Musculoskeletal System Assessment & Diagnostic Tests - 2024

Musculoskel etal system: Assessment & Diagnostic tests Elizabeth Dee 2024 References  Sherpath for Jarvis: Ch 24  All Lessons except: Anatomy & physiology of musculoskeletal system.  Omit developmental considerations for pregnant women, infants, and children throu...

Musculoskel etal system: Assessment & Diagnostic tests Elizabeth Dee 2024 References  Sherpath for Jarvis: Ch 24  All Lessons except: Anatomy & physiology of musculoskeletal system.  Omit developmental considerations for pregnant women, infants, and children throughout lessons.  Jarvis textbook: Ch 24 p. 635-675, 683 (omit developmental considerations for pregnant women, infants, and children. Omit special considerations for References Sherpath for Lewis: Ch 64 All lessons Lewis: Ch 64 EAQ Lewis: Intro to MSK(Ch.64) Practice Quiz Added Resources MSK #1 Class playlist (Youtube videos) 4  Objectives 01 02 03 04 Review Review Describe Review structure assessme age diagnostic and nt of related tests and functions musculosk changes nursing of eletal in care musculosk system musculosk related to eletal eletal them 5 system system What does the musculoskeletal system do? Support Movement Protection Production Reservoir 6 Structures and Functions of the Musculo-skeletal System COMPOSED OF: Muscle (skeletal) Five types of connective tissue 1. Bone 2. Cartilage 3. Ligaments 4. Tendons 5. Fascia 7 Structures and Functions of the Musculo-skeletal System These are also organized into: Bursae Joints 8  Types: Cardiac Smooth Skeletal Muscles Function Structure Contractions 9 Function/characteristics of muscles Provide the force to move bones Assist in maintaining posture Assist with heat production  Structure of a muscle Made up of muscle cells (muscle fibers) Together, they form a Fascicle Fascicles group together to form a specific muscle 11 Neuromuscular junction Muscle contractions Enable posture maintenance Movement\facial expressions Two types: Isometric: Isotonic: 13 Muscle contractions (cont’d) Isotonic: shorten a muscle to produce movement Make muscles grow larger and stronger Increases bone density Isometric: increase tension, produce zero movement Make muscles grow larger and stronger 14 Muscle contractions (cont’d) 15 Muscle contractions (cont’d) Atrophy Hypertrophy 16  Bones What do bones do? Provide supporting framework that keeps body from collapsing Serve as a point of attachment for muscles (by tendons) Protection of vital organs Hematopoietic tissue in marrow They act as a lever for muscles, movement with contractions 17  Chemical analysis of bone Microscopic structure Bones Gross structure Types (according to shape) 18 Chemical analysis of bone  Bone cells Bones: Cortical (compact) Microscop Cancellous ic (trabecular or spongy) structure Hematopoiesis 20  Bone Structure: Microscopi c Bone cells Bone Structure: Microscopic 22  Bone Structu re: Gross Hematopoiesis Hemato poiesis Bones Types (according to shape) Long bones Short bones Flat bones irregular 26 Cartilage What does Cartilage do? Is a rigid connective tissue (made up of collagen and/or elastic fibers) Serves as support for soft tissue (cushion) Provides the articular 28 Cartilage (Types) Hyaline(moderate amount of collagen) Articular surfaces of bones, nose, trachea, bronchi Elastic (both collagen and elastic) Ear, epiglottis and larynx Fibrocartilage (mostly 29 Cartilage 31  Ligaments and Tendons Composed of dense, fibrous connective tissues (collagen bundles) 32  ligaments Attach BONE to bone More elastic and flexible Provide than stability tendons while enabling controlled movement at the joint BLB  Tendons Attach muscle to bone An extension of the muscle Greater tensile strength than ligaments BTM Fascia Layersof connective tissue with intermeshed fibers that can withstand limited stretching Superficial Deep 35 Fasciae: Deep Allows muscles to glide over each other during contraction Provide strength to muscle tissues 36 Bursae What is a Bursa(e)? Small sacs of connective tissue containing synovial fluid Located at bony prominences or joints to relieve pressure and prevent friction between 37 Joints What is a joint? Where bones meet Allows movement between bones 39 Joints Three (3) main types of joints: Nonsynovial (Fibrous) Synovial (diarthrodial) Cartilaginous 40  Diarthro dial (Synovial ) joint  Decreased muscle cells What does Loss of elasticity in aging do?: ligaments, cartilage; joint problems The Musculosk Decreased bone density eletal Osteoarthritis, System osteoporosis and fractures become more common 46  Musculoskeletal Assessmen assessment t of the focuses on: Musculoske Subjective data letal (Health history) System Objective data (Physical Exam) 47  Subjective Assessme Health history (specific) nt of the Past health history Musculos Medications Surgery or other keletal Objective treatments System Physical examination Diagnostic studies Subjective data: What do you want to know? Joints Muscles For older Bones adults ’s)Weaknes Functional assessment (ADL Self care behaviours s Injury *Please refer to Lewis Table 64.2 & Jarvis “Health history questions” & for examples Mobility 49 Subjective data (cont’d) Past medical history Past/chronic conditions that can influence msk system or are directly related to. Medications Corticosteroids, muscle relaxers, supplements (vit D, Calcium) Surgery or other treatments 50  Physical examination (of musculoskeletal Objective system) Inspection data 1. 2. Palpation 3. Range of motion 4. Muscle-strength testing 5. Measurement 6. Other 1. Reflexes  Size and contour of the joint Objective The skin and Data: tissues over Inspectio the joint Colour n Edema Masses/deformities  Each joint (including skin) Temperature Objective muscles Bony articulations Data: Area of the joint Palpation capsule Normally, joints aren’t tender to palpation Where do we assess? Cervical spine Knee Shoulders Ankle Wrists/hands Spine Hip  Can be used to assess/test joint Exercises for improved Range of mobility motion Active vs (ROM) passive  ROM movem ents ROM: Cervical spine 57 ROM: Shoulders 58 ROM: elbow 59 ROM: wrist and hand 60 ROM: Hip ROM: Knee 62 ROM: Ankle and foot 63 ROM: Spine 64  Grading the Done while Physical strength of client individual performs Assessment muscles ROM Patient : Muscle duringbe should movements Strength strength contraction instructed should testing to apply always be resistance compared to the force in both exerted by extremities the nurse 65  usually Physical done during Assessme head-to-toe nt: assessment Muscle Hand grasps strength Upper testing extremity strength Lower body  Hand grasps Upper extremity strength Lower body strength Grad Descriptio % Assessm e n Norm ent Physical al Assessment: Muscle strength 5 Full ROM 100 Normal testing against gravity, full resistance 4 Full ROM 75 Good against gravity, some resistance 3 Full ROM 50 Fair with gravity 70  Full range of motion of all joints without pain No joint swelling, or laxity Normal deformity, or crepitation physical Normal spinal curvatures assessme No tenderness on nt palpation of spine No muscle atrophy or findings asymmetry Muscle strength of 5 (see Lewis table 64-4) 71  Diagnostic Bone Studies of Invasi Radio miner Radioi the Musculoskeletal Endos Blood ve graph al sotop System y densit es copy tests Miner proce Bon Arthr al dures Arthro X-ray y DEXA e osco meta centes py Serol bolis is Comput scan ogica ed m Electro tomogr QUS l myogra Magnet phy aphy studi Muscl ic resona es e nce enzy imagin g mes Arthrog raphy X-ray 73 Radiological studies: X-rays Used to evaluate structural changes of bones, joints and calcifications of soft tissues Able to visualize: Fractures Bone density issues 74 X-rays: Nursing Responsibilities Before: Verify pregnancy as it could be contraindicated Explain the procedure including the importance of remaining still Remove any radiopaque items (jewelry, belt buckles..) If a male patient, cover the patient's genitals with a protective cover (if possible) 75 X-ray of shoulder 76  CT (Compute d tomograp hy) 77  3-Dimension Radiologic picture using x- al studies: rays Used to identify CT some soft tissue (Compute abnormalities, d bony abnormalities and MSK trauma tomograp Contrast dye often hy) used 78  Patients with diabetes or kidney disease need to Before: Same as CT: be reminded for x-rays to Nursing adequate ly Responsi hydrate During: to flush Assess bilities out dye for advers e reactio ns to dye 79 CT of shoulder 80  Joke break 81 MRI (Magnetic resonance imaging) 82  MRI Very strong magnet Radiofrequen cy waves 3- Dimensional picture 83 Radiological studies: MRI (Magnetic resonance imaging) Used primarily to identify soft tissue (and bone) abnormalities Damage to cartilage or ligaments Herniated disks or spinal injuries Bone disorders: Avascular necrosis Tumours Multiple myeloma Contrast material often used (Gadolinium) 84  MRI: Nursing Responsi bilities 85  *Can be contraindicated in patients with metal in their body or certain implanted metal devices MRI: Nursing Responsibilities Before: Ensure no metal clothing or jewelry-have them remove it. Importance of remaining still during exam Explain noises and ability to communicate Provide reassurance to control anxiety (Claustrophobia) 87 MRI: Nursing Responsibilities During: Assess for adverse reactions to dye After: None-unless contrast dye is used If contrast dye is used, then patients with diabetes or kidney disease need to be reminded to adequately hydrate to flush out dye 88 MRI shoulder 89 Fluoroscope-takes a real time x-ray “movie” Radiological studies: Arthrography (arthrogram) When contrast dye is injected into joint (sometimes using fluoroscopy) then radiological studies are performed (often a CT or MRI is performed afterwards) Able to visualize inside the joint [and the movement of the joint (fluoroscope)] Mostly used with: Shoulders Knees Hips elbows 91 MRI-Arthrogram 92  Before: Arthrogr Depends on type of aphy: radiological studies being used Nursing A local anesthetic Responsi will be injected around the site to be bilities punctured A needle will be inserted into the 93  Edema and tenderness may occur for 1–2 days Increase fluid Arthrogr intake to aid aphy: Aft in contrast excretion via Nursing kidneys Responsi er: Compression bandage may bilities be applied Avoid strenuous use of the joint for 48 h 94  Used to measure bone density using Bone minimal radiation mineral exposure density (BMD) measurem Used for Used Determi Diagnos ents ning ing most often risk of metabol for fracture ic bone osteopo s disease rosis 95 BMD: Nursing responsibilities Same as for x-rays studies 96 DEXA Scanner for bone density 97  A radioactive isotopes (usually technetium) is injected into the Radioisot vein and is taken ope (absorbed)up by studies: the bones Pictures are then Bone taken over many hours Scan Abnormalities are (nuclear detected by an imaging) accumulation of the radioisotope (dark spots) 98 Radioisotope studies: Bone Scan (nuclear imaging) Primarily used in Diagnosis of: Cancers in the bones (primary and/or metastatic) Infections in the bone Complicated fractures Osteoporosis 99 Bone scan 100 Bone Scan: Nursing Responsibilities Before: After: Explain Increase fluid procedure: intake after Technician injects procedure radioisotope 2hrs Isotopes will be before procedure excreted within 6- Bladder must be 24 hrs emptied  oscop explorator e is y surgery insert (for ed damage to Endosco into meniscus, the cartilage, py: joint ligaments Arthrosc to or joint opy visua capsule) lize Surgical struc repairs ture may be (cam done at 102 Arthroscopy  Before: Arthrosc opy: Must be NPO Nursing after midnight Responsi Can be bilities performed in an outpatient setting 104  signs, neurovascular function & compression dressing Arthrosc Assess for pain and provide opy: Aft pain relief prn Keep the Nursing extremity Responsi er: elevated & apply ice for 24 to 48 hours bilities Minimize exercise or use of the joint for 24 - 48 hours Monitor for 105  Blood tests: Mineral Serologi Muscle metaboli cal enzymes sm studies Erythroc Alkaline C- yte Creatine Serum Calcium phospha reactive Uric acid sedimen kinase potassiu tase protein tation (CK) m (K+) rate  Alkaline phosphatase Blood (ALP): Enzyme produced by osteoblasts tests: Elevated in healing mineral Calcium fractures, bone metabolis cancers, osteoporosis Stored primarily in bones m Provides bone with rigid consistency Elevated in hyperparathyroidism, 107 Blood tests: Serological studies Uric acid End product of purine (type of protein) metabolism Excreted by kidneys Usually elevated in Gout 108 Blood tests: Serological studies Erythrocyte sedimentation rate (ESR) Non-specific index of inflammation Used to measure rapidity with which red blood cells settle out of unclotted blood in 1 hour 109 Blood tests: Serological studies C-reactive protein Used to diagnose inflammatory diseases, infections and active widespread malignancy Synthesized in the liver 110 Blood tests: Muscle enzymes Creatinine Kinase Enzyme in skeletal muscle Values increase as muscle breaks down Associated with Muscular dystrophy, polymyositis and traumatic injuries 111  Blood tests: Muscle enzymes Serum potassium (K +) Electrolyte 98% stored inside cells (80% in muscle cells) Regulates muscle contractions, nerve impulses and fluid balance With muscle trauma it releases into the blood stream increasing the risk of cardiac dysrhythmias (abnormal heart rate & rhythm) 112  Invasive procedures: Arthrocentesis Needle is inserted into the joint cavity. To obtain synovial fluid sample Remove pus Remove blood Inject medications Arthrocentesis Arthrocentesis and Intraarticular Injection 114 CO PYRIG HT © 2019 ELSEVIER CANADA , A DIVISION O F REED ELSEVIER CANADA , LTD. Arthrocentesis: Nursing responsibilities Before: Advise client that procedure uses local anesthesia Arthrocentesis: Nursing responsibilities After: Apply pressure dressing to site, watch for leakage of blood or fluid Keep the extremity elevated for 24 to 48 hours Apply cold pack for 24 to 48 hours Administer analgesics prn Minimize exercise or use of the joint for 24 -48 hours Monitor for infection Invasive procedures Electromyogram (EMG) Uses needle probes attached to leads that record electrical activity during muscle contraction Study useful in muscle weakness, motor neuron dysfunction 117 EMG: Nursing responsibilities Before: Explain procedure Inform patient that some discomfort will occur with needle insertion Fasting is not required, but abstaining from stimulants 2-3hrs before may be required *contraindications include anticoagulant therapy (blood thinners) After: Watch bleeding at puncture sites 118 Final joke 119 120