SNGP3001 LEC5 Musculoskeletal Assessment PDF

SNGP3001 Comprehensive Nursing Assessment LEC 5 – Musculoskeletal Assessment TEQSA PRV12057 CRICOS 00026A The University of Sydney Lecture Outline - Muscle Physiology - Muscle Strength - Movement Assessment - Fracture Ass...

SNGP3001 Comprehensive Nursing Assessment LEC 5 – Musculoskeletal Assessment TEQSA PRV12057 CRICOS 00026A The University of Sydney Lecture Outline - Muscle Physiology - Muscle Strength - Movement Assessment - Fracture Assessment - Physical Assessment and History Taking The University of Sydney Skeletal Function - Framework for the body - Support tissues such as muscle and tendons - Assist in movement (muscle attachment + joints) - Protection of vital organs - Blood cell production (red bone marrow) - Storage for mineral salts (calcium) - 206 bones The University of Sydney Types of Bones Long Bones Cylindrical with rounded ends Usually weight-bearing Example: Femur Short Bones Small and non-weight-bearing Example: Phalanges Flat Bones Protection of vital organs Example: Scapula Irregular-shaped Bones Have different shapes Example: Vertebral bones The University of Sydney Skeletal anatomy BONE: three major components - 1. Diaphysis: shaft, composed of compact bone - 2. Epiphysis: end of bone, cancellous (spongy) bone - 3. Epiphyseal plate: hyaline cartilage located between diaphysis and epiphysis Periosteum: connective tissue membrane that covers the outer surface of bone Endosteum: connective tissue membrane that lines the internal surfaces of all cavities with bone The University of Sydney The University of Sydney Bone Matrix - Bone Matrix - Collagen and mineral components are responsible for major functions of bone - Collagen provides flexible strength while mineral provides compression strength - Bone Cells - Osteoblasts – bone forming cells - Osteocytes – mature bone cells - Osteoclasts – breakdown and reabsorb bone - Stem cells The University of Sydney Bone Cells: Osteoblasts - Cells responsible for bone formation through ossification - involves the replacement of hyaline cartilage with bony tissue - Their primary function is to lay down new bone. The University of Sydney Bone Cells: Osteocytes - Mature bone cells - Osteoblast surrounded by matrix becomes an osteocyte The University of Sydney Bone Cells: Osteoclasts - Major resorptive (removal) cells of bone. - Large cells with several nuclei The University of Sydney Bone Cells: Stem Cells - Arise from embryological tissue - Become osteoblasts The University of Sydney Bone Growth - Closure of epiphyseal plate -Epiphyseal plate is ossified becoming the epiphyseal line -Occurs between 12 and 25 years of age - Articular cartilage -Does not ossify -Persists through life The University of Sydney Supporting Structures - Ligaments - Strong bands of fibrous connective tissue attaching bone to hold them together - Provide support by encircling joint, gripping it obliquely or by lying parallel to bone ends across joint - Tendons - Strong non-elastic bands of connective tissue holding muscle to bone - Support bone movement in response to skeletal muscle contractions - Cartilage - Connective tissue that forms bone in adults and provides support - Reduces friction and imparts flexibility at joints The University of Sydney Muscles: Types of Muscles - Skeletal (voluntary) - Allows voluntary movement - Smooth (involuntary) -Functions include propelling urine, mixing food in digestive tract, dilating/constricting pupils, regulating blood flow -In some locations, autorhythmic -Controlled involuntarily by endocrine and autonomic nervous systems -Examples include muscles in bladder wall and GI system - Cardiac (involuntary) - Found in heart The University of Sydney The University of Sydney Muscles: Muscle Categorisation Striated Muscle Unstriated Muscle Skeletal Muscle Cardiac Muscle Smooth Muscle Voluntary Muscle Involuntary Muscle The University of Sydney Muscles: Skeletal Muscle Formation - Composed of muscle cells (fibres), connective tissue, blood vessels, nerves - Fibres are long, cylindrical, multinucleated - Tend to be smaller diameter in small muscles and larger in large muscles - Striated appearance due to light and dark banding The University of Sydney Cross- section of skeletal muscle The University of Sydney Muscle Components Within each myofibril are sarcomeres, the contractile units of the muscle cell. The University of Sydney Musculoskeletal Assessment Musculoskeletal Injury - Classifed as mild to severe - Soft tissue injury - Fractures -– dysfunction to muscle, tendons, + ligaments - Amputation of limb - Crush injury The University of Sydney Soft Tissue Injury: Contusion - Contusion -Bleeding into soft tissue -Significant bleeding can cause a hematoma -Swelling and discoloration (bruise) The University of Sydney Soft Tissue Injury: Sprains - Ligament injury caused by excessive stretching - Can occur from twisting motion - May result in overstretching or tearing of ligament - Grades of sprains - Grade I: mild bleeding and inflammation - Grade II: severe stretching, some tearing, inflammation and hematoma - Grade III: complete tearing of ligament - Grade IV: bony attachment of ligament broken away The University of Sydney Fractures - Closed or Simple Fractures - Open or Compound Fractures - Complete or Incomplete Fractures - Stable or Unstable Fractures - Direction of Fracture Line -Oblique -Spiral -Length Along the Bone (Greenstick) The University of Sydney Osteoporosis - Disease where there is a loss of bone exceeding the rate of bone formation - Usually increase in older women, Caucasians but increasing in Asian populations - Clinical manifestations - Bone pain, ↓ movement - Can predispose patient to pathological fractures - Chronic diseases The University of Sydney Muscloskeletal assessment - Chronic diseases - Loss of bone density or osteoporosis - Medications - Changes in ability to move, muscle strength or perform ADL’s - Type and frequency of exercise - Smoker - Alcohol - Usual routine at home or work to lift, push or pull items, bend or stoop The University of Sydney Muscloskeletal assessment - Accidents or trauma to bones or joints resulting in fractures, strains, sprains or dislocations. Any continuing problems or difficulties from these problems - Congenital bone or joint problems. Altered activities and adaptation to this alteration - Surgery on bones, joints or muscles and outcome The University of Sydney History “Any pain or stiffness in your muscles, joints or back?” “Any trouble getting up or down stairs?” “Any difficulty getting dressed or activities of daily living?” The University of Sydney Muscloskeletal assessment - Inspection - Palpation - Movement - Compare with opposite side The University of Sydney Physical Assessment: Inspection - Axial skeleton and extremities for alignment, contour, symmetry, size and gross deformities - Muscles for size and symmetry - Shoulders and cervical, thoracic, and lumbar spine for alignment and symmetry - Skin colour / rashes - Swelling - Deformity - Scars - Muscle wasting The University of Sydney The University of Sydney Physical Assessment: Palpation - Tenderness - Heat - Swelling - Each major joint and adjacent muscles for tenderness on movement, joint stability and deformity - Pain on palpation The University of Sydney Movement Assessment - Active and Passive - Range of Movement - Crepitus -Grating, crackling or popping sounds and sensations experienced under the skin and joints - Note Pain on Movement - Instability The University of Sydney Symmetry Assessment The University of Sydney The University of Sydney The University of Sydney Fracture Assessment - Bone alignment alteration - Extremity length alteration - Change in shape of bone - Pain upon movement - Decreased ROM - Ecchymosis The University of Sydney Musculoskeletal Assessment for Older Person - Decrease in bone mass - Narrowing of intervertebral disks - Lordotic or convex curve of back flattens with both flexion and extension of back decreasing - Centre of gravity changes – Men walk with smaller steps and wider base. Women become bowlegged with a narrow standing base - Cartilage and ligaments calcify - Decrease in elasticity and tone of tendons and muscles - Muscles loose mass and strength - Loss of agility The University of Sydney Summary - Muscle anatomy compromises of skeletal, smooth and cardiac - Skeletal development continues until late adolescence - Soft tissue injuries are common - Skeletal injuries can be acute or chronic - Assessment requires inspection, palpation and diagnostic testing often - Older person testing needs to be modified The University of Sydney