This document provides a comprehensive overview of the musculoskeletal system, detailing the anatomy, physiology, and functions of bones, muscles, and joints. It covers topics such as bone formation, types of fractures, assessment techniques, musculoskeletal injuries, and various disorders, alongside their treatments and nursing care strategies. Additionally, it discusses age-related changes and risk factors associated with musculoskeletal health.

1. MUSCULOSKELETAL
SYSTEM
MODULE I
NURSING 105: ADULT NURSING
Myrna Williamson, MSN, RN,
OCN

2. In the very young…
• The skeleton is
composed of mostly
cartilage and is
therefore, pliable with
a decreased
incidence of bone
fractures and
breakage in childhood

3. Mature Bone
• Rigid connective
tissue consisting of
cells;
– Collagen
– Calcium
– Phosphate

4. SKELETON
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

5. SKELETON
• AXIAL PORTION
– Cranium
– Vertebrae
– Ribs
• APPENDICULAR
PORTION
– Limbs
– Shoulders
– Hips

6. ANATOMY & PHYSIOLOGY
REVIEW
• Structure & Function
– Skeletal System
• Bone Formation, Maintenance, Healing
– Articular System
• Joints – synarthrosis, amphiarthrosis, & diarthrosis
– Skeletal Muscle System
• Contraction
• Tone
• Actions
• Exercise, Disuse, & Repair

7. Bone Cells
Osteogenic Cells
Osteoblasts
Osteocytes
Osteoclasts

8. Bone Formation & Maintenance
• Ossification
• Resorption &
Formation
– Local stress
– Vit. D
– Parathyroid hormone
– Calcitonin
– Blood supply

9. TYPES OF BONES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

10. SPONGY BONE
• Located in the ends of long bones and the
center of flat and irregular bones
• Can withstand forces applied in many
directions

11. DENSE (COMPACT) BONE
• Covers spongy bone
• Cylinder around a central marrow cavity
• Can withstand force predominantly in one
direction

12. SPONGY BONE AND COMPACT
BONE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

13. FUNCTIONS OF BONE
• Framework
• Support
• Movement
• Shape
• Maintain Position
• Attachment of
Muscles
• Protects Organs
• Storage
• Hematopoiesis
• Remodeling
• Reformation
• Movable Joints

14. CHARACTERISTICS OF
JOINTS
• Allow the movement
between bones
• Formed where two
bones join
• Surfaces are covered
with cartilage
• Enclosed in a capsule

15. Classification of Joints
• A-C; Synarthrotic
(immovable) &
amphiarthrotic
(slightly movable)
joints.
• D-E: Diarthrodial
(freely movable) joints

16. Types of Diarthrodial Joints
• Hinge
• Ball &
Socket
• Pivot
• Condyloid
• Saddle
• Gliding

17. SYNOVIAL JOINT
From Applegate E: The Anatomy and Physiology Learning System, ed. 2, Philadelphia, 2000,
W.B. Saunders.

18. SYNOVIAL JOINT OF THE
KNEE
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

19. ANTERIOR VIEW OF MAJOR
MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

20. POSTERIOR VIEW OF
MAJOR MUSCLES
From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia:
W.B. Saunders.

21. SKELETAL MUSCLE
From Herlihy, B. &
Maebius, N. (2000).
The human body in
health and illness.

22. Neuromuscular Junction

23. CHARACTERISTICS OF
MUSCLES
• Made up of bundles of muscle fibers
• Provide the force to move bones
• Assist in maintaining posture
• Assist with heat production

24. 4 Steps of Muscle Contraction
• Excitation
• Coupling
• Contraction
• Relaxation

25. Body Movements
• Flexion
• Extension
• Abduction
• Adduction
• Rotation
• Circumduction
• Supination
• Pronation
• Inversion
• Eversion
• Protraction
• Retraction

26. Age Related Changes of
Musculoskeletal System
• Bones
• Muscles
• Joints
• Ligaments

27. Nursing Assessment
• Health History
–Initial Interview
–Assessment Data
• Pain
• Altered Sensations

28. Nursing Assessment
• Physical Assessment
– Posture
– Gait
– Bone Integrity
– Joint Function
– Muscle Strength & Size
– Skin
– Neurovascular Status

29. RISK FACTORS
• Autoimmune disorders
• Calcium deficiency
• Degenerative conditions
• Falls
• Hyperuricemia
• Infection

30. RISK FACTORS (Continued)
• Medications
• Metabolic disorders
• Neoplastic disorders
• Obesity
• Postmenopausal
states
• Trauma and injury

31. Diagnostic Evaluation
• Imaging Procedures
– X-ray
– Computed Tomography
(CT)
– Magnetic Resonance
Imaging (MRI)
– Arthrography
– Bone Densitometry

32. Diagnostic Evaluation
• Nuclear Studies
– Bone Scan
• Endoscopic Studies
– Arthroscopy
• Other Studies
– Arthrocentesis
– Electromyography
– Biopsy
• Laboratory Studies
– (CBC)
– Urinalysis (Calcium)
– Blood Chemistry
– Serum Calcium
– Serum Phosphate
– Uric Acid
– Serum Creatinine
– LDH, SGOT, CPK

33. X-RAYS
• DESCRIPTION
• IMPLEMENTATION

34. ARTHROCENTESIS
• DESCRIPTION
• IMPLEMENTATION

35. ARTHROGRAM
• DESCRIPTION
• IMPLEMENTATION
Arthrogram of the Knee

36. ARTHROSCOPY
• DESCRIPTION
• IMPLEMENTATION

37. BONE SCAN
• DESCRIPTION
• IMPLEMENTATION

38. BONE OR MUSCLE BIOPSY
• DESCRIPTION
• IMPLEMENTATION
Muscle Biopsy Showing
Polymyositis

39. ELECTROMYOGRAPHY
(EMG)
From Mourad LA (1991) Orthopedic disorders. St. Louis: Mosby.

40. MYELOGRAM
From Herlihy B, Maebius NK: The human body in health and illness, Philadelphia, 2000,
W.B. Saunders.

41. MUSCULOSKELETAL INJURIES
• Skeletal Trauma
• Injuries to Support
Structures

42. Fractures
• Described according
to location and type

43. Types of Fractures
• Complete or
Incomplete
• Open (formerly
referred to as
compound)
• Closed (formerly
referred to as simple)

44. Complete Fractures
• Linear
• Oblique
• Transverse
• Spiral

45. Complete Fractures
• Comminuted
• Impacted
• Pathologic
• Avulsion

46. Complete Fractures
• Compression
• Displaced
• Extracapsular
• Intracapsular

47. Incomplete Fractures
• Greenstick
• Torus
• Bowing fracture
• Transchondral fracture
• Stress Fractures

48. TYPES OF FRACTURES
From Ignativicius, D. & Workman, M. (2002). Medical-surgical nursing, ed 4, Philadelphia:
W.B. Saunders.

49. Types of Fractures

50. Pathophysiology of a Fracture
• Tissue Disrupted
• Bleeding Occurs
• Hematoma Forms
• Bone Tissue

51. Healing of a Fracture
• Inflammatory
response
• Vascular tissue
• Bone-forming cells
• Callus formation
• Osteoblasts
• Remodeling

52. Speed of Healing
• Hematoma formation – within hours
• Procallus – within days
• Callus formation – within weeks
• Replacement and remodeling – up
to 4 years

53. Fractures – Clinical Manifestations
• Impaired function
• Deformity (unnatural
alignment)
• Swelling
• Muscle spasm
• Tenderness
• Pain
• Impaired sensation

54. FRACTURE OF AN
EXTREMITY
• ASSESSMENT
• INITIAL CARE

55. INTERVENTIONS FOR A
FRACTURE
• Reduction
• Fixation
• Traction
• Casts

56. Fractures - Treatment
• Reduction
– Closed manipulation
– Traction (skin or skeletal)
– Open reduction and internal fixation (ORIF),
(insertion of prosthesis, screw, plate, nail or
wire).

57. CLOSED REDUCTION
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia:
W.B. Saunders.

58. INTERNAL FIXATION
From Browner BB et al (1992) Skeletal trauma. Philadelphia: W.B. Saunders.

59. Types of Internal Fixation for a Hip
Fracture

60. EXTERNAL FIXATION
From Ignatavicius, D., Workman, M. (2002). Medical-surgical nursing, ed 3, Philadelphia: W.B.
Saunders. Courtesy of Smith and Nephew, Inc., Orthopedics Division, Memphis, TN.

61. TYPES OF HIP FRACTURES
• Intracapsular
• Extracapsular

62. HIP REPLACEMENTS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St.
Louis: Mosby. Courtesy of Zimmer, Inc., Warsaw, IN.

63. TOTAL HIP REPLACEMENT
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.

64. HIP FRACTURE
• POSTOPERATIVE
CARE
• CLIENT EDUCATION

65. TOTAL KNEE REPLACEMENT
• DESCRIPTION
• POSTOPERATIVE
CARE

66. KNEE PROSTHESIS
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6,
Philadelphia: W.B. Saunders.

67. CONTINUOUS PASSIVE MOTION

68. CASTS

69. Cast Care
• Educate
• Apply Ice
• Instruct
• Prevent
• Attend

70. TRACTION
• DESCRIPTION
• IMPLEMENTATION

71. SKELETAL TRACTION
• DESCRIPTION
• IMPLEMENTATION

72. SKIN TRACTION
• DESCRIPTION
– Traction applied by the
use of elastic
bandages or adhesive
Side Arm

73. CERVICAL SKIN TRACTION
From James, S. Ashwill, R., & Droske, S. (2002). Nursing care of children, ed 2,
Philadelphia: W.B. Saunders.

74. HEAD HALTER TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical
nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

75. BUCK’S SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical
nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

76. PELVIC SKIN TRACTION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical
nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

77. BALANCED SUSPENSION
From Black JM, Matassarin-Jacobs E (1993) Luckman and Sorensen’s medical-surgical
nursing: a psychophysiologic approach, 4th ed., Philadelphia: W.B. Saunders.

78. DUNLOP’S SKIN TRACTION
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.

79. COMPLICATIONS OF
FRACTURES
• Fat embolism
• Compartment syndrome
• Infection and osteomyelitis
• Avascular necrosis
• Pulmonary emboli
• Venous thrombosis
• Delayed union & nonunion

80. FAT EMBOLISM
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION

81. COMPARTMENT SYNDROME

82. INFECTION AND
OSTEOMYELITIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION

83. AVASCULAR NECROSIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION

84. PULMONARY EMBOLISM
• DESCRIPTION
– Caused by immobility precipitated by a
fracture

85. Venous Thrombosis
• Description
• Assessment
• Implementation

86. Delayed Union & Nonunion
• Description
• Assessment
• Implementation

87. Other Skeletal Trauma
• Dislocation
• Subluxation
• Injuries to Support Structures
– Tendon tear
– Ligament tear
– Strain
– Sprain
– Avulsion
– Tendonitis
– Bursitis

88. Soft Tissue Injury of Hip

89. CARPAL TUNNEL SYNDROME
Associated with
occupations that
require
continuous wrist
movement.

90. Sports-Related Injuries
• Rotator Cuff Tears
• Epicondylitis (Tennis Elbow)
• Lateral & Medial Collateral Ligament Injury
• Anterior & Posterior Cruciate Ligament
Injury
• Meniscal Injuries
• Rupture of Achilles Tendon

91. CRUTCH WALKING

92. CRUTCH GAITS
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.

93. SINGLE- AND QUAD-FOOT
CANES
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.

94. WALKERS

95. HERNIATION:
INTERVERTEBRAL DISC

96. CERVICAL DISC
CERVICAL COLLAR

97. LUMBAR DISC
• DESCRIPTION
• IMPLEMENTATION

98. LOW BACK CARE
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6,
Philadelphia: W.B. Saunders.

99. TYPES OF DISC SURGERY
• CHEMOLYSIS
• DISCECTOMY
• DISCECTOMY WITH
FUSION
• LAMINOTOMY
• LAMINECTOMY

100. DISC SURGERY
• PREOPERATIVE
• POSTOPERATIVE: CERVICAL DISC
• POSTOPERATIVE: LUMBAR DISC

101. AMPUTATION OF A LOWER
EXTREMITY
• DESCRIPTION
– The surgical removal
of a lower limb or part
of the limb

102. AMPUTATION FLAPS
From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.

103. AMPUTATION OF A LOWER
EXTREMITY
• POSTOPERATIVE
– Monitor vital signs
– Monitor for infection and hemorrhage
– Mark bleeding and drainage on the dressing if
it occurs
– Keep a tourniquet at the bedside
– Monitor for pulmonary emboli

104. STUMP WRAPPING
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6,
Philadelphia: W.B. Saunders.

105. BELOW-THE-KNEE AMPUTATION
• POSTOPERATIVE
– Prevent edema
– Do not allow the stump to hang over the edge
of the bed
– Do not allow the client to sit for long periods of
time to prevent contractures

106. ABOVE-THE-KNEE
AMPUTATION
• POSTOPERATIVE
– Prevent internal or external rotation of the
limb
– Place a sandbag or rolled towel along the
outside of the thigh to prevent rotation

107. DISORDERS OF BONE
• Metabolic Bones Diseases
• Infectious Bone Disease
• Bone Tumors

108. Infectious Bone Disease:
Osteomyelitis
• Difficult to treat
• Physical disability
• Bacteria
– Exogenous
– Endogenous

109. OSTEOMYELITIS
• DESCRIPTION
• ASSESSMENT
• IMPLEMENTATION

110. Bone Tumors
• Incidence
• Signs & Symptoms
• Diagnosis

111. DISORDERS OF JOINTS
• Noninflammatory joint
disease
• Inflammatory joint
disease

112. INFLAMMATORY JOINT DISEASE
• Rheumatoid arthritis
• Ankylosing
Spondylitis
• Gouty arthritis

113. RHEUMATOID ARTHRITIS
(RA)
• DESCRIPTION
• ASSESSMENT

114. RHEUMATOID ARTHRITIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000,
W.B. Saunders.
MUSCLE ATROPHY
BOUTONNIERE DEFORMITY
SWAN NECK DEFORMITY

115. RHEUMATOID NODULE
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000,
W.B. Saunders.

116. RHEUMATOID ARTHRITIS
(RA)
• NONSTEROIDAL
ANTIINFLAMMATORY
DRUGS (NSAIDs)
• CORTICOSTEROIDS
• ANTINEOPLASTIC
MEDICATIONS
• GOLD SALTS

117. RHEUMATOID ARTHRITIS
(RA)
• PHYSICAL MOBILITY
• SELF-CARE

118. RHEUMATOID ARTHRITIS
(RA)
• FATIGUE
• BODY IMAGE
DISTURBANCE

119. RHEUMATOID ARTHRITIS (RA)
SURGICAL INTERVENTIONS
• SYNOVECTOMY
• ARTHRODESIS
• JOINT REPLACEMENT
(ARTHROPLASTY)

120. Ankylosing Spondylitis
• Chronic Inflammatory Disease
• Systemic autoimmune disease
• Differs from RA
• Signs & Symptoms
• Treatment

121. GOUTY JOINT
• Description
• Phases
• Assessment
• Implementation

122. GOUT
From Clinical Slide Collection of the Rheumatic Diseases, © 1991,1995,1997.
Used with permission of the American College of Rheumatology.

123. Noninflammatory Joint Disease
• Degenerative joint
disease
(osteoarthritis) is the
most common

124. OSTEOARTHRITIS
• DESCRIPTION
– Also known as
degenerative joint
disease (DJD)
JOINT CHANGES IN OSTEOARTHRITIS

125. OSTEOARTHRITIS
From Kamal A, Brockelhurst J: Color atlas of geriatric medicine, ed. 2, St. Louis, 1991, Mosby.
SEVERE OSTEOARTHRITIS
HEBERDEN’S NODES
BOUCHARD’S NODES

126. OSTEOARTHRITIS
• PHYSICAL MOBILITY

127. OSTEOARTHRITIS
SURGICAL INTERVENTIONS
• OSTEOTOMY
• TOTAL JOINT
REPLACEMENT
(TJR)

128. RHEUMATOID ARTHRITIS
AND OSTEOARTHRITIS
CLIENT EDUCATION
• Assist
• Instruct
• Review

129. Metabolic Bone Diseases
• Osteoporosis
• Osteomalacia
• Paget’s Disease

130. OSTEOPOROSIS
DOWAGER’S HUMP

131. OSTEOPOROTIC CHANGES
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6,
Philadelphia: W.B. Saunders.

132. SEVERE OSTEOPOROSIS
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000,
W.B. Saunders.

133. MILWAUKEE BRACE
From Mosby’s Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.

134. OSTEOMALACIA
• Metabolic disease
• Bone volume unchanged
• Osteomalacia – adults
• Rickets - children

135. Paget’s Disease
• Osteitis Deformans
• Increased metabolic activity
• Usually no TX
• Affects men and women equally

136. Nursing Diagnoses
• Knowledge Deficit
• Impaired Physical Mobility
• Self-care Deficit
• Risk for Infection
• Impaired Skin Integrity
• Imbalanced Nutrition
• Acute/Chronic Pain

137. THE END OF MUSCULOSKELETAL