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Congratulations for making your 3 years in nursing GREAT!!!

Punctuality in Attending Classess Late comers will enter the room after one hour  No ID no entry

Prayer Leader

Starting from no.1 onwards Same person before and after

The door will be closed exactly 1pm  Checking of attendance is by number  Seat plan will be provided  Stay in your place or else you will be marked absent





Either announced,unannouced Can be before,at the middle of discussion or after Late comers who entered the room after 1 hour will not be given special exams meaning you ve missed 1 exam

No borrowing and lending of papers  Always have a paper with you.  ( ,1/2,1 whole)


Once caught in the act automatic deduction of 5 points from the total score

A. Female 1. All female students should wear their complete proper uniform with ID 2. Hair should be neatly tied up into a bun with black hairnet and hair clip

B. Male 1. All male students should also wear their complete uniforms with ID 2. Hair should be properly trimmed according to the College of nursing required haircut

Major Exams

No Permit ,No Exam policy


Case study per group Case will not be taken from PCGH,but other tertiary Hospital Musculoskeletal case to be presented during the class Exposure at Orthopedic Hospital starting June 27

Either by group  Individual  Must be submitted on time

Grading System

Quiz Requirement Att/Att Major Exam -

40% 20% 10% 30% 100%

Perfect points is 5  Recited but not related to the topic 1  No recitation 0

Any medical and surgical book

Film Analysis

Questions will be provided based on the film

My consultation day
Monday: 1pm-5pm Tuesday: 8am-5pm Wednesday: 8am-5pm Thursday: ipm-5pm


Understanding The Musculoskeletal System

Prof. Gina T. Vierne

Objectives:  On completion of this chapter, you will be able to:  Describe the basic structure and function of the musculoskeletal system

Discuss the significance of the health history of the assessment of the musculoskeletal health

Identify the risk factors associated with musculoskeletal disorders

Describe the significance of the health history of the assessment of musculoskeletal dysfunction

Specify the diagnostic tests for assessment of musculoskeletal function  Identify medications applicable to musculoskeletal problems

Identify medical and surgical management with musculoskeletal problems  Define terms used in musculoskeletal function

Chapter Overview

Caring for patient with musculoskeletal disorders requires a sound understanding of musculoskeletal anatomy and physiology as well as body mechanics

Thorough assessment Assessment includes:  Complete history  Physical examination  diagnostic testing  Risk factors  Informations r/t psychosocial impact of the disorder on the pt and his family

Nursing diagnoses focus: impaired physical mobility  Altered peripheral tissue perfusion


Nursing interventions : designed to maintain or improve the pt s ability to carry out ADLs and prevent further injury


Patient teaching:Crucial nursing activity  Why?

Anatomy and physiology review

Video clip presentation

The musculoskeletal system include 206 bones which are connected at joints.  The joints are held together by ligaments and cushioned by cartilages  Tendons attach muscles to the bones

The Bones-body s framework Functions:  Support  Protection  Movement  Storage  Blood Cell Formation


Bones provide a hard framework that support and anchors all soft organs of the body.The bones of the legs act as pillars to support the body trunk when we stand,and the rib cage supports the thorax wall


The fused bone of the skull provide a snug enclosure for the brain. The vertebrae surround the spinal cord,and the rib cage helps protect the vital organs of the thorax.


Skeletal muscles, attached to bones by tendons ,use the bones as levers to move the body and its parts.As a result, we can walk,grasp and breathe.The arrangement of bones and the design of joints determine the types of movement possible


Saddle joint Hinge joint plane joint Condyloid joint Ball and socket joint Pivot joint


Bone matrix itself serves as a storehouse, a reservoir for minerals, the most important being calcium and phosphorous, although K, Ca,Na,Sulfur magnesium and copper are also stored.

Blood Cell Formation

The bulk of blood cell formation, or hematopoiesis, occurs within the marrow cavities of certain bones.



DIVISIONS Axial s upright structure with 80 bones 22 bones in skull 6 middle ear 1 hyoid bone 26 vertebral column 25 thoracic cage

Axial- green Appen - golden

2. Appendicular-body s appendages with 126 bones 4- pectoral girdle  60 upper limbs  60 lower limbs  2 pelvic girdle

Types of Bones
1. 2. 3. 4.

Long bones Short bones Flat bones Irregular bones

Long bones Humerus of arms

Flat Parietal bone of skull

Short bones Carpals of wrist

Irregular vertebra


How an individual bone is structured? Please read

Consist of 206 bones(long, short, flat, irregular)  Store calcium, magnesium, phosporous,and carbonate, marrow produces RBCs

Key facts:  206 bones  Stores calcium,magnesium,phosporous and carbonate

Skeletal muscles
Provide body movemetn and posture  Attach to bones by tendons  Begin contracting with the stimulus of a muscle fiber  Retain some contraction to maintain muscle tone

Key facts about skeletal muscle

Provide body movement and posture  Attach to bones by tendons  Retain some contraction for muscle tone

Tough bands of collagen fibers that connect bones  Encircle a joint to add strength and stability

tendons Nonelastic collagen cords  Connect muscle to bones

Articulation of two bone structures  Provide stabilization and permit locomotion;degree of joint movement is called ROM

Key facts about joints

Articulation of two bones surfaces  Provide stabilization permit locomotion  ROM is degree of joint movement

Membrane that line a joint s inner surfaces  Secrete synovial fluid and antibodies  Reduces friction in joints( in conjunction with cartilage)

Key facts about synovium

Lines a joint s inner surfaces  Secretes synovial fluid  Reduces friction


Contains a firm gel substance in its matrix, which gives it more flexibility than bone

Serves as a smooth surface for articulating bones  Absorb shock to joints  Atrophies with limited ROM or in the absence of weight bearing


Fibrocartilage Greatest tensile Occurs in the invertebral discs and in the symphysis pubis

2. Elastic Cartilage Possesses firmness and elasticity  Occurs in the external ear and the eustachian tube

3. Hyaline CArtilage Most common cartilage type  Cushions most of the joints to help soften any impact  Firm yet slightly flexible  Occurs also in part of the nasal bronchial rings

Key facts about cartilage

Composed of fibers embedded in firm gel  Smooth surface for articulating bones  Absorbs shocks to joints

Fluid filled sac  Serves as padding to reduce friction  Facilitates the motion of body structures that rub against each other

Key facts about the bursa

Fluid filed sac  Serves as padding  Facilitates motion of body structures

Jingle( the bone dance)

Understanding skeletal muscle movement

Skeletal muscles contract to move bone, while joints allow this movement to occur

To contract, all skeletal muscles require some form of stimulation either internal from motor neurons or external from stimuli such as electricity, heat or injury

8 ways of muscle contraction


isotonic Isometric twitch contraction Tetanic contraction Treppe or staircase phenomenon Fasciculation Fibrillation convulsion

isotonic contraction- shorten muscle length while maintaining muscle tension, generating movement  Isometric contraction-tighten a muscle by increasing muscle tension without shortening the muscle  Twitch contraction- are quick, jerky reactions to a single stimulus

Tetanic contraction- serial, continuous contractions,in which individual contractions can t be distinguish  Treppe( staircase) phenomenon-series of increasingly stronger twitch contraction occuring in response to repeated stimuli  Fibrillation- abnormal contraction in which individual fibers contact in an unsynchronized way

Fasciculation- abnormal contraction visible through the skin as a slight ripple  Convulsions- abnormal, violent rhythmic contractions and relaxations of muscle groups

Joint Motion Terminology


Flexion Extension Hyperextension Abduction/Adduction Rotation Circumduction Inversion


Eversion Pronation Supination Protraction Retraction

Flexion-Decreases the angle between the anterior surfaces of articulating bones Extension-increases the angle between the anterior surfaces of articulating bones Hyperextension-continues the act of extension beyond the original anatmical position Abduction-when seen from the front, moves a bone in the appendicular skeleton away from the body s midline


Adduction-when seen from the front, moves a bone in the appendicular skeleton towards the body s midline Rotation- pivots the bone on its axis Internal External; Circumduction-combines a number of movements to cause the distal end of a bone to describe a circle.360 degrees to complete full circle Inversion-turns an extremity or part of an extremity inward towerd the body s midline


Eversion-turns an extremity or part of an extremity outward from the body s midline Pronation-turns the palm of body s front toward the floor Supination-turns the palm, foot, or body s front toward the ceiling Protraction-moves the mandible forward Retraction-moves the protracted mandible back into its neutral anatomical position

Musculoskeletal Terminology

Atrophy Causalgia Contracture Deformity Leg length discrepancy Dislocation

Musculoskeletal Terminology

Dorsiflexion Dysplasia Kyphosi Lateral Lordosis

Musculoskeletal Terminology

Palsy Range of Motion Recurvatum Subluxation Valgus varus

Atrophy-wasting away


A severe burning pain produced by several nerves that have malfunctioning nerve endings, touch can often produce this pain




The absence of full range of motions of any joint. Most common is flexion contracture, the lack of full extension



Malformation or defect of any part of the body


Leg length discrepancy

(anisomelia)an inequality between corresponding limbs

Leg length discrepancy


Musculo skeletal, traumatic injury resulting in disruption of the continuity of joint s configuration and articulation causing the loss of contact between the joint surfaces




Abnormality of movement





Posterior convexity of thoracic portion of vertebral column, normal curvature of spine, but becomes pathologic if excessive



Concavity of the vertebral column, normal curvature existing in cervical and lumbar areas, which may become pathologic if accentuated



Lateral curvature of the spine



Palsy- paralysis Range of motion- the full motion of joint can assume



Hyperextension( beyond neutral position) Subluxation-partial or complete dislocation of joint surfaces

Valgus-angular deformity denoting angulation away from the midline of the body distal to the anatomic part named  Ex. Knock knee.  Varus- angular deformity denoting angulation toward the midline of the body distal to the anatomic part named  Ex. bowlegged

Assessment Findings
Health History  Pain  Numbness, tingling  Joint stiffness  Swelling  Fatigue  Fever  Difficulty with movement

Key assessment findings in disorders of MS

Pain  Numbness, tingling  Joint stiffness  Difficulty with movement

Physical examination
Abnormal vital signs  Inflammation  Edema  Skin breakdown  Skeletal deformity

Physical examination
Limited ROM  Poor posture  Muscle weakness  Muscle stiffness and rigidity  Abnormal skin color and temperature

Physical examination
Paresthesia  Nodules  Erythema  Tophi  Abnormal peripheral pulses  Tremors  Gait abnormalities(how to assess?)

P.E. bone integrity

Compare the left and right sides of the body,take note any deformities and anatomical misalignment

Evaluate ROM, defprmities,stabilty and nodular formation  Active  passive


Note pts s ability to change position,presence of atrophy or hypertrophy Check carefully the origin of muscle weakness because pt s fear, unwillingness, or malingering might give false positive results(muscle strength)


Note for muscle tone: sensation of resistance felt as one manipulates a joint through it ROM Measure the muscle girth at the bulkiest portion of the extremity: location and position must be the same on both extremities

Key physical findings in disorders of the MS

Skeletal deformity  Limited ROM  Inflammation  edema