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Musculoskeletal System
 Anatomy and Physiology
●
The musculo-skeletal system consists
of the muscles, tendons, bones and
cartilage together swith the joints
●
The primary function of which is to
produce skeletal movements
 Muscles
Three types of muscles exist in the body
● 1. Skeletal Muscles

– Voluntary and striated

● 2. Cardiac muscles
– Involuntary and striated
● 3. Smooth/Visceral muscles
– Involuntary and NON-striated
 TENDONS
●
Bands of fibrous connective tissue that
tie bones to muscles
 LIGAMENTS
●
Strong, dense and flexible bands of
fibrous tissue connecting bones to
another bone
 BONES
●
Variously classified according to shape,
location and size
●
Functions
1. Locomotion
2. Protection
3. Support and lever
4. Blood production
5. Mineral deposition
 JOINTS
●
The part of the Skeleton where two or
more bones are connected
 CARTILAGES
●
A dense connective tissue that
consists of fibers embedded in a
strong gel-like substance
 BURSAE
●
Sac containing fluid that are located
around the joints to prevent friction
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
●
The nurse usually evaluates this
small part of the over-all
assessment and concentrates on
the patient’s posture, body
symmetry, gait and muscle and
joint function
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
●
1. HISTORY
●
2. Physical Examination
– Perform a head to toe assessment
– Nurses need to inspect and palpate
– The special procedure is the
assessment of joint and muscle
movement
– Usually, a tape measure and a
protractor are the only instruments
 ASSESSMENT OF THE
MUSCULO-SKELETAL SYSTEM

●
Gait
●
Posture
●
Muscular palpation
●
Joint palpation
●
Range of motion
●
Muscle strength
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
●
1. BONE MARROW ASPIRATION
– Usually involves aspiration of the marrow
to diagnose diseases like leukemia, aplastic
anemia
– Usual site is the sternum and iliac crest
– Pre-test: Consent
– Intratest: Needle puncture may be painful
– Post-test: maintain pressure dressing and
watch out for bleeding
 ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
●
2. Arthroscopy
– A direct visualization of the joint
cavity
– Pre-test: consent, explanation of
procedure, NPO
– Intra-test: Sedative, Anesthesia,
incision will be made
– Post-test: maintain dressing,
ambulation as soon as awake, mild
soreness of joint for 2 days, joint
rest for a few days, ice application to
relieve discomfort
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
3. BONE SCAN
●
Imaging study with the use of a contrast
radioactive material
●
Pre-test: Painless procedure, IV radioisotope
is used, no special preparation, pregnancy is
contraindicated
●
Intra-test: IV injection, Waiting period of 2
hours before X-ray, Fluids allowed, Supine
position for scanning
●
Post-test: Increase fluid intake to flush out
radioactive material
ASSESMENT OF THE MUSCULO-
SKELETAL SYSTEM
LABORATORY PROCEDURES
4. DEXA- Dual-energy XRAY absorptiometry
●
Assesses bone density to diagnose
osteoporosis
●
Uses LOW dose radiation to measure
bone density
●
Painless procedure, non-invasive, no
special preparation
●
Advise to remove jewelry
 Nursing Management of common musculo-
skeletal problems
PAIN
●
These can be related to joint inflammation,
traction, surgical intervention
●
1. Assess patient’s perception of pain
●
2. Instruct patient alternative pain management
like meditation, heat and cold application, TENS
and guided imagery
●
3. Administer analgesics as prescribed
– Usually NSAIDS
– Meperidine can be given for severe pain
●
4. Assess the effectiveness of pain measures
 Nursing Management
IMPAIRED PHYSICAL MOBILITY
●
1. Instruct patient to perform range of
motion exercises, either passive or active
●
2. Provide support in ambulation with
assistive devices
●
3. Turn and change position every 2 hours
●
4. Encourage mobility for a short period and
provide positive reinforcements for small
accomplishments
 Nursing Management
SELF-CARE DEFICITS
●
1. Assess functional levels of the patient
●
2. Provide support for feeding problems
– Place patient in Fowler’s position
– Provide assistive device and supervise mealtime
– Offer finger foods that can be handled by patient
– Keep suction equipment ready
●
3. Assist patient with difficulty bathing and hygiene
– Assist with bath only when patient has difficulty
– Provide ample time for patient to finish activity
 Musculoskeletal Modalities
●
Traction
●
Cast
 Nursing Management
Traction
●
A method of fracture immobilization
by applying equipments to align bone
fragments
●
Used for immobilization, bone
alignment and relief of muscle spasm
 Traction
●
Skin traction- Buck, Bryant

●
Skeletal traction
 Traction
●
Balanced Suspension traction

●
Running/Straight traction
 Traction
●
Pulling force exerted on bones to
reduce or immobilize fractures,
reduce muscle spasm, correct or
prevent deformities
 Traction
●
TO decrease muscle spasms
●
TO reduce, align and immobilize
fractures
●
To correct deformities
 Nursing Management
Traction: General principles
●
1. ALWAYS ensure that the weights
hang freely and do not touch the floor
●
2. NEVER remove the weights
●
3. Maintain proper body alignment
●
4. Ensure that the pulleys and ropes are
properly functioning and fastened by tying
square knot
 Nursing Management
Traction: General principles
●
5. Observe and prevent foot drop
– Provide foot plate
●
6. Observe for DVT, skin irritation and
breakdown
●
7. Provide pin care for clients in
skeletal traction- use of hydrogen
peroxide
 Nursing Management
Traction: General principles
8. Promote skin integrity
– Use special mattress if possible
– Provide frequent skin care
– Assess pin entrance and cleanse the pin
with hydrogen peroxide solution
– Turn and reposition within the limits of
traction
– Use the trapeze
 Nursing Management
CAST
●
Immobilizing tool made of plaster of
Paris or fiberglass
●
Provides immobilization of the fracture
 Nursing Management
CAST: types
➢
Long arm
➢
Short arm
➢
Short leg
➢
Long leg
➢
Spica
➢
Body cast
 Casting Materials
●
Plaster of Paris
– Drying takes 1-3 days
– If dry, it is SHINY, WHITE, hard and
resistant
●
Fiberglass
– Lightweight and dries in 20-30 minutes
– Water resistant
 Cast application
1. TO immobilize a body part in a
specific position
2. TO exert uniform compression to
the tissue
3. TO provide early mobilization of
UNAFFECTED body part
4. TO correct deformities
5. TO stabilize and support unstable
joints
 Nursing Management
CAST: General Nursing Care
●
1. Allow the cast to air dry (usually 24-
72 hours)
●
2. Handle a wet cast with the PALMS
not the fingertips\
●
3. Keep the casted extremity
ELEVATED using a pillow
●
4. Turn the extremity for equal drying.
DO NOT USE DRYER for plaster cast
– Encourage mobility and range of
motion exercises
 Nursing Management
CAST: General Nursing Care
●
5. Petal the edges of the cast to prevent
crumbling of the edges
●
6. Examine the skin for pressure areas
and Regularly check the pulses and skin
 Nursing Management
CAST: General Nursing Care
●
7. Instruct the patient not to place
sticks or small objects inside the
cast
●
8. Monitor for the following: pain,
swelling, discoloration, coolness,
tingling or lack of sensation and
diminished pulses
 Nursing Management
CAST: General Nursing Care
●
Hot spots occurring along the cast
may indicate infection under the
cast
Thank you! :)