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Musculoskeletal System OverviewMusculoskeletal System Overview
��Three types of muscle tissueThree types of muscle tissue
��Cardiac Cardiac •• found in the heart; involuntaryfound in the heart; involuntary
��SmoothSmooth•• found in walls of hollow structures (i.e., blood vessels, air found in walls of hollow structures (i.e., blood vessels, air passageways), and most passageways), and most abdominopelvicabdominopelvic organs; involuntaryorgans; involuntary
��SkeletalSkeletal•• move bone, skin, or other skeletal muscles; voluntarymove bone, skin, or other skeletal muscles; voluntary
– Consists of individual muscle cells called muscle
fibers, which contain myofibrils
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
Skeletal System Skeletal System (cont(cont’’d.)d.)
From From HerlihyHerlihy B, B, MaebuisMaebuis NK: NK: The human body in health and illness,The human body in health and illness, eded 3, Philadelphia, 2007, Saunders.3, Philadelphia, 2007, Saunders.
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, eded 3, St. Louis, 2007, Saunders.3, St. Louis, 2007, Saunders.
�� Loss of normal bone Loss of normal bone density resulting in density resulting in increased susceptibility to increased susceptibility to fractures fractures
�� Use lighter pressure and Use lighter pressure and avoid joint mobilizations avoid joint mobilizations and compressions or and compressions or administer carefullyadminister carefully
A, from Kumar V, A, from Kumar V, AbbasAbbas AK, AK, FaustoFausto N: N: Robbins & Robbins & CotranCotran pathologic basis of disease, pathologic basis of disease, 7e, Philadelphia, 2005, WB Saunders; 7e, Philadelphia, 2005, WB Saunders;
B and C, from B and C, from ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiologyAnatomy & physiology, , eded 6, St. Louis, 2007, Mosby. 6, St. Louis, 2007, Mosby.
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
�� Progressive bone disease with Progressive bone disease with abnormal and excessive bone abnormal and excessive bone remodeling resulting in weak and remodeling resulting in weak and deformed bones of increased massdeformed bones of increased mass
�� Use lighter pressure and avoid joint Use lighter pressure and avoid joint mobilizations and compressions or mobilizations and compressions or administer carefullyadminister carefully
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
�� Bone infection most often caused by bacteriaBone infection most often caused by bacteria
�� Massage is contraindicatedMassage is contraindicated
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
�� Genetic disorder; Genetic disorder; abnormality in bodyabnormality in body’’s s connective tissue; affects connective tissue; affects many body systems, most many body systems, most often the skeletal and often the skeletal and cardiovascular systems cardiovascular systems and eyesand eyes
�� Modifications are based Modifications are based on disease severity on disease severity
From From DamjanovDamjanov I: I: Pathology for the health professions,Pathology for the health professions, eded 3, St. Louis, 2006, Saunders.3, St. Louis, 2006, Saunders.
normal posterior thoracic normal posterior thoracic
curvecurve
�� Avoid overstretching Avoid overstretching
spine; if due to spine; if due to
osteoporosis, use lighter osteoporosis, use lighter
pressurepressure
From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.
�� Lateral curvature in the normally straight vertical Lateral curvature in the normally straight vertical spinal line, usually in the thorax spinal line, usually in the thorax
�� Use deep stroking and kneading on affected Use deep stroking and kneading on affected muscles; avoid overstretching the spinemuscles; avoid overstretching the spine
From Gould BE: From Gould BE: PathophysiologyPathophysiology for the health professions,for the health professions, eded 3, 2006, St. Louis, Saunders.3, 2006, St. Louis, Saunders.
�� Medial displacement of the Medial displacement of the
first first metatarsophalangealmetatarsophalangeal
joint (great toe) joint (great toe)
�� Avoid area or use lighter Avoid area or use lighter
pressure if tender; avoid pressure if tender; avoid
joint mobilizations joint mobilizations
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
Hammer Toes and Mallet ToesHammer Toes and Mallet Toes
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
�� PesPes planusplanus (flatfoot) (flatfoot) –– Medial longitudinal arch is Medial longitudinal arch is reduced or collapsedreduced or collapsed
�� PesPes CavusCavus (high instep) (high instep) –– both medial and both medial and lateral longitudinal arches are excessively raised lateral longitudinal arches are excessively raised
�� Deep gliding, kneading, and friction strokes to Deep gliding, kneading, and friction strokes to loosen tight calf muscles; avoid any related loosen tight calf muscles; avoid any related corns or calluses or use lighter pressure if corns or calluses or use lighter pressure if tendertender
PesPes PlanusPlanus and and PesPes CavusCavus, , (cont(cont’’d.)d.)
Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, Courtesy Charles W. Bradley, DPM, MPA and Caroline Harvey, DPM, California College of Podiatric Medicine. In Seidel HM et al: California College of Podiatric Medicine. In Seidel HM et al:
MosbyMosby’’s guide to physical examinations, s guide to physical examinations, eded 6, St. Louis, 2006, Mosby.6, St. Louis, 2006, Mosby.
compressions or administer compressions or administer
carefullycarefully
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
�� Benign mass usually located on wrist tendonBenign mass usually located on wrist tendon
�� Local contraindicationLocal contraindication
Ganglion CystGanglion Cyst
A, from A, from HoppenfeldHoppenfeld S: S: Physical examination of the spine and extremities,Physical examination of the spine and extremities, Upper Saddle River, NJ, 1976, Pearson Education;Upper Saddle River, NJ, 1976, Pearson Education;
B, from B, from CallenCallen J et al.: J et al.: Color atlas of dermatology,Color atlas of dermatology, Philadelphia, 1993, WB Saunders.Philadelphia, 1993, WB Saunders.
From Courtesy Dr. M Sherlock. In From Courtesy Dr. M Sherlock. In ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis,Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
�� Progressive damage and eventual loss of Progressive damage and eventual loss of articulararticular cartilage; also called degenerative joint cartilage; also called degenerative joint disease disease
�� Avoid joints that are red, hot, or tender; use mildAvoid joints that are red, hot, or tender; use mild--to moderateto moderate--pressure; neck movements are best pressure; neck movements are best omitted or carried out with extreme caution omitted or carried out with extreme caution
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby; and 5, St. Louis, 2006, Mosby; and
From From DamjanovDamjanov I: I: Pathology for the healthPathology for the health--related professions,related professions, eded 2, Philadelphia, 2000, WB Saunders.2, Philadelphia, 2000, WB Saunders.
�� Any joint inflammation of at least 6 weeks in a Any joint inflammation of at least 6 weeks in a
childchild
�� Massage contraindicated during exacerbations; Massage contraindicated during exacerbations;
otherwise, adjust pressure to client toleranceotherwise, adjust pressure to client tolerance
From From ZitelliZitelli BJ, Davis HW: BJ, Davis HW: Atlas of pediatric physical diagnosis, Atlas of pediatric physical diagnosis, eded 5, Philadelphia, 2007, Mosby.5, Philadelphia, 2007, Mosby.
From Shipley M: A From Shipley M: A colourcolour atlas of rheumatology,atlas of rheumatology, eded 3, London, 1993, Mosby Year Book Europe.3, London, 1993, Mosby Year Book Europe.
�� Inflammatory arthritis Inflammatory arthritis resulting from uric acid resulting from uric acid crystals in jointscrystals in joints
�� During attacks, massage During attacks, massage is adjusted according to is adjusted according to symptoms; in chronic symptoms; in chronic cases, use lighter cases, use lighter pressure over nodules pressure over nodules and avoid mobs of and avoid mobs of deformed deformed jtsjts..
From Dieppe P et al: From Dieppe P et al: Arthritis and rheumatism in practice,Arthritis and rheumatism in practice, London, 1991, Gower.London, 1991, Gower.
From From KamalKamal A, A, BrockelhurstBrockelhurst JC: JC: Color atlas of geriatric medicine,Color atlas of geriatric medicine, eded 2, St. Louis, 1992, Mosby.2, St. Louis, 1992, Mosby.
From Redrawn from From Redrawn from FreundlichFreundlich B, B, LeventhalLeventhal L: The fibromyalgia syndrome. In Schumacher HR L: The fibromyalgia syndrome. In Schumacher HR JrJr, , KlippelKlippel JH, JH, KoopmanKoopman, WJ, , WJ, edseds: :
Primer on the rheumatic diseases,Primer on the rheumatic diseases, eded 11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprin11, Atlanta, 1977, Arthritis Foundation. Copyright 1997. Reprinted with permission of the ted with permission of the
Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.Arthritis Foundation, 1330 W. Peachtree St., Atlanta, GA 30309.
�� Types of trigger points are:Types of trigger points are:
�� Active: pain is produced by pressure or stretching; Active: pain is produced by pressure or stretching; this pain is experienced locally and in a referred this pain is experienced locally and in a referred area that is familiar area that is familiar
�� Latent: pain is produced by pressure or stretching; Latent: pain is produced by pressure or stretching; this pain is experienced both locally and in a this pain is experienced both locally and in a referred area that is unfamiliarreferred area that is unfamiliar
Adapted from Adapted from McCanceMcCance KL, KL, HuetherHuether SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
From From FromFrom HockenberryHockenberry MJ: MJ: WongWong’’s nursing care of infants and children,s nursing care of infants and children, eded 8, St. Louis, 2007, Mosby.8, St. Louis, 2007, Mosby.
Dislocation and Dislocation and SubluxationSubluxation
�� Dislocation Dislocation ––temporary temporary displacement of displacement of bones at the jointbones at the joint
�� SubluxationSubluxation ––contact is only contact is only partially lostpartially lost
�� Local Local contraindication for contraindication for recent injuries and recent injuries and inflamed areasinflamed areas
From Gould B: From Gould B: PathophysiologyPathophysiology for the health professions,for the health professions, eded 2, Philadelphia, 2002, WB Saunders.2, Philadelphia, 2002, WB Saunders.
�� Disruption or break in bone Disruption or break in bone
continuitycontinuity
�� Local contraindication if Local contraindication if
bone is immobilized, but bone is immobilized, but
massage to proximal and massage to proximal and
distal areas is usefuldistal areas is useful
From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.
�� Overstretching or tearing Overstretching or tearing
of ligaments without bone of ligaments without bone
displacement; three displacement; three
degrees (first, second, degrees (first, second,
and third)and third)
�� Avoid affected area for Avoid affected area for
72 hrs after injury72 hrs after injuryFrom Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases Essentials of human diseases
�� Overstretching or tearing Overstretching or tearing
of muscle or its tendons; of muscle or its tendons;
three degrees (first, three degrees (first,
second, and third)second, and third)
�� Avoid affected area for Avoid affected area for
72 hrs after injury72 hrs after injury
From Courtesy Barbara Cousins. In From Courtesy Barbara Cousins. In ThibodeauThibodeau GA, Patton KT: GA, Patton KT: Anatomy & physiology, Anatomy & physiology, eded 6, St. Louis, 2007, Mosby.6, St. Louis, 2007, Mosby.
�� Inflammation of a tendonInflammation of a tendon
�� Avoid affected area if Avoid affected area if
less than 72 hrs after less than 72 hrs after
injury; initial sessions are injury; initial sessions are
short and become longer short and become longer
as the area becomes use as the area becomes use
to pressure; follow with to pressure; follow with
iceice
From From McCanceMcCance KL, KL, HeutherHeuther SE: SE: PathophysiologyPathophysiology: the biologic basis for disease in adults and children, : the biologic basis for disease in adults and children, eded 5, St. Louis, 2006, Mosby.5, St. Louis, 2006, Mosby.
�� Occurs when pressure Occurs when pressure within a within a nonyieldingnonyieldingfascialfascial compartment compartment increases; types are increases; types are acute and chronic acute and chronic
�� Avoid area if client Avoid area if client reports intense, reports intense, stabbing pain or is stabbing pain or is hypersensitive to hypersensitive to pressure pressure
From Black JM, Hawks JH, Keene AM: From Black JM, Hawks JH, Keene AM: MedicalMedical--surgical surgical
nursing: clinical management for positive outcomes, nursing: clinical management for positive outcomes, eded 6, 6,
�� Chronic inflammation of Chronic inflammation of
the plantar fascia (the plantar fascia (““pain pain
in the heelin the heel””))
�� Avoid area if pain is Avoid area if pain is
severe; be sure affected severe; be sure affected
foot is not excessively foot is not excessively
dorsiflexeddorsiflexed
From Frazier MS, From Frazier MS, DrzymkowskiDrzymkowski JW: JW: Essentials of human diseases and conditions,Essentials of human diseases and conditions, ed. 2, Philadelphia, 2000, WB Saunders.ed. 2, Philadelphia, 2000, WB Saunders.