Musculoskeletal System Assessment PDF

y & Health Musculoskeletal Assessment Osteoarthritis Back Problems Cortney Maffett, MSN, FNP-BC 01. Musculoskeletal System & Assessment Review  Skeletal System 206 bones and multiple joints, skeletal muscles and supporting structures Growth and development pri...

y & Health Musculoskeletal Assessment Osteoarthritis Back Problems Cortney Maffett, MSN, FNP-BC 01. Musculoskeletal System & Assessment Review  Skeletal System 206 bones and multiple joints, skeletal muscles and supporting structures Growth and development primarily occurs during childhood and adolescence Function: ○ Support ○ Protection ○ Movement ○ Storage  Bones (Shapes) Long Bones Short Bones Smaller and bear little Longer than they are weight wide Irregular Bones Flat Bones Irregularly, uniquely Thin, flat, most are shaped curved Bones (Structure) Compact Smooth and Dense Outer Layer Spongy Light and Porous (mesh-like) Inner layer Osteocytes Bones (Cells) Maintain bone matrix Osteogenic cells Stem Cells Osteoblasts Bone-forming Osteoclasts Bone-destroying  Joints Referred to as articulations Region where 2+ bones meet Provide movement and flexibility Three types: Synarthrodial – completely immovable Amphiarthrodial – slightly moveable Diarthrodial (synovial) – freely movable  Muscular System/Skeletal Muscle Allows musculoskeletal function Attach to and cover the bones of the skeleton Promote body movement Help maintain posture Produces body heat Moved by conscious, voluntary control or reflex activity Approximately 600 muscles in human body Functions: ○ Excitability ○ Contractibility ○ Extensibility ○ Elasticity  Changes Related to Aging Bone structure changes (caused by expansion and resorption) Osteopenia – decreased bone density (can lead to osteoporosis) Cartilage degeneration (can lead to arthritis) Atrophied muscle tissue (increased exercise can slow atrophy) Decreased coordination and ROM Loss of muscle strength Gait changes Slowed movement Increased fall risk Assessment Health History Family History Medication History Diet History Psychosocial Assessment Physical Assessment ○ Pain ○ Inspection ○ Posture ○ Gait ○ Mobility  Diagnostics (Labs) ”Laboratory Profile: Musculoskeletal Assessment” Table on Iggy pp. 979 Blood tests specific to the musculoskeletal system: Calcium Phosphate Alkaline phosphate (ALP) Creatinine kinase (CK-MM) Lactate dehydrogenase Aspartate aminotransferase (AST) Aldolase (ALD)  Diagnostics (Imaging) X-ray DEXA Scan Ultrasound CT MRI Bone Scan Myelogram Biopsies Electromyogram (EMG) Arthroscopy 02. Back Problems  Back Problems Posture Lack of Workplace Ergonomics Physical Condition Pregnancy  Back Pain – Risk Factors ○ Obesity ○ Repetitive flexion/extension ○ Occupational injury ○ Smoking ○ Congenital (ex: scoliosis) ○ Degenerative changes ○ Prior injury ○ OA ○ Vascular changes ○ Lifestyle Back Pain - Assessment Gait and spine flexion Pain Assessment Inspect vertebral alignment & tenderness Sensory perception Straight Leg Raising Test Psychosocial  Back Pain - Management Nonpharmacological methods ○ Massage ○ Spinal manipulation (chiropractic) ○ Heat/Cold Therapy ○ Acupuncture ○ William’s position ○ Stress reduction ○ Mindfulness ○ Progressive muscle relaxation ○ Yoga ○ TENS unit ○ Weight reduction  Back Pain - Management Pharmacological methods ○ NSAIDs ○ Tramadol ○ Duloxetine ○ Skeletal muscle relaxants ○ OTC medications ○ Ziconotide ○ Antiepileptics ○ Steroids Back Pain – Surgical Management Minimally Invasive Surgeries ○ Not done if disk is pressing into spinal cord ○ Microdiskectomy ○ Laser-assisted laparoscopic surgery Open Surgical Procedures ○ Diskectomy ○ Laminectomy ○ Spinal Fusion (ALIF, PLIF, LLIF, TLIF) ○ Artificial disk replacement  Postoperative Care Pain Bleeding Wound/Drain Care Mobility Ability to void DVT prevention Neurovascular checks & VS q4h Neurological assessment Vital Signs Q-4hrs x 24hrs Major complications (Iggy pp. 891)  Prevention of Low Back Pain & Injury Box on Iggy pp. 888 Proper posture Regular exercise Stretching/Yoga Ergonomics Household assistance Avoid high-heel shoes Avoid prolonged sitting or standing Maintain ideal weight Adequate calcium intake Smoking cessation Prevention of Low Back Pain & Injury (Pregnancy) Education is Key! Good posture Proper lifting techniques Maintain wide-based stance Exercise 03. Osteoarthritis  OA Also referred to as degenerative joint disease Impairs mobility Persistent pain Disability Slow, progressive deterioration of joint cartilage Commonly affects hands and weight-bearing joints Breakdown of articular cartilage Usually limited to joints and surrounding tissue Fissures, calcifications, and ulcerations  OA – Risk Factors ○ Primary: ○ Age ○ Genetics ○ Female ○ Secondary: ○ Obesity ○ Trauma/Repetitive injuries ○ Mechanical stress ○ Metabolic diseases ○ Blood disorders ○ Smoking OA - Assessment Pain Assessment Crepitus Heberden nodes Bouchard nodes Joint effusions Decreased mobility Gait changes Spinal involvement Psychosocial  OA – Diagnostics Physical Exam Labs (ESR, CRP) X-rays MRIs Hyaluronic Acid  OA - Management Nonpharmacological ○ Exercise ○ Maintain ideal body weight ○ Heat/Cold therapy ○ Plan scheduled rest periods ○ Assist with ADLs ○ Complementary therapies ○ Assistive Devices ○ Physical Therapy  OA - Management Pharmacological ○ Acetaminophen (drug of choice) ○ NSAID/Cox-2 inhibitors ○ Topical (lidocaine, salicylates, NSAIDs) ○ Weaker opioids ○ Corticosteroids ○ Glucocorticoid injections ○ Viscosupplementation (HA injections) ○ Medical Marijuana ○ OTC meds/supplements  Total Joint Arthroplasty (TJA) Used to manage pain & increase mobility Most common: Hip, Knee, Shoulder Contraindications: infection, inflammation, uncontrolled medical conditions Preoperative Rehab Preop Care  TJA THA: Acetabular and Femoral Last 10-15 yrs Type: Cemented or Noncemented Approach: Anterior, Direct Lateral, or Posterolateral Hip dislocation is common TKA: Unilateral vs Bilateral Type: Cemented or Noncemented Joint dislocation is not common CPM machine  TJA - Complications Complications: Hip dislocation, hypotension, bleeding, VTE, infections, pneumonia, anemia, N/V, subluxation, uncontrolled pain Postop Care Observe for complications VTE prophylaxis TCDB/IS use Pain Management Mobility Incisional Care Hip Precautions (posterior approach) Frequent neurovascular checks Education Physical Therapy/Rehab THE END