Chapter 36: Managing Musculoskeletal Disorders

The comprehensive management of musculoskeletal disorders, including joint diseases, infections, and tumors, is the focus of this academic chapter. It begins with common issues such as low back pain (LBP), a primary cause of disability often linked to acute lumbosacral strain or the mechanical stress resulting from intervertebral disc degeneration, particularly at the L4-L5 and L5-S1 levels. LBP management centers on relief of discomfort through pharmacologic agents like NSAIDs, muscle relaxants, or tricyclic antidepressants for chronic pain, combined with nonpharmacologic methods such as thermal applications, exercise regimens, and strict adherence to back-conserving body mechanics, which includes lifting with the strong leg muscles while keeping the back straight and the load close to the body. The chapter details various peripheral musculoskeletal problems, including inflammatory conditions like bursitis and tendonitis, and entrapment neuropathies such as carpal tunnel syndrome, caused by median nerve compression often associated with repetitive motion, rheumatoid arthritis, or diabetes. Foot disorders, resulting from congenital issues, systemic diseases, or poorly fitting footwear, include deformities such as hallux valgus (bunion), hammer toe, pes cavus (clawfoot), and painful conditions like plantar fasciitis and Morton neuroma. These conditions are often managed conservatively with orthotic devices, but may require surgical intervention like osteotomy or excision of soft tissue masses. Osteoarthritis (OA) is covered as the most common noninflammatory, degenerative joint disease, characterized by the breakdown of articular cartilage, narrowing of the joint space, and the formation of bony outgrowths called osteophytes. OA symptoms include pain aggravated by movement and brief morning stiffness (lesser than 30 minutes). Treatment involves weight reduction, exercise, patient education, and pharmacologic therapies, progressing to surgical intervention like arthroplasty (joint replacement) when functional loss is severe. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) require meticulous preoperative preparation focused on preventing major complications, including venous thromboembolism (VTE) through prophylactic anticoagulants, and infection, often utilizing pre-operative antiseptic wash and prophylactic antibiotics. A critical nursing intervention following THA, especially the posterior approach, is the prevention of prosthetic dislocation by maintaining hip abduction, neutral rotation, and limiting flexion to no more than 90 degrees. Metabolic bone diseases are highlighted, specifically osteoporosis, characterized by reduced bone mass where osteoclast resorption exceeds osteoblast formation, leading to fragility fractures, kyphosis, and height loss, managed by maximizing calcium and vitamin D intake, engaging in weight-bearing exercise, and administering medications such as bisphosphonates or RANKL inhibitors. Osteomalacia involves inadequate bone mineralization due to a deficiency of activated vitamin D, resulting in bone softening and skeletal deformities, requiring vitamin D and calcium supplementation. Paget disease of the bone, a disorder of localized, rapid, disorganized bone turnover, causes structurally weak and highly vascularized bone, with bisphosphonates used as the primary treatment to stabilize the rapid bone turnover. Musculoskeletal infections include osteomyelitis (bone infection), often caused by Staphylococcus aureus, leading to the formation of necrotic bone (sequestrum) encased by new bone growth (involucrum), necessitating long-term antibiotics (typically 6 to 12 weeks) and surgical débridement to remove the dead tissue. Septic arthritis is an acute infection of a joint requiring immediate aspiration and organism-specific antibiotics to prevent joint destruction. Finally, the chapter addresses bone tumors, differentiating between slow-growing benign types (like osteochondroma) and aggressive malignant sarcomas (like osteosarcoma), noting that metastatic bone disease is more common than primary tumors, requiring management aimed at pain relief, structural stabilization, and treating complications like hypercalcemia.