Pathophysiology– An autoimmune disease– Usually attacks large joints

• Chronic inflammation of synovial membrane

• Involves connective tissue & viscera

– Three types• Systemic• Polyarticular• Pauciarticular

Juvenile Rheumatoid Arthritis

• Systemic– Fever – Rash– Abdominal pain– Eventual joint pain

• Polyarticular– > 5 joints– Usually small joints

• Pauciarticular – < 4 joints– Usually large joints– May develop

iridocyclitis

Juvenile Rheumatoid Arthritis

• Treatment– Supportive– Reduce pain– Promote optimal level

of independence and development

• Medications– NSAIDs– Immune suppressant

drugs– Methotrexate– Antirheumatic drugs

(sulfasalazine)

Juvenile Rheumatoid Arthritis

• Nursing Implicatioins– Instruct meds– Teach ROM– Adaptive devices such as velcro on shoes– Encourage parents to allow child to perform to

max potential

Torticollis

• Pathophysiology – Shortening of

sternocleidoomastoid muscle resulting in limited ROM

• S/S– Decreased ROM– Short neck– Asymmetry of head &

neck

Torticollis

• Treatment – exercises to stretch muscle

• Nursing implications – instruct parents about exercises

Curvature Of The Spine

• Pathophysiology– Kyphosis – humpback– Lordosis – swayback– Scoliosis – lateral curvature; most common

• Functional• Structural

Curvature Of The Spine

• Treatment– May require brace or surgery

• Harrington rod

– Braces must be worn 20-22 hrs a day• Milwaukee brace – p 582

Scoliosis Screening

• Look for asymmetry of:– Shoulders– Scapula– Arm to body– Hip

References

• Liefer, G. (2003). Introduction to maternity & pediatric nursing, (4th ed.). Saunders: Philadelphia.