MUSCULO

SKELETAL
NURSING
MUSCULOSKELETAL
DISORDERS
UPPER EXTREMITY
DISORDERS
1. Bursitis and Tendonitis
Bursitis - inflammation of bursae
Tendonitis - inflammation of muscle tendon sheaths with repetitive stretching
INTERVENTIONS: Self-limiting + Pain relief!
a. Conservative treatments
- rest + intermittent ice and heat to joint + NSAIDs
b. C________ i________
c. A________ s________ if shoulder pain and weakness persist

2. Loose Bodies (Joint Mice)

- occurs in joint spaces as result of articular cartilage wear and bone erosion
- fragments interfere with joint movement
- Arthroscopic surgery if causes pain or mobility issues
3. Impingement Syndrome
- general term for impaired movement of rotator cuff of shoulder
- occurs from repetitive o______ movement of arm or acute trauma
= r______ c__ t____ or s______ b___ grainst against c________ arch
ASSESSMENT: INTERVENTION:
Early:
- edema
- muscle spasm
- limited movement
- tender and painful shoulder
- eventual disuse atrophy
4. Carpal Tunnel Syndrome
- e_______ n_______ when m_____ nerve is compressed by thickened flexor tendon
sheath, skeletal encroachment, edema, or soft tissue mass
RISK FACTORS:
- Women
- __ to __ years old
- Comorbidities: R.A., diabetes,
acromegaly, hyperthyroidism, trauma
ASSESSMENT:
- pain
- numbness
- paresthesia
- positive T____’s sign
- night pain and/or fist clenching
upon waking up
- weakness along median nerve
distribution
INTERVENTIONS:
Nonsurgical
1. Acupuncture
2. Wrist splints to prevent hyperextension
3. Oral or intra-articular injection of corticosteroids or NSAIDs
Surgical (Nerve Release Surgery)
- recovery may take several weeks or months
1. Open nerve release surgery
2. Endoscopic laser surgery
HOW:
1. Local anesthesia
2. Incision into affected wrist
3. Cutting carpal ligament to widen carpal tunnel
4. Splint and limit hand movement during healing
5. Ganglion
- collection of neurological gelatinous material
near tendon sheath and joints
- common in women younger than 50 years
ASSESSMENT:
- round, firm, cystic swelling on dorsum of
wrist causing local tenderness and aching pain
INTERVENTIONS:
a. Aspiration
b. Surgical excision
c. Corticosteroid injection
d. Compression dressing and splint
6. Dupuytren Disease
- slowly progressive contracture (abnormal shortening) of p_____ f____
- starts in one hand but eventually affects both
PATTERN OF INHERITANCE:
RISK FACTORS:
- Men
- Older than 50 y/o
- Scandinavian or Celtic heritage
- Cigarette smoking and alcoholism
- Comorbidities: arthritis, diabetes, gout
ASSESSMENT:
- starts as nodule resulting in flexion
of ___, ___, and even ___ finger
- morning numbness
- dull and aching discomfort
- stiffness in affected fingers

INTERVENTION:
Nonsurgical
- Finger-stretching exercises
- Intranodular injections of corticosteroids
Surgical
- Palmar and digital fasciotomy
LOWER EXTREMITY
DISORDERS
1. Corn 2. Hallux Valgus (Bunion)
- area of h________ by internal pressure - g____ t__ deviates l_____ due to
- fifth toe is most commonly involved marked prominence of medial aspect of
first m_______________ joint
INTERVENTIONS: - osseous enlargement (exostosis) of
1. Podiatrist soaks and scrapes off horny medial site resulting in bursitis
layer
INTERVENTIONS:
2. Protective shield or pad
1. Shoe that conforms to shape of foot
and separation by lamb’s wool or gauze
2. Corticosteroid injections for acute
3. Surgical modification of underlying
inflammation
offending osseous structure
3. Surgical excision of exostosis and toe
realignment
3. Hammer toe 4. Ingrown Toenail (Onychocryptosis)
- free edge of nail plate penetrates
- f_____ deformity of interphalangeal joint
- toes are pulled u_____ while m_______ surrounding skin
joints are forced d_____ - secondary infection or granulation tissue
- corns develop on top while callus under may develop
- caused by improper self-treatment,
INTERVENTIONS:
external or internal pressure, trauma,
1. Open-toed footwear, pads on protruding
infection
joints, orthotics
2. Manipulation exercises INTERVENTIONS:
3. Osteotomy 1. Proper nail trimming
2. Active treatment:
5. Morton Neuroma (Plantar Digital 6. Plantar Fasciitis
Neuroma / Neurofibroma) - inflammation of foot-supporting f_____
- swelling of t____ branch of m_____ - acute onset heel pain with f____ s___ in
p_____ nerve m_____, localized to anterior medial
- throbbing, burning pain in foot relieved aspect and diminishes with gentle
by rest and massage stretching of foot and Achilles tendon
INTERVENTIONS: INTERVENTIONS:
1. Innersoles and metatarsal pads 1. Stretching
2. Corticosteroid or anesthetic injection 2. Shoes with support and cushion
3. Surgical excision of neuroma 3. Orthotic devices
4. Corticosteroid injections
7. Pes Cavus (Clawfoot) 8. Pes Planus (Flatfoot)
- foot with abnormally high arch and fixed - longitudinal arch of foot is diminished
equinus deformity of forefoot - caused by congenital abnormality,
- produces metatarsal and dorsum excessive weight, muscle fatigue,
calluses improper footwear, arthritis
- caused by Charcot-Marie-Tooth disease - burning sensation, fatigue, clumsy gait,
(familial degenerative d/o), diabetes, edema, pain
progressive neurologic disorders
INTERVENTIONS:
INTERVENTIONS:
1. Exercises
1. Exercises
2. Foot orthoses
2. Orthotic devices
3. Arthrodesis (fusion) to reshape and
stabilize foot
ARTHRITIS DISORDERS
RHEUMATOID ARTHRITIS
- a________ destruction of c______ tissue and s______ membrane within joints
- exacerbations occur during periods of physical or emotional stress

Risk Factors:
- ______ thrice than ______
- 3rd & 6th decade of life
- Genetics & family history

Mechanism:
Autoimmune reaction in synovial tissue
ASSESSMENT: Acute b______ & s______ starting from s___ joints
Initial: S______ joint p___ & m______ stiffness __ hour
Progressive:
- S______ or b______ joints on palpation
- Contractures & soft tissue deformities
Deformities:
- U___ deviation & s___ n___
- Rheumatoid nodules - n______ & m______ in subcutaneous tissue

DIAGNOSIS:
1. Joint involvement
2. Serology:
- Rheumatoid factor
- Anti-citrullinated peptide antibody (anti-CCP)
- ESR & CRP
4. Duration of sx
5. X-Ray, ULTZ, MRI

Rheumatoid factor
- blood test to assist diagnosing rheumatoid arthritis
INTERVENTIONS:
EARLY RHEUMATOID ARTHRITIS:
Pharmacological:
1. Nonbiologic vs Biologic Disease-Modifying AntiRheumatic Drugs (DMARD)

* Initially, ________ first

a. Nonbiologic DMARD -

b. Biologic DMARDS - first targeted therapy for RA

2. Janus Kinase (JAK) Inhibitors

3. NSAIDs (COX-2 Blockers)

4. Systemic Corticosteroids
OSTEOARTHRITIS
- non-i________ d________ disorder of joints = progressive d________ of a______
c______ in p______ and a____ joints
- affects weight-bearing joints and with greatest stress
- begins 3rd decade; peaks between 5th & 6th decades

Risk Factors:
1. Women
2. Hispanic or African American
3. Age - >65 y/o
4. O_____
5. Laborious occupations & sports activities
6. Hx of prev. injuries & genetics

Mechanism:
Genetic & hormonal factors/ mechanical injury/ previous joint damage
ASSESSMENT:
- Pain aggravated by m______ or e______ & relieved by r___+ morning stiffness <30
mins
- Enlarged joint + <ROM in weight-bearing joints:
Bouchard’s nodes
Heberden’s nodes
- C______ on palpation over affected knee
- Mild joint effusion but no systemic manifestations

DIAGNOSIS:
X-Ray
INTERVENTIONS:
Nonpharmacological
- Position joint in f______ position
- Avoid l___ p_____ under head or knees

Pharmacological
- Viscosupplementation

Surgical
- O_______ - bone r_______
- A_______ - T___ j___ r_______
GOUT
- systemic disease where u____ c_____ deposit in joints and other body tissues

Types:
1. Primary
2. Secondary

Risk Factors:
1. _____ 3-4x more than _____
2. Age
3. BMI
4. Diet:

Mechanism:
Hyperuricemia
ASSESSMENT:
1. Hyperuricemia
2. Gouty arthritis
3. T____i - crystalline deposition in a______ tissues, c______
4. Uric acid u_____ c_____ & gouty n_______

Stages:
1. Asymptomatic hyperuricemia
2. Acute gouty arthritis
3. Intercritical gout
4. Chronic tophaceous gout
DIAGNOSIS:
Polarized light microscopy of synovial fluid

INTERVENTIONS:
Acute attacks:
1. C______
- anti-mitosis = inhibits B-tubulin polymerization into microtubules

2. NSAID (Indomethacin) or Corticosteroid

Lowering uric acid:

1. X______ o______ inhibitors (A______ & F______)
- blocks enzyme xanthine oxidase

2. U______ agents (P______)

- blocks urate transporter 1 protein

3. Lifestyle changes
 Rheumatoid Osteoarthritis Gout Osteoporosis
Arthritis (Degenerative Joint
Disease)

Definition

Affectation

Pain
Characteristics

Hallmark
assessment data
PEDIATRIC DISORDERS
Congenital Clubfoot (Congenital Talipes Equinovarus)

Types:
Risk Factors::

ASSESSMENT:

INTERVENTIONS:
Ponseti method:
Legg-Calve´-Perthes Disease

Risk Factors:

Mechanism:
Stages:
Stage I - Avascular Stage (Months - 1
year)

Stage II - Fragmentation
or Revascularization Stage (Up to 2
years)
Stage III - Reparative Stage (1-3 years)

Stage IV - Regenerative Stage (Few

years until bone heals)
ASSESSMENT:

DIAGNOSIS:

Mechanism:
INTERVENTIONS:

Initial: Conservative

Surgical:
Fibrodysplasia Ossificans Progressiva

Affected Gene:
Pattern of Inheritance: Autosomal Dominant

ASSESSMENT:

INTERVENTIONS:
Marfan’s Syndrome

Affected Gene:
Pattern of Inheritance: Autosomal Dominant

ASSESSMENT:

INTERVENTIONS: