Chapter 61: Adult Musculoskeletal Problems

The skeletal system is organized into axial and appendicular divisions, with bone growth occurring through epiphyseal cartilage lengthening in adolescence and osteoblast-driven widening throughout life. Joint function depends on structural classification ranging from immobile synarthroses to freely movable diarthroses, while muscle contraction requires calcium signaling and adenosine triphosphate availability initiated by acetylcholine neurotransmission. Diagnostic evaluation employs radiography, magnetic resonance imaging, arthrocentesis for synovial fluid analysis, arthroscopy for direct visualization, bone scintigraphy with radioisotopes, and electromyography to assess neuromuscular function. Acute musculoskeletal injuries include strains affecting muscles and tendons versus sprains damaging ligaments, both managed initially through rest, ice, compression, and elevation protocols. Fracture care involves realignment through reduction, stabilization via internal or external fixation, and weighted traction systems maintained with proper hanging mechanics. Serious complications include fat embolism from long-bone trauma presenting with restlessness and dyspnea, acute compartment syndrome requiring fasciotomy to prevent tissue necrosis, and osteomyelitis necessitating prolonged intravenous antibiotic therapy. Mobility restoration requires proper crutch fitting with brachial plexus protection and asymmetrical cane positioning on the unaffected side. Orthopedic surgical interventions such as hip fracture repair demand strict hip flexion limitation to prevent dislocation, while lower-extremity amputation care prevents flexion contractures through prone positioning and limb-dependent positioning protocols. Spine surgery requires logrolling to maintain vertebral alignment. Chronic inflammatory arthritis, exemplified by rheumatoid arthritis, presents as systemic autoimmune joint destruction with prolonged morning stiffness, whereas osteoarthritis represents degenerative joint disease with characteristic nodular formations at interphalangeal joints. Metabolic bone disease includes osteoporosis predisposing to pathological fractures and gout resulting from monosodium urate crystal deposition managed through dietary purine restriction and hyperuricemia control.