Musculoskeletal disorders notes

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  • 1. Musculoskeletal Disorders Physiology Functions - Provide protection for vital organs o Bones ribs, sternum, thoracic vertebrae o Muscles internals and intercostal muscles, diaphragm - Support body structures by providing a strong and sturdy framework - Locomotion and movement - Mineral storage o For metabolism o 99% of the total calcium content of the body is located in the bone - Haematopoiesis o RBC and WBS are produced according to their nature stem cells - Heat production o Through contraction = contain and control heat inside the body Anatomy - 206 bones in total - Classified according to their location o Axial (80) Skull Vertebral column o Appendicular (126) Pectoral girdle Scapula Clavicle Radius Ulna Pelvic girdle Iliac Ischium Femur - Basic Cell types o Osteoblasts- the CARPENTER Bone formation Made possible through the secretion of matrix calcium is the main component Initiates bone formation via calcification Process where there is mineralization of the collagen fiber MATRIX and CALCIUM THE CEMENT; THE FOUNDATION o Osteocytes MAINTAINS THE HOUSE Mature type of the osteoblasts Main cell found in the bone Maintenance of bone Excretion of waste materials Is found inside the spaces called lacunae

2. o Osteoclasts THE ANAYS (THE ONE THAT DESTROYS THE HOUSE) Huge cells derived from the fusion as many as 50 monocytes Usually concentrated at the endosteum of the bone Endosteum at the lumina area, where the medullary cavity is For bone resorption: bone destruction or bone remodelling Bone destruction Ca is removed - According to General Features o Long Bone Longer than they are wide Upper and lower limbs Humerus and Femur o Short Bones As broad as they are long Wrist and Ankle o Flat Bones Relatively thin; flattened shape Certain skull bones, ribs, scapulae (shoulder bones, blades and sternum) o Irregular Do not fit readily into the other three categories Vertebrae and facial bones (mandible, maxillary, zygomatic arch, among others) o Each long bones consists of a central shaft called diaphysis o While the two ends is called epiphysis o A thin layer of the articular cartilage covers the end of the epiphyses where the bone articulates with other bones o A long plate that is still growing has an epiphyseal plate or growth plate, composed of cartilage, between each epiphyses and the diaphysis o Bones contain cavities such as the large medullary cavity in the diaphysis, as well as smaller cavities in the epiphyses of long bones and in the interior of other bones o These spaces are filled with either yellow ro red marrow o Marrow The soft tissue in the medullary cavities o Yellow marrow Consists of mostly fat o Red marrow Blood forming cells and is the only site of blood formation in adults o Most of the outer surface of the bone is covered by dense connective tissue called periosteum which contains blood vessels and nerves o The surface of the medullary cavity is lined with a thinner connective tissue membrane called endosteum o The periosteum and endosteum contain osteoblasts which function in the formation of bone as well as the repair and remodelling of the bones o When osteoblasts become surrounded by matric, they are referred to as osteocytes o Bones is formed in thin sheets of extracellular matrix called lamellae, with osteocytes located between the lamellae o The osteocytes are located with spaces called lacunae o Cell processes extend from the osteocytes across the extracellular matrix of the lamellae with tiny canals called canaliculi Histological Structure - Compact Bone o Forms most of the diaphysis of long bones and the thinner surfaces of all other bones 3. o Most of the lamellae of compact bone are organized into sets of concentric rings with each set surrounding a central or haversian canal o Blood vessels that run parallel to the long axis of the bone are contained within the central canals o Each canal with the lamellae and osteocytes surrounding it is called osteon or haversian system o Each osteon looks like a microscopic target with the central canal as the bulls eye o Osteocytes located in lacunae are connected to one another by cell process in canaliculi o The canaliculi give the osteon the appearance of the having tiny cracks in lamellae - Cancellous Bone o Spongy bone because of its appearance o Located mainly in the epiphyses of long bones and it forms the interior of all other bones o Consists of delicate interconnecting rods or plates of bone called trabeculae which resemble the beams of scaffolding of a bulding Articulations - The site where bones meet with each other - Joints o Synarthrosis (sutures) o Ampiarthrosis (vertebral and pelvic) o Diarthrosis (maximum movement) o Fibrous (sutures area: coronal, frontal, sagittal), cartilaginous and synovial o Prevent direct contact to two opposing bones o Provides gliding motion o Shock absorption o Bursa sock filled with synovial fluid; important for shock absorption o Position and movement of bones Ligaments retinaculum (hands) Tendon- structures that connects /attach muscles to bones o Specific Types Fibrous joints Consists of two bones that are united by fibrous tissue and exhibit little or no movement Sutures o Fibrous joints between the skull Gomphoses o Consists of pegs fitted onto sockets and held in place by ligaments Cartilagenous Joints Untie two bones by means of cartilage. Only slight movement can occur at these joints Fibrocartilage o Is a type of cartilage that reinforces by additional collagen fibers. It is the kind of cartilage where much strain is placed on the joint Synovial Joint Freely movable joints that contain synovial fluid in a cavity surrounding the ends of articulating bones Articular Cartilage o Provides a smooth surface where the bones meet Joint Cavity o Filled with synovial fluid Joint Capsule o Helps hold the bones together and allows movement Synovial Membrane 4. o Produces synovial fluid Bursa Diarthrosis joint Plane of gliding joints o Joints in carpal bones Saddle Joints o Joints at the base of thumb Hinge joints o Elbow and knee joint Pivot Joint o Radius and ulna Ball and socket o Hip and shoulder o Functions Prevents direct contact btw two end bones Allow gliding or sliding motions Absorb shock o Bone Maintenance and Healing Regulatory factors determining both formation and resorption Physical activity Diet Calcitonin o For bone mineralization; stimulated if px is hypercalcemic Parathyroid hormone Thyroid hormone o Hyperthyroidism = bone dimineralization Cortisol Growth hormone Sex hormones o Dec Estrogen = bone deminiralization = osteoporosis Weight bearing stress stimulate local bone formation and resorption; in mobility, where weight bearing is prevented, Calcium is lost in the bone Vit. D promotes absoption of calcium from the GI and accelerates Vit D maintain increase Serum Ca levels Types Intramembranous o Compact bone Endochondreal o Cancellous Bone marrow osteoblast Bone cortex osteon Periosteum hard callus is formed (intramembranous) Cartilage endochondrial ossification Phases Reactive o Hematoma/recruitment of inflammatory cells. Angiogenesis and granulation Reparative o Pre-callus precursor (3-4 weeks) Remodelling o Nursing Consideration Age 5. Very young = immature bones give all supplements to promote bone growth Very old = osteoporosis quite at risk for fractures consider displacement and site of fracture Displacement of fracture Site of fracture Nutritional level Blood Supply to the area of injury CAN AFFECT TIME REQUIRED FOR BONE HEALING Anatomy of Muscular System - 3 Types o Smooth Found in the hollow organs of the body Eg. Stomach (capable of mixing waves), small and large intestine, airways (capable of peristalsis), blood vessels Slightly striated involuntary o Skeletal Striated because of the alternating lines myocinand myofilaments Voluntary Lower neurons control the activity of the skeletal muscles Energy is consumed when the skeletal muscles contract in response to stimulus Lactic Acid By-product of muscle metabolism when O2 available to cell is not sufficient Muscle fatigue results from increased work of the muscle o Depleted glycogen and energy stores o Accumulation of lactic acid muscle cramps o Cardiac Exclusively found in the myocardium Intercalated disks gives automaticity involuntary - types of Muscle Contraction o Isometric Contraction Length of muscle remains constant but the force generated is increased o Isotonic Contraction Shortening if muscles, but no increase in muscle tension - Muscle Tone o Flaccid (Limp) o Spastic o Atonic (soft and flabby px who are post-stroke) - Muscle Action o Prime Mover Deltoid muscle o Synergist Same actions Biceps o Antagonist Biceps - Types of motions o Flexion o Extension 6. o Abduction o Adduction - Older Adult Care Focus o Decreased bone density (most are osteoporotic) Ensure safety o Decreased in subcutaneous tissue less soft tissue over bony prominences o Degenerative changes in the spine alter posture and gait o Degenerative changes in cartilage and ligaments leads to decreased movement of joints o ROM decreases o Slowed movements and decreased muscle strength Assessment - Health history - Past health, social and family history - Physical Assessment o Posture: Kyposis (forward curvature of the thoracic spine), lordosis (lumbar), scoliosis (lateral curvature) o Gait o Bone integrity (crepitus) o Joint function (contracture, dislocation, subluxation) o Muscle strength and size (clonus/fasciculation) o Skin o Neurovascular status (circulation, motion, sensation) Laboratory/Diagnostic Tests - Blood Tests o ESR (elevated in SLE and arthritis) o Rheumatoid factors (+ in rheumatoid arthritis) o Lupus erythematosus cells (LE Cells) o Antinuclearantibodies (ANA) (+rheumatoid arthritis) o Anti-DNA (+ in SE) o C Reactive protein ( o Minerals Calcium Decreased levels in osteomalacia, osteoporosis Increased in