MSK: Nursing

  1. Systematic assessment of MSK system

SUBJECTIVE DATA (General principles): 1. presenting complaint 2. gait, arms, legs and spine (GALS) screening asses. 3. joints 4. muscles 5. bones 6. functional assessment (ADLs)7.health and lifestyle management 8. add. hist. for infants and children (eg. wellness, bone deformity) 9. add. hist. for adolescents (sport participation, bone deformity) 10. add. hist. for adults (walking aids, falls)

OBJECTIVE DATA (Physical exam): 1.Systemic approach (head to toe, proximal to distal, compare corresp. paired joints - neurovascular asses. 2. Order of exam: inspect, palpate and then move 3. GALS screening asses: validated, quick and efficient MSK asses. sys.4. Inspection: size and contour of joint - colour, swelling and masses/deformity5.palpation: - temp, muscles, articulations, area of joint capsule - tenderness, crepitus, swelling or masses - boggy synovial membra.(not normally palpable) 6. range of motion: - ask for activ, move. - passive motion - gonimeter (physio an OT) 7. crepitation (sound on movement) 8. muscle testing: bilateral strength: resist opposing force 9. movement and ROM: with/out resistance

  1. Common MSK condition

Abnormal findings

Osteoporosis: bone remodelling - disease characterised by low bone add and micro-architectural deterioration of bone tissues - bone loss occurs silently risk factors - family hist., increase age, Vit. D deficiency, lifestyle.

multiple joints: inflammatory conditions(rheumatoid arthritis)-degenerative conditions(osteoarthritis) shoulder - fracture, dislocation, frozen shoulderelbow - fracture, subcutaneous nodules, epicondylitiswrist and hand: - ganglion cyst knee - septic arthrits - swelling of menisci ankle and foot - sprain, callus, chronic/cute gout spine - scoliosis, chronic pain

  1. Diagnostic studies

-X-ray, MRI, bone scan, CT +/- contrast, bone mineral density, arthroscopy - arthrography-electromyogrpahy

4.Principles and methods of fracture immobilisation

RICE(R): RestIceCompressionElevationReferral

5.Nursing management: simple fracture & soft tissue injury

fractures - sling, collar&cuff, plaster of paris soft tissue injuries - compression bandaging treatment 1. open reduction & internal fixation 2. local anaesthetic, manipulation and plaster 3. general anaesthetic, manipulation and plaster

  1. Neurovascular assessment

NVO (neurovascular observations) includes assessing peripheral pulses and neurological functioning of limbs to detect pressure on nerves and vascular supply which will determine compromised vascular or neurological function

indications - post skin flap surgery - prior/post spinal surgery - fracture - application of bandages(post/prior) - bites on limbs - signs of infec. on limbs. - soft tissue injury on MSK - vascular surgery frequency: -1/2 hrly for first 4 hrs - once each shift - 2 hrly for 4 hrs

  1. Components of NVA

5-Ps: Pain: assess pain at injury site -rating scale - location, radiation and characteristics Pulse should be same rate and vol. of unaffected limb. Capillary refill Pallor: - skin colour, warm to touch Paresthesia - sensation assessed in distal digits - alteration in sensation like numbness, pressure, tightness, tingling Paralysis - assess motor function - muscle weakness


Pressure: oedema causes tenseness of the distal limb tissue will feel firm and check for blood loss

  1. Alterations in neurovascular supply of periphral MSK areas and effect on function

radial nerve: extends wrist and fingers at knuckle joint median nerve: bring thumb and little finger ulna: abduct all fingers tibial ability to plantar flex ankle and toes peroneal dorsiflex ankle and toes

COMPARTMENT SYNDROME: build of pressure within compartment compromises tissue perfusion : pressure build up reduces capillary blood flow to that space. pressure within compartment compromised neurovascular supply - muscle and nerve become ischaemic