msk Flashcards
(115 cards)
1
Q
what does the msk system consist of
A
bones, joints, ligaments, muscles, tendons, and connective tissues that support and bind tissues and organs together
2
Q
ligaments vs tendons
A
Ligaments bind bones together at joints
ligaments = Connective tissue that attaches bone to bone at a joint; stabilizes joint and prevents movement beyond intended range of motion
Tendons attach muscles to bones
tendons = Connective tissue that attaches muscle to bone; tendon acts on bone when the muscle contracts to cause movement
3
Q
skeletal bone provides
A
form, support, protection, stability, and movement to the body
Shape to the body
Physical support
Protection of organs
Stores minerals – calcium; and lipids
Responsible for blood cell formation
Muscle attachment sites – to facilitate movement
4
Q
muscles
A
keep skeleton upright and facilitate body’s physical movement
attach to the bones of the skeletal system
- each muscle is a discrete organ composed of skeletal muscle tissue, blood vessels, tendons, nerves
- muscle tissue found in the heart, digestives organs, blood vessels
- ~ 700 muscles that account for half person’s body weight
5
Q
how many bones in human body
A
206
-bones are formed from osseous tissue-provides structure and function to the body
6
Q
nerves
A
- control the contraction of skeletal muscles
- interpret sensory information
- coordinate the activities of the body’s organ systems
7
Q
osseous tissue composed of
A
composed of calcified connective tissue
Ground substance and 90-95% collagen fibers (ossein) create the bone matrix
Calcium and phosphorus stored in matrix adding strength and density
Osteocytes are contained in the matrix
8
Q
cartilage
A
semi-rigid connective tissue deposited in areas where the bones need to move such as ribcage and joints
Soft connective tissue found between joints; shock absorber to reduce friction
9
Q
structure of bone
A
Periosteum
Outermost layer of bone; protective sheath; thin tough membrane of fibrous tissue; provides support for tendons
Completely covers all bones except at joints where there is a layer of cartilage
Two layers: inner cellular osteogenic layer that forms new bone tissues and outer fibrous connective tissue layer for blood and nerve supply to bone
Osteogenic layer decreases in older bones
10
Q
compact bone
A
under periosteum
hard outer layers of the bone; no spaces between lamellae
11
Q
cancellous/spongy bone
A
under compact bone
lighter, softer, weaker, more porous but with greater surface area; spaces between lamellae; more vascular; “honeycomb appearance”
12
Q
medulla
A
hollow cavity containing marrow within cancellous bone
13
Q
bone development
A
Cartilage is the major component of skeleton when very young –provides greater flexibility and resiliency
Cartilage becomes harder with deposition of calcium phosphate in it
Some cartilage cells break loose and channels develop in the shaft of the bones
Blood vessels enter these channels and carry other connective tissue cells – some develop into osteoblasts and osteoclasts
Osteoblasts enter cartilage and form the layers of bone
Osteoclasts tear down old and excessive bone structures, allowing osteoblasts to rebuild with new bone – continuous process which slows down with age
14
Q
osteoblasts
A
bone forming cells which secrete collage and substances to form the ground substance of bone
15
Q
osteocytes
A
most common cell in mature bone
Responsible for bone growth and density
16
Q
osteoclasts
A
cells that reabsorb bone tissue
17
Q
lamellae
A
circular layers of bone matrix around the Haversian canal (osteon – functional unit of compact bone)
18
Q
trabeculae
A
functional unit of cancellous bone; contain osteocytes but no osteons; receive nutrition from marrow tissue
19
Q
bone marrow
A
Fills inner core of bones - the medullary cavity
Soft, gelatinous tissue – myeloid tissue
Red bone marrow for hematopoiesis OR yellow bone marrow filled with adipose tissue (or both)
20
Q
red marrow
A
Primarily in central bones of adults – skull, vertebrae, sternum, ribs, pelvis, and upper thirds of long bones (humerus and femur)
In all bones until age seven – when need is high for new blood formation
21
Q
yellow marrow
A
Primarily a storehouse for fats
Can be converted to red marrow under certain conditions (severe blood loss, fever)
Fill the cavities of other bones without red marrow
22
Q
types of bone
A
endochondral and intramembranous long short flat sesamoid irregular
23
Q
endochondral and intramembranous bones
A
Endochondral/intra-cartilaginous - ossification from centers arising in cartilage
Intramembranous – direct formation of bone on the mesenchyme (embryonic connective tissue) for formation of flat bones
24
Q
ossification: formation of bone
A
Conversion of connective tissues into bone
Initiated at centers of ossification – points at which bone formation is started by osteoblasts through laying down of lamellae
Centers of ossification – primary or secondary
25
primary center of ossification
present before birth
| first to start process of ossification
26
secondary center of ossification
usually appears after birth
| process of ossification starts here after it has been started at the primary center
27
endochondral ossification
Embryonic mesenchymal cells develop into cartilaginous models which become ossified and form bone
Cartilage is gradually replaced by bone radiating out from the primary ossification center in the diaphysis to the epiphysis (secondary ossification center)
Cartilage remains at epiphysis as articular cartilage for joint movement
and as epiphyseal cartilage plate for bone
lengthening at junction with diaphysis
28
intramembranous ossification
Mesenchyme differentiates into osteoblasts which deposit osteoid (unmineralized matrix)
Then osteoblasts deposit calcium phosphate into the osteoid, and the osteoid is converted into a bony matrix called bony spicules
The osteoblasts transform into osteocytes
The spicules coalesce into layers (lamellae) which form around the blood vessels and develop into osteons (Haversian canal system); osteoblasts lay down lamellae at the surface of the developing bone forming compact bone
Mesenchyme differentiates into bone marrow
29
bone growth and remodeling
lengthening
growth in thickness
healing bone fractures
bone remodeling (bone metabolism)
30
bone lengthening
At diaphyseal-epiphysial junction where the epiphysial cartilages plate cells multiply, move towards diaphysis/shaft of bone, and become replaced by osteocytes
Is completed by puberty; growth in bone length stops [bone growth stops between ages of 18 and 30 years]
31
bone growth in thickness
Osteoblasts (bone forming cells) in periosteum (diaphysis/shaft) multiply continuously and form osteocytes, increasing the thickness of the bone
32
healing bone fractures
Cartilage laid down at edges of fracture
| Endochondral process of bone replacing cartilage
33
bone remodeling (bone metabolism)
Purpose is to regulate calcium homeostasis, repair micro-damage to bones from everyday stress, and to shape the skeleton during growth
Lifelong, regulated process
Mature (old/defective) bone tissue is removed from the skeleton (bone resorption by osteoclasts) and new bone tissue is formed (ossification or new bone formation by osteoblasts)
34
types of muscles
```
voluntary
involuntary
striated
skeletal
smooth
cardiac
```
35
voluntary muscles
muscle that can be consciously controlled
36
involuntary muscles
muscle that is controlled by the autonomic nervous system (not consciously controlled)
37
striated muscles
muscle tissue that has a striped appearance due to its fiber composition
38
skeletal muscle
voluntary and striated
| attach to bones and control conscious movement
39
smooth muscle
involuntary and non-striated
| in the hollow organs
40
cardiac muscle
involuntary and striated
| only in heart and specialized to pump blood
41
each skeletal muscle is an organ
Composed of skeletal muscle fibers, blood vessels, nerve fibers, connective tissue
Enclosed by connective tissue – the epimysium
42
within each skeletal muscle
Bundles of muscle fibers/cells - fascicles
Enclosed by connective tissue – perimysium
Each muscle fiber/cell enclosed by connective tissue - endomysium
43
within each muscle fiber/cell
Multiple nuclei to produce large amounts of proteins and enzymes
Proteins organized into myofibrils
Hundreds to thousands of myofibrils within one muscle fiber/cell
Sarcoplasmic reticulum – store, release and retrieve calcium ions
44
within each myofibril
Thousands of sarcomeres
Sarcomeres – smallest functional unit of muscle fiber/cell
Each sarcomere - contains organized arrangement of contractile, regulatory and structural proteins
45
synovial fluid
synovia
lubricates the cartilage and reduces friction between the articular cartilages of the joints during movement
shock absorber by becoming more viscous under pressure to protect the joint from shocks
46
ATP required for
muscle contraction and relaxation:
| ATP is stored in resting muscles
47
calcium required to
contract muscle fibers:
| Calcium flows out to allow muscles to relax and lengthen again
48
nervous system signals
muscle fiber stimulating myosin filaments and pulling actin filaments closer together, shortening the sarcomeres within the fiber and causing it to contract
49
neuronal development in first trimester
– rapid brain growth with differentiation into cerebrum, cerebellum, brain stem and spinal cord; brain susceptible to injury
50
neuronal development in second trimester
neuronal development and differentiation [mature and specialize] leading to detectable reflex movements in fetus by 15th week of gestation; majority of neurons formed by end of second trimester
51
neuronal development in third trimester
formation of synapses between neurons and nervous system; myelination begins late in trimester and continues into adolescence
52
age related changes on bones and joints
```
decreased bone mass and minerals
decreased calcium reabsorption
shortening of vertebrae
thinning of intervertebral disks
deterioration of cartilage
```
53
age related changes on muscles
```
muscles fibres atrophy
decreased muscle mass and strength
decreased ROM
shrinking/hardening of tendons
muscles cramps more common
```
54
musculoskeletal disorders
Musculoskeletal disorders (MSDs) include injury or disorder of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissue including sprain, strain and inflammation
55
typical work related MSDs
tendonitis, hand-arm vibration syndrome, and back strains and sprains.
56
risk factors for msk disorders
```
Autoimmune disorder
Calcium deficiency
Falls
Infection
Metabolic disorders
Neoplastic disorders
Obesity
Postmenopausal states
Trauma and injury
```
57
msk system nursing assessment symptom analysis
location, quality, timing, severity, intensity of presented symptoms, and precipitating, alleviating, and associating factors
58
msk system nursing assessment functional assessment
Range of joint motion, muscle strength and tone, self-care deficits
59
msk system nursing assessment medical/family/personal/social history
Recent injury, arthritis, co-morbidities
Bone cancer, osteoporosis, arthritis/autoimmune
Dietary intake, exercise habits, sports, work hazards/potential for injury/repetitive motions
60
common msk assessment tests
phalen's
bulge
mcmurray
61
blood tests specific to msk system
```
alkaline phosphate
calcium
phosphorous
rheumatoid factor
uric acid
human leukocyte antigen
creatine kinase
```
62
msk alkaline phosphate test
```
to identify bone diseases
increased in bone cancer
paget's disease
healing fractures
RA
osteoporosis
```
63
msk calcium test
to monitor calcium levels and detect calcium imbalances
decreased with lack of calcium and vitamin d intake and with malabsorption form the GI tract
increased in bone cancer and multiple fractures
64
msk phosphorous test
to assess phosphorus levels
| increased with bone tumors and phosphate healing fractures
65
msk rheumatoid factor test
to diagnose RA
| also increased in lupus and scleroderma
66
msk uric acid test
to diagnose and monitor the treatment of gout
67
msk human leukocyte antigen test
to diagnose diseases such as juvenile RA and ankylosing spondylitis
68
msk creatine kinase test
to diagnose muscle trauma or disease
| increased in muscular dystrophy and traumatic injuries
69
diagnostic evaluation of msk system
Radiographic examinations:
X-rays
CT scans
MRI
Bone scans
Bone density examination
Evaluate bone mineral density and evaluate the degree of osteoporosis
Arthrocentesis
Withdraw fluid from a joint by needle aspiration
Arthroscopy
Fiber-optic endoscope to examine the joint interior, to diagnose diseases, and to perform surgery
70
effects on immobilized client
```
Physiological
Muscular Skeletal and skeletal
Metabolic
Decreased metabolic rate
Negative nitrogen balance
Hypercalcemia
Cardiovascular
Orthostatic hypotension
Increased work of the heart
Thrombus formation
```
71
psychological effects on immobilized client
Diminished environmental stimuli (isolation and boredom)
Altered perception of self and environment
Increased feelings of frustration, helplessness, anxiety
Depression, anger, aggressive behavior
72
osteoporosis
Metabolic disease characterized by bone demineralization, with loss of calcium and phosphorus salts leading to fragile bones and subsequent risk for fractures.
Occurs from imbalance between new bone formation and old bone resorption
Occurs most commonly in the wrists, hip, and vertebral column (thoracic and lumbar).
Affects 1 in 4 Canadian women and 1 in 8 Canadian men over 50
Fractures from osteoporosis are more common than heart attack, stroke, and breast cancer combined.
73
osteoporosis risk factors
```
Smoking
Early menopause, pregnancy
Excessive use of alcohol
Family history of osteoporosis/osteoporotic fracture
Female gender
Increasing age
Obesity, Cushing syndrome
Insufficient intake of calcium, vitamin C & D, magnesium, phosphorus
High caffeine intake, anorexia, malabsorption conditions
Sedentary lifestyle
White or Asian
Medications
Propensity to fall
Small stature, thin build
```
74
osteoporosis patho
decreased mass (density of bone) and structural deterioration of bone tissue
Cortical bone becomes more porous and thinner
Trabecular bone structural integrity impaired; more porous/less dense framework
Hormones most commonly associated with osteoporosis are growth hormone, thyroid hormone, parathyroid hormone, cortisol
75
osteoporosis clinical manifestations
Classic dowager’s hump or kyphosis of the dorsal spine
Loss of height, often 2-3 inches
Back pain, often radiating around the trunk
Pathologic fractures: often occurring in the distal end of the radius and the upper third of the femur
Compression fracture of spine: assess ability to void and defecate
Fatal complications include fat or pulmonary embolism, pneumonia, hemorrhage, and shock.
76
osteoarthritis
Degradation and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs [osteophytes]
Degenerative joint disease
Affects the weight-bearing synovial joints and synovial joints that receive the greatest stress, such as hips, knees, lower vertebral column, and hands.
77
osteoarthritis risk factors
People can inherit an increased risk of developing osteoarthritis, not the condition itself. This predisposition can be passed through generations in families, but the inheritance pattern is unknown.
Increased age (> 50)
Joint trauma, long-term mechanical stress
Endocrine disorders (hyperparathyroidism)
Drugs (steroids, indomethacin)
Obesity
Smoking
Rheumatoid arthritis
Congenital or acquired skeletal deformities
78
osteoarthritis patho
Altered joint function and damage
Degradation and eventual loss of articular cartilage
Excessive friction [bone against bone] combined with risk factors
Variable degrees of mild synovitis and thickening of the joint capsule
Degraded articular cartilage released into synovial cavity initiates synovial inflammation
79
primary (idiopathic) osteoarthritis
Most common, of unknown etiology
Localized OA [to one or 2 joints]: affects the hands, feet, knee, hip, and spine
Generalized OA [GOA/polyarticular/multi-joint OA]: involvement of 3 or more joint sites
80
secondary osteoarthritis
```
occurs after injury
Post-traumatic or mechanical
Post-inflammatory or post-infection
Heritable skeletal disorders
Endocrine disorder
Atypical joint trauma due to loss of proprioceptive senses
Avascular necrosis
Congenital malformations
```
81
osteoarthritis diagnostic evaluation
```
X-ray studies of affected joints
Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
Hyaluronic acid
Lubricating substance in cartilage and joint synovial fluid
May be a useful marker indicating the presence and severity of OA
```
82
clinical manifestations of osteoarthritis
```
Appear in the 5th or 6th decade of life
Pain
Stiffness
Enlargement of the joint
Crepitus
Tenderness
Limited motion
Deformities
Weight loss
Fever
Heberden and Bouchard nodes
```
83
scoliosis
Most common spinal deformity
| Abnormal sideways curvature of the spine -- lateral curvature and rotation.
84
nonstructural vs structural scoliosis
Nonstructural -- results from a temporary cause other than the spine itself (i.e. posture); involves only side-to-side curvature; Functional scoliosis
Structural -- involves spinal rotation and side-to-side curvature; most common
85
adult degenerative scoliosis
Two categories: Degenerative Scoliosis and De novo (new) Scoliosis
Degenerative scoliosis occurs in an adult with a history of scoliosis
De novo scoliosis first appears in adulthood
Common condition that occurs later in life as the joints in the spine degenerate – “wear and tear” of spine due to age
Typically diagnosed after age of 50
86
scoliosis diagnostic evaluation
Adam’s Forward Bend Test: initial screening test
Standing radiographs to determine degree of curvature
Cobb angle: Measure scoliosis curve
Curve < 10 ° considered a postural variation
Curve < 20 ° is mild; if nonprogressive - no treatment required
Curve > 25 ° significant
Curve > 45-50° severe
Risser scale: Evaluate skeletal maturity on the radiographs
Tanner Scale: Assess maturity to predict curve progression
87
scoliosis clinical manifestations
Shoulders are uneven – one or both shoulder blades may stick out
Head is not centered directly above the pelvis
One or both hips are raised or unusually high
Rib cages are at different heights
Waist is uneven
The appearance or texture of the skin overlying the spine changes (dimples, hairy patches, color abnormalities)
The entire body leans to one side
88
muscular dystrophy types
```
duchenne MD
becker MD
psudohypertrophic MD
limb-girdle MD
facioscapulohumeral (landouzy-dejerine) MD
```
89
duchenne MD
DMD
Most severe and common of the muscular dystrophies of childhood:
Dystrophin protein is missing or found in very small amounts
Dystrophin protein is needed for muscles to function properly
X-linked recessive inheritance
Generally affects males
Female carriers – mild or no symptoms
Incidence: 1 in 3,600 male births
Early onset -- usually between 3 and 5 years of age
Survival – early 30’s
90
DMD diagnostic evaluation
```
Mutations to the dystrophin gene
Confirmation by electromyelography (EMG)
Muscle biopsy
Serum enzyme measurement
Serum creatinine kinase levels are extremely high in the first 2 years of life, before the onset of clinical weakness.
```
91
DMD clinical manifestations
Slow motor development
Progressive weakness
Muscle wasting
Pseudohypertrophy:
Calf muscle hypertrophy in most patients
Muscular enlargement caused by deposits of fat and fibrous tissue
Sitting and standing are delayed
The child is clumsy, falls frequently, and has difficulty climbing stairs
As muscle weakness progresses respiratory weakness breathing difficulties (susceptible to respiratory tract infections)
Death from respiratory or cardiac failure:
Usually in late teens or 20’s
Some degree of learning disability—cognition and behaviour
92
Becker's MD
X-linked recessive
Primarily affects males
Females as carriers
mutation in dystrophin gene – results in abnormal version of dystrophin
Symptoms are similar to Duchenne but onset is later in childhood and progression is slower
Initial signs:
Muscle weakness presents between 5 – 15 years of age
Cardiomyopathy can be first sign in some cases
Incidence: 1 in 30,000 live births for the Becker type
Death due to heart or respiratory complications in 4th decade
93
pseudohypertrophic MD
Muscular enlargement caused by deposits of fat and fibrous tissue
Gradual deterioration of muscles
94
limb-girdle MD
Autosomal dominant or recessive disease of later childhood, adolescence, or early adulthood
Atrophy/wasting and weakness of voluntary muscle of hip and shoulder areas
Varied progression depending on subtype
95
facioscapulohumeral MD
Inherited as an autosomal dominant disorder of early adolescence
Initially affects skeletal muscles of face, scapula, and upper arms
Progression is slow and the lifespan is usually unaffected
96
cerebral palsy
Defined as a group of permanent disorders of the development of movement and postures, causing activity limitations attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.
Characterized by abnormal muscle tone and coordination
Most common permanent physical disability in childhood
Global Incidence: 1.5 to > 4 per 1,000 live births
~ 40% of children with CP will also have epilepsy
97
cerebral palsy risk factors
```
Prenatal brain abnormalities:
80% of cases are caused by unknown prenatal factors
Intrauterine exposure to intrauterine infection
Intrauterine growth restriction
12% of infants born prior to 36 weeks
Result of shaken baby syndrome
Additional Factors:
Bacterial meningitis
Motor vehicle accidents
Increased risk for CP is found in mother > 40 or < 20 years of age
Mothers or fathers of African American ethnicity
Premature
Multiple births
Low birth weight
Blood type incompatibility
Neonatal sepsis
```
98
types of cerebral palsy
spastic
dyskinetic (athetoid)
ataxic
mixed
99
spastic CP
Cerebral cortex or pyramidal tract injury
| 75% of cases
100
dyskinetic CP
Extrapyramidal, basal ganglia injury (may be associated with kernicterus)
10-15% of cases
101
ataxic CP
Cerebellar (extrapyramidal) injury
| 5-10% of cases
102
mixed CP
Injury to multiple areas (5-10% of cases)
103
cerebral palsy diagnostic evaluation
```
usually based on clinical findings (Achievement of Developmental Milestones
Meeting standards for height and weight
Reflexes
Focus and Hearing
Posture and movements)
Ultrasonography
Fetal and neonatal abnormalities of the brain
Neuroimaging (CT, MRI)
Metabolic and genetic testing
Neuromotor tests
Evaluate the presence of normal movement patterns and absence of primitive reflexes and abnormal tone
Delays in key areas of motor function, such as:
Holding his/her head up
Rolling over
Visual alertness
Sitting
Crawling
Walking
Picking up small objects
```
104
possible motor clinical signs of cerebral palsy
Lack of muscle coordination
Shaky, spastic movements
Muscles may become extremely stiff or extremely loose
Difficulty in controlling certain body movements
Inability to grasp small objects
Using the arms to pull themselves around while the legs drag behind (most prominent after 6 months of age and into the toddler years)
Slow, writhing movements
Excessive drooling due to the inability to control facial muscles
Favoring one side of the body over the other side
Poor head control and clenched fists after age 3 months
Stiff or rigid limbs
Arching back and pushing away
Floppy tone
Unable to sit without support at 8 months
Seizures, sensory impairment
After 6 months, persistent tongue thrusting
105
common developmental delays with cerebral palsy
Failure to sit alone without assistance by six months of age
Failure to roll over without assistance by four months of age
Failure to walk by age two
Failure to smile by six weeks of age
Failure to climb stairs by three years of age
Failure to stand on one foot (for a few seconds) by three years of age
106
possible behavioural clinical signs with cerebral palsy
```
Excessive irritability
No smiling by age 3 months
Excessive sleeping
Lack of interest in surroundings
Feeding difficulties
30-50% of CP patients have some level of cognitive impairment
```
107
spina bifida patho
Congenital neural tube defect
| Incomplete closure of vertebrae of neural tube
108
3 types of spina bifida
Spina Bifida Occulta
Meningocele
Myelomeningocele
109
spina bifida predisposing factors
```
Folic Acid deficiency
Genetic factors: family history, previous birth of child with spina bifida
Additional factors:
Maternal obesity
Maternal diabetes mellitus
Low maternal vitamin B12
Maternal hyperthermia
```
110
new born assessment of spina bifida occulta
Usually no signs or symptoms
| May have visible indications – abnormal tuft of hair or small dimple/birthmark or lipoma usually midline lumbosacral
111
new born assessment of meningocele
CSF-filled sac; no central nervous tissue
| No neurological defects
112
new born assessment of myelomeningocele
Severe form—diagnosed prenatally or at birth
Spinal canal remains open along several vertebrae in the lower or middle back.
Both the membranes and the spinal cord or nerves protrude at birth, forming a sac, which may or not be covered by skin.
113
spina bifida diagnostic evaluation
```
Clinical manifestations
Examination of the meningeal sac
Evaluate the brain and spinal cord:
MRI
Ultrasound
CT
Myelography
Prenatal screening via ultrasound scan of the uterus
Prenatal maternal concentration testing for α-fetoprotein (elevated
```
114
chronic challenges of living with spina bifida
```
Myelomeningocele – infant surgery
Hydrocephalus -- infant shunt surgery; ongoing as child grows
Tethered Spinal Cord
Mobility and Physical Activity
Using the Bathroom
Skin Care
Latex (Natural Rubber) Allergy
Health Checks
Other concerns –quality of life; mental health; lifestyle; learning; relationships
```
115
adults living with spina bifida
Have unique and specific medical and social needs
Pain issues: shoulders, back, neuropathic
Neurogenic bowel and bladder common – lead to kidney failure, dialysis
Hypertension
Lifelong management of hydrocephalus
Tethered cord syndrome – scoliosis, gait changes, spasticity
Cognitive impairment
