Musculoskeletal disorders

1. Musculoskeletal disorders
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2. Overview of Anatomy & physiology
Musculoskeletal system includes
• bone
• Joint
• Skeletal muscle
• Cartilage
• Ligaments
• Tendon
• And their supporting structures
The musculoskeletal system is the largest organ
system of the human body.
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3. Overview of Anatomy & physiology…
Functions
–Provides protection for vital organs.
–Provides sturdy frame work to support body
structures
–Provides posture & Shape of the body
–Permits coordinated movement and activity
–Bone matrix stores Ca,Mg,phospherus etc.
–Bone marrow produces RBCS,WBCs…
–Muscle maintains body temperature.
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4. Contusions…
A contusion is a soft tissue injury produced by blunt
force, such as a blow, kick, or fall.
Many small blood vessels rupture and bleed
into soft tissues (ecchymosis, or bruising).
A hematoma develops when the bleeding is
sufficient to cause an appreciable collection of
blood.
Local symptoms such as:
 pain
swelling, and
Discoloration -are controlled with
intermittent application of cold.
• Most contusions resolve in 1 to 2 weeks.
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5. Contusions…
• Soft tissue contusions cause skin discoloration, as blood
vessels may bleed directly under the skin.
• This can create a virtual rainbow of colors and a bruise
might look brown, red, blue, purple, or yellow.
• Bruising may be minimized by using ice or a cold pack
directly after an injury occurs.
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6. Contusions…
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7. Contusions…
• The bone bruise: is the most severe type of contusion .
This isn’t an actual break, but it can be extremely
uncomfortable.
• It may need x-rays to rule out any broken bones because
pain can be severe, and it may inhibit movement just as a
break would.
• It requires physical therapy to help preserve or enhance
range of motion in the area of injury.
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8. Management of contusion
People should follow the RICE method of treatment
Rest: Protect the injured area from further harm by
stopping play/activity/ or use crutches.
Ice: Apply ice wrapped in a clean cloth (Remove
ice after 20 minutes.)
Compression: Lightly wrap the injured area in a
soft bandage.
Elevation: Raise it to a level above the heart.
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9. Strain…
A strain is a “muscle pull” caused by overuse,
overstretching, or excessive stress.
• Strains are microscopic, incomplete muscle tears with
some bleeding into the tissue.
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10. Strain…
Symptoms and Signs
– Swelling, bruising or redness, or open cuts as a
consequence of the injury.
soreness or sudden pain, with
local tenderness on muscle use and swelling.
Weakness of the muscle or tendons.
Inability to use the muscle at all.
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11. Diagnostic finding
• History
• P/E
• X-ray to rule out fracture.
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12. Management of strain
The first-line treatment in the acute phase(P.R.I.C.E.)
– Protection: Apply soft padding to minimize impact with
objects.
– Rest: Rest accelerate healing and reduce the potential for
reinjure.
– Ice: reduces swelling by reducing blood flow to the injury
site. Never ice for more than 20 minutes at a time.
– Compression: Wrap the strained area to reduce swelling
with soft-wrapped bandage.
– Elevation: to the level of the heart as is conveniently
possible to keep blood from pooling in the injured area.
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13. Management of strain…
• Apply ice to prevent fluid leaking into the injured area
• NSAIDs reduce inflammation and relieve pain.
• It is C/I during the period of bleeding because it inhibits
clotting, and thereby bleeding and swelling.
• If severe pain, limb cannot be used, or noticeable
tenderness over an isolated spot.
– These can be signs of a fractured bone, a sprain, or a
complete muscle tear.
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14. sprain …
A sprain is an injury to the ligaments surrounding a joint
that is caused by a wrenching or twisting motion.
 A ligament is a thick, tough, fibrous tissue that
connects bones together or holding the skeleton
together in a normal alignment.
Its function is maintaining stability while
permitting mobility.
A torn ligament loses its stabilizing ability.
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15. Sprain …
• Commonly injured ligaments are in the ankle, knee, and
wrist.
Blood vessels rupture and edema occurs; the joint is
tender, and movement of the joint becomes painful.
• The degree of disability and pain increases during the first
2 to 3 hours after the injury because of swelling and
bleeding.
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16. Sprain …
Causes of a Sprain: is caused by a ligament being
stretched too far. This injury often occurs in activities
such as:
 Running,
 Hiking, and
 Basketball
 People will fall or step on an uneven surface and roll
their foot to the inside.
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17. Clinical Manifestation …
–Heat
–Discoloration
–Limitation of functions
–Decreased ability to move the limb
–pain, swelling, and bruising of the affected
joint.
X-ray is diagnostic finding to rule out fracture
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18. Management of sprain
• Rest of the affected part
• Ice/cold application for the first 24 hours (20 min at a time)
• Apply elastic bandages to reduce swelling and provide
support.
• Elevation of the affected part
Apply heat to affected area after 24 hours (20 minutes at a
time).
• In sprain the affected joint is immobilized for several weeks.
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19. Nursing intervention…
• Ensure correct use of crutches or other mobility
aid.
• Some times severe sprains may require surgical
repair.
• Assess neurovascular status
• Instruct patient on use of pain medication.
• Immobilization for a muscle strain until pain and
swelling subsides.
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20. Nursing intervention…
• Teach the patient:
 To avoid excessive exercise of injured part
&
To rest injured part for about a month.
To avoid re injury by “warming up” before
exercise and resume activities gradually.
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21. Dislocation
• Dislocation- When the surface of the bone forming the
joint are no longer in anatomic position.
– It follows a severe trauma that disrupts the holding
ligaments.
• A Subluxation is a partial dislocation in which the bone
ends are still in partial contact with each other.
Dislocation can be: Traumatic, Pathologic, Congenital
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22. Clinical features…
–Pain
–Deformity
–Change in the length of the extremity
Diagnosis
–By physical examination.
–X-ray confirmation of dislocation.
–Loss of normal movement.
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23. Medical &Nursing intervention
• Immobilization
• Reduction of dislocation
• Assess neurovascular status
• Administration of anti pain medication
• Ensure proper use of immobilization device after
reduction.
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24. Osteoarthritis
Osteoarthritis, or degenerative joint disease, is the most
common form of arthritis that causes destruction of the
articular cartilage and over growth of bone.
• By age 75 years, 85% of the population has either x-ray
or clinical evidence of OA,
• but only 15% to 25% of these people experience
significant symptoms.
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25. Pathophysiology…
• Changes in articular cartilage occur first, later,
secondary soft tissue changes may occur
• Progressive wear and tear on cartilage leads to thinning
of joint surface and ulceration in to bone
• Leads to inflammation of the joint and increased blood
flow and hypertrophy of subchondral bone.
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26. Pathophysiology…
• New cartilage and bone formation at joint
margins results in osteophytosis, altering the
size and shape of bone .
• This causes stiffness, pain & difficulty to move.
• It occurs most often in weight bearing joints
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28. Causes
Cause is unknown, but risk factors for OA are:
Increased age
Obesity
Previous joint damage
Repetitive use
Anatomic deformity
Genetic predisposition
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29. Clinical Manifestation
• Pain: is due to an inflamed synovium, stretching
of the joint capsule or ligaments, irritation of
nerve endings.
• Stiffness: Stiffness, is common in the morning
usually lasts <30 minutes and decreases with
movement.
• Functional impairment: is due to pain on
movement and structural changes in the joints.
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30. Diagnostic evaluation…
• Diagnosis of OA is complicated because of no
specific laboratory examination.
Complete history and physical examination
X-ray of the affected joints
Analysis of synovial fluid
Arthroscopy identifies soft tissue swelling
by showing internal joint structure
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31. Medical &Nursing Management
• Rest and joint protection
• Relieve pain by using NSAIDs
• Advice patient to avoid activity that precipitate pain
• Apply heat
• Teaching correct posture and body mechanics
• Provide crutches, braces, or cane
• Advise wearing corrective shoes
• Encourage weight loss
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32. Management…
In severe cases orthopedic surgery, like
• Arthroplasty (partial/total): replacement of
deteriorated part of joint with prosthetic appliance.
• Arthrodesis: Surgical fusion of bones, primarily in
the spine.
• Osteoplasty: scraping and lavage of deteriorated bone
from the joint.
• Osteotomy: excision or cutting of a wedge of bone
(usually in the lower leg) to change alignment and
relief stress.
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