Chapter 23 Musculoskeletal System

temporomandibular joint (TMJ)

- you inspect the area just anterior to the ear - crepitus and pain occur with TMJ dysfunction during movement of teeth also causes palpable or audible check

How does lifestyle contribute to musculoskeletal changes?

-a sedentary lifestyle hastens musculoskeletal changes of aging -physical exercise increases skeletal mass and helps prevent or delay osteoporosis -physical activity delays or prevents bone loss in postmenopausal women in a dose-dependent manner

Muscles

-account for 40-50% of the body's weight -contract to produce movement -Skeletal, smooth, cardiac

Things to check for in adolescents playing sports?

-assess safety of sport for child -note if childs height and weight are adequate for a particular sport -use of safety equipment and presence of adult supervision decrease risk for sport injuries -students may not report injury or pain for fear of limiting participation in sport

What does BMD mean?

-bone mineral density - a higher BMD values means a denser bone - a lower BMD value is a strong and consistent predictor of hip and vertebral fracture among postmenopausal women

growth of long bones continues until closure of the epiphysis at what age?

20 years old

Humans have how many vertebrae?

7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3 or 4 coccygeal vertebrae

joint

A place where two or more bones meet. they are the functional units of the musculoskeletal system because they permit the mobility needed for ADLs

A patient has been diagnosed with osteoporosis and asks the nurse, "What is osteoporosis?" What is the best explanation by the nurse? a."It is the loss of bone density." b."It is an increase in bone matrix." c."It is new bone growth that is weaker." d."There is a decrease in phagocytic activity."

ANS: A After age 40 years, a loss of bone matrix (resorption) occurs more rapidly than new bone formation. The net effect is a gradual loss of bone density, or osteoporosis. The other options are not correct. There is a decrease, not increase, in bone matrix with aging; new bone growth is slower than the loss of bone matrix (not weaker bone growth); and phagocytic activity has nothing to do with bones.

A woman who is 8 months pregnant comments that she has noticed a change in her posture and is having lower back pain. The nurse tells her that during pregnancy, women have a posture shift to compensate for the enlarging fetus. What is the term for this shift in posture? a. Lordosis b. Scoliosis c. Ankylosis d. Kyphosis

ANS: A Lordosis compensates for the enlarging fetus, which would shift the center of balance forward. This shift in balance, in turn, creates a strain on the low back muscles, felt as low back pain during late pregnancy by some women. Scoliosis is lateral curvature of portions of the spine; ankylosis is extreme flexion of the wrist, as observed with severe rheumatoid arthritis; and kyphosis is an enhanced thoracic curvature of the spine. Scoliosis is lateral curvature of portions of the spine; ankylosis is extreme flexion of the wrist, as observed with severe rheumatoid arthritis; and kyphosis is an enhanced thoracic curvature of the spine. The symptoms this patient is experiencing are lordosis.

An 85-year-old patient comments during his annual physical examination that he seems to be getting shorter as he ages. Why does height decrease with aging? a. The vertebral column shortens. b. Long bones tend to shorten with age. c. A significant loss of subcutaneous fat occurs. d. A thickening of the intervertebral disks develops.

ANS: A The vertebral column shortens. Postural changes are evident with aging and decreased height is most noticeable due to shortening of the vertebral column. Long bones do not shorten with age. Intervertebral disks actually get thinner with age. Subcutaneous fat is not lost but is redistributed to the abdomen and hips.

The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? a.Assessing bone density annually b.Taking medications to prevent osteoporosis c.Performing physical activity, such as fast walking d.Taking 800 mg calcium and 200 IU vitamin D supplements daily

ANS: C Physical activity, such as fast walking, delays or prevents bone loss in perimenopausal women. The faster the pace of walking, the higher the preventive effect is on the risk for hip fracture. The other options are not correct. Annually assessing bone density does not prevent or delay bone loss, it just monitors it. There are no medications to prevent osteoporosis, but to treat it. Taking 800 mg calcium and 200 IU vitamin D supplements daily is not enough to meet the recommended daily doses for a perimenopausal woman. The best way to prevent or delay bone loss is exercise.

What are the fibrous bands that run directly from one bone to another, strengthen the joint, and help prevent movement in undesirable directions called? a. Bursa b. Tendons c. Cartilage d. Ligaments

ANS: D Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called ligaments. The other options are not correct.

What is the first line of therapy for osteoporosis

Bisphosphonates - hormone therapy is not recommended due to risk factors

The knee joint is the articulation of three bones, the: A) femur, fibula, and patella. B) femur, radius, and olecranon process. C) fibula, tibia, and patella. D) femur, tibia, and patella.

C) fibula, tibia, and patella.

To palpate the temporomandibular joint, the nurse's fingers should be placed in the depression _____ of the ear. A) distal to the helix B) proximal to the helix C) anterior to the tragus D) posterior to the tragus

C.) Anterior to the tragus

rheumatoid arthritis

Chronic inflammatory and painful disease of joints; caused by autoimmune reaction against joint tissues (synovial membrane). -pain is worse in the morning - occurs 2.5 more in women than in men; its peak ages is 30-60 years

True or false. Do long bones shorten with age?

FALSE; long bones do not shorten with age

abduction

Movement away from the midline of the body

Adduction

Movement toward the midline of the body

________________________ ___________________ ______________ may limit range of motion and cause pain and muscle spasms during abduction, whereas forward flexion remains fairly normal.

Rotator cuff lesions

fracture

a break in a bone

lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition); compensates for the enlarging fetus. it creates strain on the lower back muscles , which in some women is felt as low back pain during late pregnancy

intervertebral discs

are elastic fibrocartilaginous plates that cushion the spine similar to shock absorbers and help it move

cartilaginous joints

are separated by fibrocartilaginous dics and are only slightly movement (eg. vertebrae)

Any occupational hazards that could affect the muscles or joints be sure to

assess risk for back pain or carpel tunnel syndrome

Flexion

bending a limb at a joint

acromion process

bump on the highest portion of the shoulder (scapula)

At what month does the fetus form a "scaled model"?

by 3 months gestation. during the next few months in utero, the cartilage ossifies into true bone and starts to grow through adolescence

If a pt. has osteoporosis what two supplemental medications are recommended?

calcium and vitamin D

Ortolani maneuver

check hips for congenital dislocation, done until 1 yr old, should be smooth with no sounds, abnormal= feels like a clunk as head of femur pops back into place- positive ortolani sign

dislocation

complete loss of contact between the two bones in a joint

positive bulge sign

confirms the presence of swelling caused by fluid in the suprapatellar pouch

dysplasia of the hip (DDH)

congenital dislocation of the hip

bone remodeling

cyclic process of bone resorption and deposition respobsibile for skeletal maintenance at sites that need repair or replacement

What postural changes are evident with aging?

decreased height of 3-5 cm occurs with shortening of the vertebral column caused by loss of water content and thinning of the intervertebral discs and by a decrease in height of individual vertebrae from osteoporosis - a progressive decrease in height is not evident until 60 years old -a greater decrease occurs in the 70s and 80s as a result of osteoporotic collapse of the vertebrae

Osteoporosis

disease involving the loss of mineralized bone mass and leading to porous bone and thus risk factors

Polydactyly

extra fingers or toes

rheumatoid arthritis symptoms

fatigue, weakness, anorexia, weight loss, low-grade fever, and lymphadenopathy

Traumatic injury increases risks for

fractures (eg. humerus, clavicle). period of anoxia may result in hypotonia of muscles

Synovial joints are

freely movable because they have bones that are separated from one another and enclosed in a joint cavity

the ________________________________ _________________ of the femur is palpated when the person is standing, and it appears as a flat depression on the upper lateral side of the thigh

greater trochanter

lateral tilting and sciatic pain with straight leg raising are findings that occur with a

herniated nucleus pulposus

The knee is a ___ joint, permitting movement (flexion and extension) between the femur and tibia on one plane

hinge

the ischial tuberosity lies under gluteus maximus muscle and is palpable when the _____________________________

hip is flexed

Peak bone or bone mineral density (BMD) is reached?

in the early to late 20s

increased levels of circulating hormones (estrogen, relaxin from the corpus luteum, and corticosteroids) cause:

increased mobility in the joints. which contributes to changes in maternal posture

crepitation

is an audible and palpable crunching or grating that accompanies movement - it occurs when the articular surfaces in the joints are roughed, as with RA

is joint pain associated with chills, fever, recent sore throat, trauma, repetitive activity?

joint pain 10-14 days after an untreated strep throat suggests rheumatic fever. Joint injury occurs from trauma or repetitive motion

What are the most common concerns that prompt a person to seek care?

joint pain and loss of function

depression

lowering a body part

the joint located just above the ring finger is the ___________________joint

metacarpophalangeal

pronation

movement that turns the palm downward

Supination

movement that turns the palm up

retraction

moving a body part backward and parallel to the ground

protraction

moving a body part forward and parallel to the ground

Circumduction

moving the arm in a circle around the shoulder

rotation

moving the head around a central axis

inversion

moving the sole of the foot inward at the ankle

eversion

moving the sole of the foot outward at the ankle

Osteoporosis

noninflammatroy, localized, progressive disorder involving deterioration of articular cartilages and subchondral bone remodeling, synovial inflammation, and formation of new bone at joint surfaces -increased risk occurs with older age, females, and caucasians -obesity increases risk and progression of OA, especially in the knee -affected joints have stiffness, swelling with hard, bony protuberances; pain with motion, and limitation of motion -pain is worse later in the day movement makes it worse

During inspection of the musculoskeletal system

note the size and contour of every joint. inspect the skin tissues over the joints for color, swelling, and any assess or deformity - swelling may be excess joint fluid (effusion), thickening of the synovial lining, inflammation of surrounding soft tissue (bursae, tendons), or bony enlargement

Lengthening of long bones

occurs at the epiphysis, or growth plates.

What does is mean when you hear a "pop" in an injury?

pop may mean tear in ligament or fracture. - with direct knee trauma, obtain an x-ray if the pt. is unable to flex the knee to 90 degrees or unable to bear weight for 4 steps, if pain is experienced at the fibula head or patella, or if a patient is over 55 years

Trauma or infection at the epiphysis can:

put the growing child at risk for bone deformity

elevation

raising a body part

What increases bone density at the hip and lumbar spine?

resistance and weight bearing exercises, but the exercise needs to be regular and high intensity

If patient is taking any medications for musculoskeletal system:

review daily aspirin and NSAID schedule; screen for adverse effects such as GI pain, bleeding

contracture

shortening of a muscle leading to limited ROM of joint

The effects of smoking and drinking for osteoporosis pts.

smoking increases bone loss and risk of fracture in older women; moderate-to-heavy alcohol drinking increases fall risks

bone and cartilage

specialized forms of connective tissue

ankylosis

stiffness or fixation of a joint

extension

straightening a limb at a joint

an imaginary line connecting the highest point on each iliac crest crosses

the fourth lumbar vertebra

a rotator cuff injury involves

the glenohumeral joint, which is inclosed by a group of 4 powerful muscles and tendons that support and stabilize it

phalan test

the nurse should ask the person to hold both hands back to back while flexing the wrists 90 degrees. It produces numbness and burning in a person with carpal tunnel syndrome

tibial torsion

twisting of the tibia

syndactyly

webbed fingers or toes