Musculoskeletal Notes

Musculoskeletal System

KYPHOSIS

an anteroposterior curving of the spine causes a bowing of the back, usually at the
thoracic level.
Occurs in children and adults

Causes
Congenital kyphosis leads to cosmetic deformity and reduced pulmonary function.
Appear in adolescence or adulthood
Adult kyphosis may result from aging and associated degeneration of intervertebral
disks, atrophy, and osteoporotic collapse of the vertebrae; from endocrine disorders, such
as hyperparathyroidism and Cushing’s disease; and from prolonged steroid therapy

Assessment findings
Mild pain at the apex of the curve
Fatigue
Tenderness or stiffness in the involved area or along the entire spine
Prominent vertebral spinous processes at the lower dorsal and upper lumbar levels
Round back appearance associated with weakness of the back and generalized fatigue
Disk lesions called Schmorl’s nodes develops in the anteroposterior curving of the spine

Diagnostic tests
On PE: curvature of the spine in varying degrees of severity.
X-ray: show vertebral wedging, Schmorl’s nodes, irregular end plates
Mild scoliosis of 10 to 20 degrees

Treatment
Therapeutic exercises
Bed rest on firm mattress (with or without traction)
Brace to straighten the kyphotic curve until spinal growth is complete
Pelvic tilt to decrease lumbar lordosis
Hamstring stretch to overcome muscle contractures
Thoracic hyperextension to flatten the kyphotic curve
Lateral X-rays taken every 4 months to evaluate correction
Gradual weaning from the brace
Surgery for spinal curve greater than 60 degrees or intractable and disabling back pain in
a patient with full skeletal maturity.
ANKYLOSING SPONDYLITIS

chronic, progressive inflammatory disease

affects the sacroiliac, apophyseal, and costovertebral joints and adjacent soft tissue
disease progresses unpredictably and can go into remission, exacerbation, or arrest at any
stage

Causes
unknown
more than 90% of patient with this disease exhibit the histocompatibility antigen HLA-
B27
Immunity activity by the presence of circulating immune complexes
Familial tendency

Assessment findings
Intermittent lower back pain, most severe in the morning or after a period of inactivity
Stiffness and limited motion of the lumbar spine
Pain and limited expansion of the chest
Peripheral arthritis involving the shoulders, hips and knees
Kyphosis, in advanced stages, caused by chronic stooping to relieve symptoms
Hip deformity and limited range of motion
Tenderness over sites of inflammation
Tenderness over the sacroiliac joint
Mild fatigue, fever, anorexia, or weight loss
Occasional iritis
Aortic regurgitation and cardiomegaly

Diagnostic tests
X-ray findings: blurring of the bony margins of joints in the early stage, bilateral
sacroiliac involvement, patchy sclerosis with superficial bony erosions, eventual squaring
of the vertebral bodies, and “bamboo” spine with complete ankylosis? confirms the
diagnosis
Slightly elevated ESR and alkaline phosphatase and creatine kinase levels

Treatment
Management aims to delay further deformity by good posture, stretching and deep-
breathing exercises
Braces and lightweight supports
Anti-inflammatory analgesics, such as aspirin, indomethacin, and sulindac, control pain
and inflammation
Surgery
Nursing interventions
Promote patient comfort
Administer medications as ordered
Apply local heat and provide massage to relieve pain
Assess mobility and degree of discomfort frequently.

CARPAL TUNNEL SYNDROME

Most common nerve entrapment syndrome, results form compression of the median
nerve at the wrist, within the carpal tunnel.
The median nerve, along with blood vessels and flexor tendons, passes through this
tunnel to the fingers and thumb.
Occurs in women between ages 30 and 60 and poses a serious occupational health
problem

Causes
Some conditions can cause the contents or structure of the carpal tunnel to swell and
press the median nerve against the transverse carpal ligament
Conditions like: rheumatoid arthritis, flexor tenosynovitis, nerve compression,
pregnancy, renal failure, menopause, diabetes mellitus, acromegaly, edema following
Colle’s fracture, hypothyroidism, myxedema, benign tumors, and tuberculosis.
Dislocation or acute sprain of the wrist

Assessment findings
Weakness, pain, burning, numbness, or tingling in one or both hands
This paresthesia affects the thumb, forefinger, middle finger, and half of the fourth finger
Decreased sensation to light touch or pinpricks in the affected fingers
Inability to clench the hand into a fist
Nail atrophy
Dry, shiny skin and pain

Diagnostic test

(+) Tinel’s sign: tingling over the median nerve on light percussion
(+) Phalen’s wrist-flexion test: holding the forearms vertically and allowing both hand to
drop into complete flexion at the wrists for 1 minute
Compression test: blood pressure cuff inflated above systolic pressure on the forearm for
1 to 2 minutes provokes pain and paresthesia along the distribution of the median nerve
Electromyography: detects a median nerve motor conduction delay of more than 5
milliseconds
Treatment

Resting the hands by splinting the wrist in neutral extension for 1 to 2 weeks
Correction of underlying disorder
Surgical decompression of the nerve by sectioning the entire transverse carpal tunnel
ligament

Nursing interventions

Mild analgesics
Apply splint.
Perform range of motion exercises
After surgery, monitor vital signs, and regularly check the color, sensation, and motion
of the affected hand