Musculo-Skeletal Disorders CANCELLOUS
(Trabecular/Spongy)
(02/03/2022)
-Epiphyses (Loosely packed)
-Contains red marrow
SKELETAL SYSTEM CORTICAL (Compact)
-PROVIDES STRUCTURE -Diaphysis,
-SUPPORT FOR SURROUNDING TISSUE -Contains Yellow marrow
-PROTECT VITAL ORGANS (HEART, EPIPHYSEAL PLATE CLOSES at
LUNGS AND ALL THAT) AVERAGE 22 years old
-ASSIST IN MOVEMENT
MANUFACTURE BLOOD CELL (BONE BONE MARROW
MARROW-RBC, WBC PLATELETS) -In medullary cavity
-STORAGE FOR MINERALS In long flat bones
BONE COMPOSITION RED MARROW (hematopoiesis)
● CELLS (osteocytes) -Sternum, ilium, vertebrae, ribs
● CHON MATRIX -In flat bones
-COLLAGEN+Ground substance -Ends of long bones (pedia)
(glycochon, proteoglycans) YELLOW MARROW
-Produced by osteoblast (bone forming -In diaphysis of long bones
cells) BONES
-Deposition of minerals CELLS
● MINERALS deposits Osteoblast
-98% total body calcium -Secrets bone matrix- collagen and ground
-2% Phosphorous, Magnesium, Fluoride substances
-Never take antacids with calcium* 2-4 -Located in periosteum
hours -Calcium goes back to bones (movement;
BONES bone forming function)
206 bones Osteoclast
Types (shape) -Bone resorption
Flat- There's blood cells formation - In endosteum (inner layer) responsible for
-Skull, Scapula, sternum, ribs dissolving, remodeling bone
-Hematopoiesis (blood forming cells) -Calcium goes outside the bone (when we
-Protect vital organs don't eat enough, when were bed bound or
Long Bones lack of movement which makes bones
-Legs,arms thinner, and decrease in size/ brittle)
-Weight bearing movement Osteocytes
Short -Mature bone cells
-Wrist, Ankles -Bone maintenance function
Irregular shapes CARTILAGE
-Facial Vertebrae -Flexible, strong
Sesamoid bone LIGAMENT (bone to bone)
-Develops within tendon -Connective tissues connecting bone joints
Ex. Patella
Types (COMPOSITION) TENDONS
-Connects bone to muscle Bone matrix (collagen) and Hardening
Tendinitis (Inflammation of tendon) minerals deposited into collagen fibers
Process of ossification
JOINTS 1. ENDOCHONDRAL
-points Where the bones meet -Cartilage like tissue formed, resorbed,
● MAJOR JOINTS replaced by bone
● PIVOT JOINT (head/neck) 2. INTRAMEMBRANOUS
● BALL AND SOCKET -Bone develops within the membrane, Ex.
JOINT(shoulder and Hip) face/skull
● HINGE JOINT (elbow and knee) BONE MAINTENANCE
● ELLIPSOID JOINT (wrist) -Resorption(osteoclast)–Formation
● SADDLE JOINT (Thumb) (osteoblast)
● GLIDING JOINT (ankle) -Regulating factors
● CONYLOID JOINT (finger) (Local Stress -weight bearing) Mobilization
is important for bone formation and prevent
Gliding more bone resorption
-Flapping of hands (up and down of hands) -Vitamin D (calcitriol) for absorption of
Extension Flexion calcium which hastens it
-Head Looking up (flexion) and down PTH (Parathyroid gland)
(extension) -Promotes bone resorption
-Hyperextension (beyond 180 degrees) Calcitonin (thyroid gland)
Plantar Flexion/ Dorsiflexion -Inhibit bone resorption
-Footdrop, great toe in positive babinski sign Hypercalcemia (calcitonin helps)
Abduction/Adduction Blood supply
-Arms -Affects osteogenesis, bone density, bone
-Fingers close together (adduction) necrosis
CIRCUMDUCTION Hormones
-Arm form circle -GH sex hormones cortisol
Rotation MIACALCIN (Calcitonin) Nasal/ injectible
-Head turns sideways -Alternating of nares
Pronation/Supination Calcitonin Salmon- Refrigerate
-Hands VITAMIN D food
Inversion (Medial)/Eversion CHeese
-Foot Margarine
Protraction/Retraction Butter
Chin Fortified milk
Elevation depression Cereals
-Shrug shoulders Fatty fish
Opposition CALCIJEX (activated vitamin D)
-Fingers But once u open it its okay
PHASES OF BONE HEALING
OSTEOGENESIS 1. REACTIVE PHASE
-Ossification -Bleeding hematoma
-Cytokine release-fibroblast -Long extended fibers; Striped or striated
proliferation–angiogenesis occur -Attached to bones
-Starts granulation tissues within clot CARDIAC (MYOCARDIUM)
2. Reparative phase (ossification) -Striated/striped
-Granulation tissue replaced by -Attached to itself
procallus -Involuntary
-Fibrocartilage replaced by more SMOOTH MUSCLE (involuntary)
dense bony callus (3-4 weeks) post -Attached to internal/visceral organs (blood
injury vessels, GI TRACT)
-Lamellar bone forms (months post -Controlled by nervous system and
injury) hormones
-Autonomic nervous system sympa and
3. REMODELLING PHASE parasympathetic
-remodel new bone into its former
structural arrangement MUSCLE TONE
(months-yrs) Flaccid- No muscular contraction ex.
Paralyzed lead to atrophy
PHYSIOLOGIC CHANGES RELATED TO Spastic- Spasms and muscular contraction
AGING ex. tension , increased stength
-Decreased bone density
-Up bone prominence Isometric contraction- Muscle length
-Kyphotic posture constant/ same+up in muscle strength
-Cartilage degeneration (moist heat=up generated
blood flow) When they're wearing a cast
-Decreased ROM Isotonic contraction
-Muscle atrophy, decreased strength -Muscle shortens+no up in muscle tension
-Slowed movement Ex. flex forearm
When we can move the joint
MUSCULAR SYSTEM MUSCLE STRENGTH RATING
-MYOFIBRILS/MYOFILAMENTS PUT PICTURE
SARCOMERE
-ACTIN (thin) 5-
-MYOSIN (thick) 4-1-2 pounds
3- can still put down arms but with
650 MUSCLES assistance with pulling it up (you can't do
-Attached to skeletal system weights)
PROVIDE MOBILITY 2- Someone else is doing ROM(up and
GENERATE HEAT down) for you but can do side to side
PROVIDE BASIC POSTURAL SUPPORT 1- No movement but whenever you put
187 JOINTS hand on the muscle its a little contracted
MUSCULAR SYSTEM 0-paralyzed
SKELETAL (VOLUNTARY MUSCLES) ASSESSMENT OF PATIENT WITH MS
- 40% BODY WEIGHT PROBLEM
-Pain on passive ROM
QUESTIONS -Absence of feeling
-Pain COMPARTMENT SYNDROME
Place/ what provokes the pain -Leading to irreversible neurovascular
Quality assessment.
Relieving factors/Radiation ASSESSMENT
Severity (pain score 0-10) Visual analog MUSCLE
(left right pain scale) -Size (symmetry)
Time -Tremors (hold arms out, ask if they took
-ADL functioning? Grooming (facial, coffee or anything with caffeine) or hold the
makeup, shaving, combing hair, oral) hands
bathing, defecation and urination, dressing -Tonicity (muscle at rest)
and feeding/nutrition. -Active (you can do it) /Passive (people
-Mobility (can you still do the things you can have to do it for you) ROM
do Contraindications: Check chart for order,
Weakness? (numbness or tingling) THR, ORIF hip, Hip sx
-Past surgeries when (hip sx) Flaccidity, spasticity
-Assistive devices (crutches walkers) Smoothness for movement
-Sports? Falls? Injury? Muscle strength
-Diet? (purine, calcium) -Contractures (tendons are quite stiff when
-Weight gain extending/ shortening or stiffness of
-Medications (Multivitamins, calcium, tendons)
vitamin D
-Deformity? Swelling? ASSESSMENT
-Gait? Posture? Muscle strength and size? BONES
(0-5 rating/ Handgrip) -Normal structures, deformities
-Skin? Neurovascular status (circulation and -edema, tenderness
innervation of that area/ cool to touch, JOINTS
warm/ red/ hypoxia -Joint swelling
-Bone integrity? Joint function? Tenderness
Edema
NEUROVACULAR ASSESS Crepitation (joint inflammation,
degenerative joint changes)
CIRCULATION nodules
-Skin Color -Joint ROM
-Skin temperature DIAGNOSTIC ASSESSMENTS
-Pulses -Lab test/ Blood Draws
-Capillary refill (least reliable) -SERUM CAlcium, Phosphorus (inverse
-TICA (most reliable) relationship
MOTION -Serum ionized calcium (1.1-1.4 mmol/L)
-Movement weaknesses paralysis -Alkaline phosphatase (liver damage, bone
SENSATION damage)
-Unrelenting pain (increasing) Serum muscle enzymes
-Paresthesia (pins and needles)--necrosis -Creatine kinase (CK-MM
-AST/SGOT (aspartate aminotransferase)
-Aldolase (ALD)
-Lactic dehydrogenase (LDH)
DIAGNOSTIC ASSESSMENT
Imaging procedures
Standard X Ray
Myelography
Spine x ray/ dye
Pre: consent, NPO, Proper draping
-Check allergies
Post: Sitting, HOB 30 degrees (no lie flat for
24 hours)
-Prevent dye going to brain
-Voided 6 hours after to secrete the dye
medium
ARTHROGRAPHY
-Joint x ray
IMAGING PROCEDURES
