Assessment of Musculoskeletal Function (CH. 40)

Sex hormones: estrogen and testosterone

1) *Estrogen* stimulates osteoblasts and inhibits osteoclasts thatt's why bone formation is enhanced and resorption is inhibited. 2) *Testosterone* causes skeletal growth in adolescents and increases bone formation.

Muscles

Attached to bones and other structures by tendons. They are composed of fibrous tissue called *fascia*. The more fascia contained in a muscle, the more precise the movements are.

Short bones

Found in ankles or hands

Long bones

Found in upper and lower extremities

Flat bones

Found where underlying structures are needed (Ex: Sternum of skull)

Calcitrol

Helps increase the amount of calcium in the blood by promoting absorption of calcium in GI tract

Arthrography

Identifies the *cause of joint pain* and progression of joint disease. A contrast agent is injected into the joints to visualize joints. If a tear is present, the contrast agent leaks out and is seen in x-ray image.

Muscle Maintenance

Muscle Tone Muscle Action Exercise

Exercise, disuse and repair

Muscles need to maintain function and strength. When a muscle repeatedly develops maximum tension over a long time, such as regular exercise with weights, the muscles increases. This enlargement is *hypertrophy* due to an increase in the size of individual muscle fibers without increase in number. Age and disuse cause loss of muscular function as fibrotic tissue replaces contractile tissue. Decrease on size of muscle is *atrophy* which can be caused by bedrest and immobility.

Bone Scan

Nuclear medicine test to see for cancer(necrosis, tumors, osteomyelitis)

Calcitonin

Secreted by thyroid gland in response to elevated blood calcium level, inhibits bone resorption and increases deposit of calcium in bone

Arthocentesis

Synovial fluid is injected in order to help relieve pain in joints and also reveals presence of hemarthrosis, which suggests trauma or bleeding.

Diarthrosis

Synovial joints that are *freely movable*

Amphiarthrosis

cartilagenous joints that allow *limited motion* (vertebral joints and symphysis pubis)

Synarthrosis Joints

fibrous joints which are *immovable* because of fibrous tissue banding (skull sutures)

Joints

junction of two or more bones

Dietary foods for Calcium

low-fat milk, cheese, yogurt, orange juice, cereal, and bread

Assessment

1) Include *data* related to function ability: ADLs, IADLS, ability to perform various activities or if they have any mobility problems 2) *Health history*: general health or nutrition. If patient is obese, they will have this pressure that will lead to osteoarthritis. *Think about patient's lifestyle* (Do they walk a lot? Do they just sit down all the time?* 3) *Meds*: Such as steroids can eat up the calcium and Vitamin D in your body. Ex: Rheumatoid Arthritis(joint inflammation of ahnds and feet) 4) Assessment of *pain and altered sensations* like paresthesias (numbness, tingling or burning) 5) *Physical Assessment*: posture, gait, bone integrity or joint function

Bone remodeling

A process where old bone is removed(resorption) and new bone is added to the skeleton(formation)

What if patient has Hypercalcemia?

As a nurse, the first thing you would think of is cancer, which will cause the bone to dissolve or breakdown.

Muscle Action

Body should be able to perform a wide variety of movements due to coordination of muscle groups.

Biopsy

Determines the structure and composition of bone marrow, bone, muscle or synovium to help diagnose specific diseases.

Bone Densitometry

Evaluates bone mineral density

Osteoblasts

Function in bone formation by secreting bone matrix which consists of collagen and ground substances (glycoproteins and proteoglycans) that provide a framework in which inorganic mineral salts are deposited.

Irregular bones

Includes bones of vertebrae or jaw

Osteocytes

Mature bone cells involved in bone maintenance

Osteoclasts

Multinuclear cells that are involved in dissolving and reabsorbing bone

Radiographs (X-Ray)

Shows how the bone looks like. If person is conclusive or demented, you may not get a clear picture of bone because this person may be moving a lot and might not be able to stay still

Growth hormone

Stimulates liver to produce produce insulinlike growth factor which helps in bone modeling in children and adolescents

Electromyography

This test is performed to evaluate muscle weakness, pain and disability. The purpose is to determine any abnormality in the muscles or nerves.

Lab studies

Vitamin D, Calcium, CMP, CBC, RBC, hormones

Osteogenesis

bone formation that begins before birth

The balance between bone resorption and formation is influenced by following factors:

1) Nutrition 2) Physical Activity 3) Hormones: Calcitrol (Vitamin D), PTH, Calcitonin, Thyroid hormone, Cortisol, Growth Hormone and sex hormones like estrogen and testosterone.

Bone Healing

1) When the bone is fractured, the bone begins a healing process to reestablish strength. The bone fragments are not patched with scar tissue, instead, the bone regenerates itself. 2) When a bone breaks always think of how you can prevent further damage 3) Pay attention to alignment (reduce fracture) by keeping it together so that bone can start to heal.

Skeletal Muscle Contraction

1) Each muscle cell contains units called sarcomeres which are composed of thick myosin and thin actin filaments. 2) Muscles contract to bring two points of attachment together resulting in *movement* 3) Main source of energy for muscle contraction is *ATP* 4) During periods of strenous activity, when sufficient oxygen is not available, glucose is metabolized into lactic acid 5) During muscle contraction, energy released from ATP is not completely used. Instead, the excess energy is scattered in the form of heat. Seen in isotonic or isometric exercises.

Muscle Tone (Seen in CVA, Hip fracture or disabilities)

1) Maintenance of some of the muscle fibers in a contracted state. 2) It is minimal when a person sleeps or is anxious 3) Flaccid: limp muscle, no tone 4) Spastic: muscle with greater than normal tone 5) Typically upper motor neuron has increased tone (hyperactive), while lower motor neuron has decreased tone(atonic)

Physical Activity

1) Particularly weight bearing activities help stimulate bone formation and remodeling. Therefore, bones are thick and strong. 2) People who don't engage in weight bearing activity or have physical disabilities have increased bone resorption from calcium loss and bones become weak and may fracture easily.

Function of Musculoskeletal System

1) Protects vital organs: heart, brain, lungs 2) Mobility and Movement 3) Produce heat to maintain temperature 4) Brings deoxygenated blood back to the right side of heart 5) Produces red blood cells and essential minerals

PTH (Parathyroid hormone)

1) Regulates the calcium in blood by promoting movement of calcium from bone. 2) In response to low calcium levels in the blood, increased levels of PTH, encourage the mobilization of calcium, demineralization of bone and formation of cysts