Muscokoskeletal Disorder Report

The skeletal system, composed of more than 200 bones connected by the joints and
tendons, provides the structural casing or protective armor for the internal organs
of the
body and supplies the body with red and white blood cells grown in the central
marrow.
Skeletal muscles, which are attached to the bones by connective tissue, tendons,
and
ligaments, allow for voluntary movement, including gross motor activities, such as
running, and fine motor activities, such as writing. Together, the skeletal and
muscular
systems both support the body and make coordinated movement possible.
Childhood fractures (break in the continuity or structure of bone) heal much more
quickly than fractures do in adults and because a child’s bone grows from the
epiphysis or growth plate, a fracture within this area may cause serious
complication, such as a deformity.
The Musculoskeletal System

BONES AND BONE GROWTH
Bones are generally classified by their shape as long (those found in extremities),
short
(those of the wrist or ankle), flat (those of the skull, ribs, scapula, and clavicle), or
irregular (the vertebrae, the pelvis, and the facial bones of the skull).
The mark of a long bone is a lengthy central shaft (the diaphysis), a rounded end
portion (the epiphysis), and a thin area between them (the metaphysis)
Increases in the length of long bones occur at the cartilage (connective tissue)
segment
(the epiphyseal plate), between the epiphysis and the metaphysis. Injury to this
area in
a growing child is always potentially serious because it may halt growth, stimulate
abnormal growth, or cause irregular or erratic growth.
MUSCLE
The skeletal muscular system is composed of striated muscle (differentiated from
the
smooth muscle found in body organs, which is responsible for such activities as
intestinal peristalsis). Activation of skeletal muscle occurs with innervation from a
motor nerve and is under voluntary control. Myopathy, or disease of the muscular
system, can be inherited (as in muscular dystrophy) or acquired (as in myasthenia
gravis).
Assessment of Musculoskeletal Function

In addition to a history and physical examination, diagnostic tests are frequently
necessary to detect musculoskeletal dysfunction. These may include X-ray and
bone
scans, bone and muscle biopsies, electromyography, and arthroscopy. Ultrasound
and
magnetic resonance imaging (MRI) studies are used to reveal soft tissue disorders.
Furthermore, obtain information on how parents and children are adjusting to a
potential
disability because poor acceptance of a condition can limit a child’s potential as
much
as the physical involvement
RADIOGRAPHY
Because bones are opaque, they outline well on an X-ray or computerized
tomography
(CT) scan to provide information about a specific bone or a joint. Other tests,
however,
are indicated to confirm problems with cartilage, tendons, and ligaments. X-rays in
children are limited to the least number necessary for diagnosis or prognosis
because
excessive radiation is associated with the development of malignancies, such as
leukemia.
BONE SCAN (SCINTIGRAPHY)

A bone scan is a study of the uptake by bone of intravenously injected radioactive
substances (American College of Radiology, 2014). Areas of increased metabolic
activity cause the substance to concentrate in that area, often providing information
on
very early stages of bone disease and healing, possibly before they are visible on
an X-
ray.
ELECTROMYOGRAPHY
Electromyography studies the electrical activity of skeletal muscle and nerve
conduction
to determine the location and cause of disorders such as myasthenia gravis,
muscular
dystrophy, and lower motor neuron and peripheral nerve disorders.
CASTING
Casts are used to treat a wide range of musculoskeletal disorders, from simple
fractures
in the extremities to correction of congenital structural bone disorders.
Cast Application
Casts are created from either plaster of Paris or fiberglass. Fiberglass is an
attractive
material to use for children’s casts because it is light in weight; comes in attractive
colors; and, when a special waterproof liner is used, can be immersed in water.
Unfortunately, it is more expensive and may not be practical for casts that need
frequent
changing, such as those used to correct talipes disorders, a common congenital
disorder
that requires serial casting.
Cast Removal
Most casts remain in place for 4 to 8 weeks and are then removed using an electric
cast
cutter with a rapidly vibrating, circular disk Cast cutters are frightening
because the disk makes a very loud noise as it cuts through the cast material and
also
generates heat.
TRACTION
Traction, which is used to reduce dislocations and immobilize fractures, involves
pulling on a body part in one direction against a counterpull exerted in the opposite
direction.
DISTRACTION
Distraction is the use of an external device to separate opposing bones, which then
encourages new bone growth. It can be used to lengthen a bone if one limb is
shorter
than the other. It also can be used to immobilize fractures or to correct defects if
the
bone is rotated or angled.
Disorders of Skeletal Structure

Spinal disorders in children may include kyphosis (an outward curvature of the
cervical
spine) or lordosis (an inward curving of the lumbar spine), but idiopathic scoliosis
(an
S-shaped curve) is the most commonly seen type of these disorders.
Disorders of the Joints and Tendons: Collagen Vascular

Disease
Collagen is composed of bundles of protein-rich fibers that form the connective
tissue
of tendons, ligaments, and bones. Because this tissue is found throughout the body,
collagen diseases are systemic. They tend to be painful, involve inflammation, and
are
long term.
JUVENILE IDIOPATHIC ARTHRITIS
JIA, also called simply juvenile arthritis (JA) or juvenile rheumatoid arthritis
(JRA),
primarily involves the joints of the body, although it also affects blood vessels and
other
connective tissues. Three groups have developed sets of criteria to classify children
with
arthritis:
• American College of Rheumatology (ACR)
• European League Against Rheumatism (EULAR)
• International League of Associations for Rheumatology (ILAR)
The ACR-accepted terminology for JIA includes children younger than 16 years of
age who have chronic arthritis (swelling or effusion, or presence of two or more of
the
following signs: limitation of range of motion, tenderness or pain on motion, and
increased heat) in one or more joints (lasting more than 6 weeks) and in whom no
other
specific cause of arthritis can be identified. Onset type is defined by type of disease
in
3173the first 6 months. The organization recognizes the following three subtypes:
• Polyarticular: five or more inflamed joints, often involving weight-bearing
joints. Rheumatoid nodules may be seen in patients with rheumatoid factor (RF)-
positive disease and symmetrical involvement of small joints in the hands.
• Pauciarticular: less than five inflamed joints. Large, weight-bearing joints, such
as the knees and ankles, are typically affected.
• Systemic: arthritis in one joint for at least 6 weeks’ duration in a child age 16
years with or preceded by fever of at least 2 weeks’ duration that is documented
to be daily (“quotidian”) for at least 3 days and accompanied by one or more of
the following: evanescent erythematous rash, generalized lymphadenopathy,
hepatomegaly or splenomegaly, and serositi.
Medication
NSAIDs such as ibuprofen (Motrin) or naproxen (Naprosyn) are the analgesics of
choice for children with JA because they not only control pain and inflammation,
thereby reducing joint swelling, joint discomfort, and morning stiffness, but also
may
contribute to improvement in malaise and irritability. NSAIDs are taken about four
times a day and must be taken for at least 6 to 8 weeks to ensure effectiveness.

Muscokoskeletal Disorder Report

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Muscokoskeletal Disorder Report

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The skeletal system, composed of more than 200 bones connected by the joints and

The Musculoskeletal System

Assessment of Musculoskeletal Function

BONE SCAN (SCINTIGRAPHY)

Disorders of Skeletal Structure

Disorders of the Joints and Tendons: Collagen Vascular

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