Transcript Nrsg 407 Disorders of Bones, Joints, and Skeletal Musclex

Disorders of Bones, Joints, and
Skeletal Muscle
Nrsg 407
Normal Skeleton
Bones
3 Functions: mechanical, metabolic, and
hematopoietic
Composed of lamellar bone
Other type is woven bone present in the fetus and
during healing from fractures and bone disease
Lamella bone is organized by 2 structural bone
Compact bone-hard outer shell
Spongy bone-central marrow cavity
Types of Bone Cells
Osteoprogenitor cells-found in bone marrow and
periosteum which differentiate into osteoblasts and
osteoclasts
Osteoblasts: bone-forming cells
Osteoclasts: bone-dissolving cells
Joints
Busiest, hardest working parts of the body
Place where two bones meet
Classified according to movement they allow
Joints cont’d
Fibrous joints are synarthroses by joining bones by
fibrous tissue
Includes bones of the skull
Synovial joints-diarthroses, join bones by ligaments,
have a space and allow range of motion
Knee, elbow, shoulder, wrist, hip
Cartilaginous joints-amphiarthroses, join bones by
cartilage, have no space, allow for limited movement
Joints between vertebral bodies and wrists
Skeletal Muscle
Motor unit:
Lower motor neuron
Motor end plate
Skeletal muscle cell(s)
Composed of two fiber types
Type I-red/slow twitch
Type II-white/fast twitch
Osteoporosis
Decreased mineralization of bones, increased bone
porousness, and decreased bone mass
Bone tissue no longer provides proper mechanical support and
strength
Primary-most common
Post-menopausal women
Secondary-due to another
condition (hyperparathyroidism)
Primary Osteoporosis
Postmenopausal women
Less tall – compression of
spine  curvature of
spine, drooped posture
Weak abdominal muscles –
protruding abdomen
Compression of lungs from
posture – resp insufficiency
Fractures
Broken bone, defined as a discontinuity of the
anatomy of a bone
Risk factors:
80+ years old
Weight less than 130lb
Long-term use of benzodiazepines
Lack of walking/running for exercise
Poor vision
Brain disease affecting physical stability/mental capacity
Types of Fractures
Types of Fractures
Avulsion – ligament or tendon attached to bone pulls away
Comminuted – many small fragments (> 2 pieces)
Displaced – displacement of fracture fragments, can be axially
displaced, angulated or rotated
Greenstick – incomplete fracture in which the bone bends
Impacted – one broken end driven and wedged into the other –
commonly seen with comminuted fxs
Interarticular – related to joints
Longitudinal – lengthwise along bone
Oblique – across the shaft of the bone, combo of bending and
twisting
Pathologic – related to disease making bones brittle
Spiral – fracture line spirals around the shaft of the bone
Stress – bone subjected to repeated stress, AKA fatigue fx
How Fractures Heal
Inflammatory phase:
Hematoma
Reparative phase:
Granulation
Callus formation
Consolidation
Remodeling phase
Treatments for Fractures
Closed reduction
Open reduction
Open reduction internal
fixation
Pins, plates, screws, nails,
grafts, implants
Arthritis
Disease of painful joint condition contributing to joint
abnormalities
Most common: osteoarthritis
Progressive, noninflammatory erosion of joint cartilage
Primary-not attributed to specific circumstance
Secondary-abnormal stress on a joint
Obesity
Harsh physical activity (knees of professional athletes)
Physical malformation creating abnormal joint stress
Joints of individuals with peripheral nerve disease
Rheumatoid Arthritis
Systemic, chronic autoimmune disease involving synovial
joints
Exact cause unknown but viruses and genetics suspected
Autoimmune reaction due to T lymphocytes
B lymphocytes also play a role
Inflammatory reaction stimulates growth of blood vessels
and fibrous tissue into the synovium and joint cartilage
Highly vascular inflammatory membrane covers cartilage
surface and releases destructive enzymes to dissolve
cartilaginous plate
RA Signs and Symptoms
2 main signs:
Deviation of bones in hand toward radial side of arm
while the fingers deviate towards the opposite side (Z
deformity)
Rheumatoid nodules-painless 1-2cm subcutaneous
inflammatory nodules
Diagnosis depends on clinical signs (not laboratory
tests)
Detection of RF in blood can confirm but not exclude if
not found
Carpel Tunnel Syndrome
Carpal Tunnel Syndrome
Condition of the tendons and tendon sheaths of
ventral wrist
Repetitive finger and wrist motions
Fibromyalgia
Pain syndrome with no objective abnormalities
Clinical syndrome of fatigue, muscle, tendon, and
ligament pain, tenderness, and stiffness
NOT associated with any objective signs of disease
Diagnosis depends on ruling out all other potential
causes of patient’s symptoms