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8/2/2019 Understanding Musculoskeletal System
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Congratulations for
making your 3 years innursing GREAT!!!
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Rules
Punctuality in Attending
ClassessLate comers will enter the room
after one hour
No ID no entry
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Prayer Leader
Starting from no.1
onwardsSame person before
and after
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Attendance
The door will be closed exactly
1pm Checking of attendance is by
number
Seat plan will be provided
Stay in your place or else you
will be marked absent
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Cellphones NO CELPHONES ALLOWED
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EATING IS NOT ALLOWED
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QUIZZES Either announced,unannouced
Can be before,at the middle of discussion or after
Late comers who entered the roomafter 1 hour will not be given specialexams meaning youve missed 1 exam
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No borrowing and lending of
papers Always have a paper with you.
( ¼,1/2,1 whole)
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Cheating
Once caught in the act
automatic deduction of 5 pointsfrom the total score
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Grooming
A. Female
1. All female students shouldwear their complete properuniform with ID
2. Hair should be neatly tied upinto a bun with black hairnet
and hair clip
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GroomingB. Male
1. All male students should also
wear their complete uniformswith ID
2. Hair should be properlytrimmed according to theCollege of nursing required
haircut
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Major Exams
No Permit ,No Exam policy
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Requirements: Case study per group
Case will not be taken from PCGH,but other tertiary Hospital
Musculoskeletal case to be presentedduring the class
Exposure at Orthopedic Hospitalstarting June 27
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Assignment
Either by group
Individual Must be submitted on time
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Grading System Quiz - 40%
Requirement - 20% Att/Att - 10%
Major Exam - 30%
100%
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Recitation
Perfect points is 5
Recited but not related to the topic1
No recitation 0
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References
Any medical and surgical book
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Film Analysis
Questions will be provided
based on the film
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My consultation dayMonday: 1pm-5pm
Tuesday: 8am-5pmWednesday: 8am-5pm
Thursday: ipm-5pm
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ANY QUESTION?
REACTIONS?
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UnderstandingThe Musculoskeletal System
Prof. Gina T. Vierne
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Objectives:
On completion of this chapter,you will be able to:
Describe the basic structureand function of themusculoskeletal system
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Discuss the significance of
the health history of theassessment of the
musculoskeletal health
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Identify the risk factors
associated withmusculoskeletal disorders
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Describe the significance of
the health history of theassessment of musculoskeletal dysfunction
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Specify the diagnostic tests for
assessment of musculoskeletalfunction
Identify medications applicableto musculoskeletal problems
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Identify medical and surgical
management withmusculoskeletal problems
Define terms used inmusculoskeletal function
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Chapter Overview Caring for patient with
musculoskeletal disordersrequires a sound understandingof musculoskeletal anatomy and
physiology as well as bodymechanics
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Overview Thorough assessment
Assessment includes:
Complete history Physical examination
diagnostic testing
Risk factors Informations r/t psychosocial impact of the
disorder on the pt and his family
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overview Nursing diagnoses focus:
impaired physical mobility Altered peripheral tissue
perfusion
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overview Nursing interventions :
designed to maintain orimprove the pts ability to carryout ADLs and prevent further
injury
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overview
Patient teaching:Crucial
nursing activityWhy?
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Anatomy and
physiology review
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Video clip presentation
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The musculoskeletal system
include 206 bones which areconnected at joints.
The joints are held together byligaments and cushioned bycartilages
Tendons attach muscles to thebones
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The Bones-bodys frameworkFunctions:
Support
Protection
Movement
Storage
Blood Cell Formation
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protection Bones provide a hard
framework that support and
anchors all soft organs of thebody.The bones of the legs act as pillars to support the bodytrunk when we stand,and therib cage supports the thorax
wall
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Protection The fused bone of the skull
provide a snug enclosure forthe brain. The vertebraesurround the spinal cord,and
the rib cage helps protect thevital organs of the thorax.
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Movements Skeletal muscles, attached to bones by
tendons ,use the bones as levers to
move the body and its parts.As a result,we can walk,grasp and breathe.Thearrangement of bones and the design of
joints determine the types of movement possible
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Example: Saddle joint
Hinge joint
plane joint
Condyloid joint
Ball and socket joint Pivot joint
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Storage Bone matrix itself serves as a
storehouse, a reservoir for minerals, the
most important being calcium andphosphorous, although K, Ca,Na,Sulfurmagnesium and copper are also stored.
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Blood Cell Formation The bulk of blood cell formation, or
hematopoiesis, occurs within the
marrow cavities of certain bones.
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DIVISIONS1. Axials upright structure with
80 bones
22 bones in skull 6 middle ear
1 hyoid bone 26 vertebral column
25 thoracic cage
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Axial- green Appen - golden
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2. Appendicular-bodys
appendages with 126 bones4- pectoral girdle
60 upper limbs60 lower limbs
2 pelvic girdle
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Types of Bones1. Long bones
2. Short bones3. Flat bones
4. Irregular bones
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Long bonesHumerus of arms
Short bonesCarpals of wrist
Flat Parietal bone of skull
Irregular
vertebra
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Assignment
How an individual bone is
structured? Please read
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skeleton Consist of 206 bones(long,
short, flat, irregular) Store calcium, magnesium,
phosporous,and carbonate,
marrow produces RBCs
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skeletonKey facts:
206 bones Stores
calcium,magnesium,phosporous
and carbonate
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Skeletal muscles Provide body movemetn and
posture
Attach to bones by tendons
Begin contracting with the
stimulus of a muscle fiber Retain some contraction to
maintain muscle tone
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Key facts about skeletal
muscle Provide body movement and
posture Attach to bones by tendons
Retain some contraction for
muscle tone
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ligaments Tough bands of collagen fibers
that connect bones Encircle a joint to add strength
and stability
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tendonsNonelastic collagen cords
Connect muscle to bones
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joints Articulation of two bone
structures Provide stabilization and permit
locomotion;degree of joint
movement is called ROM
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Key facts about joints Articulation of two bones
surfaces Provide stabilization permit
locomotion
ROM is degree of joint movement
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synovium Membrane that line a joints
inner surfaces Secrete synovial fluid and
antibodies
Reduces friction in joints( inconjunction with cartilage)
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Key facts about synovium Lines a joints inner surfaces
Secretes synovial fluid Reduces friction
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CARTILAGES
Contains a firm gel
substance in its matrix,which gives it more
flexibility than bone
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cartilage Serves as a smooth surface for
articulating bones Absorb shock to joints
Atrophies with limited ROM or
in the absence of weight bearing
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TYPES1. Fibrocartilage
Greatest tensile Occurs in the invertebral
discs and in the symphysispubis
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2. Elastic CartilagePossesses firmness and
elasticityOccurs in the external earand the eustachian tube
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3. Hyaline CArtilageMost common cartilage type
Cushions most of the jointsto help soften any impact
Firm yet slightly flexible
Occurs also in part of thenasal bronchial rings
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Key facts about cartilage Composed of fibers embedded
in firm gel Smooth surface for articulating
bones
Absorbs shocks to joints
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bursa Fluid filled sac
Serves as padding to reducefriction
Facilitates the motion of body
structures that rub against eachother
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Key facts about the bursa Fluid filed sac
Serves as padding Facilitates motion of body
structures
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Jingle( the bonedance)
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Understanding skeletal muscle
movement Skeletal muscles contract to
move bone, while jointsallow this movement tooccur
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To contract, all skeletal
muscles require some formof stimulation either internalfrom motor neurons or
external from stimuli such aselectricity, heat or injury
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8 ways of muscle contraction
isotonic Isometric
twitch contraction
Tetanic contraction Treppe or staircase phenomenon
Fasciculation
Fibrillation
convulsion
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isotonic contraction- shorten muscle
length while maintaining muscletension, generating movement
Isometric contraction-tighten a muscle
by increasing muscle tension without shortening the muscle
Twitch contraction- are quick, jerky
reactions to a single stimulus
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Tetanic contraction- serial, continuous
contractions,in which individualcontractions cant be distinguish
Treppe( staircase) phenomenon-series
of increasingly stronger twitchcontraction occuring in response torepeated stimuli
Fibrillation- abnormal contraction inwhich individual fibers contact in anunsynchronized way
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Fasciculation- abnormal contraction
visible through the skin as a slight ripple
Convulsions- abnormal, violent rhythmic contractions andrelaxations of muscle groups
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Joint Motion Terminology Flexion
Extension
Hyperextension
Abduction/Adduction
Rotation
Circumduction
Inversion
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Eversion
Pronation
Supination
Protraction
Retraction
Flexion Decreases the angle between
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Flexion-Decreases the angle betweenthe anterior surfaces of articulating
bones Extension-increases the angle between
the anterior surfaces of articulatingbones
Hyperextension-continues the act of extension beyond the original anatmicalposition
Abduction-when seen from the front,moves a bone in the appendicularskeleton away from the bodys midline
Add ti h f th f t
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Adduction-when seen from the front, movesa bone in the appendicular skeleton towards
the bodys midline Rotation- pivots the bone on its axis
Internal
External; Circumduction-combines a number of
movements to cause the distal end of a bone
to describe a circle.360 degrees to completefull circle
Inversion-turns an extremity or part of anextremity inward towerd the bodys midline
Eversion turns an extremity or part of an
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Eversion-turns an extremity or part of anextremity outward from the bodys midline
Pronation-turns the palm of bodys front toward the floor
Supination-turns the palm, foot, or bodys
front toward the ceiling Protraction-moves the mandible forward
Retraction-moves the protracted mandible
back into its neutral anatomical position
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Musculoskeletal Terminology Atrophy
Causalgia
Contracture
Deformity
Leg length discrepancy
Dislocation
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Musculoskeletal Terminology Dorsiflexion
Dysplasia
Kyphosi
Lateral
Lordosis
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Musculoskeletal Terminology Palsy
Range of Motion
Recurvatum Subluxation
Valgus
varus
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Atrophy-wasting away
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causalgia A severe burning pain produced
by several nerves that havemalfunctioning nerve endings,touch can often produce this
pain
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Causalgia
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circumduction
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contracture The absence of full range of
motions of any joint. Most common is flexion contracture,the lack of full extension
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contracture
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deformity Malformation or defect of any
part of the body
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deformity
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Leg length discrepancy (anisomelia)an inequality
between corresponding limbs
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Leg length discrepancy
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dislocation Musculo skeletal, traumatic
injury resulting in disruption of the continuity of jointsconfiguration and articulation
causing the loss of contact between the joint surfaces
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dislocation
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dorsiflexion
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dysplasia Abnormality of movement
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dysplasia
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eversion
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inversion
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kyphosis Posterior convexity of thoracic portion
of vertebral column, normal curvature
of spine, but becomes pathologic if excessive
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kyphosis
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lordosis Concavity of the vertebral
column, normal curvatureexisting in cervical and lumbarareas, which may become
pathologic if accentuated
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Lordosis
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scoliosisLateral curvature of the
spine
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scoliosis
P l l i
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Palsy- paralysis
Range of motion- the full motion of joint can assume
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palsy
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recurvatum
Hyperextension( beyond neutralposition)
Subluxation-partial or complete
dislocation of joint surfaces
Valgus-angular deformity denoting
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Valgus angular deformity denotingangulation away from the midline
of the body distal to the anatomicpart named
Ex. Knock knee. Varus- angular deformity denoting
angulation toward the midline of
the body distal to the anatomicpart named
Ex. bowlegged
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Assessment FindingsHealth History
Pain
Numbness, tingling Joint stiffness
Swelling
Fatigue Fever
Difficulty with movement
Key assessment findings in
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Key assessment findings indisorders of MS
Pain
Numbness, tingling Joint stiffness
Difficulty with movement
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Physical examination
Abnormal vital signs
Inflammation Edema
Skin breakdown
Skeletal deformity
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Physical examination
Limited ROM
Poor posture Muscle weakness
Muscle stiffness and rigidity
Abnormal skin color andtemperature
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Physical examination
Paresthesia
Nodules
Erythema
Tophi
Abnormal peripheral pulses Tremors
Gait abnormalities(how to assess?)
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P.E. bone integrity
Compare the left and right sidesof the body,take note anydeformities and anatomicalmisalignment
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joints
Evaluate ROM,defprmities,stabilty and nodularformation
Active
passive
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muscles
Note ptss ability to changeposition,presence of atrophy or
hypertrophy Check carefully the origin of muscle
weakness because pts fear,
unwillingness, or malingering might givefalse positive results(muscle strength)
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muscles
Note for muscle tone: sensation of resistance felt as one manipulates a
joint through it ROM Measure the muscle girth at the bulkiest
portion of the extremity: location and
position must be the same on bothextremities
Key physical findings in