Mobility and Musculoskeletal (MSK) Study Guide Summary & Study Notes

🧾 Diagnostic Testing Overview

Diagnostic tests for musculoskeletal disorders include imaging and electrodiagnostic studies such as X-ray, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), dual-energy x-ray absorptiometry (DXA), bone scans, arthroscopy, electromyography (EMG), and nerve conduction studies. Each test has specific indications: imaging for structural changes, DXA for bone density, and EMG/nerve conduction for neuromuscular function.

🦴 Dual-Energy X-ray Absorptiometry (DXA)

The DXA scan estimates bone mineral density usually at the hip or spine and is the standard test for diagnosing osteoporosis. It uses two X-ray beams and produces a score comparing the client’s bone mass to a reference population. Clients lie on an X-ray table during the scan; no contrast is used.

🔧 Osteoarthritis (OA)

Osteoarthritis is a progressive degenerative loss of articular cartilage in joints. Manifestations include chronic joint pain, stiffness, limited movement, joint effusion, Heberden’s and Bouchard’s nodes, and muscle atrophy. Management focuses on pain control, range-of-motion and isometric exercises, assistive devices for ADLs, heat/ice, adequate rest, and medications such as NSAIDs, corticosteroids, topical analgesics, and supplements (glucosamine, chondroitin sulfate). Diagnostics include X-ray, CT, and MRI.

🦴 Osteoporosis

Osteoporosis is characterized by decreased bone mass and increased fracture risk, commonly occurring after menopause. Diagnosis often involves DXA scanning and assessment of labs related to calcium, magnesium, and parathyroid hormone (PTH). Prevention and treatment target bone preservation and fracture prevention.

🤝 Synovitis

Synovitis is inflammation and swelling of the synovial membrane, often from overuse or associated with arthritis. The major symptom is joint pain; definitive diagnosis is by a rheumatologist and may use MRI or ultrasound. Treatment depends on severity: rest, NSAIDs, and ice for mild cases; DMARDs and steroid injections for moderate cases; and synovectomy for severe, refractory disease.

🦴 Fractures and Immobilization

Fractures are classified by pattern, location, and displacement; management aims to realign and immobilize bone. Splints are removable and allow skin monitoring and swelling control. Casts provide rigid immobilization to maintain reduction and prevent contractures. Both protect, reduce pain, and support healing.

🏥 Hip Arthroplasty (Total Hip Replacement)

Hip arthroplasty replaces a diseased hip joint with a prosthesis to relieve pain and restore function. Indications include osteoarthritis, osteonecrosis, rheumatoid arthritis, trauma, or congenital anomalies. Postoperative care includes pain control, infection and DVT/PE monitoring, early ambulation with assistive devices, adherence to hip precautions (no hip flexion >90°, no crossing legs, use of abduction pillow, avoid low chairs), and neurovascular checks (the 6 P’s).

🦠 Osteomyelitis

Osteomyelitis is bone infection, often from Staphylococcus species, presenting with constant localized bone pain, erythema, edema, fever (may be absent in older adults), and leukocytosis. Diagnostics include bone scan, MRI, and cultures. Treatment requires prolonged antibiotics (often months), possible surgical debridement, and adjuncts such as hyperbaric oxygen or implanted antibiotic beads. Untreated or refractory cases can lead to amputation.

🩺 Lower Back Pain (LBP)

Lower back pain can be acute or chronic and arises from muscle strain, ligament sprain, disc herniation, degeneration, or spinal stenosis. Symptoms vary from dull to sharp pain aggravated by movement, with potential muscle spasm and paresthesia. Red flags (fever, bowel/bladder incontinence, progressive neurologic deficit) require urgent evaluation. Diagnostics include X-ray, CT, MRI, bone scan, myelogram, and EMG/nerve conduction. Management ranges from conservative care (heat, exercise, weight management, physical therapy, NSAIDs, topical agents) to interventional procedures and surgery when indicated.

🪢 Traction

Traction applies a mechanical pulling force to relieve muscle spasms, immobilize, or align fractures. Nursing care includes frequent skin inspections, ensuring bandages are wrinkle-free, and that weights hang freely. Continuous neurovascular assessment (6 P’s) is essential; complications include skin breakdown, nerve damage, and DVT.

⚠️ Compartment Syndrome

Compartment syndrome occurs when elevated pressure within a fascial compartment impairs perfusion, risking muscle and nerve necrosis. Common causes include fractures, crush injuries, burns, and overuse. Early signs include severe pain out of proportion, tense swelling, and numbness; late signs are the “six P’s.” Immediate fasciotomy is required to prevent permanent damage, followed by wound care and rehabilitation.

✂️ Amputations

Amputation is removal of a body part, often an extremity, due to trauma, infection, malignancy, or peripheral vascular disease. Pre- and postoperative nursing focuses on infection prevention, monitoring residual limb perfusion and healing, managing pain (including phantom limb pain), and facilitating rehabilitation and prosthetic fitting. Diagnostic vascular studies (angiography, Doppler, TcPO2, ABI) guide surgical decisions.

💊 Medications to Know

Commonly used medications in MSK care include allopurinol, colchicine, calcium carbonate, dantrolene, cyclobenzaprine, baclofen, and methocarbamol. These agents treat gout, electrolyte/mineral needs, muscle spasm, and spasticity; each has specific indications, dosing considerations, and side effects that must be monitored.

🩺 Nursing Priorities and Assessment

Key nursing responsibilities across MSK conditions include pain management, neurovascular assessments (the 6 P’s: pain, pallor, paresthesia, pulselessness, paralysis, poikilothermia), infection surveillance, wound and dressing care, mobility and safety education, and client teaching about precautions and home care. Early recognition of complications such as DVT, PE, compartment syndrome, and surgical site infection is critical.