The Musculoskeletal System  Extension- increasing the angle of between two

Consists of the: joints

 Muscles  Abduction- movement of the limb from the
 Tendons midline
 Ligaments  Adduction- movement of towards the midline
 Bones  Internal rotation- moving the body part inward
 Cartilage towards the midline
 Joints  External rotation- moving the body part
 Bursae outward away from the midline
 Supination- turning a body part upward
Functions:  Pronation- turning a body part downward
1. Locomotion and protection
2. blood production in the bone marrow Muscles of the face
3. heat generation 1. Frontalis
4. maintenance of posture 2. Orbicularis oculi
5. storage of minerals 3. orbicularis oris
4. Buccinator
Three types of muscles exist in our body: 5. Zygomaticus
- Voluntary skeletal muscle • Facial Nerve innervation
- Involuntary cardiac muscle
- Involuntary visceral smooth muscle Muscles of Mastication
1. Masseter
Properties of Muscles 2. Temporalis
Electrical excitability 3. Pterygoid muscles
• Ability to contract to certain stimuli • Innervated by TRIGEMINAL NERVE
Contractility
• Ability to contract forcefully when stimulated Muscles of the neck
Extensibility 1. Platysma
• Ability to stretch without being damaged 2. Sternocleidomastoid
Elasticity Muscle of the upper limb
• Ability to return to its original length and shape
■ 1. Biceps
Muscle Physiology ■ 2. triceps
- Muscle fibers are enclosed sheaths perimysium, ■ 3. deltoid
epimysium and endomysium
- Each muscle cell has actin and myosin filaments Muscles of the lower limb
arranged in a sarcomere 1. Hamstring muscles
- The sarcomere is the basic structural unit of the 2. Quadriceps
muscle 3. Gluteal muscles
- Muscle contraction occurs as actin and myosin 4. Calf muscles
slide past one another causing the sarcomeres to
shorten TENDONS
- Calcium ion is released by the muscle  These are bands of fibrous connective tissues
endoplasmic reticulum to initiate contraction that attach muscles to bones
- ATP is used both for muscle contraction and
muscle relaxation LIGAMENTS
 These are dense, strong, flexible bands of
Muscle contraction can be of two types fibrous connective tissue that bind bones to
1. ISOMETRIC-iso = same, metric distance: The length other bones
of the muscle does not change, but the tension increases
2. ISOTONIC - iso = same, tonus-tone: The amount of BONE
muscle tension is constant but the length of the musde  Living growing tissue made of porous
varies mineralized structure.
 The human skeleton contains 206 bones
Muscle tone - refers to the constant tension produced by
muscles of the body for long periods of time  Axial bones are bones on the midline like the
vertebrae, skull, facial bones, ribs and sternum
FAST - twitch muscles contract quickly and fatigue  Appendicular bones include the scapulae, bones
quickly of the arms and legs
SLOW - twitch muscles contract slowly and are more Classification of Bones
resistant to fatigue
 Long bones have a shaft and ends. Ex: tibia,
 Smooth Muscle is not striated, contracts more humerus, femur
slowly, is autorhythmic and under involuntary
 Short bones - Small and cubical Ex: carpals and
control
tarsals
 Irregular bones - vertebrae, mandible
 Cardiac muscle is striated, is autorhythmic, and
 Sesamoid bones- bones embedded in the
under involuntary control
tendons. Ex:patella
MUSCLE and JOINT MOVEMENTS  Flat bone-scapulae, ribs, clavicle
 Flexion- decreasing the angle between two
joints
Structure of the bone - These are air-filled cavities in the facial bones
surrounding the nose and open into the nasal
 Long bones have a diaphysis (shaft) and cavity
epiphysis (ends)
 Bones consist of layers of calcified matrix - They decrease the weight of the skull and act as
occupied by bone cells. resonator of sounds
 The outer layer of bone is composed of dense
compact bone (cortical bone) The Vertebrae
- Composed of 32-33 bones
✔The inner layer is composed of spongy cancellous - 7 cervical
bones - 12 thoracic
- 5 lumbar
Bone Structure - 5 sacral
- 3-4 coccygeal
■ Blood supply of bones reaches by way of arterioles in
the haversian canal, through the vessels in the Functions of the vertebrae
Volkmann's canal 1. Supports the weight of the head and trunk
2. Protects the spinal cord
- Bone formation can be from the cartilage and from the 3. Allows spinal nerves to exit the spinal cord
membrane 4. Provides a site for muscle attachment
5. Permits the movement of the head and trunk
Bone Structure
The Cervical Vertebrae
 OSTEOBLAST-bone cell responsible for bone
formation and calcification  7 in number
 OSTEOCLAST-bone cell responsible for bone  C1- atlas
resorption and destruction  C2-axis
 OSTEOCYTES - are matured bone cells  C7- cervical prominence
 Atlas and occipital bone= "yes" motion
Bone Modeling  Atlas and Axis= "no" motion
- Refers to the shaping and lengthening of the bones
according to their location and function The Thorax
 Made up of the sternum and ribs. The sternum
Bone Remodeling has 3 parts
 Bone remodeling involves the removal of old
bones by cells called osteoclasts and deposition • Manubrium
of new bones by the osteoblasts. • Body
• Xyphoid process
 Bone is the major storage of calcium • The slight elevation in the sternum is
called the Sternal Angle of Louis. It
 If calcium levels in the blood falls, it is removed identifies the location of the second rib
from the bone
The Ribs
Bone repair  . The are 12 pairs of ribs
• When a bone is broken, blood vessels are also damaged  True ribs= 1st-7thpairs
clot  False ribs= 8th-10thpairs
 Floating ribs=11th-12th pairs
2-3 days after injury, blood vessels and cells Invade the
blood clot callus formation The shoulder

• Osteoblasts enter the callus and begin to form ■ The clavicle and scapulae constitute the shoulder
a spongy bone - Immobilization of the bone is required
because the delicate new matrix of bone is easily The clavicle
damaged by excessive movement
 Articulates with the sternum
The Skull  Most commonly fracture bone
- Skeleton of the head  The Scapulae
- Made of 21 bones  Attached to the ribs and vertebrae by muscles
- Cranial bones only
- Frontal
 Has an acromion process, where the clavicle
- Parietal
attaches
- temporal
 The Upper extremity
- occipital
- Facial bones
Composed of the following bones
- Maxilla
- Mandible  Humerus
- Zygoma  Ulna
- Nasal  Radius
- Vomer  Carpals (wrist bones)
- Palatine  Metacarpals
 Phalanges
The paranasal sinuses  The pelvic girdle
Composed of the 3 fused bones- pubis, ilium and  Synarthrosis - immovable joints
ischium - Amphiarthrosis - semi - movable joints
 ■ Diarthrosis - freely movable joints
 Constitute the hip bone
Bursae
 The pelvic girdle
- Small synovial fluid sacs located at friction
 Female pelvis has the following structure: The points around joints, between tendons, ligaments
pelvic inlet is large/oval, symphysis is shallow. and bones
obturator foramen is oval or triangular, sacrum
is broader - ■ Act as cushions, decrease stress on adjacent
structure
 The male pelvis has the following: The pelvic
inlet is small/round to heart-shape, symphysis is
deep. Obturator foramen is round ASSESSMENT
Objective:
The Lower extremity bones
 Swelling
Composed of the  Fever
 Deformity
- Thigh bones- femur
 Changes in skin temperature
 . The leg bones- Tibia and Fibula  Discoloration
 Rigidity/spasms Motor deficits
 ■ The ankle-tarsal bones
ASSESSMENT
 ■ The foot- metatarsal bones
 When assessing the nurse takes into
CARTILAGE consideration:

- A dense connective tissue that consists of fibers  History mechanisms of injury. medical/surgical
embedded in a strong, gel-like substance. history, occupation/ activities, presence of risks
like smoking. inactivity, malnutrition, etc.
- . Cartilage supports and shapes various
structures such as the ear pinna, intervertebral  Skeletal component
disks, ear canal, larynx, etc.  Joint component
 Neuro-Muscular component
Types of Cartilage  Skin component

■ Fibrous cartilage COMMON DIAGNOSTIC EXAMS

Found in the intervertebral disks
 X-ray
■ Hyaline cartilage  Bone Scan
Found in the symphisis, the thy oid cartilage  Bone Densitometry
 Magnetic Resonance Imaging
■ Elastic cartilage
 Arthrogram
Found in the ears, the epiglottis
 Myelogram
Joints  Diskogram
 . These are point of attachment or contact  Arthrocentesis
between two bones  Arthroscopy
 Nerve Studies Electromyography, Nerve
o Variously classified according to its conduction velocities, etc.
movement and xibility
X-RAY
o Fibrous joints- with fibrous tissue with
little or no movement 1. Bone x-ray:
determines density, texture, integrity. erosion, and
 Cartilaginous joints- with cartilage changes in bone relationships

• Synovial joints- with capsule; 2. Cortical x-ray:

freely movable joints detects widening, narrowing or irregularities in bone

Synovial joints 3. Medullary cavity x-ray: detects alteration in density

4. Joint x-ray: shows fluid, irregularities, spur formation

 ■ Plane joint- intercarpal joint of wrist Hinge
in bones and joints
joint- elbow and ankle
 ■ Pivot- atlas and axis
5. Tomogram: a special x-ray technique for detailed
 ■ Condyloid- "egg-shape" metacarpophalangeal view of a special plane of a bone
joint
Bone Scan
Joints according to movement
  detects metastatic bone disease, inflammatory:
skeletal disease and fracture To strengthen and condition the patient's body

 requires parenteral injection of CRUTCH WALKING PRINCIPLES

radiopharmaceutical (usually Gallium)
concentration of isotope uptake to reveal skeletal  Measurement
problem  When lying
 When standing
(A bone density scan is a low-dose x-ray which checks
an area of the body such as the hip. hand or foot for Adjustment
signs of mineral loss and bone thinning) •Axilla •Height/length
•Elbows
BONE DENSITOMETRY
 Preparatory exercises
 A noninvasive study that yields an actual  Stance
measurement of bone density and is diagnostic CRUTCH WALKING DEMONSTRATION
for osteoporosis and other bone degenerative 1. Four-point gait
disease. 2. Three-point gait
3. Two-point gait
 A simple portable screening test that can analyze 4. Swing to
the wrist or heel is common 5. Swing through

MYELOGRAPHY CANE WALKING

Injection of contrast media into the subarachnoid space  Canes are artificial support that assist patients
and lumbar space in the spine to determine level of disk who need aid in walking
herniation or site of a tumor
 They come in a variety of shapes but majority
An x-ray follows after the contrast is injected have curved handle and rubber tip.

ARTHROGRAPHY  Used for much balance and support

Injection of radiopaque substances or air into the joint WALKER

cavity to outline soft tissue structures (like the meniscus) Provides more stability and balance but does not provide
and contour of joint. natural reciprocal walking pattern
An x ray usually follows after the contrast CAST
Is an immobilization device made up of layers of plaster
DISKOGRAPHY of Paris (POP) or fiberglass (water activated
polyurethane in) bandage molded to the body part that it
Injection of a small amount of contrast medium into the encases.
lumbar disk to detect abnormalities
CAST-PURPOSES
An x ray usually follows after the contrast
 To immobilize and hold bone fragments in
ARTHROCENTESIS reduction
 To apply uniform compression of the soft tissues
Insertion of a needle into the joint and aspiration of
 To permit early mobilization
synovial fluids for purposes of examination or just to
 To correct and prevent deformities
reduce excessive synovial fluids.
CAST-APPLICATION
OTHER STUDIES
Nerve Studies
 Requires an Xray or other similar laboratory
1. Electromyography - measures electrical potential exams prior to cast application"
generated by the muscle during relaxation and
contraction  The physician and the nurse measure the area to
be casted and determine which size/ type of cast
2. Nerve conduction velocities- measures rate of to use
potential generation along specific nerves
 Consent is required
CRUTCH WALKING
CAST PRINCIPLES
Crutches are artificial support that assist patients who
need aid in walking because of injury or birth defect in  POP cast causes crystallization reaction and heat
the lower extremity. is given off (exothermic reaction)

CRUTCH WALKING  Open air is helpful to get the cast to dry faster

Goals:  Wet cast appears dull and gray while dry cast
appears white, is resonant with percussion,
1. Helps develop power in the shoulder girdle and upper odorless and is firm.
extremities that will bear the patient's weight
CAST - TYPES
CAST-OVERALL CARE
 Short arm cast (below elbow-prox. palmar 1. Maintain adequate tissue perfusion
crease) 2. If neurovascular symptoms appear (compartment
 Long arm cast (axillary fold-prox. palmar syndrome)- notify doctor stat, bivalve split cast, expose
crease) padding
 Short leg cast (below knee-base of toes) 3. Minimize effects of immobility
 Long leg cast (upper/mid-thigh-base of toes) 4. Promote nutrition and increase fluids
 Cylinder cast 5. Report any crack in the cast
 Gauntlet cast (includes the thumb) 6. Health teaching: weight bearing, cast care, gait/
walking, reporting, etc.
CAST-TYPES
TRACTION
Force applied in a specific direction
 Body cast/ plaster jacket
To apply the force, materials are needed:
 Shoulder Spica Cast (single or double) (trunk.
 Ropes
shoulder, elbow)
 Pulleys
 Hip Spica (single) (unk and lower extremity)
 Weight
 Hip Spica (double) (Trunk and both Leg)
 Cast Brace
TRACTION-PURPOSES
 Basket cast
 To reduce and immobilize fracture
 Others
 To regain normal length and alignment of an
injured extremity
CAST CARE
 To lessen or eliminate muscle spasms o To
prevent deformity
1. Newly applied Cast
 To give patient freedom from in-bed activities
 Expose to air
 To reduce pain
 Allow to cool within 15 minutes
 Do not allow ambulation or manipulation; avoid
TRACTION PRINCIPLES
dents
Types of Traction according to direction:
 Running traction pull is exerted in one
2. Subsequent days after application
direction. Ex. Buck's Extension Traction
 Keep dry and clean
 Balanced traction pull is exerted with counter
 Cover when showering
balance via the use of additional weights. Ex.
 Partial or no weight bearing Thomas Splint with Pearson Attachment
CAST-COMPLICATIONS TRACTION PRINCIPLES
1. Pressure on neurovascular and bony. structures cause Types of Traction according to structures involved:
necrosis, pressure sores and nerve palsies
 Skin traction - temporary; light materials are
used on the skin; may be applied by nurses
2 Immobility and confinement increase the risks to
(running traction is applied)
develop multisystem problems
 Skeletal traction applied (in the OR) by
orthopedic doctor using pins, tongs placed
 Compartment Syndrome - trauma or surgery
through bones: common with fractured femur,
affecting an extremity will produce swelling and
humerus, tibia and cervical spine; running or
vascular insufficiency note: is irreversible
balanced
CAST-COMPLICATIONS
TRACTION CARE
 Minimize effects of immobility
 Compartment Syndrome pathophysiology
 Maintain skin integrity
 Compression (of nerves and blood vessels) from
 Avoid infection
swelling
 Promote tissue perfusion
 Recreased blood supple (ischemia)
 Provide health education
 Decreased oxygen supply to tissues - skin,
muscles, bones
PRINCIPLES OF NURSING CARE:
 Tissue death/ necrosis:
 The alignment and moving of the patient will
 Irreversible damage
only be changed on physician's directive and the
affected extremity will need to be maintained in
CAST-COMPLICATIONS
proper alignment at all times with the ropes and
Complications from immobility
traction straps making sure the mentioned is
unobstructed and weights hanging freely.
1. Cardiovascular thrombo phlebitis/ DVT, possible
pulyembolisma poor circulation, etc
 If it is necessary to move the patient while
skeletal traction is in place, the patient should be
2. Respiratory infection like Pneumonia from innefective
moved in the bed with weights hanging freely.
coughing, others

3. GIT constipation from poor peristalsis, anorexia, N/V,  In most cases traction will be applied for a
distension, others number of weeks to months and Neurovascular
checks will need to be performed by the nurse
4. Urinary - UTI, retention, stone formation

5. Psychological anxiety, diaphoresis, etc.