short note on musculoskeletal system for nurses : Introduction


Anatomy and Physiology
1. Axial portion
o cranium
o vertebrae
o Ribs.
• 2- Appendicular portion
o limbs
o shoulders
o Hips

Types of Bone
• 1. According to shape
o Long bone
o short bone
o irregular bone
o flat bone
• 2. According to tissue
o spongy bone ( inner portion)
o compact bone (outer portion)

Functions of Bone
• Maintain shape.
• Support and protect structure of the body.
• Provide attachments for muscles, tendons, and ligaments.
• Assist in regulating calcium and phosphate level.
• Bone marrow which is the centre of bone produces the blood cells.

Bone growth
• The length of bone growth is a result of the ossification of epiphyseal cartilage at the ends of bones.
• It stops between 18 to 25 years.
• The width of the bone growth is a result of the activity of osteoblasts and occurs throughout the life bout slow down with the aging process.


• Allow the movement between bones.
• Formed where two bones join.
• Allow the movement of whole body.

Nature of a joints
• Surfaces are covered with cartilage.
• Enclosed in a capsule and covered with a membrane called synovial membrane.
• Contain a cavity filled with synovial fluid.
• Ligaments hold the bone and joint in the correct position.

Function of synovial fluid
• Lubricates the cartilage and joint cavity.
• Cushion for shock.

Type of joints
1. Synarthrosis
Fibrous or fixed joints, No movement associated with these joints.
• 2. Amphiarthosis
Cartilaginous joints, slightly movable joints.
• 3. Diarthrosis
Synovial joints, Ball and Socket joints. Condyloids joints Freely movable joints. Allow frictionless, painless movement.


• Are made up of bundles of muscle fibers.
• Provide force to move bones.
• Assist in maintaining posture.
• Assist with heat production.

• white fibrous shiny tissue which connect bone to bone and hold the bone and joint in a correct position.


• It also white shiny fibrous tissue which connect muscle to bone.

Diagnostic Tests
1. X-rays

• It is a commonly used procedure to diagnose disorders of the muscular skeletal system.
Nursing Responsibility
• Remove any jewelry in the body.
• Handle injured area carefully.
• Administer analgesics.
• Inform the client that exposure to radiation is minimal.
• Health care provider should wear a lead apron.

2. Arthrocentesis
• Removal of synovial fluid from the joint and instillation of medication in the joint cavity.
Nursing Responsibility
• Obtain a consent.
• Apply a compress bandage after procedure.
• Provide joint rest for 24 hours.
• If fever or swelling should be report to doctor.

3. Arthrogram
• A radiographic examination of the soft tissues of the joint structure to diagnosis the trauma to the joint capsule or ligaments after administering air or contrast medium into the joint cavity.
Nursing Responsibility
• NPO for 8 hours.
• Written consent .
• Assess allergy to iodine or seafood.
Post procedure
• Minimize the joint use for 12 hours after the procedure.
• Instruct the client that joints may be edematous and tender for 1 to 2 days after the procedure. If more than two days inform the doctor.
• Apply ice packs.
• Apply ace wrap over the joint for 3 to 4 days.
• If air was used for injection crepitus may be felt in the joint for up to 2 days.

4. Arthroscopy

• A endoscopic examination of various joint to assess.
o Articular cartilage abnormality.
o Loose bodies can be removed.
o Cartilage can be trimmed.
o Biopsy may be performing during the procedure.
Nursing Responsibility
• NPO for 8 to 12 hr.
• Written consent.
Post Procedure
• The Ace wrap should be worn for 2 to 4 days.
• Administer pain medication.
• Walk without weight bearing.
• Limit activity for 1 to 4 days.
• Elevate extremity for two days and place ice on the site for comfort.
• Use crutches for 5 to 7 day.
• If pain or edema persists more than 3 days inform doctor.

5. Bone scan
• Radioisotope is injected IV and will collect in area that indicate abnormal bone metabolism and some fracture, if they exist.
• From 1 to 3 hours after the injection, have the client void and then scanning procedure is performed.
• The isotope is excreted in the urine and feces within 48 hours and is not harmful to others.

Nursing Responsibility
• NPO 4 hours before procedure.
• Consent.
• Remove the jewelry and metal object.
Post procedure
• Increase the fluid intake.
• Patient need to lie supine during the procedure.
• Observe the injection site for redness, and swelling.

6. Bone or muscle biopsy
• May be done during surgery or through aspiration, or punch, or needle biopsy.
Nursing Responsibility
• Obtain consent.
• Monitor for bleeding, swelling, hematoma and pain.
• Elevate the site for 24 hours following the procedure to reduce edema.
• Apply ice pack to reduce hematoma.
• Monitor for infection.
• Inform the client that mild to moderate discomfort is normal following procedure.

7. Electromyography
• Measure electrical potential associated with skeletal muscle contractions.
• Needles are inserted into the muscle, and recording of muscular electrical activity are traced on recording paper through an oscilloscope.
Nursing Responsibility
• Informed consent.
• May feel discomfort because of needle prick.
• Should avoid stimulation and sedative for 24 hr prior to the procedure.
• May occur bruising at the needle insertion site.

8. Myelogram
• Injection of dye or air into the subarachnoid space to detect abnormalities of the spinal cord and vertebrae.

Nursing Responsibility
• Obtain consent.
• Provide hydration for at least 12 hours before the test.
• Assess for allergies to seafood.
• Pre medicate with sedation if prescribed.
Post procedure
• Seal the sight to prevent leaking.
• Access the vital signs and neurological signs.
• Provide comfortable position.
o If water base dye is used elevate the head 15 to 30 degrees for 8 hours.
o If oil based bye give flat position for 8 hours.
o If air based dye give head down from trunk.
• Force fluid to flush out the dye.
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