learning Objectives - Describe various musculo skeletal disorders and diseases. Demonstrate skills in management of musculo skeletal diseases.
Hours - 10
Teaching and Learning Activities - Lecture cum discussion Clinical teaching Demonstration
Assessment Methods - Short answer Objective type Essay type
Content of the chapter
a) Review of Anatomy and Physiology of
musculo skeletal system
b) Assessment
– History
– Physical examination
– Diagnostic tests
c) Infections and inflammations
– Septic arthritis
– Gonococcal arthritis
– Osteomyelitis
– Tuberculosis of the spine and bones
– Sprains
– Dislocations
– Fracture of spine and extremities
d) Degenerative conditions of joints, spine
e) Tumors, Amputation and prosthesis
f) Deformities – Congenital and acquired
g) Range of motion exercises
h) Care of patient:
– Skin and skeletal traction
– Orthopedic splints
i) POP application and removal
j) Neurogenic bladder
k) Preparation for bone surgery
l) Use of orthopedic assist devices
– Crutches
– Canes
– Walker
m) Alternate therapies
n) Drugs used in treatment of musculo-skeletal
disorders disorders
Nursing Management of Patients with Musculoskeletal Disorders and Diseases
Musculoskeletal disorders affect bones, joints, muscles, ligaments, tendons, and connective tissues. Nursing care aims at pain relief, maintaining mobility, promoting healing, preventing complications, and patient education.
a) Review of Anatomy and Physiology
- Bones: structural support, protection of organs, mineral storage, hematopoiesis
- Joints: allow mobility; types – synovial (freely movable), cartilaginous, fibrous
- Muscles: produce movement, maintain posture
- Ligaments & Tendons: connect bones to bones and muscles to bones
- Nervous supply: controls muscle contraction, proprioception
- Physiology: bone remodeling, joint lubrication, muscular contraction
b) Assessment
History
- Pain, swelling, stiffness, deformity, trauma
- Functional limitations (walking, gripping, lifting)
- Previous injuries, surgeries, chronic illnesses (e.g., osteoporosis, arthritis)
- Family history of musculoskeletal disorders
Physical Examination
- Inspection: deformities, swelling, redness, muscle wasting
- Palpation: tenderness, temperature, crepitus
- Range of motion (ROM) testing
- Gait and posture analysis
Diagnostic Tests
- Imaging: X-ray, MRI, CT scan, bone scan
- Lab tests: CBC, ESR, CRP for infection/inflammation
- Bone density tests: for osteoporosis
- Joint aspiration: for septic arthritis or gout
c) Infections and Inflammations
- Septic arthritis: bacterial infection of joint; care: antibiotics, immobilization, joint aspiration
- Gonococcal arthritis: sexually transmitted; care: antibiotics, pain management
- Osteomyelitis: bone infection; care: antibiotics, surgical debridement, monitoring for sepsis
- Tuberculosis of spine/bones: chronic infection; care: anti-TB therapy, spinal support, mobility management
- Sprains: stretching/tearing of ligaments; care: RICE (Rest, Ice, Compression, Elevation), analgesics
- Dislocations: joint displacement; care: reduction, immobilization, pain management
- Fractures of spine/extremities: care: immobilization, pain management, traction, neurovascular assessment
d) Degenerative Conditions of Joints and Spine
- Osteoarthritis: joint pain, stiffness; care: ROM exercises, weight management, analgesics, joint protection
- Spondylosis, spinal stenosis: spine degeneration; care: pain control, physiotherapy, postural education
- Care focus: maintain mobility, prevent contractures, reduce pain
e) Tumors, Amputation, and Prosthesis
- Bone and soft tissue tumors: benign or malignant; care: pain management, pre- and post-operative care, emotional support
- Amputation: care: preoperative counseling, postoperative wound care, pain and phantom limb management, prosthesis fitting and training
f) Deformities – Congenital and Acquired
- Examples: clubfoot, scoliosis, bow legs, kyphosis
- Care: correction through surgery, orthotics, physiotherapy, patient/caregiver education
g) Range of Motion (ROM) Exercises
- Active ROM: patient moves joint voluntarily
- Passive ROM: nurse moves joint to prevent stiffness
- Purpose: prevent contractures, maintain flexibility, improve circulation
h) Care of Patients with Traction and Splints
- Skin and skeletal traction: maintain alignment, prevent pressure sores, monitor neurovascular status
- Orthopedic splints: immobilization, swelling control, pressure monitoring
i) POP (Plaster of Paris) Application and Removal
- Application: ensure proper positioning, padding, circulation checks, teach patient to avoid wetting plaster
- Removal: post-care: skin inspection, ROM exercises, muscle strengthening
j) Neurogenic Bladder
- May result from spinal injuries; care: catheterization, bladder training, monitoring for UTI
k) Preparation for Bone Surgery
- Preoperative teaching, consent, baseline vitals, laboratory tests, patient education about post-op care and mobility
l) Use of Orthopedic Assistive Devices
- Crutches: proper fitting, weight-bearing instructions, safety tips
- Canes: support and balance, correct side usage
- Walkers: safe ambulation, preventing falls
m) Alternate Therapies
- Physiotherapy, hydrotherapy, yoga, massage for pain relief and mobility
- Heat/cold therapy for inflammation
- Nutritional supplements (calcium, vitamin D) for bone health
n) Drugs Used in Musculoskeletal Disorders
- Analgesics: paracetamol, NSAIDs
- Muscle relaxants: baclofen, cyclobenzaprine
- Corticosteroids: for inflammatory conditions
- Bisphosphonates: for osteoporosis
- Disease-modifying anti-rheumatic drugs (DMARDs): methotrexate, hydroxychloroquine
- Antibiotics: for osteomyelitis and septic arthritis
- Supplementation: calcium, vitamin D
Conclusion
Nursing management of musculoskeletal disorders focuses on:
- Accurate assessment and early diagnosis
- Pain management and mobility maintenance
- Prevention of complications (contractures, pressure sores, neurovascular compromise)
- Patient education on self-care, exercises, and assistive devices
- Pre- and post-operative care for fractures, surgery, and prosthesis
Proper nursing care promotes recovery, preserves function, prevents disability, and improves the quality of life.