Musculoskeletal disorders

Assessment and diagnostic test

Assessment
The nursing assessment of the patient with musculoskeletal dysfunction
includes an evaluation of the effects of the musculoskeletal problem on
the patient.
 Muscle Contraction.
 Altered Sensations
 Assessment of peripheral nerve function has two key elements:
evaluation of sensation and evaluation of motion.
 Posture : Common deformities of the spine include:
a. kyphosis, an increased forward curvature of the thoracic spine.
b. lordosis, an exaggerated curvature of the lumbar spine
c. scoliosis, a lateral curving deviation of the spine .

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  Gait: gait is assessed by having the patient walk away from the
examiner for a short distance.
 Bone Integrity
The bony skeleton is assessed for deformities and Symmetric parts of
the body, such as extremities, are compared. Abnormal bony growths
due to bone tumors may be observed. Shortened extremities,
amputations, and body parts that are not in anatomic alignment are
noted.
 Joint Function. The articular system is evaluated by noting range of
motion, deformity, stability, and nodular formation.
 Muscle Strength and Size
 Age-Related Changes of the Musculoskeletal System

Diagnostic Procedures
1. X-ray Studies
X-ray studies are important in evaluating patients with musculoskeletal
disorders. Bone x-rays determine bone density, texture, erosion, and
changes in bone relationships.
2. Computed Tomography
A computed tomography (CT) scan shows in detail a specific plane of
involved bone and can reveal tumors of the soft tissue or injuries to the
ligaments or tendons. It is used to identify the location and extent of
fractures in areas that are difficult to evaluate
3. Magnetic resonance imaging (MRI)
Is a noninvasive imaging technique that uses magnetic fields, radiowaves,
and computers to demonstrate abnormalities (ie, tumors or narrowing of
tissue pathways through bone) of soft tissues such as muscle, tendon,
cartilage, nerve, and fat.
4. Arthroscopy:
It is a procedure that allows direct visualization of a joint to diagnose
joint disorders. Treatment of tears, defects, and disease processes may be
performed through the arthroscopy.
5. Arthrocentesis (joint aspiration):
This procedure is carried out to obtain synovial fluid for purposes of
examination or to relieve pain due to effusion

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 6. Bone densitometry:
It is used to estimate bone mineral density (BMD). This can be performed
through the use of x-rays or ultrasound.
7. Electromyography (EMG):
It provides information about the electrical potential of the muscles and
the nerves leading to them.

8. Laboratory Studies:
 CBC
 Serum calcium levels are altered in patients with osteomalacia,
parathyroid dysfunction, Paget's disease, metastatic bone tumors,
or prolonged immobilization.
 Serum phosphorus levels are inversely related to calcium levels
and are diminished in osteomalacia associated with malabsorption
syndrome.
 Thyroid studies and determination of calcitonin, parathormone, and
vitamin D levels.
 Serum enzyme levels of creatine kinase and aspartate
aminotransferase become elevated with muscle damage.

Osteomyelitis
 Osteomyelitis is an infection of the bone.
 In most cases, a bacteria called Staphylococcus aureus, a type of
staph bacteria, causes osteomyelitis.
 Osteomyelitis can occur in infants, children, and adults. Different
types of bacteria typically affect the different age groups.
 In children, osteomyelitis most commonly occurs at the ends of
the long bones of the arms and legs, affecting the hips, knees,
shoulders, and wrists.
 In adults, it is more common in the bones of the spine (vertebrae),
feet, or in the pelvis.
Causes
1. Extension of soft tissue infection (eg, infected pressure or vascular
ulcer, incisional infection).
2. Direct bone contamination from bone surgery, open fracture, or
traumatic injury (eg, gunshot wound).

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 3. Hematogenous (blood borne) spread from other sites of infection
(eg, infected tonsils, infected teeth, upper respiratory infections).
4. Patients with conditions or taking medications that weaken their
immune system are at a higher risk of developing osteomyelitis.
Risk group
 Poorly nourished, elderly, or obese people
 Impaired immune systems,
 Chronic illnesses (eg, diabetes)
 Receiving long-term corticosteroid therapy or immunosuppressive
agents.
 HIV or AIDS
 Rheumatoid arthritis
 Intravenous drug use
 Alcoholism
Signs &Symptoms
1. Difficulty or inability to use the affected limb or to bear weight or
walk due to severe pain.
2. Fever,
3. irritability
4. fatigue
5. Tenderness and swelling around the affected bone.
6. Lost range of motion.
7. Pulsation pain
Diagnostic procedures
1. Magnetic resonance imaging (MRI)
2. Blood studies reveal leukocytosis and an elevated ESR.
3. Wound and blood culture studies are performed to identify
appropriate antibiotic.
4. Bone scans .
Treatments
1. Antibiotics therapy.
2. Splinting or cast immobilization
3. Surgical management
o Sequestrectomy.
o Drain the infected area.

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Nursing Diagnoses
 Acute pain related to inflammation and edema
 Impaired physical mobility related to pain, use of immobilization
devices, and weight-bearing limitations
 Risk for extension of infection: bone abscess formation
 Knowledge deficient related to lack of education about treatment
regimen.
Nursing Interventions
1. The affected part may be immobilized with a splint to decrease
pain and muscle spasm.
2. Monitors the neurovascular status of the affected extremity.
3. Provide prescribed analgesics and other pain-reducing techniques.
4. The infected bone must be protected by immobilization devices
and by avoidance of stress on the bone.
5. Activity restrictions.
6. Encourage the patient to full participation in ADLs within the
physical limitations to promote general well-being.
7. Controlling the Infectious Process with long-term, intensive
antibiotic therapy.
8. Wound and skin care

Osteoporosis
 Osteoporosis is a condition characterized by a decrease in the
density of bone, decreasing its strength and resulting in fragile
bones.
 Osteoporosis literally leads to abnormally porous bone that is
compressible, like a sponge. This disorder of the skeleton weakens
the bone and results in frequent fractures (breaks) in the bones.
 Osteopenia is a condition of bone that is slightly less dense than
normal bone but not to the degree of bone in osteoporosis.
Risk factors
 Female gender
 Thin and small body frame
 Family history of osteoporosis
 Cigarette smoking and excessive alcohol consumption
 Lack of exercise, Diet low in calcium, and Poor nutrition and poor
general health

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 Malabsorption (nutrients are not properly absorbed from the
gastrointestinal system).
 Low estrogen levels in women (such as occur in menopause or with
early surgical removal of both ovaries)
 Chronic inflammation, due to chronic diseases such as rheumatoid
arthritis
 Immobility, such as after a stroke or from any condition that
interferes with walking
 Hyperthyroidism, and Hyperparathyroidism, and Vitamin D
deficiency.
 Certain medications can cause osteoporosis. These include long-term
use of heparin (a blood thinner), antiseizure medications
Signs and symptoms
1. Osteoporosis can be present without any symptoms for decades
because osteoporosis doesn't cause symptoms until bone fractures.
2. Fracture pain.
Diagnostic procedures
 CBC
 A routine X-ray :the affected bones appear much thinner and
lighter than normal bones.
 Bone density scanning known as dual-energy X-ray absorptiometry
(DEXA) and bone densitometry to measure bone density in the hip,
the spine, and the forearm.
Treatment
Prevention of bone fractures by reducing bone loss by increasing bone
density and strength as following;
 Lifestyle changes; including
a. quitting cigarette smoking
b. curtailing excessive alcohol intake
c. exercising regularly
d. consuming a balanced diet with adequate calcium and vitamin D
 Medications that stop bone loss and increase bone strength, such
as, Calcitonin (Calcimar)
 Medications that increase bone formation such as teriparatide
(Forteo).
 Calcium supplements
 Hormonal therapy

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Consequences of osteoporosis
 Decreased quality of life.
 Lost workdays, and disability.
 Patients suffering a hip fracture will require long-term nursing-
home care.
 Elderly patients can develop pneumonia and blood clots due to the
inactivity.
 Prolonged bed rest after the hip fracture increased the risk of death.
Nursing diagnoses
 Sever pain related to osteoporosis.
 Activity intolerance related to pain.
 Sleep pattern disturbance related to pain.
 Risk for potential injury related osteoporosis
Nursing Interventions
1. Provide a safe and hazard-free environment, and assist the client to
identify hazards in the home environment and use side rails to
prevent falls.
2. Move the client gently when turning and repositioning.
3. Encourage ambulation; assist with ambulation if the client is
unsteady.
4. Instruct in the use of assistive devices such as a cane or walker.
5. Provide range of motion exercises.
6. Instruct the client in the use of good body mechanics.
7. Instruct the client in exercises to strengthen abdominal and back
muscles to improve posture and provide support for the spine.
8. Instruct the client to avoid activities that can cause vertebral
compression.
9. Apply a back brace as prescribed during an acute phase to immobilize
the spine and provide spinal column support.
10.Provide a diet high in protein, calcium, vitamins C, D and iron.
11.Encourage adequate fluid intake to prevent calculi.
12.Advise the client to avoid alcohol and coffee.
13.Administer calcitonin and estrogen as prescribed to inhibit bone loss.
14.Administer analgesics, muscle relaxants, and anti-inflammatory
medications as prescribed.

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 Arthritis
 Arthritis is inflammation of one or more joints.
 Symptoms of arthritis include pain and limited function of joints.
 A joint is an area of the body where two different bones meet..
 Arthritis is frequently accompanied by joint pain. Joint pain is
referred to as arthralgia.

Type of arthritis
Two common types of arthritis are osteoarthritis and rheumatoid arthritis.
 Osteoarthritis (OA)
Is a painful, degenerative joint disease that often involves the hips,
knees, neck, lower back, or small joints of the hands. OA usually
develops in joints that are injured by repeated overuse from
performing a particular task or playing a favorite sport or from
carrying around excess body weight. Eventually this injury or repeated
impact thins or wears away the cartilage that cushions the ends of the
bones in the joint. As a result, the bones rub together, causing a
grating sensation. Joint flexibility is reduced, bony spurs develop, and
the joint swells.
 Rheumatoid arthritis (RA)
Is an autoimmune inflammatory disease that usually involves various
joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet,
and ankles. An autoimmune disease is one in which the body releases
enzymes that attack its own healthy tissues. In RA, these enzymes
destroy the linings of joints.

Causes of arthritis
 Injury (leading to osteoarthritis).
 Metabolic abnormalities (such as gout).
 Hereditary factors.
 The direct and indirect effect of infections (bacterial and viral)
 A misdirected immune system with autoimmunity (such as,
systemic lupus erythematosus).

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 Signs and symptoms
Common signs and symptoms may include:
 Pain
 Fever
 Stiffness
 Swelling
 Redness
 Decreased range of motion
Diagnostic Procedures.
1. Review the history of symptoms.
2. Examine the joints for inflammation and deformity, as well as ask
questions about or examine other parts of the body for inflammation
or signs of diseases that can affect other body areas.
3. Blood, urine, joint fluid tests
4. X-ray tests might be ordered.
Management of arthritis
1. Physical therapy.
2. Splinting, cold-pack application.
3. Paraffin wax dips.
4. Anti-inflammatory medications.
5. Pain medications
6. Immune-altering medications
7. Surgical operations (joint replacement).
8. Keep sugary and/or fatty foods to a minimum - such as red meat
9. Eating plenty of fruit and vegetables, as well as whole grains.
10.Omega-3essential fatty acids are thought to relieve to some extent
the symptoms of arthritis.
11.Maintain ideal body weight.
Nursing Intervention :
1. Assess pain; note the location and intensity (scale 0-10). Write down the
factors that accelerate and signs of pain non-verbal.
2. Give a hard mattress, small pillows, elevate the bed linen as needed.
3. Instruct to frequently change positions. Helps to move in bed, prop a pain
in the joints above and below, avoid jerky movements.
4. Instruct the patient to a warm bath or shower at the time awake.
5. Give a massage to enhance relaxation and reduce pain

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6. Encourage the use of stress management techniques, such as progressive
relaxation
7. Give the drug prior to activity that is planned as directed to increase
relaxation and to make it easier to participate in therapy.
8. Give anti-inflammatory and mild analgesic effect in reducing stiffness
and increasing mobility.
9. Give the ice-cold compress if needed. That can relieve pain and swelling
during the acute period.

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