Muscular Skeleton system includes
skeleton, joints, ligaments, muscles, and tendons
Functions of the skeleton
Support
Protection
Movement
Hematopoeisis
Storage
Compact Bone
Hard and dense composes the shaft of the long bones and outer layer of bones
Spongy Bone
Composed of small bony plates contains more spaces than compact bone Filled with soft substance: Marrow
What are the 2 types of Bone Marrow
Yellow and Red (responsible for hematopoiesis
Where is red marrow found
Stenum, ileum, vertebrae, and ribs
Where is yellow marrow found
in long bones
Cancellous (spongy bone)
light contains may spaces found mostly at rounded, irregular ends or epiphyses of long bones
Cortical (Compact)Bone
Dense and Hard found mostly in the long shafts or diaphyses of bones in arms and legs
Osteoblasts
Cells that build bones
Osteoclasts
Cells involved in destruction reabsorbtion and remodeling of bone
Osteocytes
Mature bone cells
What factors affect bone growth
Heredity
Nutrition
Exercise
Hormones
Muscle tissue characteristics
What is vitamin D needed for
to absorb calcium and phosphous
What is vitamin A and C needed for
For bone calcification
Hormones affecting Bone growth
Growth Hormone( in the pituitary)
Thyroxine (increases protein synthesis)
Glucose ( provides energy)
Parathyroid Hormone ( increases the removal of calcium and reduces serum calcium) Phosphate from bone and calcitonin promotes retention in bone and reduces serum calcium
Sex Hormone estrogen and testosterone(important for the retention of calcium in adult bones
What can happen in children with damage to the epiphyseal growth plate
The younger the child is when injury occurs the greater the final deficit in length between the injured limb and uninjured limb will be
Synathroses
immovable joint
Amphiarthroses
slightly immovable
Diarthroses
freely movable
Ligaments
tough fibers that bind bones together
Synovial membrane
secretes synovial fluid a lubricating material
Bursae
Fluid filled sac that cushions movement of the muscles and tendons
What do synovial joints have?
Smooth white articular hyaline cartilage to decrease friction
Joint capsule lined with a synovial membrane
Cavity filled with synovial fluid clean and nearly colorless lubricates joint to decrease friction
Bones in these joints have bursae small sacs of synoval fluid between joint and tendon permits tendons to slide as joint moves
Synovitis
joint is swollen tender painful with restricted motion May result from strain or sprain
What are the muscle classification
Skeletal Controls movement of skeleton
Smooth/Visceral Controls involuntary motion inside body organs
Cardiac Automatic responsible for propelling blood through blood vessels
Functions of muscles
Muscles move skeleton and maintains normal body tmeperature
Purpose of ligaments
Connect bones to muscles or cartilage
Support internal organs or structures
Allows great flexibility stretching movement
Accessory ligaments
Don not move or stretch but strengthen or support other ligaments to produce stability of joints
Tendons
cordlike structures that attach muscles to periosteum of the bone
Ligaments
Fibrous tissue connecting two adjacent freely movable bone Help to stabilize the joint and keep in proper alignment
Cartilage
Firm Dense type of connective tissue Reduces friction between articular surfaces absorb shocks and reduce stress on joint surfaces
Bursae
Small sac filled with synovial fluid reduces friction between areas such as tendon and bone and tendon and ligament
In order for muscles to contract Nerve impulses originates from where to initiate muscle contraction
Frontal lobe of the cerebral cortex
What coordinates and regulates voluntary movement muscle contraction
Cerebellum
Where do nerve fiber and muscle fiber make contact
Neuromuscular juntions
What happens with muscular skeletal system with aging
Women after menopause lose more calcium than is replace
Weight bearing joints wear down
Muscle strength decreases
What does PQRST stand for when assessing for pain
P= provoking incident
Q= quality of pain(burning, throbbing, stabbing)
R= Region radiation relief
S= Severity of pain(pain rating scale)
T= Time (how long does it last, when does it occur when is it worse)
Scoliosis
Lateral curvature of the spine
Kyphosis
Exaggerated convex curvature of the thoracic spine (humpback)
Lordosis
Excessive concave curvature of the lumbar spine (Swayback)
Physical Assessment
Inspection check joints and muscles of hands arms legs and feet palpate
What does an x-ray determine in muscular skeletal system
determine bone density alignment swelling and intactness
Why use CT scan for muscular skeleton
Provides cross section of bony soft tissue
MRI is used for what
More accurate than CT the only dx modality that can demonstrate for demelinated cord lesions found in MS also detects tumors, degenerated discs, osteomyelitis
Arthroscopy
Internal inspection of a joint by means of an instrument called an arthroscope
Arthrocentesis
aspiration of synovial fluid or inject corticosteroid
Arthrogram
radiographic exam of a joint fluroscopy synovial fluid is aspirated contrast medium injected
Crackling of clicking noise for up to 2 days
what is a bone scan
IV injection of a radionuclide to detect uptake of radioactive substance by the bone. Can detect bone lesions, fracture, some inflammatory disorders
Bladder needs emptied before exam increase fluids after procedure
Bone biopsy
Identifies bone composition muscle or synovium
do not more for 8 to 12 hours
Myoglobin
protein found in striated skeletal or cardiac muscle released in blood when skeletal or cardiac muscle is damaged
creatine kinase aldolase AST and LDH
enzymes elevated with disease such as Muscular Dystrophy, Polyositis, and dermatomyositis
Ultrasonography
visualization of bone or soft tissue ,noninvasive, uses sound waves
Use to detect osteomyelitis soft tissue disorders joint injuries and surgical hardware placement
EMG
Nerve conduction study Electrical shocks to nerves and muscles any alteration in the electrical waves indicates a problem with the nerves or the muscles
Myelogram
Visualization of the spine and spinal cord after injection of a contrast medium injected in the subarachnoid space
Postop assess for headache and nausea HOB should be raised no more than 45 degrees for 3 hours
Gallium thallium scan
injected with radioactive substance which migrates to bone, brain ,breast and inflammatory tissue
Fractures
exceeds maximum resistance begins to repair itself immediately heals in approx 6 weeks
Fx identification
skin intactness
type
location
alignment status
Close fracture
no break in the skin simple fracture
open fracture
bone protrudes thru skin compound fracture
Proximal
close to the body
Distal
Away from the body
Midshaft
Middle portion of the body
Nondisplaced
bone fragments are aligned at the fracture sight
Displace
two edges of fracture moved out of alignment zigzag contour
Angulation
Edges are postioned but the fragments are out of alignment
Stages of healing
hematoma formation
cellular proliferation
New capillaries and vessels
callus forms
excess callus
Types of cast
plaster of paris and synthetic
Spica cast
body cast limit calorie intake
window cast
when a wound is under cast portion of cast may be removed ( window)
Bivalved cast
with signs and sysptoms of neurovascular compromise the cast is bivalved by cutting it length wise and elastic bandage used to secure
Petal Cast
moleskin or adhesive tape lines cut 2 inch strips of adhesive tape or moleskin in the shape of petals line the edge of the cast
Cast syndrome
commonly occurs with spica cast claustrophobia signs are increase VS diaphoretic nausea abdominal pressure and pain pressure on the mesentary artery against the duodenum causing nausea
Contusion
capillaries small vessels rupture and bleed into the surrounding area causes skin color to change as blood is absorbed color changes bruising and color changes Pain swelling and discoloration
strains
injury to muscle or tendon related to overstretching overuse or excessive stress
three classes of strains
Mild overstretching of muscle and connective tissue
Moderate tearing of muscle and connective tissue
Severe extensive tearing of muscle and fascia
Symptoms of severe stains
muscle soreness swelling local tenderness with use sudden pain with pain on movement discoloration with contusions or soft tissue injury
Sprain
caused by tearing twisting stretching injury involves the ligament surrounding the joint
acute trauma activities with overhead movements deterioration with aging
Mild sprain
ligament stretched or microscopic tear local tenderness swelling can move the affected part
Moderate sprain
Some ligament tearing edematous tenderness moderate pain with movement
Severe sprain
ligament is disrupted with stress joint instability unable to flex joint or bear weight
RICE
rest ice compression elevation
Meniscus tear
involves extension and flexion injuries usually the knee
ACL
anterior cruciate ligament tears due to twisting sudden stopping motion
Achilles tendon
attaches the muscle to the heel
Rotator cuff tear
tears of the shoulder due to damage to the rotator cuff muscles or tendons due to the repetitve injury or sudden trauma Pain weakness loss of shoulder movement
Bursitis
inflammation of the bursa small sac between the muscles and joint due to mechanical irritation bacterial infection trauma gout
Epicondylitis
Tennis elbow damage to the tendons of the medial or lateral radial and ulnar epicondyles
Carpal Tunnel Syndrome
repetitive wrist motion swelling involves the median nerve against transverse carpal ligament pain burning mostly at night and early am decrease sensation lost or reduced in the thumb index middle and portion of the ring finger
Phalen's sign
occurrence of numbness with wrist flexion
Tinel's sign
indicates nerve irritability produced by tapping over median nerve of the wrist results in distal tingling sensation on percussion of damage nerve
Dislocations
Trauma of great force caused by congential or acquired hip dislocations neuromuscular disorders RA
Subluxation
an incomplete dislocation contact between joint surfaces are disrupted stuctures become trapped and may result in ishchemic
Internal fixation
prosthesis causes many pathological fractures in elderly Austin More or Thompson prosthesis referred to as hemiarthroplasty
External fixation
metal pins inserted into bone from the outside skin surface and attached to pins through a compression device
Types of fractures
Direct blow to bone indirect twisting motion or severe muscle spasm crushing injuries fatigue or stress fracture Disease such as cancer or osteoporosis
Collies Fracture
A broken wrist
Comminuted fracture
the bone is broken or shattered into multiple smaller pieces
Compound fracture
frequently caused by degenerating bone conditons such as osteoporosis this is when the vertebrae seem to shrink
Greenstick fracture
Primarily seen in kids this is when the bone is not totally broken like a young twig this is when part of the bone is splintered but not completely broken
Impacted fracture
denotes when a piece of the bone is shoved into a different part of the bone
oblique fractue
an angled break
Pathologic fracture
fracture caused by sickness disease
spiral fracture
incredibly slow to heal is when the broken bone is twisted around the axis common to sports or work related injuries
Stress fracture
caused by compounded low intensity movements such as running rather than by a lone force
transverse fracture
a complete degree break
Avulsion
a fracture caused by tearing away of a fragment of bone where strong ligaments or tendons are attached
it forcibly pulls the fragment away from the bone tissue
Intra-articular
in the joint
displaced fracture
complete break into 2 pieces malaligned
longitudinal fracture
the fracture is parallel with the bone
oblique
fracture goes in a slanting direction in the bone
segmental fracture
having a segment of the bone fractured and detached
depressed fracture
fragments pushed inward and depressed
Arthritis symptoms
persistent pain and stiffness
pain and tenderness of the joints
swelling in the joints recurrence of symptoms
obvious redness and warmth in the joint
Bouchards nodes
enlargement of the proximal inter-phalangeal joints
Herberdens nodes
grows in the terminal phalengeal joints with DJD
Osteoarthritis
primarily affects weight bearing joints most common cause of disability in the elderly
slow deterioration of the articular cartilage and bone ends of a joint
Intervertebral disk
results when a small pad or disk or cartilage nuclues pulposus between the two vertebrae presses against the spinal nerve that radiate out from the spinal cord also knoown as herniated muclleus pulposus and sciatica
Osteomyelitis
Infection of the bone bone tissue becomes necrotic often as a bone abcess
Osteoporosis
metabolic disorder bone loses density bone resorbtion exceeds bone formation irreversible bone loss with increasing age cancellous bone loss first then compact bone
risk factors for osteoporosis
caucasian postmenopausal women
sedentary lifestyle
decrease calcium intake
lack of vitamin d
excessive alcohol intake smoking
petite body build and increase caffient
secondary risk factors for osteoporosis
hyperparathyroid
long term drug therapy esp steroids
prolonged immobility esp in the spinal cord
blood test for bmd
decrease in serum calcium and vitamin d increase phosporous increas alkaline phospatase with severe bone loss
Padget's disease
osteitis deformans metabolic disease of bone excessive bone destruction increase in number of osteoclast excess bone resorption the increase in osteoblast that leads to enlarged bones poor mieralization
signs of padgets
bone and joint pain low back pain bowing of long bones loss of normal spine curvature enlarged thick skull pathologic fractures osteogenic scarcoma
Primary malignant bone tumors
osteosarcoma mets to the lungs
ewings sarcoma most malignant
chrondosarcomas better prog
multiple myeloma
most common primary bone cancer it is malignant tumor of the bone marrow affects apprx people per million each yeary between ages -
Osteosarcoma
second most common bone cancer it mostly affects teens develops in growing bone mets to the lungs
Ewings sarcoma
ages - begins in the nerve tissue in bone marrow most malignant
Chondrosarcoma
affects mostly ages- 40-70 starts in the cartilage has better prog