1 . A bursa is a fluid-filled sac that facilitates motion of structures that move against each other.
MUSCLES, JOINTS, AND CONNECTIVE TISSUES: STRUCTURAL AND FUNCTIONAL
INTER-RELATIONSHIPS
A bursa is a fluid-filled sac that facilitates motion of
structures that move against each other. It can be found between skin and bone, muscle and
bone, tendons and bone, ligaments and bone, and between muscles. The bursae function as
padding between structures to reduce friction caused by moving parts [4].
2 . Tendons are the musculoskeletal structure most frequently influenced by degenerative disease.
PATHOPHYSIOLOGIC INFLUENCES AND EFFECTS
The joint is the musculoskeletal structure most frequently
influenced by degenerative disease. Changes are most often associated with aging, excess
weight, trauma, and inflammatory conditions. In the presence of these factors, articular
cartilage softens, thins, and ulcerates, and the joint surfaces become rough. There may be a
narrowing of the joint space and swelling of adjacent soft tissue. The normal smooth-gliding
joint action is diminished, and the periosteum becomes irritated by friction, stimulating
the growth of bone spurs at the joint margins. The effects of this destruction include joint
pain, stiffness, and joint deformity, which can result in slight to moderate limitation of
movement. Crunching or grating sounds, called crepitus, may be heard upon movement [8,9].
3 . Heberden nodes may be noted on the distal interphalangeal joint of patients with rheumatoid arthritis.
NURSING ASSESSMENT: ESTABLISHING THE DATA BASE
Joints may be assessed for changes by observation and
palpation. Heberden nodes may be noted on the distal interphalangeal joint of patients
with osteoarthritis. Likewise, rheumatoid nodules may be noted near the joints of patients
with rheumatoid arthritis, even in the absence of other signs. Joints may be compared
bilaterally to assess symmetry, position, and changes in alignment [17,19].
4 . The American Academy of Physical Medicine and Rehabilitation indicates that ultrasound is an essential component in the diagnosis of tendinopathies/tendon tears.
NURSING ASSESSMENT: ESTABLISHING THE DATA BASE
Because it is readily available and avoids the use of
radiation, ultrasonography is often a good option in the assessment of musculoskeletal
disorders and injuries. Ultrasound allows for the visualization of joints, tendons,
muscles, bursae, ligaments, cartilage, nerves, fascia, and related soft tissue and can
have a role in diagnosis and/or evaluation of disease progression for a variety of
conditions. The American Academy of Physical Medicine and Rehabilitation indicates that
ultrasound is an essential component in the diagnosis of tendinopathies/tendon tears,
nerve entrapments (e.g., carpal tunnel syndrome), and acute or chronic muscle injury [32]. It may also be involved in the
evaluation of ligamentous injury and joint instability syndromes,
subluxations/dislocations, and fascia injury or inflammation. When joint aspiration is
necessary, it may be guided by ultrasound, as may therapeutic injections.
5 . The most common ocular symptom of Marfan syndrome is retinal detachment.
SPECIFIC DISORDERS OF CONNECTIVE TISSUE AND MUSCLES
There is wide variability in clinical symptoms in Marfan
syndrome, with the most notable occurring in eye, skeleton, connective tissue, and
cardiovascular systems. The most common symptom is myopia. Ocular problems are a result of
defective supporting tissue of the lens, which can cause bilateral subluxation or total
dislocation of the lens. The dislocation is usually upward, but slit-lamp examination is
done to detect more subtle variations. Complications such as reduced visual acuity,
uveitis, glaucoma, cataracts, and retinal detachment may also occur [33].
6 . Immune dysregulation, in the form of auto-immunity, is thought to be the prime cause of lupus.
SPECIFIC DISORDERS OF CONNECTIVE TISSUE AND MUSCLES
Immune dysregulation, in the form of autoimmunity, is
thought to be the prime cause of lupus. In patients with lupus, the body produces an
accelerated inflammatory response, resulting in the production of autoantibodies, causing
immune complexes (antigens combined with antibodies) [49,56]. These
autoantibodies and complexes assault the body's own healthy cells and tissues [47,49,50,51]. Symptoms of SLE are the result of the
damage to the body's tissues secondary to the immunologic response. One of the hallmark
indicators of lupus is the formation of autoantibodies, and the presence of autoantibodies
in the blood is a key factor to the diagnosis of lupus [47,49,51].
7 . The most common sprains affect the ankle.
SPECIFIC DISORDERS OF CONNECTIVE TISSUE AND MUSCLES
The most common sprains affect the ankle and occur when
inversion of the foot tears a ligament, usually the anterior talofibular ligament. Knee
sprains cause swelling, hemarthrosis, significant decrease in range of motion, and joint
laxity. Often the person hears a "pop" when the injury occurs and later describes the knee
as feeling as it is going to "give way." The medial collateral ligament is most commonly
involved [70]. Following the acute injury,
patients are usually able to bear weight.
8 . Sacroiliac joint syndrome is a diagnosis of exclusion made after ruling out serious causes of the back pain.
SPECIFIC DISORDERS OF THE JOINTS
Sacroiliac Joint
Syndrome. SI joint syndrome typically manifests as localized pain in the
lower back or upper buttock area that overlies the SI joint. Pain is intensified by
attempts to walk up stairs, and while pain may be referred to the posterior thigh,
extension below the knee is unusual [100].
Tenderness over the SI joint is often found in physical examination, and pain is
aggravated by the Patrick test or single-leg standing [97]. The onset of SI joint pain is usually gradual (over months to years),
and although etiology is often elusive, trauma, infection, and tumor represent infrequent
yet known causes of SI joint pain [100].
9 . Therapeutic goals for patients with rheumatoid arthritis include preservation of function and quality of life, minimization of pain and inflammation, joint protection, and control of systemic complications, with the ultimate aim being low disease activity or remission.
SPECIFIC DISORDERS OF THE JOINTS
Rheumatoid arthritis has no known prevention or cure.
Lifelong treatment is usually required, including medication, physical therapy, exercise,
and possibly surgery. In order to provide the best outcomes, patients should be educated
regarding the most appropriate treatment regimens for their disease manifestations, as
earlier rheumatoid arthritis diagnosis can assist in aggressive early treatment for
rheumatoid arthritis (when indicated), thereby delaying joint destruction. The 2010
ACR/EULAR Classification Criteria for Rheumatoid Arthritis is now a well-established
diagnostic and prognostic tool; as such, guidelines (e.g., the 2016 update of the EULAR
Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological
Disease-Modifying Antirheumatic Drugs) recommend that patients start treatment with a
disease-modifying antirheumatic drug (DMARD) immediately following a rheumatoid arthritis
diagnosis [189]. Therapeutic goals include
preservation of function and quality of life, minimization of pain and inflammation, joint
protection, and control of systemic complications, with the ultimate aim being low disease
activity or remission [23,24,27,189,190].
10 . Hemangiomas are rare vascular tumors often associated with arteriovenous malformations of skin vascular disease.
SPECIFIC DISORDERS OF THE JOINTS
Hemangiomas are rare vascular tumors often associated
with arteriovenous malformations of skin vascular disease. They tend to affect younger
individuals, often teenage girls who have been symptomatic since childhood. The knee is
the most commonly involved joint [37].
