1. Musculoskeletal System
Assessment & Disorders
Dr Ibraheem Bashayreh, RN, PhD

2. Skeletal System
 Bone types
 Bone structure
 Bone function
 Bone growth and metabolism affected
by calcium and phosphorous,
calcitonin, vitamin D, parathyroid,
growth hormone, glucocorticoids,
estrogens and androgens, thyroxine,
and insulin.

3. Bones
 Human skeleton has 206 bones
 Provide structure and support for soft
tissue
 Protect vital organs

4. Figure 41-1 Bones of the human skeleton.

5. Figure 41-2 Classification of bones by shape.

6. Bones
 Compact bone
◦ Smooth and dense
◦ Forms shaft of long bones and outside
layer of other bones
 Spongy bone
◦ Contains spaces
◦ Spongy sections contain bone marrow

7. Bone Marrow
 Red bone marrow
◦ Found in flat bones of sternum, ribs, and
ileum
◦ Produces blood cells and hemoglobin
 Yellow bone marrow
◦ Found in shaft of long bones
◦ Contains fat and connective tissue

8. Joints (Articulations)
 Area where two or more bones meet
 Holds skeleton together while allowing
body to move

9. Joints
 Synarthrosis
◦ Immovable (e.g., skull)
 Amphiarthrosis
◦ Slightly movable (e.g., vertebral joints)
 Diarthrosis or synovial
◦ Freely movable (e.g., shoulders, hips)

10. Synovial Joints
 Found at all limb articulations
 Surface covered with cartilage
 Joint cavity covered with tough fibrous
capsule
 Cavity lined with synovial membrane
and filled with synovial fluid

11. Ligaments
 Bands of connective tissue that
connect bone to bone
 Either limit or enhance movement
 Provide joint stability
 Enhance joint strength

12. Tendons
 Fibrous connective tissue bands that
connect bone to muscles
 Enable bones to move when muscles
contract

13. Muscles
 Skeletal (voluntary)
◦ Allows voluntary movement
 Smooth (involuntary)
◦ Muscle movement controlled by internal
mechanism
◦ e.g., muscles in bladder wall and GI
system
 Cardiac (involuntary)
◦ Found in heart

14. Skeletal Muscle
 600 skeletal muscles
 Made up of thick bundles of parallel
fibers
 Each muscle fiber made up of smaller
structure myofibrils
 Myofibrils are strands of repeating
units called sarcomeres

15. Skeletal Muscle
 Skeletal muscle contracts with the
release of acetylcholine
 The more fibers that contract, the
stronger the muscle contraction

16. Changes in Older Adult
 Musculoskeletal changes can be due
to:
◦ Aging process
◦ Decreased activity
◦ Lifestyle factors

17. Changes in Older Adult
 Loss of bone mass in older women
 Joint and disk cartilage dehydrates
causing loss of flexibility contributes to
degenerative joint disease
(osteoarthritis); joints stiffen, lose
range of motion

18. Changes in Older Adult
 Cause stooped posture, changing
center of gravity
 Elderly at greater risk for falls
 Endocrine changes cause skeletal
muscle atrophy
 Muscle tone decreases

19. Assessment
 Health history
 Chief complaint
 Onset of problem
 Effect on ADLs
 Precipitating events, e.g., trauma

20. Assessment
 Examine complaints of pain for
location, duration, radiation character
(sharp dull), aggravating, or alleviating
factors
 Inquire about fever, fatigue, weight
changes, rash, or swelling

21. Physical Examination
 Posture
 Gait
 Ability to walk with or without assistive
devices
 Ability to feed, toilet, and dress self
 Muscle mass and symmetry

25. Physical Examination
 Inspect and palpate bone, joints for
visible deformities, tenderness or pain,
swelling, warmth, and ROM
 Assess and compare corresponding
joints
 Palpate joints knees and shoulder for
crepitus

26. Physical Examination
 Never attempt to move a joint past
normal ROM or past point where
patient experiences pain
 Bulge sign and ballottement sign used
to assess for fluid in the knee joint
 Thomas test performed when hip
flexion contracture suspected

27. Figure 41-4 Checking for the bulge sign.

28. Figure 41-5 Checking for ballottement.

29. Diagnostic Tests
 Blood tests
 Arthrocentesis
 X-rays
 Bone density scan
 CT scan
 MRI
 Ultrasound
 Bone scan

30. Diagnostic Evaluation
 Imaging Procedures – CT, Bone Scan, MRI
 Nuclear Studies - radioisotope bone density,
 Endoscopic Studies –arthrocentesis,
arthroscopy
 Other Studies –biopsy, synovial fluid,
Arthrogram, venogram,
 Electromyography
 Myelography*
 Laboratory Studies

31. Musculoskeletal
Assessment – Diagnostic Test
 Laboratory
◦ Urine Tests
 24 hour creatine-
creatinine ratio
 Urine Uric acid –24
hr specimen
 Urine deoxypyridino-
line
 Laboratory
◦ Blood Tests
 Serum muscle
enzymes
 Rheumatoid Factor
 LE Prep/Antinuclear
Antibodies(ANA)
 Erythrocyte
Sedimentation Rate
 Calcium,
Phosphorous, Alkaline
phosphatase

32. Muscoluloskeletal
Assessment – Diagnostic
 Blood Tests
◦ CBC – Hgb, Hct
◦ Acid phosphatase
◦ Metabolic/Endocrine
◦ Enzymes
Increase creatine kinase,
serum increase
glutamin-oxaloacetic
due to muscle damage,
aldolase, SGOT

33. Musculoskeletal - Radiographic
 Standard radiography, tomography
and xeroradiography, myelography,
arthrography and CT
 Other diagnostic tests: bone and
muscle biopsy

34. Arthroscopy
 Fiberoptic tube is inserted into a joint
for direct visualization.
 Client must be able to flex the knee;
exercises are prescribed for ROM.
 Evaluate the neurovascular status of
the affected limb frequently.
 Analgesics are prescribed.
 Monitor for complications.

36. Bone Scan
 Nuclear medicine procedure in which
amount of radioactive isotope taken
up by bones is evaluated
 Abnormal bone scans show hot spots
due to malignancies or infection
 Cold spot uptakes show areas of bone
that are ischemic

37. Arthroscopy
 Flexible fiberoptic endoscope used to
view joint structures and tissues
 Used to identify:
◦ Torn tendon and ligaments
◦ Injured meniscus
◦ Inflammatory joint changes
◦ Damaged cartilage

38. Interventions for Clients with
Musculoskeletal Trauma

39. Musculoskeletal Trauma
 Tissue is subjected to more force than
it can absorb
 Severity depends on:
◦ Amount of force
◦ Location of impact

40. Musculoskeletal Trauma
 Mild to severe
 Soft tissue
 Fractures
◦ Affect function of muscle, tendons, and
ligaments
 Complete amputation

41. Preventing Trauma
 Teach importance of using safety
equipment
◦ Seat belts
◦ Bicycle helmets
◦ Football pads
◦ Proper footwear
◦ Protective eyewear
◦ Hard hats

42. Soft Tissue Trauma
 Contusion
◦ Bleeding into soft tissue
◦ Significant bleeding can cause a
hematoma
◦ Swelling and discoloration (bruise)

43. Soft Tissue Trauma - Sprain
 Ligament injury (Excessive stretching
of a ligament)
 Twisting motion
 Overstretching or tear
◦ Grade I—mild bleeding and inflammation
◦ Grade II—severe stretching and some
tearing and inflammation and hematoma
◦ Grade III—complete tearing of ligament
◦ Grade IV—bony attachment of ligament
broken away

44. Sprains
 Treatment of sprains:
◦ first-degree: rest, ice for 24 to 48 hr,
compression bandage, and elevation
◦ second-degree: immobilization, partial
weight bearing as tear heals
◦ third-degree: immobilization for 4 to 6
weeks, possible surgery

45. Soft Tissue Trauma - Strain
 Microscopic tear in the muscle
 May cause bleeding
 “Pulled muscle”
 Inappropriate lifting or sudden
acceleration-deceleration

46. Soft Tissue Trauma
 To decrease swelling and pain, and
encourage rest
◦ Ice for first 48 hours
◦ Splint to support extremities and limit
movement
◦ Compression dressing
◦ Elevation to increase venous return and
decrease swelling
◦ NSAIDs

47. Soft Tissue Trauma
 Diagnosis
◦ X-ray to rule out fracture
◦ MRI

49. Fractures
 Break in the continuity of bone
◦ Direct blow
◦ Crushing force (compression)
◦ Sudden twisting motions (torsion)
◦ Severe muscle contraction
◦ Disease (pathologic fracture)

50. Fractures
Classification of Fractures
 Closed or simple
 Open or compound
 Complete or incomplete
 Stable or unstable
 Direction of the fracture line
◦ Oblique
◦ Spiral
◦ Lengthwise plane (greenstick)

51. Stages of Bone Healing
 Hematoma formation within 48 to 72 hr
after injury
 Hematoma to granulation tissue
 Callus formation
 Osteoblastic proliferation
 Bone remodeling
 Bone healing completed within about 6
weeks; up to 6 months in the older
person

52. Fractures – Emergency Care
 Immobilize before moving client
 Joint above and below
 Check pulse, color, movement,
sensation before splinting
 Sterile dressing for open wounds

53. Fractures – Emergency Care
 Fracture reduction
◦ Closed—external manipulation
◦ Open—surgery

55. Acute Compartment Syndrome
 Serious condition in which
increased pressure within one or
more compartments causes
massive compromise of circulation
to the area
 Prevention of pressure buildup of
blood or fluid accumulation
 Pathophysiologic changes
sometimes referred to as ischemia-
edema cycle

56. Emergency Care - Acute
Compartment Syndrome
 Within 4 to 6 hr after the onset of
acute compartment syndrome,
neuromuscular damage is
irreversible; the limb can become
useless within 24 to 48 hr.
 Monitor compartment pressures.
(Continued)

57. Emergency Care (Continued)
 Fasciotomy may be performed to
relieve pressure.
 Pack and dress the wound after
fasciotomy.

58. Possible Results of Acute Compartment
Syndrome
 Infection
 Motor weakness
 Volkmann’s contractures: (a deformity of
the hand, fingers, and wrist caused by a lack of blood
flow (ischemia) to the muscles of the forearm)

59. Other Complications of Fractures
 Shock
 Fat embolism syndrome: serious
complication resulting from a
fracture; fat globules are released
from yellow bone marrow into
bloodstream
 Venous thromboembolism
(Continued)

60. Other Complications of Fractures
(Continued)
 Infection
 Ischemic necrosis
 Fracture blisters, delayed union,
nonunion, and malunion

61. Musculoskeletal
Complications (continued)
 Muscle Atrophy, loss of muscle strength
range of motion, pressure ulcers, and other
problems associated with immobility
 Embolism/Pneumonia/ARDS
◦ TREATMENT – hydration, albumin,
corticosteroids
 Constipation/Anorexia
 UTI
 DVT

62. Musculoskeletal Assessment - Fracture
 Change in bone alignment
 Alteration in length of extremity
 Change in shape of bone
 Pain upon movement
 Decreased ROM
 Crepitation
 Ecchymotic skin
(Continued)

63. Musculoskeletal Assessment – Fracture
(Continued)
 Subcutaneous emphysema with
bubbles under the skin
 Swelling at the fracture site

64. Special Assessment Considerations
 For fractures of the shoulder and upper
arm, assess client in sitting or standing
position.
 Support the affected arm to promote
comfort.
 For distal areas of the arm, assess
client in a supine position.
 For fracture of lower extremities and
pelvis, client is in supine position.

65. CAST
CAST

66. Casts
 Rigid device that immobilizes the
affected body part while allowing other
body parts to move
 Cast materials: plaster, fiberglass,
polyester-cotton
 Types of casts for various parts of the
body: arm, leg, brace, body
(Continued)

67. Casts (Continued)
 Cast care and client education
 Cast complications: infection,
circulation impairment, peripheral
nerve damage, complications of
immobility

68. Managing Care of the Patient in a Cast
 Casting Materials
 Relieving Pain
 Improving Mobility
 Promoting Healing
 Neurovascular Function
 Potential Complications

69. Cast, Splint, Braces, and Traction
Management Considerations
 Arm Casts
 Leg Casts
 Body or Spica Casts
 Splints and Braces
 External Fixator
 Traction

71. POLYESTER/FIBERGLASS

72. UPPER EXTREMITY CAST

74. LOWER EXTREMITY CAST

78. Musculoskeletal
Nursing Care - Casts
◦ Neurovascular
 Check
color/capillary refill
 Temperature
 Pulse
 Movement
 Sensation
 Traction Nursing Care
◦ Pin Site care
◦ Skin and
neurovascular check

79. Cast Care (continued)
 Elevate Extremity
 Exercises – to unaffected side; isometric
exercises to affected extremity
 Keep heel off mattress
 Handle with palms of hands if cast wet
 Turn every two hours till dry
 Notify MD at once of wound drainage
 Do not place items under cast.

80. Traction
 Application of a pulling force to the
body to provide reduction,
alignment, and rest at that site
 Types of traction: skin, skeletal,
plaster, brace, circumferential
(Continued)

81. Traction (Continued)
 Traction care:
◦ Maintain correct balance between
traction pull and counter traction force
◦ Care of weights
◦ Skin inspection
◦ Pin care
◦ Assessment of neurovascular status

84. Musculoskeletal – Fractures
Treatment
 Primary Goal – reduce fracture-
◦ Realign and immobilize
 Medications
◦ Analgesics, antibiotics, tetanus toxoid
 Closed Reduction – Manual and Cast;
External Fixation Device
 Traction; Splints; Braces
 Surgery
◦ Open reduction with internal fixation
◦ Reconstructive surgery
◦ Endoprosthetic replacement

86. Figure 42-5 In external fixation, pins placed through the bone above and below the fracture are attached to external
fixation rods that hold the pins and bone in place.

88. Nursing Management
 Positioning
 Strengthening Exercises
 Potential Complications

89. Musculoskeletal
Nursing Care
 Promote comfort
 Assess infection
 Promote mobility
 Teach safety
 Vital Signs
 Flotation, sheep skin
 Nutrition
 Vital Signs
 Monitor elimination
 Elevate extremity
to decrease
swelling/ ice pack
 Teach skin care,
cast care, diet,
complications

90. Operative Procedures
 Open reduction with internal
fixation
 External fixation
 Postoperative care: similar to that
for any surgery; certain
complications specific to fractures
and musculoskeletal surgery
include fat embolism and venous
thromboembolism

91. Managing the Patient Undergoing
Orthopedic Surgery
 Joint Replacement
 Total Hip Replacement
 Total Knee Replacement

93. Risk for Infection
 Interventions include:
◦ Apply strict aseptic technique for
dressing changes and wound
irrigations.
◦ Assess for local inflammation
◦ Report purulent drainage immediately
to health care provider.
(Continued)

94. Risk for Infection (Continued)
◦ Assess for pneumonia and urinary
tract infection.
◦ Administer broad-spectrum antibiotics
prophylactically.

95. Imbalanced Nutrition: Less Than Body
Requirements
 Interventions include:
◦ Diet high in protein, calories, and
calcium, supplemental vitamins B and
C
◦ Frequent small feedings and
supplements of high-protein liquids
◦ Intake of foods high in iron

96. Upper Extremity Fractures
 Fractures include those of the:
◦ Clavicle
◦ Scapula
◦ Humerus
◦ Olecranon
◦ Radius and ulna
◦ Wrist and hand

97. Lower Extremity Fractures
 Fractures include those of the:
◦ Femur
◦ Patella
◦ Tibia and fibula
◦ Ankle and foot

99. Fractures of the Hip
 Intracapsular or extracapsular
 Treatment of choice: surgical
repair, when possible, to allow the
older client to get out of bed
 Open reduction with internal
fixation
 Intramedullary rod, pins, a
prosthesis, or a fixed sliding plate
 Prosthetic device

103. Fractures of the Pelvis
 Associated internal damage the
chief concern in fracture
management of pelvic fractures
 Non–weight-bearing fracture of the
pelvis
 Weight-bearing fracture of the
pelvis

104. Compression Fractures of the Spine
 Most are associated with
osteoporosis rather than acute
spinal injury.
 Multiple hairline fractures result
when bone mass diminishes.
(Continued)

105. Compression Fractures of the Spine
(Continued)
 Nonsurgical management includes
bedrest, analgesics, and physical
therapy.
 Minimally invasive surgeries are
vertebroplasty and kyphoplasty, in
which bone cement is injected.
(Continued)

106. Amputations
 Surgical amputation
 Traumatic amputation
 Levels of amputation
 Complications of amputations:
hemorrhage, infection, phantom
limb pain, problems associated
with immobility, neuroma (a growth or
tumour of nerve tissue), flexion contracture

107. Amputation
Nursing Management
◦ relieving pain
◦ minimizing altered sensory
perception
◦ promoting wound healing
◦ enhancing body image
◦ self-care

108. Phantom Limb Pain
 Phantom limb pain is a frequent
complication of amputation.
 Client complains of pain at the site
of the removed body part, most
often shortly after surgery.
 Pain is intense burning feeling,
crushing sensation or cramping.
 Some clients feel that the removed
body part is in a distorted position.

109. Management of Phantom Pain
 Phantom limb pain must be
distinguished from stump pain
because they are managed
differently.
 Recognize that this pain is real and
interferes with the amputee’s
activities of daily living.
(Continued)

110. Management of Phantom Pain
(Continued)
 Some studies have shown that
opioids are not as effective for
phantom limb pain as they are for
residual limb pain.
 Other drugs include intravenous
infusion calcitonin, beta blockers,
anticonvulsants, and
antispasmodics.

111. Exercise After Amputation
 ROM to prevent flexion
contractures, particularly of the hip
and knee
 Trapeze and overhead frame
 Firm mattress
 Prone position every 3 to 4 hours
 Elevation of lower-leg residual limb
controversial

114. Prostheses
 Devices to help shape and shrink
the residual limb and help client
readapt
 Wrapping of elastic bandages
 Individual fitting of the prosthesis;
special care

115. Crush Syndrome
 Can occur when leg or arm injury
includes multiple compartments
 Characterized by acute compartment
syndrome, hypovolemia, hyperkalemia,
rhabdomyolysis, and acute tubular
necrosis
 Treatment: adequate intravenous fluids,
low-dose dopamine, sodium
bicarbonate, kayexalate, and
hemodialysis

116. Metabolic Bone Disorders
Osteoporosis
Osteomalcia
Paget’s Disease

117. Osteoporosis
 A disease in which loss of bone exceeds
rate of bone formation; usually increase in
older women, white race, nulliparity.
 Clinical Manifestations – bone pain,
decrease movement.
 Treatment – Calcium, Vit. D, estrogen
replacement, Calcitonin, fluoride, estrogen
with progestin, SERM (Selective Estrogen
Receptor Modulator) with anti-estrogens,
exercise.
 Pathologic fracture-safety.

118. Classification of Osteoporosis
 Generalized osteoporosis occurs most
commonly in postmenopausal women
and men in their 60s and 70s.
 Secondary osteoporosis results from
an associated medical condition such
as hyperparathyroidism, long-term
drug therapy, long-term immobility.
 Regional osteoporosis occurs when a
limb is immobilized.

119. Health Promotion/Illness Prevention -
Osteoporosis
 Ensure adequate calcium intake.
 Avoid sedentary life style (a type of
lifestyle with a lack of physical
exercise) .
 Continue program of weight-
bearing exercises.

120. Osteoporosis - Assessment
 Physical assessment
 Psychosocial assessment
 Laboratory assessment
 Radiographic assessment

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124. Drug Therapy
Osteoporosis
 Hormone replacement therapy
 Parathyroid hormone
 Calcium and vitamin D
 Bisphosphonates
 Selective estrogen receptor
modulators
 Calcitonin
 Other agents used with varying
results

125. Diet Therapy - Osteoporosis
 Protein
 Magnesium
 Vitamin K
 Trace minerals
 Calcium and vitamin D
 Avoid alcohol and caffeine

126. Fall Prevention - Osteoporosis
 Hazard-free environment
 High-risk assessment through
programs such as Falling Star
protocol
 Hip protectors that prevent hip
fracture in case of a fall

127. Others - Osteoporosis
 Exercise
 Pain management
 Orthotic devices

128. Osteomalacia
 Softening of the bone tissue
characterized by inadequate
mineralization of osteoid
 Vitamin D deficiency, lack of
sunlight exposure
 Similar, but not the same as
osteoporosis
 Major treatment: vitamin D from
exposure to sun and certain foods

129. Paget’s Disease of the Bone
 Metabolic disorder of bone remodeling,
or turnover; increased resorption (the
process by which osteoclasts break down bone and
release the minerals, resulting in a transfer of calcium
from bone fluid to the blood) of loss results in
bone deposits that are weak, enlarged,
and disorganized
 Nonsurgical management: calcitonin,
selected bisphosphonates, mithramycin
 Surgical management: tibial osteotomy
or partial or total joint replacement

130. Paget’s Disease
 An imbalance of increase osteoblast and
osteoclast cells; thickening and
hypertrophy.
 Bone pain most common symptom;
bony enlargement and deformities
usually bilateral, kyphosis, long bone.
 Analgesics, meds bisphosphonates and
calcitonin, NSAID, assistance devices,
and hot/cold treatment.

131. Osteomyelitis
 A condition caused by the invasion
by one or more pathogenic
microorganisms that stimulates the
inflammatory response in bone
tissue
 Exogenous, endogenous,
hematogenous, contiguous

132. Osteomyelitis
 Infection of bone; causative agent – Staph/Strept
 Typical signs and symptoms : Acute osteomyelitis
include:
 Fever that may be abrupt
 Irritability or lethargy in young children
 Pain in the area of the infection
 Swelling, warmth and redness over the area of the
infection
 Chronic osteomyelitis include:
 Warmth, swelling and redness over the area of the
infection
 Pain or tenderness in the affected area
 Chronic fatigue
 Drainage from an open wound near the area of the
infection
 Fever, sometimes
 Treatment – IV antibiotic; long term for 4-6 months

133. Surgical Management
Osteomyelitis
 Sequestrectomy (Surgical removal of a
sequestrum), a detached piece of necrotic bone
that often migrates to a wound, abscess, etc.
 Bone grafts
 Bone segment transfers
 Muscle flaps
 Amputation

134. Bone Tumors
Benign Bone Tumors
Malignant Bone Tumors
Metastatic Bone Disease

135. Bone Tumors
 Benign bone tumors
(noncancerous):
◦ Chrondrogenic tumors:
osteochondroma, chondroma
◦ Osteogenic tumors: osteoid osteoma,
osteoblastoma, giant cell tumor
◦ Fibrogenic tumors

136. Interventions
 Nondrug pain relief measures
 Drug therapy: analgesics, NSAIDs
 Surgical therapy: curettage (simple
excision of the tumor tissue), joint
replacement, or arthrodesis

137. Malignant Bone Tumors
 Primary tumors, those tumors that
originate in the bone
◦ Osteosarcoma
◦ Ewing’s sarcoma
◦ Chondrosarcoma
◦ Fibrosarcoma
◦ Metastatic bone disease

138. Osteosarcoma
 Cancer of the bone – metastasis to the
lung is common. Most in long bones.
 Clinical manifestations – dull pain,
swelling, intermittent but increases per
time; night pain common.
 Treatment – radiation, chemotherapy,
hormonal therapy, surgical excision with
prosthetics, assistance devices,
palliative measures.

139. Treatment Cancer of Bone
 Interventions include:
◦ Treatment aimed at reducing the size or
removing the tumor
◦ Drug therapy; chemotherapy
◦ Radiation therapy
◦ Surgical management
◦ Promotion of physical mobility with ROM
exercises

140. Cancer of Bone
Anticipatory Grieving
 Interventions include:
◦ Active listening
◦ Encouraging client and family to
verbalize feelings
◦ Making appropriate referrals
◦ Helping client and others to cope with
the loss and grieving
◦ Promoting the physician-client
relationship

141. Cancer of Bone
Disturbed Body Image
 Interventions include:
◦ Recognize and accept the client’s view
of body image alteration.
◦ Establish and maintain a trusting
nurse-client relationship.
◦ Emphasize the client’s strengths and
remaining capabilities.
◦ Establish realistic mutual goals.

142. Potential for Fractures
Bone Cancer
 Interventions
◦ Nonsurgical management: radiation
therapy and strengthening exercises.
◦ Surgical management: replace as much of
the defective bone as possible, avoid a
second procedure, and return client to a
functioning state with a minimum of
hospitalization and immobilization.

143. Carpal Tunnel Syndrome
 Common condition; the median
nerve in the wrist becomes
compressed, causing pain and
numbness
 Common repetitive strain injury via
occupational or sports motions
 Nonsurgical management: drug
therapy and immobilization
 Possible surgical management

144. Scoliosis
 Abnormal spinal curvature of various
degrees or severity involving
shortening of muscles and
ligaments.
 Milwaukee brace (a back brace used in the
treatment of spinal curvatures) , internal
fixative devices.

145. Scoliosis
 Changes in muscles and ligaments
on the concave side of the spinal
column
 Congenital, neuromuscular, or
idiopathic in type
 Assessment: complete history, pain
assessment, observation of posture
 Interventions: exercise, weight
reduction, bracing, casting, surgery