Musculoskeletal system: Musculoskeletal disorders

Musculoskeletal disorders are disorders of the bones, joints, and the skeletal muscles, affecting movement. Therefore, any daily activity and quality of life is also affected.

They make individuals prone to falls and injuries, and dependant on others’ assistance in everyday life activities. Some of these disorders are osteoporosis, arthritis, and muscular dystrophy.Osteoporosis is a disorder of the bones that causes them to lose their strength and mass, giving them a porous, or sponge-like, appearance.

This makes them very frail and susceptible to breaking. The most commonly affected bones are of the vertebrae, which can get compressed, leading to a height reduction, back pain, and forward bending of the upper spine, causing a deformity called a dowager’s hump.

Other commonly affected bones are the hip bones, long bones of the extremities, and the wrist bones. Sometimes, the bones might be so fragile that even normal daily activities, like walking down the stairs, can result in a fracture.Factors that increase clients’ risk for developing osteoporosis include: advanced age; family history of osteoporosis; small stature; diet that lacks calcium and proteins; vitamin D deficiency that decreases calcium absorption from food; eating disorders, like anorexia nervosa; smoking and consuming alcohol.

Other risk factors include immobility; sedentary lifestyle; medications, like corticosteroids; and other conditions, like thyroid dysfunction.

Menopause in biological females is also an important risk factor because there’s decreased production of estrogen: a hormone that has protective effects on the bones.As a nursing assistant, you should encourage your clients that are at higher risk for osteoporosis to take precautionary measures in order to delay or even prevent its development.

These include regular exercise, like walking and lifting weights; proper diet rich in calcium and proteins, like dairy products; vitamin D supplements; and avoiding smoking and alcohol consumption.

Remember that clients with osteoporosis are at an increased risk of fractures from falls, so it's important to pay special attention to all safety precautions when performing exercise with them.

Also, you should be extra careful while repositioning them or helping them move and transfer. Hip fracture is a fracture of the upper part of the thigh bone, called the femur, causing severe pain around the hip that increases with movement and making the injured leg shorter.

Factors that increase clients’ risk of hip fracture include conditions that make clients more prone to falls, like strokes; previous hip fractures; medications that can cause dizziness; and conditions that make bones brittle and weak, like osteoporosis.

Clients that are recovering from a hip fracture will be immobile for a long period of time, which can lead to some serious complications that include pressure ulcers; deep vein thrombosis, or formation of blood clots in the veins of the legs; pulmonary embolism when those clots break off and travel to the lungs; infections of wounds, the lungs, and the urinary tract; mental confusion; and constipation.

Moving on to the most common musculoskeletal disorder: arthritis, where “arthr” refers to the joints and “itis” to the inflammation of the joints that causes them to become swollen, painful, and stiff.

This makes any movement harder to perform. Common types of arthritis include osteoarthritis, rheumatoid arthritis, and gout.In osteoarthritis, the cartilage in the joints that serves as a cushion for the ends of the bones gets damaged over time as a result of the normal aging process until it eventually wears out.

Without cartilage, bones rub against each other, causing inflammation, swelling, and stiffness of the joints and making movement difficult and painful.

The most commonly affected joints are those that bear a lot of weight, like the knees, hips, and spine. Joints of the hands are also a common location.

Factors that increase a client’s risk of developing osteoarthritis include advanced age that decreases cartilage elasticity and flexibility; obesity, which increases the weight put on the joints; previous joint injury; and a family history of osteoarthritis.Now, rheumatoid arthritis is an autoimmune disorder, meaning that our immune system mistakenly damages our own tissue.

In the case of rheumatoid arthritis, the target is the synovial membrane that lines the inside of the joint cavity where inflammation and eventually scarring cause permanent deformities.

It usually affects parallel joints on both sides of the body, most commonly the finger and wrist joints, but also affects other joints in the arms, legs, and feet.

Affected joints might not have any symptoms until a flare-up occurs, which is when they become swollen, red, warm, and painful.

Sometimes this can occur with fever and fatigue. The immune system might also damage other organ systems besides the joints, like the heart, lungs, and eyes.

Unlike osteoarthritis, it most often starts in the 20’s-40’s. Factors that increase a client’s risk of developing rheumatoid arthritis include a family history of rheumatoid arthritis, being a biological female, smoking, and obesity.

Finally, gout is a type of acute arthritis that develops when there’s a high level of uric acid. This is a molecule that’s produced when the body breaks down certain foods, like proteins or alcohol.

It could also build up when the kidneys are not working properly, so they can’t be excreted with urine. Uric acid level increases, and they start depositing inside joints, forming crystals.

This can cause irritation, inflammation, and pain. Although any joint in the body can be affected, the big toe is the most commonly involved.

Middle-aged biological males are more at risk of developing gout. Other risk factors include obesity, family history of gout, a diet rich in red meat and seafood, alcohol consumption, and recent trauma or surgery.

Because all types of arthritis share some characteristics, they also have similar management that include medications that can relieve pain, swelling, and inflammation; application of heat and cold to reduce discomfort and swelling; exercise to preserve the range of motion, strength, and stability; weight reduction to relieve joints of excess stress, which is especially important for clients with osteoarthritis; assistive devices, like canes and walkers to ensure stability and safety and splints to reduce joint deformities, like in rheumatoid arthritis; rest; proper diet; and lastly, surgical joint replacement.

As a nursing assistant, you should be familiar with your client’s care plan as you will be asked to assist in performing exercises.

Some clients will be able to do exercises on their own while you provide safety and encouragement. Other clients will need your help, in which case, you should be gentle and careful, consider their limitations, and do not force any movements that are painful.Lastly, muscular dystrophy is a group of inherited disorders that cause skeletal muscles to deteriorate and weaken.

There are many types, and they could stop developing at various ages, affect specific muscles, and progress at different speeds.

The most common type, and also the one that starts developing in childhood, is the Duchenne muscular dystrophy. Muscle weakness progresses quickly, affecting the whole body, and once it affects the respiratory musculature, it causes death due to the inability to breathe.

In adults, the most common type is myotonic muscular dystrophy, where individuals are unable to relax their muscles after contracting them.

Other than muscle weakness and deterioration, these individuals can have heart problems and cataracts, which is a clouding of the lens of the eye.

As a nursing assistant, you will be asked to assist clients with muscular dystrophy in everyday activities. These include walking, positioning, and exercising.When caring for your clients, there are a few things you should report to the nurse right away.

Let the nurse know if there are any new areas that are swollen, red, or painful and if there is a decrease in range of motion and pain in a joint.

Also, report if a client becomes weaker, starts having difficulty walking, if a client has fallen, and any other abnormal observations.

All right, as a quick recap… Musculoskeletal disorders involve disorders of the bones, joints, and muscles and affect movement and daily activities.

Osteoporosis is a disorder of the bones that causes them to lose their strength and mass, making them frail and susceptible to breaking.

Factors that increase the risk of osteoporosis include advanced age, menopause, calcium and vitamin D deficiency, family history, smoking, alcohol, and sedentary lifestyle.

Hip fracture is a fracture of the upper part of the thigh bone, leaving clients that are recovering from it immobile for a long period of time and susceptible to complications, like pressure ulcers, deep vein thrombosis, mental confusion, and infections.

Arthritis is the inflammation of the joints making them swollen, painful, and harder to move. The most common types are osteoarthritis caused by age related wear and tear of the cartilage and rheumatoid arthritis caused by an autoimmune reaction at the synovial membrane of the joints.Gout is caused by uric acid crystal deposits in the joint space.

Finally, muscular dystrophy is a group of inherited disorders that affect skeletal muscles, causing them to deteriorate and become weak.

When caring for clients with musculoskeletal disorders, remember to report any usual signs and symptoms to the