Chapter 64: Musculoskeletal Problems
Osteomyelitis is a severe infection of bone, bone marrow, and surrounding soft tissue.
Infecting microorganisms can invade by indirect or direct entry. After entering the blood, they
lodge in an area of bone and grow which results in increased pressure, eventually leading to
Once ischemia occurs, the bone dies.
Chronic osteomyelitis is a continuous, persistent problem or a process of exacerbations and
Acute symptoms are fever, night sweats, malaise, and constant bone pain.
Some immobilization of affected limb (e.g., splint, traction) is indicated to decrease pain. The
patient is frequently on bed rest in the early stages of the acute infection.
Vigorous and prolonged IV antibiotic therapy is treatment of choice for acute osteomyelitis.
Oral antibiotics, hyperbaric oxygen therapy, and surgery may be prescribed for chronic disease.
Most primary bone cancer is called sarcoma.
Sarcomas can also develop in cartilage, muscle fibers, fatty tissue, and nerve tissue.
Common types are osteogenic sarcoma, chondrosarcoma, Ewing’s sarcoma, and chordoma.
Osteochondroma is a primary benign bone tumor characterized by overgrowth of cartilage and
bone near end of the bone at the growth plate. Manifestations include painless, hard, and immobile mass, one leg or arm longer than other,
and pressure or irritation with exercise.
No treatment necessary if asymptomatic. If patient has pain or neurologic symptoms due to
compression, surgical resection is usually done.
Nursing care does not differ significantly from the care given to patients with a malignant
disease of any other body system.
Osteogenic sarcoma (osteosarcoma) is a primary bone tumor that is extremely aggressive and
rapidly metastasizes to distant sites.
Manifestations are usually associated with gradual onset of pain and swelling, especially around
Preoperative (neoadjuvant) chemotherapy is used to decrease tumor size.
Limb-salvage procedures are considered when there is a clear 6- to 7-cm margin surrounding
Metastatic Bone Cancer
The most common type of malignant bone tumor occurs as a result of metastasis from a primary
Metastatic bone lesion is commonly found in vertebrae, pelvis, femur, humerus, or ribs.
Metastasis to bone may be suspected in patients with local bone pain and past cancer history.
Treatment may be palliative and consists of radiation and pain management.
LOW BACK PAIN
Low back pain is common, affecting about 80% of adults during their lifetime. Acute low back pain is usually associated with activity that causes undue stress (often
hyperflexion) on the lower back.
o If muscle spasms and pain are not severe, treatment includes avoiding activities that
aggravate pain, analgesics, muscle relaxants, massage and back manipulation; and heat
and cold compresses.
o Most acute cases spontaneously improve.
Chronic low back pain causes include degenerative disk disease, lack of physical exercise, prior
injury, obesity, and structural and postural abnormalities.
o Treatment can include weight reduction, analgesics, rest periods, heat or cold
application, and exercise and activity to keep muscles and joints mobilized.
o Surgery may be indicated for severe chronic low back pain that is not responding to
INTERVERTEBRAL LUMBAR DISK DAMAGE
Structural degeneration of the lumbar disk is often caused by degenerative disk disease (DDD).
This is a normal process of aging, and results in intervertebral disks losing their elasticity,
flexibility, and shock-absorbing capabilities.
An acute herniated intervertebral disk (slipped disk) can be the result of DDD or repeated stress