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USCULOSKELETAL SYSTEM OUTLINE:

A. Fxn bones= support, voluntary movement, protect underlying organs, production blood, storageminerals.

B. BONE CELLS:a. Osteoblasts- build boneb. Osteoclasts- break down bone- remodellingc. Osteocyte- mature bone cell

C. TYPES BONES:a. Long bones- bear weight ex. Femur

oEpiphysis- consist spongy cancellous bone--oMetaphysic- resp longitudinal growth of boneoDiaphysis- compact bone- yellow & red marrowtrabeccaspongy, haversiniansystem

In adults, flat & irregular bones of skull, shoulder, pelvis ribs and sternumproduce blood cells.

b. Short-ex. Phalangesc. Flat-ex. Scapula

D. GROWTH & METABOLISM IS AFFECTED BYa. Ca2+ & phosphorus, Vit D-necessary for absorption Ca2+, insulin, gluccorticoids-

protein metabolism, calcitonin-decreases serum Ca2+, parathyroid hormone-increases

serum Ca2+, estrogens & androgens stimulate osteoblast activity, thyroxine protein

synthesis, growth hormone-increase length bone.

E. JOINTS- articulation for movement & flexibilitya. Synarthroidal - immovable joint ex skullb. Amphiarthroidal- slightly moveable ex. Pelvisc. Dyarthroidal (synovial)- freely moveable-flexion, extension, ab/adduction rotation,

circumduction

F. BURSAE-sacs filled with synovial fluid which decrease friction between moving joints

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G. ISOMETRIC CONTRACTIONS- squeezing muscledont move, ISOTONIC CONTRACTION-moves muscle

H. MUSCULOSKELETAL CHANGES ON OLDER PERSON:a. Loss motor neuronsb. Muscle atrophy and weaknessc. Increased bone re-absorption w/ decreased bone production oteopenia &

osteoporosis

d. Degeneration cartilagee. Loss flexibility tendons & ligaments

I. ILLNESSESS AFFECTING MUSCULOSKELETAL SYSTEM:a. DM, poliomyelitis, tuberculosis, parathyroid problems, rickets, scurvy, soft tissue

infection, neuromuscular disabilities.

oAsk if had vaccination for polio & tetanus, what are results for TB testJ. MEDICATIONS THAT AFFECT MUSCULOSKELETAL SYSTEM

a. Anti-seizure, corticosteroids, potassium depleting diureticsoAsk if bouts amenorrheaosteoporosis, ask postmenopausal women about HRT,both sexes about Ca2+, Vit D supps

K. LABS & DIAGNOSTIC TESTS:a. RADIOGRAPHIC TESTS:

oStandard x-ray- eval. Structure & fxn bone Explain procedure, avoid excessive exposure, remove Radiopaque objects,

verify not pregnant

oMyelogram (myelpgraphy)- injection Radiopaque dye into subarachoid space ofvertebral column after removal sm. Amt CSF

NPO after liquid breakfast, Check iodine allergy, Informed consent If oil based dielie flat for12hrs, water dye- HOB 30-45 & institute

seizure precautions

Inform spinal headache should resolve 1-2dys w/ rest & fluids & notifyHCP

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oMRI- views soft tissue, Gadolinum may be injected to better view structures Contraindicated those with pacemaker, shrapnel, hearing aid, electronic

devices aneurism clips or metal implants

Remove al jewellery & cloths w/ metal, Instruct to lie still & may haves/s/ claustrophobia, Admin anti-anxiety meds

b. ENDOSCOPYoARTHROSCOPY- insert arthroscope into joint, removes loose bodies 7 biopsy

Inform outpt. Procedure w/ strict asepsis, under local or generalanesthesia

After cover wound w/ P-dressing 24hrs, limit activityc. INVASIVE PROCEDURES

oARTHROCENTESIS- puncture of joint capsule to obtain synovial fluid or removeexcess fluid. Local anesthetic & asepsis

Inform done @ bedside or exam room, pressure dressing, observe bloodor fluid

d. ELECTROMYELOGRAM (EMG)- records electrical activity of muscle by inserting small-gauge needles attached to leadsdx lower motor dysfxn

Inform perform in electromyelogram lab while supine on a table,discomfort from needle insertion must stay awake to respond to

commands from movement

Avoid stimulants ex. Caffeine & sedatives 24hrse. BLOOD STUDIES

oRHEUMATOID FACTOR N