Care of the Patient with a Musculoskeletal Disorder PN 135.

Care of the Patient with a Musculoskeletal Disorder

PN 135

Overview of Anatomy and Physiology

• Divisions of the skeleton–Axial-• Cranium (skull, face, and ears), vertebrae,

ribs–Appendicular• Limbs, shoulders, pelvis, hips

Divisions of Skeleton

• 206 bones total• Axial skeleton– 80 bones– Head & trunk

• Appendicular skeleton– 126 bones– Extemeties, shoulders, hips

Figure 44-2

Skeleton, anterior view.

(From Thibodeau, G.A., Patton, K.T. [1997]. The human body in health and disease. [2nd ed.]. St. Louis: Mosby.)

Figure 44-3

Skeleton, posterior view.

(From Thibodeau, G.A., Patton, K.T. [1997]. The human body in health and disease. [2nd ed.]. St. Louis: Mosby.)

Overview of Anatomy and Physiology

• Functions of the skeletal system– Support–Protection–Mineral storage-calcium/phosphorus–Movement–Hemopoiesis

• Structure of bones– Long, short, flat, and irregular

Functions of the Skeletal System

• Support– Rigid framework– Supports against pull of gravity– “hanger” for our muscles!


• Protection– Soft body parts– Brain– Heart– Lungs– Vascular system


• Movement– Provide sites for muscle attachment– Bones and muscles work together as simple

mechanical lever systems to produce body movements.


• Mineral Storage– The bones serve as a storage specifically for 2

minerals—calcium and phosphorus– Intercellular matrix of bone contains large

amounts of…• Calcium• When blood calcium levels drop• Calcium is released from the bones• Excess Calcium is stored in the bone


• Storage– Bone tissue contains smaller amounts of…• Sodium • Magnesium• Potassium• Carbonate


• Hematopoesis – Blood cell formation– Takes place in red marrow of bones– Infants primarily have red marrow– As we age red marrow changes to yellow marrow

for fat storage


• Hematopoesis (cont.)

– Adults• Red marrow is limited to the spongy bone–Skull–Ribs–Sternum–Clavicles–Vertebrae–Pelvis


• Red Marrow Functions– Formation of…• Red Blood Cells• White Blood Cells• Blood Platelets


• Red Marrow (summary)– Manufactures blood cells – Found in ends of long bones– Center of other bones

• Yellow Marrow (summary)– Shaft of long bones– Composed largely of fat

Bones

• Bones stop growing in length by late teens, early 20’s

• Children- bone repair is much faster• Elderly- past active phase, repair takes longer,

bones more fragile

Types of Bone

• Types of Osseous/Bone Tissue• Cancellous– Spongy

• Epiphysis, end of long bone & center or others• Filed with red marrow

• Cortical– Compact

• Diaphysis, shaft of long bone• Outer layer of other bones• Haversion canal contains nerves and blood vessels

Types of Bones

• Short bones and flat bones– Cancellous/spongy covered by Cortical/compact

• Irregular – e.g. vertebrae• Long bones– Ends are Cancellous/Spongy– Shafts are Cortical/Compact

Types of Bone

• Four classifications based on form and shape:– 1. Long – eg. Humerus– 2. Short – eg. Phalanges of the fingers– 3. Flat – eg. Occipital, sternum– 4. Irregular - eg. Vertebrae

Classification

• Long Bones: longer than they are wide

• Short Bones: – roughly cube-shaped– Vertical and horizontal dimensions approx. =– E.g. Wrist, ankle

Classification

• Flat bones: – Thin, flattened, usually curved– Made like sandwich with a middle layer of

spongey bone called diploӫ. The diploӫ is covered on each side by a layer of compact bone.

– E.g. Cranium

Classification

• Irregular Bones– One of a group of bones having peculiar or

complex forms• E.g vertebrae

Structure of Bones

Bone Membranes

• Periosteum– Membrane on outside of bone– Contain osteoblasts

• Endosteum– Lines marrow cavity– Cells aid in growth and repair

Bone Cells and Actions

• Osteoblasts- build bone• Osteocytes- are mature bone cells • Osteoclasts- break bone down

Projections

• Head- rounded knob– At end of bone– E.g. ____________________

• Process- large projection– E.g. Spinous process on vertabrae

• Crest- border or ridge– E.g. __________________

• Spine- sharp projection– E.g. spine of scapula

Depressions or Holes

• Foramen- hole allows vessel or nerve to pass through

• Sinus- air space in some skull bones• Fossa- depression• Meatus- short channel or passage– E.g. Passage to inner ear

12 Ribs

• True Ribs– First seven pair– Attach to sternum by costal cartilage

• False Ribs– Next five pair• 8th, 9th, & 10th attach to rib above • 11th & 12th have no anterior attachment (Floating ribs)

Vertebral Column

• Cervical vertebrae- 7, support & move head• Thoracic vertebrae- 12, ribs attached here• Lumbar vertebrae- 5, support weight• Sacral vertebrae- 5, fuse to single bone• Coccyx – 4-5 in child– Fuse to 1 in adult

Bones and Joints

Bones and Joints

• Bursa– Fluid-filled sacs– Joint movement

• Fascia– Connective tissue– Includes tendons, ligaments, and aponeuroses

• Tendons– Attach muscle to bones

• Ligaments– Bind joints together

Overview of Articulations

• Articulations (joints)Connect bones and allow movement–Three types according to degree of

movement• Synarthrosis—no movement• Amphiarthrosis—slight movement•Diarthrosis—free movement

Joints

• Diarthrosis-freely moveable– Hinge: elbow, knee– Ball and socket: hip and shoulder– Pivot: skull and 1st vertabrae

• Synarthrosis-immovable– Sutures

• Amphiarthrosis-slightly movable– Vertebrae and pelvis

Diarthrosis• Hinge: permitting only flexion and extension as in

the elbow and knee joints.

• Gliding: Flat or slightly flat surfaces move against each other allowing sliding or twisting. This happens in the carpals in the wrist and the tarsals in the ankle.

Diarthrosis• Ball-and-Socket: The ball-shaped end of one

bone fits into a cup shaped socket on the other bone allowing the widest range of motion including rotation. Examples include the shoulder and hip.

• Pivot: An example is the joint between the axis and atlas in the neck.

Diarthrosis

• Articulating Joints– Covered with articular cartilage– Have joint capsules• Outer layer-fibrous• Inner layer- synovial, secretes synovial fluid to lubricate

joints

Types of Joints

Structure of a freely movable (diarthrotic) joint.

Synovial Joint Movement

• Flexion-decreases angle between bones (close fingers)

• Extension-increases angle between bone (open fingers)

• Abduction-movement away from midline• Adduction-movement toward midline

Joint Movement

• Rotation-twisting or turning–Supination-turn up–Pronation-turn down– Inversion-turning inward–Eversion-turning outward

Synarthrosis and Amphiarthrosis

• Fibrous joint– Fibrous connective tissue– E.g. sutures in skull– Immovable, synarthrosis

• Cartilaginous joint– Connected by cartilage– E.g. vertebrae and ribs connecting to sternum– Slightly movable, amphiarthrosis

Care of the Patient with a Musculoskeletal Disorder PN 135.

Documents

Transcript of Care of the Patient with a Musculoskeletal Disorder PN 135.