THE MUSCULOSKELETAL SYSTEM ANATOMY PHYSIOLOGY DISEASE PROCESS

Anatomy Bones – 206 total –Long –Short –Irregular –Flat

Anatomy Joints – union of bones –Ligaments – bones to bones –Tendons – muscles to bones Types of joints –Synarthroses – no movement –Amphiarthroses – little movement –Diarthroses – free movement

Anatomy Muscles –Smooth –Striated –Cardiac

Physiology Children’s bones more porous, thus less susceptible to fx Bone length growth occurs at epiphyseal plate – –Cartilage cells replced by osteocytes One end of bone grows more actively than the other

Physiology Bone growth to the diameter occurs by deposition of osteocytes directly onto bone surface Bone growth regulated by growth hormone Bone growth stops when epiphyseal plates replaced by bone –This occurs earlier in girls than boys

Physiology Children may require prolonged immobilization due to fx, congenital deformity, diseases Complications may include anemia, fatigue Feelings of isolation, withdrawal can occur

Sprains & Strains Pathophysiology –Strain – stretching of muscle or tendon –Sprain – tearing with ligament involvement Treatment –RICE Nursing Implications

Fractures Pathophysiology –Simple –Compound –Comminuted –See p 571 Types of traction –Skeletal traction –Skin traction –See p 571 Immobilization –Bryant’s traction –Buck’s traction –Russell traction Volkmann’s ischemia Compartment syndrome Nursing Implications –See p 572 & 574

Osteomyelitis Pathophysiology –Infection of bone –s. aureus & h. influenzae most common S/S –Infants – fever & limited movement of affected area –Children – fever, pain, swelling, redness, tenderness

Osteomyelitis Treatment –Antibiotic –Bedrest –I&D Nursing implications –Support affected area –Reduce pain –Give antibiotics

Duchenne’s Muscular Dystrophy Pathophysiology –most common –Genetic –Occurs in boys only –Lack of dystrophin, a protein found in muscle cells

Duchenne’s Muscular Dystrophy S/S –Frequently diagnosed between 2 & 6 years because child is slow to develop –Clumsiness –Gower’s maneuver –Hypertrophy of calf muscles (to overcome weakness of gluteal & lumbar muscles) –Mental impairment –Weakness progresses; child usually confined to w/c by adolescence

Duchenne’s Muscular Dystrophy Treatment –No cure –Palliative Nursing implications –Instructions –Prevent complications

Legg-Calve-Perthes Disease Pathophysiology –Necrosis occurs of femoral head due to interruption of blood supply –Eventually replaced with live bone –Cause is unknown

Legg-Calve-Perthes Disease S/S –Limping –Limited ROM –No pain Treatment –NSAIDs –Restricted activity –Brace –Bedrest –Good prognosis

Osteosarcoma Pathophysiology –Usually in long bone near epiphyseal growth plate –Lungs common met site S/S –Pain –Swelling Treatment –Chemotherapy –Surgery

Ewing’s Sarcoma Pathophysiology –Commonly in marrow of long bones –Mets to lungs & other bones S/S – Pain Treatment –Chemotherapy –Surgery

Juvenile Rheumatoid Arthritis Pathophysiology –An autoimmune disease –Usually attacks large joints Chronic inflammation of synovial membrane Involves connective tissue & viscera –Three types Systemic Polyarticular Pauciarticular

Juvenile Rheumatoid Arthritis Systemic –Fever –Rash –Abdominal pain –Eventual joint pain Polyarticular –> 5 joints –Usually small joints Pauciarticular –< 4 joints –Usually large joints –May develop iridocyclitis

Juvenile Rheumatoid Arthritis Treatment –Supportive –Reduce pain –Promote optimal level of independence and development Medications –NSAIDs –Immune suppressant drugs –Methotrexate –Antirheumatic drugs (sulfasalazine)

Juvenile Rheumatoid Arthritis Nursing Implicatioins –Instruct meds –Teach ROM –Adaptive devices such as velcro on shoes –Encourage parents to allow child to perform to max potential

Torticollis Pathophysiology –Shortening of sternocleidoomastoid muscle resulting in limited ROM S/S –Decreased ROM –Short neck –Asymmetry of head & neck

Torticollis Treatment – exercises to stretch muscle Nursing implications – instruct parents about exercises

Curvature Of The Spine Pathophysiology –Kyphosis – humpback –Lordosis – swayback –Scoliosis – lateral curvature; most common Functional Structural

Curvature Of The Spine Treatment –May require brace or surgery Harrington rod –Braces must be worn hrs a day Milwaukee brace – p 582

Scoliosis Screening Look for asymmetry of: –Shoulders –Scapula –Arm to body –Hip

References Liefer, G. (2003). Introduction to maternity & pediatric nursing, (4 th ed.). Saunders: Philadelphia.