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muscleskeletal system
consist of bones, muscle, joints, tendons, ligaments, cartilage, bursae
- bones-206 in body
- short bones- fingers, toes
- long bones- femur, ulna
- flats bones- sternum, rib
- Irregular bones- vertabrea
- 2 types of bony tissue
- cancellus bone/spongy bone- light & has many spaces, found @ the rounded, irregular ends, epiphyses of long bones
- cortical bone- compact bone- dense & hard, cortical boney tissue found mainly in long shaft or diaphyses bones in arms & legs
- both give strenght & support, yet keeps skeleton light
- bones compoed of cells, protein matrix, & mineral disposits
- osteoblast- cells that bulid bones, secrete bone matrix (collagen)
- osteocytes-change osteoblast 2 mature bone, by process of ossification & calcification, also involved in maintaining bone tissue
- oseoclast- cells involved in destrution, resorption, remodeling of bone
- part of mononucleat phagocyte system(blood cells that recycle old bone)
periosteum- layer of tissue, covers bone not joints, inner layer has osteoblast 4 bone formation, itz rich in blood & lymph vessels & supplies bone nourishments
- types of bone marrow
- red bone marrow- primarily in sternum, ilieum, vertabrae, & ribs, produces blood cells & hemoglobin
- yellow bone marrow- found in long bones, consist of fat cells & CT, if blood supply becomes compromised ittake characteristics of red bone marrow & begin producing blood cells when needed
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muscles
- skeletal muscles
- voluntary, brain & spinal cord control their function
- promotes movements
- composed of muscle cell or fibers that have many myofibrils (made of sliding filaments called sarcomeres)
- actin & myosin promotes sliding of sarcomeres leading to contraction of muscle
- smooth & cardiac muslces
- involuntary, controlled by mechanism in their tissue & by neurotransmitters released from ANS
- found in walls of certain organs & cavities of body like stomach, intestne, blood vessels, & ureters, cadiac in heart
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joints
- junction between 2/more bones
- most are free-moving joints or diarthrodial joints (covered by hyaline cartilage which reduces friction during movement
- space between joint cavity which enclosed by a fibrous capsule lined w/ synovial memebrane which produces synovial fluid that lubs joint
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tendons
- cordlike structures that attached muscles to periosteum of bone
- muscles have 2/more attachments
- *origin- more fixed
- *insertion- more movable
- when muscle contracts both attachments pulled & insertions moved closer to origin
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ligaments
- consist of fibrous tissue 2 adjacent freely movable bones
- helps protect joint by stabilizing their surfaces & keeping them alignment
- some completely enclose joint
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cartilage
- firm, dense type of CT that consist of cells embedded in a substance called a matrix which is firm & compact
- function is 2 redue friction between articlar surface, absorb shock, & reduce stress on joint
- hyaline or articular covers movable joint- elbow
- costal cartilage- connects ribs & sternum
- semilunar cartilage- knee
- fibrous cartilage- between vertabrea
- elastic cartilage- laynx, epiglottis, & outer ear
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bursae
- sm. sac filled w/ synovial fluid
- reduces friction between areas like tendon & bone, & tendon & ligament
- inflammation to this area called brusitis
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Assessment
- chronic disorder: medical, drug, allergy; familial & occupational HX
- recent injury: when/ how trauma
- list of symptoms: onset, duration, location of discomfort/pain
- whether activity makes it better/worse
- identify other symptoms like leg cramping or skin lesions, & ask if it interferes w/ ADL
- if open wound find out when last tetnus shot was
- hx past disorders & medical/surgical tx ASAP
- attention to chronic/concurrent disorders like DM
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physical exam
- ability 2 ambulate, sit, stand, perform activities req. fine motor skills
- inspection symmetry,size, conour extremities & random movements
- palpates mucsle & joint 4 swelling, degree of firmness, warm areas, involuntary movements
- apply force 2 extremity as pt pushes aginst force
- neurovascular assessment: ROM (dont force), observe degree of movement & ROM
- note abnormal movements like spasm or tremors
- inspect/palpate 4 pain, tenderness, swelling, & redness
- check 4 muscle wasting
- look 4 abnormal size/alignment & symmetry comparing sides
- spinal inspection:
- *Kyphosis- exaggerated convex curvature of thoracic spine (hunchback)
- *Lordosis- excessive concave curvature of lumber spine (swayback)
- *Scoliosis- lateral curvature of spine
depending on finding also look 4 changes in gait & body posture, favoring certain side, ability 2 bend & twist trunk, head & extremities
by 35y/o may expirience loss of bone mass, HT, changes in structures of spine, joints
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asssessment if traumatic injury
- v/s
- cut clothes if injury if needed
- compare structures
- b gental, b/c assessment can cause pain
- exam includes:
- check swelling, external bleeding, brusing
- palpate peripheral pulses
- check peripheral circulation, pulse, skin color, temp., capillary refill
- check senstation on injury area
- look broken skin, open wound, debris in/around wound, protusion of bone or other tissue
- examin area around injury
- look malalignment of injured limb
- assess 4 pain noting type & location
Dr. need to check pt before nurse
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DX test
- imaging procedures:
- x-ray, CT scan, MRI, 4 fractures/dislocations, malignant bone lesions, joint diformities, calcifications, degenerative changes, osteoporosis, joint diseases
- arthrogram- usually knee/shoulder, 1st anesthetic, & inserts needle 2 joint space, fluoroscopy 2 check placement of needle, synovial fluid is aspirated & sent to lab, then contrast injected & x-ray taken
- nurse should tell pt that a cracking/clicking sound heard 4 about 2 days
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arthroscopy
- internal inspection
- seeing knee joint, give anesthetic, dr. insert lrg needle in joint & inject steril saline 2 distend joint
- checking 4 injury/deterioration
- fluid taken & sent to lab
- depending on finding DR may use arthroscope to remove bits of torn/floating cartilage
- after pt leg elavated w/o flexing knee
- appy cold pack over dressing @ site of arthroscope inserted
- RX analgesic given
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arthrocentisis
- aspiration of synovial fluid, 4 discomfort or to inject meds (corticosteriod)
- give anesthetic before procedure
- fluid may b sent to lab
- may b performed during athrogram or arthroscopy
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synovial fluid analysis
- fluid aspirated & examined traumatic arthritis, septic arthritis(caused by microorganism), gout, rhuematic fever, & systemic lupus, erythematosus
- normal fluid clear
- test includes exam of blood cells, crystals, & formed debri that may b present in joint space after injury
- if infection suspected C&S ordered
- chemical analysis 4 protein, glucose may b preformed
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Bone scan
- uses IV injection of radioneuclide to detect uptake of radioactive sustances by bone
- 2 detect metastatic bone lesions, fractures & certain inflammatory disorders
- radioneuclide taken up in areas of increased metabolism which occurs in bone cancer, metastatic bone disease, & osteomyelitis (bone infection)
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bone densitometry
- radiography of wrist, hip, spine, helps determines bone mineral density (BMD)
- bone density scaning & dual-energy x-ray absorptiometry (DXA/DEXA) 2 measure BMD
- mostly on lower spine, hips
- portable DEX device use x-ray or ultrasoud 2 measure quantity & quality of wrist, finger, or heel
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electromyography
- test electrical potential of muscles & nerves leading to muscle
- 2 evaluates muscle weakness/deterioration, pain, disability, & 2 differantiate muscle & nerve problems
- Dr. inserts needle electrodes to selected muscle & stimlates muscle
- oscilloscope records responses to stimuli
- if pt get pain after study, apply warm compresses
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biopsy
- 2 identify composition of bone , muscle, or synovim
- removed w/ needle or excised surgically while pt under anesthetic
- after nurse checks 4 signs bleeding or swelling, pain, apply ice
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blood test
CBC- detect infection, inflammation, anemia
- ex. dx test & findings of muscleskeletal disorders:
- elevated alkaline phosphatase levels, which may indicate bone tumors & healing fractures
- elevated acid phosphatase levels, indicates pagets disease(bone distruction & disorganized repair) & metastatic cancer
- decreased serum calcium level, indicates oseomalacia, oseoporosis, bone tumors
- increased serum phosphorus level, indicate bone tumor & healing fractures
- elevated serum uric acid level, indicate gout(treated/untreated)
- elevated antineuclear antibody level, indicate systemic lupus erythematosus, a CT disorder
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urine test
- when ordered 24hr sample to check uric acid & calcium excretion
- when gout uric acid high
- calcium high inmetastati bone lesion & when pt w/ prolonged immobility
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