New User Special Price Expires in

Let's log you in.

Sign in with Facebook


Don't have a StudySoup account? Create one here!


Create a StudySoup account

Be part of our community, it's free to join!

Sign up with Facebook


Create your account
By creating an account you agree to StudySoup's terms and conditions and privacy policy

Already have a StudySoup account? Login here

Pathophysiology- Musculoskeletal System

by: Shelby Stephens

Pathophysiology- Musculoskeletal System NUR 305

Shelby Stephens
GPA 3.5

Preview These Notes for FREE

Get a free preview of these Notes, just enter your email below.

Unlock Preview
Unlock Preview

Preview these materials now for free

Why put in your email? Get access to more of this material and other relevant free materials for your school

View Preview

About this Document

Study Guide
50 ?




Popular in Pathophysiology

Popular in Nursing and Health Sciences

This 15 page Study Guide was uploaded by Shelby Stephens on Wednesday December 9, 2015. The Study Guide belongs to NUR 305 at University of Alabama - Tuscaloosa taught by Owings in Fall 2015. Since its upload, it has received 55 views. For similar materials see Pathophysiology in Nursing and Health Sciences at University of Alabama - Tuscaloosa.

Popular in Nursing and Health Sciences


Reviews for Pathophysiology- Musculoskeletal System


Report this Material


What is Karma?


Karma is the currency of StudySoup.

You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!

Date Created: 12/09/15
Musculoskeletal System  BONES and CARTILAGE  Includes bones, joints, muscles, ligaments, tendons, and other connective tissue  Axial Skeleton= Skull, thorax, vertebral column, (axis of the body)  Appendicular Skeleton= upper and lower extremities, shoulders, and hips girdles Bones:  Specialized form of connective tissue  Site of fat and mineral storage as well as hematopoiesis  206 bones in the skeleton   Skeletal divisions ◦ Axial skeleton forms the long axis of the body and includes the skull,  vertebral column, and rib cage ◦ Appendicular skeleton consists of bones that form the arms, shoulders,  pelvis, and legs  The skeleton forms from hyaline cartilage during fetal development  Cartilage – tough and flexible connective tissue  PTH promotes bone resorption by decreasing calcium  Calcitonin increases blood calcium levels Periosteum – layer of connective tissue that covers compact bone surfaces  Serves as the site of muscle attachment (via tendons)  The outer surface contains cells that aid in remodeling and repair  (osteoblasts)  Richly supplied with blood vessels and nerve fibers  Bone Marrow – in the shaft of long bones  Most infants have red marrow  Red marrow is the site of hematopoiesis  Red marrow is slowly replaced by fat with age, creating yellow marrow  Yellow marrow begins to form during adolescence and is present in most  bones by adulthood  Hematopoiesis occurs in the vertebrae, pelvis, and a few other sites in  adults  The yellow marrow can be reactivated to produce blood cells when needed (e.g., after an injury) Types of Bones:  Long bones  ◦ Upper and lower extremities  Short bones ◦ Ankle and wrist  Flat bones ◦ Scapula, skull  Irregular bones ◦ Jaw, vertebrae  Sesamoid bones ◦ Knee cap Bone Remodeling:  Osteoclasts – break down spongy bone  Osteoblasts – rebuild new compact bone  Osteocyte – osteoblasts surrounded by calcified extracellular material  Matrix ◦ Extracellular material in which the osteocytes are embedded  ◦ Consists of calcium phosphate crystals that make bones hard and strong ◦ Also contains collagen fibers that reinforce the bone to give flexible  strength ◦ Balance between the mineral and collagen is necessary for optimal bone  function Bone Growth:  Bones grow in two ways ◦ Appositional growth – new bone forms on the surface of a bone ◦ Endochondral growth – bone eventually replaces new cartilage growth in  the epiphyseal plate  Proper nutrition and physical activity are essential for the development and  maintenance of healthy bone  Growth hormone works with thyroid hormones to control normal bone growth ◦ Causes cartilage and bone cells to reproduce and lay down their  intercellular matrix  ◦ Stimulating mineralization within the matrix  Calcitonin and parathyroid hormone regulate bone remodeling and mineralization  of calcium  Estrogen inhibits formation of osteoclasts in women  Testosterone increases bone length and density in men  Vitamin D controls the absorption of calcium from the intestine and increases  calcium and phosphate reabsorption in the kidneys Joints: • Structures that connect bones of the skeleton • Synovial joints  – Most common type – Freely moveable  – Contain cartilage that is lubricated by a transparent viscous fluid (synovial fluid) that contains leukocytes to fight infections and provides nutrients  – Contains a joint capsule, a structure that joins one bone to another – Consists of dense connective tissue that attaches to the periosteum of  adjacent bones – Many contain ligaments that connect bones to bones and provide support  to the joint • Amphiarthroses joints (cartilaginous) – Slightly moveable  – Found in the vertebral column  • Synarthroses joints (fibrous) – Immoveable  – Found in the skull and pubic symphysis Muscles:  Skeletal muscles – voluntary muscles that connect to bone ◦ 350 skeletal muscles that are controlled by the brain  Smooth muscles – involuntary muscles that line walls of hollow organs and tubes  and are found in the eyes, skin, and glands   Cardiac muscle – involuntary muscle that comprises the heart  Tendons – tough bands of dense connective tissue that are continuous extensions  of the periosteum ◦ Attaches muscles to bones  Skeletal Muscles:  Comprised of muscle fibers, connective tissue, blood vessels, and nerves   Muscle fiber – muscle cell   Myofibrils – threadlike structures that extend the entire length of the muscle fiber  Myofibrils contain two types of myofilaments – actin and myosin   Myofilaments are organized into repeated structural units called sarcomeres   Muscle fibers contract by sliding actin filaments over myosin filaments  Calcium and adenosine triphosphate is required for muscle contractions Skeletal Muscle Growth: • Growth hormone causes muscle growth • The number of muscle fibers in a muscle remains relatively constant throughout  the life span • Increases in muscle sizes reflect increases in individual muscle fibers • When muscles work harder, they respond by becoming larger and stronger from  an increase in contractile protein inside the muscle fiber • The muscle protein is produced and destroyed quickly, and the growth may be  short lived Injury and Trauma  Fracture:  A break in the rigid structure of the bone   Most common traumatic musculoskeletal disorders    Manifestations:  o Deformity (e.g., angulation, shortening, and rotation),  o Swelling and tenderness at the site o Inability to move the affected limb o Crepitus o Pain o Paresthesia and muscle flaccidity progressing to spasms    Diagnosis:  o History/ physical examination o X­rays    Treatment:  o Immediate immobilization (e.g., splints or traction, reduction (closed or  open) o Surgery (may include pins, plates, rods, or screws) o Debridement o Long­term immobilization (e.g., casts, splints, or traction) o Physical therapy    Complications: o Fat embolism o Osteomyelitis o Osteonecrosis, or avascular necrosis  o Delayed union, malunion, or nonunion o Compartment syndrome Types of Fractures:  Simple fracture—a single break with bone ends maintaining their alignment and  position  Complete fractures  Incomplete fractures ­ partial break   Open fractures, or compound fractures  Closed fractures – skin is intact  Comminuted fracture—multiple fracture lines and bone pieces  Greenstick fracture—an incomplete break in which the bone is bent and only the  outer curve of the bend is broken  Compression fracture—bone is crushed or collapses into small pieces  Impacted fractures  Pathologic fractures  Stress fractures, or fatigue fractures   Depressed fractures Fracture Healing: 1. Hematoma formation 2. Necrosis of the broken bone ends  3. Fibroblasts invade the clot within a few days 4. Fibroblasts secrete collagen fibers, which form a mass of cells and fibers called a  callus 5. Callus bridges the broken bone ends together inside and outside over 2–6 weeks  6. Osteoblasts invade the callus and slowly converts it to bone over 3 weeks to  several months (usually 4–6 weeks) Dislocations: • Separation of two bones at a joint      Manifestations: ◦ Visibly out­of­place, discolored, or deformed joint ◦ Limited movement ◦ Swelling or bruising ◦ Intense pain, especially with movement or weight bearing ◦ Paresthesia near the injury     Diagnosis:  o History, physical examination o X­rays, and magnetic resonance imaging Sprains: • Injury to a ligament that often involves stretching or tearing of the ligament or the capsule surrounding the joint.     Treatment: • RICE • Heal more slowly Strains:  Injury to a muscle or tendon that often involves stretching or tearing of the muscle or tendon      Treatment: o RICE o Possible surgery of severe tendon tears Osteomyelitis:  Acute or chronic infection of the bone or marrow.   Very difficult to treat     Manifestations:  ◦ Fever, redness, swelling  ◦ Bacteremia    Treatment: ◦ Treat causative agent ◦ Abx, possibly surgery for I & D Osteonecrosis:  Avascular necrosis  Caused by interruption in blood flow rather than infection ◦ Fractures, vessel injury (trauma), decompression sickness (SCUBA  diving), sickle cell disease, radiation therapy, compartment syndrome. ◦ Can also be caused by corticosteroid therapy  Neoplasms (Bone Tumors):  More frequently benign than malignant  Both can develop from the cartilage (chondrogenic), bone (osteogenic), and  supporting elements of bone (fibrinogenic)  Location of the tumor provides important diagnostic information.     Manifestations: o Pain, presence of a mass, impairment of function.   Some tumors are found incidentally Benign:  Chondromas, osteochondromas, giant cell tumors  Usually resolve in 2­3 years  Giant cell tumors are classified as “intermediate” in nature between benign and  malignant. Malignant:  Osteosarcomas, chondrosarcoma, Ewing Sarcoma  Can happen at anytime but certain tumors target age groups and anatomic sites  Paget disease increases risk for development of bone cancer Osteosarcoma:  Aggressive and highly malignant bone tumor  Most common malignant bone tumor  Typically occurs in persons younger than 20yo  Men>Women  Unknown cause (although some link it to age and period of maximum growth)    Treatment: o Surgery and Chemotherapy Chrondrosarcoma:  Malignant tumors of cartilaginous lineage and sub­classified according to site of  origin.   Commonly arise in the central portions of the skeleton, pelvis, shoulders, and ribs.  ½ as frequently as osteosarcomas  Middle to later in life, slow growing often metastasize late and are often painless.   Early dx is important because radical surgery excision tends to have better  outcomes.     Treatment: o Radical surgery excision, combo chemotherapy.  o Typically does NOT respond to radiation Ewing Sarcoma:  A member of the family of tumors that include primitive neuroectodermal tumor  (PNET)  Densely packed, regularly shaped, small cells with round or oval nuclei,  reciprocation of chromosome 11 and 31.   Primarily seen in children, and usually located in the femur and pelvis, but can be  found in other bones.     Treatment: o Multiagent chemo for shrinking of tumor, surgery, and radiation  therapy Skeletal Disorders in Children:  Osteogenesis Imperfecta ◦ “brittle bone disease” ◦ Autosomal recessive trait that causes deficiencies in the synthesis of type I collagen ◦ Extreme skeletal fragility ◦ No definitive treatment for correction  Genu Varum ◦ “Bowlegs” ◦ Bowing of the knees greater than 1inch when the medial malleoli of the  ankles are touching.   Genu Valgum ◦ “Knock knees” ◦ Deformity in which there is decreased space between the knees  Developmental Dysplasia of the Hip (DDH) ◦ “congenital dislocation of the hip”  ◦ Can lead to unstable, malformed, subluxed, or dislocated hip in severe  cases.  ◦ Newborn screening includes Barlow test.  Confirmation of dysplasia is  obtained with Ortolani “click”  Legg­Calve­Perthes Disease. ◦ Idiopathic osteonecrotic disease of the proximal femoral epiphysis.  Avascular necrosis of the bone and marrow involving the epiphyseal  growth center.  ◦ Main symptoms are pain in the hip and groin area ◦ Unknown cause ◦ Typically treated with surgery to reduce deformity and preserve femoral  head.  Osgood Schlatter Disease ◦ Micro fractures in the area where the patellar tendon inserts to the tibial  tubercle.  ◦ Pain in the front of the knee associated with inflammation and thickening  of the patellar tendon.  ◦ Treatment is rest, activity restriction, and occasional knee immobilization  Slipped Capital Femoral Epiphysis (SCFE) ◦ “coxa vera” disorder of the growth plate that occurs near the age of  skeletal maturity.  ◦ Three dimensional displacement of the epiphysis (posteriorly, medially,  and inferiorly) ◦ Pain usually in the knee area with fatigue and difficulty walking.  ◦ Diagnosis is made by x­ray and treatment is determined by severity of  slippage.   Scoliosis (also seen in adults) ◦ Curvature of the spine in the upright position ◦ Affects the thoracic or lumbar area  ◦ Congenital, neuromuscular, and idiopathic        Complications:  o Pulmonary compromise,  o Chronic pain,  o Degenerative arthritis of the spine,  o Intervertebral disk disease, and  o Sciatica ­ Manifestations vary depending on the degree of curvature and are exaggerated when an affected person bends over o Asymmetrical hip and shoulder alignment  o Asymmetrical thoracic cage  o Asymmetrical gait o Back pain or discomfort, fatigue o Indications of respiratory compromise  Kyphosis:   • Increase in the curvature of the thoracic spine outward  Lordosis:  Exaggerated concave of the lumbar spine  Osteoporosis:  Metabolic condition characterized by a progressive loss of bone calcium that  leaves the bones brittle      Complications:  o Pathological fractures (typically in the wrist, hip, and spine)      Manifestations: o Often asymptomatic in early stages o Osteopenia  o Bone pain or tenderness o Fractures with little or no trauma  o Low back and neck pain, kyphosis o Height reduction (as much as 6 inches) over time    Diagnosis: o Conducted screening periodically on those persons at risk o History, physical examinations,  o Bone density scans, X­rays, and spinal computed tomography o Advances in diagnostic methods of bone mass density have made early  detection possible Rickets and Osteomalacia:  Rickets (pediatric form)– soft, weak bones in children, usually because of an  extreme and prolonged vitamin D, calcium, or phosphate deficiency  Osteomalacia – adult form    Manifestations: o Becomes apparent in children as the soft bones cannot support the  growing child o Skeletal deformities (e.g., bowed legs, asymmetrical skull, scoliosis,  kyphosis, pelvic deformities, sternum projection) o Delayed growth in height or limbs o Dental problems o Bone pain o Muscle cramps or weakness Paget’s Disease:  Progressive metabolic condition characterized by excessive bone destruction that  occurs along with the replacement of bone by fibrous tissue and abnormal bone  The new bone is bigger but weakened and filled with new blood vessels    Manifestations: o Vary depending on the area affected o Often insidious in onset and may be asymptomatic early o Skeletal deformities (e.g., bowing of the legs, asymmetrical skull, and  enlarged head) o Headache, Hearing and vision loss o Joint pain or stiffness, Neck pain, bone pain, fractures o Reduced height o Warmth over the affected bone o Paresthesia or radiating pain in the affected region  o Hypercalcemia Osteoarthritis:  Degenerative joint disease characterized by local deterioration of articulating  cartilage and its underlying bone as well as bony overgrowth  Results in joint space narrowing, joint instability, stiffness, and pain    Manifestations: o Gradual onset, usually beginning after the age of 40 o Joint pain that worsens during or after movement or weight bearing o Joint tenderness with light pressure o Enlarged, hard joints o Limited joint range of motion o Hard nodules around the affected joint (bone spur) Rheumatoid Arthritis:  Systemic, autoimmune condition involving multiple joints  The exact cause is unknown, but it is thought to be caused a genetic vulnerability  that permits a virus or bacteria to trigger the disease    Risk factors:  o Being female o Family history o Advancing age (however, there is a juvenile form)   o Smoking    Manifestations: o Usually insidious onset Progressively worsen o Anorexia o Low­grade fever, malaise, fatigue o Lymphadenopathy o Muscle spasms o Morning stiffness lasting more than 1 hour o Warmth, tenderness, and stiffness in the joints when not used o Bilateral joint pain, Swollen and boggy­ joints, Limited joint range of  motion o Contractures and joint deformity (e.g., boutonniere deformity and swan  neck deformity) o Unsteady gait o Depression, Anemia Gout:  Inflammatory disease resulting from deposits of uric acid crystals in tissues and  fluids  Phases:  1 .     Asymptomatic  ­ Uric levels climb in the bloodstream and crystals deposit in the tissue ­ Crystals accumulate, damaging tissue  2 .     Acute flares or attack ­ Tissue damage triggers an acute inflammation  ­ Characterized by pain, burning, redness, swelling, and warmth at the  affected joint lasting days to weeks ­ Most initial attacks occur in the lower extremities (most often the big  toe)  3 .     Intercritical period ­ After the attack subsides and the disease is clinically inactive until the  next flare ­ Hyperuricemia and crystal accumulation continues  ­ These periods in between attacks become shorter as the disease  progresses ­ Reoccurring attacks are often precipitated by sudden increases in  serum uric acid  4 .     Chronic gouty arthritis ­ Characterized by joint soreness and aching present most of the time ­ May also develop tophi that can drain or renal calculi    Manifestations: o Vary depending on the phase o Intense pain at the affected joint that frequently starts during the night and  is often described as throbbing, crushing, burning, or excruciating o Joint warmth, redness, swelling, and tenderness (even to light touch) o Fever o Joint deformities  o Limited joint mobility Ankylosing Spondylitis:  Progressive inflammatory disorder affecting the sacroiliac joints, intervertebral  spaces, and costovertebral joints    Manifestations: o Intermittent lower back pain (early) o Pain and stiffness that typically worsens with inactivity and improves after activity o Lower back pain that evolves to include the entire back o Pain in other joints (especially the shoulders, hips, or lower extremities) o Muscle spasms o Fatigue, Low­grade fever, Weight loss o Kyphosis Muscular Dystrophy:  Group of inherited disorders characterized by degeneration of skeletal muscle  Most types are inherited, but some occur because of a genetic mutation (often  spontaneously)  Some types cause tremendous disability and rapidly decline whereas others have  minimal symptoms and hardly noticeable progression    Manifestations: o All of the muscles may be affected or only a selected group o Mental retardation (in some types) o Muscle weakness and spasms that progresses o Delayed development of muscle motor skills o Difficulty using one or more muscle groups o Poor coordination, frequent falls o Drooling o Ptosis  o Progressive loss of joint mobility and contractures (e.g., clubfoot and foot  drop) o Unilateral calf hypertrophy o Scoliosis or lordosis    Diagnosis:  o History, physical examination o Muscle biopsy o Electromyelography, electrocardiogram  o Serum creatine kinase levels, serum presence of defective dystrophin o Genetic testing o Fetal chorionic villus testing (as early as 12 weeks’ gestation)    Treatment: o No cure for MD o Gene therapy may potentially be the answer o Goal is to maintain motor function and prevent deformities as long as  possible o Includes: physical therapy, muscle relaxants, immunosuppressant agents,  assistive devices (e.g., walker, braces, and splints), surgical contracture  release, coping strategies, and support Fibromyalgia:  Syndrome predominately characterized by widespread muscular pains and fatigue  Affects muscles, tendons, and surrounding tissue, but it does not affect the joints    Manifestations: o Vary depending on the weather, stress, fatigue, physical activity, and time  of day o Widespread pain, typically described as a constant, dull muscle ache with  trigger points o Fatigue, sleep disturbances, depression, irritable bowel syndrome,  headaches, and memory problems 


Buy Material

Are you sure you want to buy this material for

50 Karma

Buy Material

BOOM! Enjoy Your Free Notes!

We've added these Notes to your profile, click here to view them now.


You're already Subscribed!

Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'

Why people love StudySoup

Bentley McCaw University of Florida

"I was shooting for a perfect 4.0 GPA this semester. Having StudySoup as a study aid was critical to helping me achieve my goal...and I nailed it!"

Kyle Maynard Purdue

"When you're taking detailed notes and trying to help everyone else out in the class, it really helps you learn and understand the I made $280 on my first study guide!"

Steve Martinelli UC Los Angeles

"There's no way I would have passed my Organic Chemistry class this semester without the notes and study guides I got from StudySoup."

Parker Thompson 500 Startups

"It's a great way for students to improve their educational experience and it seemed like a product that everybody wants, so all the people participating are winning."

Become an Elite Notetaker and start selling your notes online!

Refund Policy


All subscriptions to StudySoup are paid in full at the time of subscribing. To change your credit card information or to cancel your subscription, go to "Edit Settings". All credit card information will be available there. If you should decide to cancel your subscription, it will continue to be valid until the next payment period, as all payments for the current period were made in advance. For special circumstances, please email


StudySoup has more than 1 million course-specific study resources to help students study smarter. If you’re having trouble finding what you’re looking for, our customer support team can help you find what you need! Feel free to contact them here:

Recurring Subscriptions: If you have canceled your recurring subscription on the day of renewal and have not downloaded any documents, you may request a refund by submitting an email to

Satisfaction Guarantee: If you’re not satisfied with your subscription, you can contact us for further help. Contact must be made within 3 business days of your subscription purchase and your refund request will be subject for review.

Please Note: Refunds can never be provided more than 30 days after the initial purchase date regardless of your activity on the site.