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Musculoskeletal system: Musculoskeletal disorders



Content Reviewers:

Lisa Miklush, PhD, RNC, CNS

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.