Introduction to the

Musculoskeletal System
Frengki Apryanto, Ns., M.Kep
Medical/Surgical Nursing
 Learning Objectives

On completion of this chapter, you will be able to:

1. Describe major structures and functions of the
musculoskeletal system.
2. Discuss elements of the nursing assessmen t of
the musculoskeletal system.
3. Identify common diagnostic and laboratory tests
used in the evaluation of musculoskeletal
disorders.
4. Discuss the nursing management of clients
undergoing tests for musculoskeletal disorders.
 The musculoskeletal system consists of bones,
muscles, joints, ten-dons, ligaments, cartilage,
and bursae.
It supports the body and facilitates movement.
Other functions include storage of calcium,
phosphorus, magnesium, and fluoride;
production of blood cells in the bone marrow;
and protection and support to body organs,
such as the lungs, heart, and brain.
Injury to or disease in any part of the
musculoskeletal system can cause pain,
immobility, or disability and potentially affect
quality of life.
ANATOMY AND PHYSIOLOGY
Bones
The human body has 206 bones. The bones of
the skeleton are classified
as:
1. Short bones, such as those in the fingers and
toes
2. Long bones, such as the femur and ulna
3. Flat bones , such as the sternum
4. Irregular bones, such as the vertebrae
 Bone is compose d of cells, protein
matrix, and mineral deposits.
The three types of bone cells are
osteoblasts, osteocytes, and
osteoclasts.
 Cells that build bones are called osteoblasts.
These cells secrete bone matrix (mostly collagen),
in which inorganic minerals, such as calcium salts,
are deposited.
This process of ossification and calcification
transforms the osteoblasts into mature bone cells,
called osteocytes, which are involved in
maintaining bone tissue. During times of rapid bone
growth or bone injury, osteocytes function as
osteoblasts to form new bone.
Osteoclasts are the cells involved in the
destruction, resorption, and remodeling of bone.
 A layer of tissue called periosteum
covers the bones (but not the joints).
 Inside the bones are two types of
bone marrow: red and yellow.
Red bone marrow, found primarily
in the sternum, ileum, vertebrae, and
ribs, manufactures blood cells and
hemoglobin.
Long bones have yellow bone
marrow, which consists primarily of
fat cells and connective tissue.
 Muscles
There are three kinds of muscles: skeletal,
smooth, and cardiac.
Skeletal muscles are voluntary muscles;
impulses that travel from efferent nerves of
the brain and spinal cord control their function.
The skeletal muscles promote movement of
the bones of the skeleton. Examples of skeletal
muscles are the biceps in the arms and the
gastrocnemius in the calves
 Smooth and cardiac muscles are
involuntary muscles; their activity is
controlled by mechanisms in their tissue of
origin and by neurotransmitters released
from the autonomic nervous system.
Smooth muscles are found mainly in the
walls of certain organs or cavities of the
body, such as the stomach, intestine,
blood vessels, and ureters. Cardiac muscle
is found only in the heart.
 Joints
A joint is the junction between two or
more bones.
Free moving joints, or diarthrodial
joints, make up most skeletal joints.
They allow certain movements.
Glossary of Diarthrodial Movement
 Tendons
Tendons are cordlike structures that
attach muscles to the periosteum of
the bone.
 Ligaments
Ligaments consisting of fibrous tissue
connect two adjacent, freely movable
bones.
They help protect the joints by
stabilizing their surfaces and keeping
them in proper alignment.
 Cartilage
Cartilage is a firm, dense type of connective
tissue that consists of cells embedded in a
substance called the matrix.
The matrix is firm and compact, thus
enabling it to withstand pressure and torsion.
The primary functions of cartilage are to
reduce friction between articular surfaces,
absorb shocks, and reduce stress on joint
surfaces
 Hyaline or articular cartilage covers the
surface of movable joints, such as the elbow,
and protects the surface of these joints.
Other types of cartilage include costal
cartilage, which connects the ribs and
sternum; semilunar cartilage, which is one of
the cartilages of the knee joint; fibrous
cartilage, found between the vertebrae
(intervertebral discs); and elastic cartilage,
found in the larynx, epiglottis, and outer ear
 Bursae
A bursa is a small sac filled with
synovial fluid. Bursae reduce friction
between areas, such as tendon and
bone and tendon and ligament.
Inflammation of these sacs is called
bursitis.
 ASSESSMENT
History
The focus of the initial history depends on
whether the client has a chronic disorder or a
recent injury.
If the disorder is long-standing, the nurse obtains
a thorough medical, drug, and allergy history.
If the client is injured, the nurse finds out when
and how the trauma occurred.
He or she compiles a list of symptoms that
includes information about the onset, duration,
and location of discomfort or pain.
 Determining whether activity makes the
symptoms better or worse is important .
The nurse also id entifies associated
symptoms, such as muscle cramping or
skin lesions, and asks the client if the
problem interferes with activities of daily
living .
If the client has an open wound, the nurse
ascertains when the client last received a
tetanus immunization.
 The nurse must obtain a history of past
disorders and medical or surgical
treatments as soon as possible.
Attention to chronic or concurrent
disorders, such as diabetes mellitus, is
essential.
In addition, the nurse obtains a family
history, especially when relatives have had
similar symptoms, and an occupational
history
Physical Examination
For a general musculoskeletal assessment,
the nurse observes the clients ability to
ambulate, sit, stand, and perform activities
requiring fine motor skills, such as grasping
objects.
General inspection includes examining the
client for symmetry, size, and contour of
extremities and random movements.
A spinal inspection includes identifying
spinal curvatures
 Kyphosisexaggerated convex
curvature of the thoracic spine
(humpback)
Lordosisexcessive concave
curvature of the lumbar spine
(swayback)
Scoliosislateral curvature of the
spine
FIGURE 1. Common spinal curvatures include kyphosis,
lordosis, and scoliosis
 The nurse palpates the muscles and
joints to identify swelling, degree of
firmness, local warm areas, and any
involuntary movements.
To test the clients muscle strength,
the nurse applies force to the clients
extremity as the client pushes
against that force.
 The nurse also must perform a
neurovascular assessment (Table 1),
which includes assessing range of
motion for the joints, taking care not
to force movement.
The nurse notes any abnormal
muscle movements such as spasms
or tremors.
TABLE 1. Neurovascular Assessment Findings in
Musculoskeletal Assessment
In addition, the nurse:
Looks for abnormal size or alignment and
symmetry, comparing one side with the other.
Inspects and palpates for pain, tenderness,
swelling, and redness .
Ob serves the degree of movement and range
of motion, but never persist s beyond the
point of pain.
Tests for muscle strength.
Inspects for muscle wasting
 If the client has a traumatic injury, physical
assessment begins with taking vital signs.
Further assessment depends on the type
and area of injury.
As the nurse conducts the assessment, he
or she maintains standard precautions.
The nurse needs to cut the clothing from
around an injured area if there is no other
way to examine the client.
 The examination includes the following:
1. Observing for swelling, external bleeding, or bruising
2. Palpating the peripheral pulses
3. Evaluating peripheral circulation; assessing peripheral
pulse (rate and character), skin coloration (pink, gray,
pale, ashen), temperature, and capillary refill time
4. Checking the sensation of the injured part
5. Looking for broke n skin, open wounds, superficial or
embedded debris in or around the wound, protrusion of
bone or other tissue from the wound
6. Examining for injury beyond the original area; for example,
auscultating the chest and abdomen if an abdominal or
thoracic injury occurred or checking the pupils and mental
status if a head injury occurred
7. Looking for malalignment of the injured limb
8. Assessing for pain, noting the type and location
Diagnostic Tests
Imaging Procedures: computed tomography (CT), and
magnetic resonance imaging (MRI).
Arthroscopy
Arthrocentesis
Bone Scan
Synovial Fluid Analysis
Biopsy
Blood Tests
Urine Tests
Ect..
Nursing Process for the Client With a
Musculoskeletal Injury
Assessment
Assess the clients injury in terms of its location,
nature, and effects on mobility.
Also determine the circulatory status to the
injured area by checking circulation, sensation,
and mobility, if it is not contraindicated.
Assessing the clients level of pain is essential.
Monitor the clients vital signs and closely
observe for signs of shock.
Diagnosis, Planning, and
Interventions
Maturnuwu
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