Chapter 52: Assessment of th Musculoskeletal system Flashcards
Hormones involved in bones
Bones account for 99% of calcium and 90% of phosphorus.
Calcitonin, produced by thyroid, decreases serum calcium by inhibiting bone resorption and increasing renal excretion.
Vitamin D promotes the absorption of calcium and phosphorus from the small intestine. A decrease can result in osteomalacia.
Parathyroid hormone stimulates the bone to release calcium into the blood.
Growth hormone secreted by the anterior lobe of the pituitary is responsible for increasing bone length and determining the amount of matrix form before puberty. Increase can result in gigantism and a decrease in dwarfism. An increase in adulthood causes acromegaly.
Adrenal glucocorticoids regulate protein metabolism and helping with that matrix of the bone. They aid in regulating intestinal calcium and phosphorus absorption.
Estrogens stimulate osteoblastic/bone building activity and inhibit parathyroid hormone. Decreases in menopause increased the risk of osteoporosis. Androgens and testosterone promote anabolism/bone building and increase bone mass.
Thyroxine is secreted by the thyroid gland and is to increase the rate of protein synthesis synthesis in all types of tissues including bone.
Synovial joint
Type eventually lined with synovium, remembering that secrete synovial fluid for lubrication and shock absorption
Tendon
Tough fibrous tissue that attaches muscle to bones
Ligament
attach bones to other bones at joints and serve to support joints
Musculoskeletal changes with aging
Osteopenia is decreased bone density. We need to prevent falls, reinforce exercise and weight-bearing exercise. The bones are more likely to fracture and exercise slows bone loss.
There is an increase in bony prominence due to less soft tissue and skin breakdown. Prevent pressure on boney prominences
Kyphotic posture: wide gait, shift in center of gravity. Teach proper body mechanics and instruct the patient to sit in supportive chairs with arms. Correct posture problems to prevent further deformity. There should be support for bony structures.
Cartilage degeneration: Moist heat increases blood flow to area.
Decreased ROM: The ability to perform ADLs and mobility. They may need assistance
Muscle atrophy, decreased strength: Teach isometric exercises to increase muscle strength
Slowed movement: do not rush.
Myopathy
A problem in muscle tissue and is usually a proximal weakness
Neuropathy
A problem in nerve tissue and is usually a distal weakness
Antalgic gait
Abnormality in the stance phase of gait. When one leg is painful the person shortens the stance phase on the affected side.
Lurch
An abnormality in the swing phase of gait. Occurs when the muscles in the butt or legs are too weak to allow the person to change weight from 1 foot to the other
genu valgum
a deformity in which the knees are abnormally close together and the space between the ankles is increased. Knock-kneed
Genu Varum
A deformity in which the knees are abnormally separated and the lower extremities are bowed inward. Bowleg
Neurovascular assessment
Assessment of the neuromuscular system that includes inspection of skin color, temperature, capillary refill distant to injury, surgical procedure, or cast. Palpation of pulses in the extremities below the level of injury and assessment of sensation, movement, and pain in the injured part
Lovetts scale for grading muscle strength
5: normal ROM with full resistance
4: Good
3: fair, ROM against gravity
2: Poor
1: trace
0: no evidence of muscle contractility
ALP alkaline phosphatase
30-120 units/L (slightly higher with age)
Increase indicates metastatic cancers of the bone, Paget’s disease, or osteomalacia
It increases with bone or liver damage
Serum CK creatine kinase
Men 55-170
Women 30-135
Elevations include muscle trauma, progressive muscular dystrophy, effects of electromyography.
They begin to rise 2 to 4 hours after muscle injury.
AST aspartate aminotransferase
0-35units/L increased in elderly
Elevations indicate skeletal muscle trauma and progressive muscular dystrophy
Serum calcium
9-10.5 mg/dL decreased with age
Hypercalcemia is seen with metastatic cancers of the bone, Pagets disease, bone fractures in the healing stage.
Hypocalcemia is seen osteoporosis and osteomalacia
Serum phosphorus
3.0-4.5 mg-dL decreased with age
Hyperphosphatemia is seen with bone fractures in the healing stage, bone tumors, acromegaly.
Hypophosphatemia is seen with osteomalacia
tomography
An imaging technique that produces planes or slices for focus and blurs the images of other structures. Different from standard x-rays which superimpose one structure on another
xeroradiography
X-ray technique in which images are produced electrically rather than chemically, permitting lower exposure time and radiation energy than those of ordinary x-rays. Images exhibit edge contrast which is useful for identifying minute calcifications in the breast.
they do not determine tissue densities
myelography
Radiography of the spine after injection with contrast into the subarachnoid space of the spine. Used to visualize the vertebral column, intervertebral discs, spinal nerves, and blood vessels. CT and MRI have replaced for the most part. care is similar to lumbar puncture, keep head elevated to 30-50 degrees to prevent contrast from brain.
Arthrogram
X-ray of a joint after contrast medium of air or solution has been injected to enhance its visualization
CT computed tomography
Cross-sectional slices are taken and can build three-dimensional pictures. The contrast medium may be used. Ask patient about iodine-based allergies
Bone scan
The nuclear scan in which radioactive material is injected for visualization of the entire skeleton. Used to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fractures, or unexplained bone pain. Very helpful for hairline fractures and metastatic the bone disease
gallium: Migrates to the brain, liver, a breast tissue. More specific and sensitive in detecting bone problems. Give 4-6 hours before scan. Must lie still for 30-60 minutes. Push fluids to help with excretion. Not harmful or radioactive.
Thallium: Evaluates the extent of disease in patients with osteosarcoma
MRI
Not safe with pacemakers, stent, and surgical clips. must ask the patient if pregnant, have ferromagnetics fragments or implants, an aneurysm clip, Electronic implants, they lie still for 45 to 60 minutes, they need life-support equipment available, they communicate clearly, tattoo more than 20 years ago, claustrophobic?
Ultrasonography
Used to see soft tissue disorders such as masses and fluid accumulation, traumatic joint injuries, osteomyelitis, surgical hardware placement.
EMG Electromyography
Evaluate diffuse or local muscle weakness. Usually along with nerve conduction studies. It is contra indicated for patients undergoing anticoagulant therapy. Inform the patient it may cause discomfort. Mild sedation could be prescribed. Inspect needle sites for hematoma. Ice can prevent it. Some physicians require you to discontinue your muscle relaxants several days before the test.
Arthroscopy
Knee must be able to flex 40° and must not have infection. Follow-up care is to evaluate the neurovascular status of the affected limb every hour. monitor distal pulses, warm, color, capillary refill, pain, movement, and sensation. Encourage patient to perform exercises taught before the procedure. Use ice for 24 hours, elevate 12 to 24 hours. Complications include swelling, increased joint pain, thrombophlebitis, infection.
