Skeletal

• Bone Elements


  • Ground substance
  • Crystallized materials (e.g. calcium)
• Bone Cells


  • Osteoblasts (formation of new bone)
  • Osteocytes (maintain bones)
  • Osteoclasts (remove and reabsorb bone)
• Bone Matrix


  Ground substance, collagen fibers, and other proteins and minerals
• Bone Minerals


  • Calcium
  • Phosphorus
• Calcium


  Crystallizes and provides rigidity and strength (about 98% of total body calcium stored in bones)
• Phosphorus


  Regulates vitamin D and promotes mineralization
• Types of Bone Tissue


  • Cancellous (spongy)
  • Cortical (compact)
• Characteristics of Bones


  • Axial Skeleton (head and trunk)
  • Appendicular Skeleton (upper and lower limbs)
  • Long Bones
  • Short Bones
  • Flat Bones
  • Irregular Bones
  • Diaphysis
  • Metaphysis
  • Epiphysis
  • Epiphyseal Plate
• Periosteum

  Dense, fibrous membrane that covers bones, provides nourishment, facilitates growth, and serves as an attachment site for tendons and ligaments
• Bone Marrow

  • Red Bone Marrow (produces RBC, WBC, and Platelets)
  • Yellow Bone Marrow (fatty storage)
• Remodeling


  Simultaneous resorption (removal of tissue) and osteogenesis (formation of new bone)
• Repair


  Process of bone cells removing and forming new bone when there has been an injury to the bone (e.g. fracture healing)
• Muscle Contraction


  Isometric (static or holding position, muscle does not lengthen or shorten, no ROM) or Isotonic (muscle lengthens and shortens, ROM is being performed)
• Muscle Movement


  • Agonistic action
  • Antagonistic action
• Connective Tissue Examples


  • Bone
  • Cartilage
  • Ligaments
  • Tendons
• Function of Bones


  Support organs and structures, attachment of muscles, hematopoiesis, storage of bone minerals
• Types of Joints


  • Synarthrosis (immobile/fixed)
  • Amphiarthrosis (limited mobility)
  • Diarthrosis (freely moveable)
• Types of Diarthrosis Joints


  • Ball-and-socket
  • Hinge
  • Saddle
  • Pivot
  • Gliding
• Diarthrosis Joints


  Contain fibrous capsule, synovial membrane, synovial fluid, and articular cartilage
• Osteogenesis


  Occurs in utero before birth, cartilage turns into bone by ossification
• Remodeling


  Begins in early adulthood, changes in bones, joints, and muscles occur in older adults
• Age-Related Changes in Bones


  • Decreased bone mass, strength, and density
  • Decreased bone remodeling and rate of mineralization
  • Erosion of articular cartilage
  • Bones are weaker and more brittle
• Age-Related Changes in Joints


  • Decreased viscosity of synovial fluid
  • Scar tissue formation
  • Degenerative changes in cartilage, collagen, and elastin
  • Decreased range of motion
• Age-Related Changes in Muscles


  • Sarcopenia (age-related loss of skeletal muscle)
  • Decreased muscle strength
  • Decreased muscle bulk
  • Decreased basal metabolic rate
  • Decreased lean body mass
• Osteoarthritis


  Localized non-inflammatory musculoskeletal disorder affecting the joints
• Osteoarthritis


  • Affects joints of fingers
  • Affects weight-bearing joints (i.e. hips and knees)
  • Also referred to as Degenerative Joint Disease (DJD)
  • This is the most common and most frequently disabling form of arthritis
• Osteoarthritis - Pathophysiology


  • Cause is unknown (idiopathic)
  • Secondary to various risk factors
  • A chronic slowly progressive disease
  • Typically affects adults aged 50 or older
  • Degeneration or erosion of articular cartilage
  • This covers the end of bones
  • Combined with hypertrophy of the bone at the joint site
  • Can result in formation of bone spurs
  • Results in joint pain, stiffness, and loss of movement/function
• Osteoarthritis - Risk Factors


  • Genetic Predisposition
  • Poor posture
  • Joint Trauma/misalignment of joints
  • High impact sports/occupations that exert excessive force on the joints
  • Obesity
  • Female Gender
  • Aging
• Osteoarthritis - Clinical Manifestations


  • Pain after exercise, relieved with rest
  • Stiffness in the morning or with inactivity (usually 10-30 min)
  • Muscle Spasms
  • Decreased strength
  • Swelling and tenderness associated with activity
  • Decreased, limited, and painful ROM
  • Crepitus with ROM
  • Prominent bony enlargements
  • Heberden's Nodes-enlargement of distal interphalangeal joints of fingers
  • Bouchard's Nodes-enlargement of proximal interphalangeal joints of fingers
  • Flexion contractures
• Osteoarthritis - Diagnosis


  • X-Ray
  • Arthroscopy
  • MRI
  • CT Scan
  • H&P-risk factors?
  • Clinical Manifestations
• Osteoarthritis - Treatment Goals


  • Manage pain
  • Maintain joint function (limit disability)
  • Prevent further stress
  • Reduce weight to alleviate strain
• Osteoarthritis - Treatment


  • Heat/Cold/Massage for aching and stiff joints
  • PT and OT to maintain functional independence
  • Prevent orthopedic deformities
  • Analgesics, anti-inflammatory, steroids
  • Tylenol-Max dose 3,000-4,000mg/day
  • Arthroplasty – repair/replacement of joint
  • Massage, Yoga
  • Glucosamine and Chondroitin
• Osteoarthritis - Nursing Care


  • Assess joints for pain and function
  • Prevent further trauma
  • Teach posture/body mechanics
  • Avoid continuous standing
  • Avoid high-impact exercises
  • Maintain mobility
  • Exercising
  • Change positions frequently/Proper positions and joint alignment
  • Education about medications
  • Teach hot and cold therapy
  • Preparation for surgery if needed
• Osteoarthritis - Life Style Change Recommendations


  • Weight loss
  • Modify activities
  • Balance rest and activity
  • Thermotherapy
  • Education about disease
  • PT and OT referral
• Rheumatoid Arthritis


  • Chronic and progressive systemic arthritic disease
  • Not just localized!
  • Inflammatory changes occur throughout the body's cartilage
  • Destroys joint internally
  • Most common in hands, wrists, feet, elbows, knees, and ankles
  • Can also affect the shoulders, hips, cervical spine, and temporomandibular joints
• Rheumatoid Arthritis - Pathophysiology


  • Effects the synovial joints/tissues
  • Cause is unknown but is an autoimmune disease
  • Auto antibodies attack causing macrophages to start destroying self tissue
  • Formation of pannus at the joint site
  • Vascular granulation tissue – erodes articular cartilage and bone
  • Characterized by exacerbations and remissions
• Rheumatoid Arthritis - Risk Factors


  • Autoimmune
  • Peak onset age 30-60
  • Microorganisms
  • Viruses
  • Genetic Predisposition
  • Gender - Females more than males
• Rheumatoid Arthritis - Clinical Manifestations (Subjective)


  • Sore, swollen joints
  • Bilaterally/symmetrically
  • Can also have warmth/erythema
  • Fatigue
  • Weakness
  • Malaise
  • Anorexia
  • Morning stiffness lasting at least 30-45 min
  • Joint pain
• Rheumatoid Arthritis - Clinical Manifestations (Objective)

  • Low-grade fever
  • Splenomegaly
  • Vasculitis
  • Weakened grip
  • Anemia
  • Weight loss
  • Subcutaneous nodules over bony prominences
  • Enlarged lymph nodes
  • Joint deformity
  • Muscle atrophy
  • Limited ROM
  • Edema and joint tenderness
• Rheumatoid Arthritis - Diagnosis

  • Elevated Erythrocyte Sedimentation Rate (ESR)
  • Slightly elevated WBC
  • Positive for Rheumatoid Factor antibodies
  • Positive Antinuclear Antibody (ANA)
  • Arthrocentesis
  • X-Ray
  • Decreased H&H
  • Elevated C-reactive protein