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Muskulo Skeleton System

The document provides an overview of the musculoskeletal system, detailing the structure and function of bones, muscles, and joints. It categorizes bones into various types, describes the skull and vertebral column, and outlines the appendicular skeleton, including the upper and lower limbs. Additionally, it explains joint classifications and types, emphasizing the characteristics of synovial joints.

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0% found this document useful (0 votes)
36 views40 pages

Muskulo Skeleton System

The document provides an overview of the musculoskeletal system, detailing the structure and function of bones, muscles, and joints. It categorizes bones into various types, describes the skull and vertebral column, and outlines the appendicular skeleton, including the upper and lower limbs. Additionally, it explains joint classifications and types, emphasizing the characteristics of synovial joints.

Uploaded by

Goldex Jangid
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MUSCULO-SKELTON SYSTEM

MUSCULO – SKELTON
Axial (80)

BONE (206) MUSCLE JOINTS


Appendicular
(126)

 Bone:-

 25% Water, 25% Organic substance and cell, 50% inorganic substance.
 1 diaphysis, 2 epiphysis.
 In diaphysis compact bone with center medullary canal.
 In canal yellow bone marrow is present.
 Bone covering layer periosteum .
 Bone development consist 2 process
 Secreation by osteoblast.
 Calcificaton.
 Main variety:-
 Long bone (increase length, decrease width) femur, humerus, radio-ulna.
 Short bone (equal length-width) cube shape, carpal- tarsal.
 Flat bone (thin. large area for musde) cranium. sternum, scapula.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 1
MUSCULO-SKELTON SYSTEM
 Irregular (Complex) vertebrae, hip, facial.
 Sesamoid (sead like) patella.
THE SKULL
(22)

CRANIUM FACIAL
(8) (14)
 CRANIUM:-
1. Frontal :- Roof of orbital cavity, contain sinus, supra orbital Foramen present.
2. Parietal :- pair and contain sutures .
3. Temporal: - have 2 process - Anterior (zygomatic)
- Posterior (mastoid)
 Form temporo- mondibular joint.
 1 styloid process For voice- box attach ment.
 Have petrous portion in which auditory canal present.
4. Occipital :- Foramen magnum present inferiorly connect with medulla oblongata and cord.
 Form atlanto- occipital joint.
5. Sphenoid:- Triangular, leaf, butterfly shape contain sinus.
 Form base/ Floor and connect to all other.
 Hollow space called sellaturcica.
 Optic Foramen present.
6. Ethamoid:- Anteriar to sphenoid posterior to nose.
Anterior portion of cranial floor.
Form Medial orbit wall.
Superior to nasel septum.
Side of nasel cavity.
Cribiform/ prepandicular plate make roof of nasel cavity.

 FACE:-
1. Nasel bone : Small, flat, rectangular Form nasel bridge.
2. Lacrimal : Smallest in face, thin Finger Nail size.
3. Palatine : L shape and Form posterior part of hard palate.
4. Inferior conche : Inferior to ethamid, pyramid like.
5. Vomar : Single, triangular, Form inferior of septum.
6. Maxillae : Upper jaw bone articulate with every facial bone except mandible.
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 2
MUSCULO-SKELTON SYSTEM
Make hard palate that seprate nasel, from oral cavity.
7. Zygomatic : Cheek bone, attach to maseter muscle, connect to temporal.
8. Mandible : Lower jaw bone. Largest, strongest, only movable.
Form temporo- mandibular(TM) joint.
TM joint syndrome : popping noise when chewing, Earpain.

 HYOID BONE :-
 Single U shape. No articulation with anyone.
 At anterior neck between mandible/ larynx.

 VERTEBRAL COLUM:-
 Male 71 c.m. (28’’), Female 61 c.m. (24’’)
 Formula is C5 T12 L5 S1 (5) C1(4), total 26
 Curve - Convex (cervical, Lumber)
- Concave (thorasic, sacral)
 Inter Vertebral Disc - Outer Annulus Fibrous
- Inner Nucleus pulpossus.
 Typical vertebra:-
 Body (thick, disc shape)
 Arch (2 short process pedicle)
 Process (7)
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 3
MUSCULO-SKELTON SYSTEM

 Cervical (1 to7):-
 1st Atlas (Atlanto- occipital:yes)
 2nd Axis (Atlanto-axial : no)
 7th vertebra prominence
 Thorasic (T1-T12):-
 T1-T10 :- Articulate with ribs(vertebra-castla)
 T11-T12:- Articulate transverse process with ribs

 Lumber (L1-L5):-
 Largest, strongest, five unfused bone.
 Sacrum (1To 5):-
 Triangular
 Cocyx:-
 C1 to C4 Fusion, tail like.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 4
MUSCULO-SKELTON SYSTEM

 THORAX/CHEST:-

 Breast bone, 15 c.m.(6’’)


 3 Part- manubrium, body, xiphoid.
 Junction between manubrium and body form sternal angle.
 Depression on superior surface form supra sternal notch.
 Laterally Clavicular notch connect with clavicle.
 Manubrium articulate with 1,2 Ribs.
 Body attach to 2nd – 10th Ribs.
 Xiphoid attach to abdominal muscle.

 Ribs:-
 12 PAIR
 From 1 to 7 increase in length then decrease.
 1to 7 (true)-sterno-costal then costovertebral joint.
 8 to 10 (False)- indirectly attachment with vertebra by mean of costal cartilage
 11 to 12(Floating)- not attached
 Space between ribs Inter Costal space (ICS).

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 5
MUSCULO-SKELTON SYSTEM

APPENDICULAR SKELTON
MEAN-HANG FUNCTION IS MOVEMENT

UPPER (64) LOWER (62)

Pectoral girdle (2x2=4) Pelvic girdle (4)


Upper limb (30x2=60) Lower limb (58)

 PECTORAL GIRDLE/SHOULDER:-
 Two in number.
 Anterior in clavicle and posterior scapula (shoulder blade)
 Clavicle connect with sternum (sterno-clavicular)
 Scapula:-
 Clavicle (Acromino - Clavicular)
 Humerus (Gleno - Humeral)
 Clavicle is collar bane, beauty bone, s shape, single One Horizontal bone -:
 Medially sterna
 Laterally Acromial

MUSCULO-SKELTON

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 6
MUSCULO-SKELTON SYSTEM
 SCAPULA:-

 Shoulder Blade, triangular, 2nd - 7th rib level, Form post thorax.

 UPPER, LIMB:-
(1) HUMERUS:-

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 7
MUSCULO-SKELTON SYSTEM
 Largest/longest in upper limb
 Proximal with glenoid cavity
 Distal with radius-ulna (Elbow)
 Surgical neck below head obove shaft
 Capitulum for radius
 Trochlear for Ulna

(2) RADIUS- ULNA:-

 Distal end of radius articulate with bone:-


 Lunate
 Scaphoid
 Triquetrum

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 8
MUSCULO-SKELTON SYSTEM

(3) CARPAL/WRIST:-

 8 small bone joint each other by intercarpal joint.


 Proximal 1st line from lateral to medial
Scapoid Lunate Triquetrium Pisiform

Boat like Moon shope Triangular Pea shape

 Distal 2nd line from lateral to medial :-


Trapezium Trapezoid Capitate Hamete

Wedge shape Head,largest Hook like

(4)MATA-CARPAL/PALM:-
 5 in Number
 Carpo- metacarpal and metacarpo- phalengeal joint.
 Boxer fracture at 5th metacarpal (liltle finger).
(5) PHALANGES:-
 Total 14 finger 4x3= 12
Thumb 1x2=2
 Inter phalengeal joint.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 9
MUSCULO-SKELTON SYSTEM

 LOWER LIMB:-
(1) FEMUR-
 Thigh bone
 Longest/largest/heaviest
 More fracture in neck

(2) PATELLA -
 Knee cap
 sesamoid type
 triangular
 Anterior to knee joint
 patella femoral joint

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 10
MUSCULO-SKELTON SYSTEM

(3) TIBIO- FIBULA -

TIBIA
 Flute, shine bone
 Front part of leg
 Proximal end with femur(tibio-femoral)
 Proximal end with fibula(tibia- fibular proximal)
 Distal end with fibulashaft articulation (interosseous membrane)
FIBULA:-
 Parellal and lateral to tibia
 Smaller then tibia
 Does not articulate with femur

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 11
MUSCULO-SKELTON SYSTEM

(4) TARSAL/ANKLE
 Talus (ankle bone) connect to tibia-fibula.
 Calcaneus (heel) largest, strongest
 Nevicular (little boat)
 Cueniform I,II,III (medial-lateral)
 Cuboid (cube shape)
 Connected by inter-tarsel joint

(5) META- TARSEL


 Inter mediate foot boes,5 in number
 1 to 5 medial to lateral
 Proximal – intermediate – distal
 Tarsometatarsal joint with I,II,III Cuneiform
(6) PHALANGES
 14 in number
 2 in toes
 3 in each digit

 Tendon - [bone tmuscle] - Dense tough, inelastic


 Ligament - [bone-bone] - Strong, elastic.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 12
MUSCULO-SKELTON SYSTEM

JOINTS
Arthrology - Joint study
Kinesiology - Motion study
Arthrosis - Point of contact

 Classification:-
(1) Presence or absence of synovial cavity
(2) Type of connective tissue
 Fibrous (no cavity, bone connected by fibrous tissue)
 Cartilagenous (no cavity, connected by hyaline/fibro cartilage)
 Synovial (yes cavity with articular cartilage 2 capsule)
(3) MOVMENT BASED
 Synarthrosis (immovable)
 Amphiarthrosis (slight movable)
 Diarthrosis (Free movable)

 Discription:-
A- FIBROUS JOINT
SUTURE SYNDESMOSIS INTEROSSEOUS
Between skull bane band or ligament Membrane of dense irregular tissue
In child movable more dense irregular Slight move
- In adult nonmove tibio-fibular Radio-ulna

B- CARTILAGENOUS

SYNCHONDROSIS SYMPHYSIS
Hyaline cartilage connection Fibro cartilage connection
Pubic symphysis, intervertebral
Between maubrium and body of sternum

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 13
MUSCULO-SKELTON SYSTEM
C-SYNOVIAL
(1) PLANE:-
Articulate surface flat/slight curve, biaxial-triaxial, movment, intercorporaltarsel, sterno-
clavicular
(2) HINGE:-
Convex of 1st connect into concave of 2nd, door open closing, 1 fix another move, move around -
axis.Uniaxial, knee – elboul
(3 ) PIVOT:-
Pointed surface 1st connect to ring shape 2nd onlyRotation uniaxial radio – ulnar atlanto– axial.
(4) CONDY LOIDAL:-
Ovale projection of 1st into ovale depression of 2nd biaxial ulrist joint.
(5) SADDLE:-
1st bone saddle shape 2nd sit into saddle biaxialCircumduction, carporometacarpal.
(6) BOLL and Socket:-
Ball shape 1st cup shape 2ndtriaxial shoulder hip joint.
 SYNOVIAL JOINT:-

 Cavity is present, joint free movable cover by hyaline cartilage.


 Articular capsule surround joint close cavity and havetwo layer :-
 Outer fibrous (dense with collagen)
 Inner synovial (areolr with elastic)
 Synovial fluid viscous,clear, pale yelloish. Hyalyronic acid from fibrolastic cell.
 Acessory ligament both intra- extra capsular.
 Articular disc made from fibro cartilage.
 Labrum is lip like structure present in ball 2 socket.
 Bursae lie between skin joint, joint, tendon bone muscle bone.
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 14
MUSCULO-SKELTON SYSTEM

 MOVEMENT:-
1. Gliding (flat bone)
2. Angular (Flexion,extension,abduction,adduction,circumduction)
3. Rotation (medial- lateral)
4. Special
 (elevation-depression da/ks mij&uhps)
 (protrection-retraction xnZu vkxs&ihNs)
 (Inversion-eversion iSj vanj&ckgj)
 (supination-pronation, planter-dorsiflexion)
 AXIAL SKELTAN JOINT:-
 Suture (non movable fibrous)
 Atlanto occipital (synovial, diarthrosis)
 Atlanto axial (Synovial ) diarthrosis
 Intervertebral
 Body (cartilagenaus, amphiarthrosis)
 Arch (synovial, diarthrosis)

 Vertebra costal (synovial, diarthrosis)


 Sterno costal
 Sternum+1st (cartilaginous, synarthrosis)
 Sternum+2-7 (synorial, diarthrosis)
 Lumbo-sacral
 Body (cartilaginous, amphiarthrosis)
 Base (synavial, diarthrosis)

 APPENDICULAR-SKELTON JOINT:-
 Synovial Diarthrosis:-
 (Sterno-clavicular, acromio-clavicular, Radio-ulnar,wrist, sacro-iliac, Metacarpo
metatarsophalengealgnter, Phalangeal tarso metatarsalGntercarpel (plain and saddke,
diarthrosis)
 Intercarpel (Plain and saddle, diarthrosis)
 Carpo- symphsis (plain and saddle,diarthrosis)
 Pubic-symphysis (cartilaginous, amphiarthrosis)
 Tibio- fibular
 Proximal (synovial, syndesmosis)
 Distal (fibrous, amphiarthrosis)
 Inter-tarsal (plain and saddle,diarthrosis)

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 15
MUSCULO-SKELTON SYSTEM
MUSCLE
 Importent variety
 Skelton (striated, voluntry)
 Cardiac (striated, involuntry)
 Smooth (nonstriated, involuntary)
 Basic fuction include movment, position, storage, heat
 Basic properties
 Electrical excitement
 Contractility
 Extansibility
 Elasticity
 Basic structure have 3 surrounding lagers :-
 Epimyseum – iwjh muscle ds ckgj
 Perimyseum - 10 ls 100 muscle fiber ds bundle fascicle dks doj djus okyh
 Endomyseum - cover each muscle fiber from bundle.

 Each muscle have artery and vein and neuron called Somaticmotor.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 16
MUSCULO-SKELTON SYSTEM
Microscopic Anatomy of Muscle Fiber:-
 Diameter 10-100 mm, length 10c.m.(4 inch)
 Each fiber contain cell k/s sarcomere.
 Sarcolema is outer covering of sarcomere.
 Sarcoplasm present within sarcolema.
 Protein in sarcoplasm is myglobin.
 Mypfibril is thread like structure present in sarcoplasm.
 Myofibril is contractile orgen.
 Fluid filled sac around myofibrill known as sarcoplasmic reticulum.
 In myofibrill protein structure are present called as Myofilament:-
 THICK (Actin)
 THIN (myosin)
 Sarcomere is functional unit of myofibril.
 Dense protein within sarcomere have disc which seprate I and next sarcomere.

 Z Disc : Seprate 2 sarcomere.


 I Band : Space between thick filament of 2 sarcomere.
 A Band : Complete sarcomere area contain thick filament.
 H Zone : Space between thin filament.
 M LINE : Mid line of sarcomere.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 17
MUSCULO-SKELTON SYSTEM

MUSCLE PROTEIN:-
 Contractile (Actin/myosin)-generate force
 Regulatory (troponin/tropomyosin)- on-off regulation.
 Structural (titin, actisin, myomesin, dystropin)
MUSCLE METABOLISM:-
(i) Creatine phosphate (in resting, more ATP)
(ii) Anarobic (ATP production without oxygen)
(iii)Aerobic (ATP produetion need oxygen)

MUSCLE TONE:-
Hypo Hyper
 Spasticity (Increase tone, Increase reflex)
 Rigidity (Increase tone, no reflex)
Contrection
 Isometric (Equal length with change in tone)
 Isotonic (Equal tension with change in length)

(Concentric) Eccentric
(↓se angel) (↑se Angle)
MUSCLE SPECIAL:-
 40% of total body weight.
 200 muscle are used in making one step.
 Muscle are Fix in-Number from birth to death.
 Cardiac muscle never tired.
 Shortest/Smallest/Weakest – Stepedius (Ear).
 2nd smallest – Erectarpilli (HAIR).
 Longest – Sartorius / tailor.
 Largest/thickest – gluteus maximus (buttock).
 Strongest – messetar (tcM+k).
 Swimmer/Widest/Broadest – Lattismusdorsi.
 Deepest – Adductor (Group in thigh).
 Boxer muscle – Serrator (palm).
 Eye blink – Levatorpalpebri/ orbicularis.
 Smile – Zygomatic.
 Biceps Flexion, tricep’s extension.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 18
MUSCULO-SKELTON SYSTEM

BODY MUSCLE:-
 In Humen body 639 muscle.
 Usual Origion proximal, insertion distal.
 Body of muscle belly.
Face
 Occipito – Frontalis (surprised look)
Mouth
 Orbicularis oris (kissing speech)
 Buccinator (whistle,blow suck)
Neek
 Platusma (depress mandible)
Orbit/Eyebrow
 Orbicularis occuli (close eye)
Mastigation
 Masseter (close mouth)
 Temporalis (elevate mandible)
Tongue movement
 Genioglossus, styloglossus.
 Hypoglossus, palatoglossus
Neck Movement
 Sterno- cleido- mastoidal
Breathing
 Diaphragm
 External- internal intercostals
Eye ball

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 19
MUSCULO-SKELTON SYSTEM
Swallowing Suprahyoid
 Infra hyoid
Abdominal visera (Six pack)
 Internal oblique
 External Oblique
 Ractusabdominus
 Transverse abdominus
 Quadratuslumborum.

Pelvic Floor
 LevatorAni (ileo-ischio-pubococcygeus)
Thorax
 Anterior (subclavius, pectoralis Minor, serratous)Posterior (Trapezius, rhomboid, Levator)

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 20
MUSCULO SKELTON DISORDERS
I. INJURIES
1. SPRAIN/STRAIN:-
 Sprain is ligament tear without bone dislocation; common site is ankle and wrist.
 Strain is tear in muscle and tendon, site is back and leg muscle.
 Degree include
I. (Injury then in Flammarion)
II. (Partial Tear)
III. (Complete Tear)
 Problem include pain, swelling, decrease movement in sprain and no movement in strain.
 Diagnose by CT, MRI, Arthroscopy.
 Management follow Hot/cold, NSAIDS, Muscle relaxant,
RICE-REST- R
ICE APPLICATION –I
COMPRESSION BY CRAP/WRAP BANDAGE-C
ELEVATION OF PART-E
2. Rotator Cuff Injury:-
 Rotator cuff is group of muscle that originate from scapula and insert in humerus involve- (i)
deltoid (ii) Trapezius (iii) Pectoralis major
 Strain or tear in rotator cuff commonly in baseball players, volleyball, sweimmer due to
shoulder movement involve circumduction.
 Mostly seen in supra-spinatus tendon of rotator cuff.
 In rotator cuff “SITS”
S- Supra spinatus
I- Infra spinatus
T- Teres minor
S- Sub Scapularis
 Drop arm test is unability to perform abduction.
 Intervention involve NSAIDS physiotherapy
3. DISLOCATION:-
 Dislocation is ligament injury leads to displacement, Separating articular surface.
 Subluxation is incomplete joint surface displacement, force disrupt soft tissue.
 Intervention includes pain relief, joint support, protection, open-close reduction.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 21
MUSCULO SKELTON DISORDERS
4. DISC HERNIATION:-
 Nucleus Pulposus of disc protrude into annulus cause nerve compresses.
 More common in lumbar region
 CERVICAL:-
 At the level of C5-C6, C6-C7
 Pain radiate to arm, shoulder, hand, scapula.
 Intervention includes bed rest, immobilize with collar, heat cervical traction, log-roll
position.
 LUMBER:-
 L4-L5, L5-S1 Mainly
 Lower back spasm radiate to hip and downward.
 Intervention include hard mattress, heat, sidelying with hip-knee flexion, maintain back
straight.
 Analgesic, Relaxant, Steroid.
 Surgical approach:-
 Diskectomy- Disc Removal
 Diskectomy with fusion- Fusion with graft
 Laminectomy- removal of Lamina to relieve pressure.
 Lominotomy- Lamina division
 Edoscopic by laser
 Maintain knee-chest postion.

II. FRACTURE
1. FRACTURE:-
 (FRACTURE LIST ACCORDING TO NATURE)
 Simple, closed – Skin is intact
 Open compound – Skin not intact, soft tissue injury and infection.
 Comminuted- Crush, bone break in piece.
 Complete- 2 part separation
 Compression- Fractured bone Compress by other.
 Depressed- Piece of bone depressed into organ.
 Green stick- 1st side break, 2nd side bent,
 Impacted- Part of fractured bone move to another bone.
 Incomplete- Fracture lines not extend fully at transverse width of bone.
 Oblique- Fracture line across the axis of bone.
 Pathological- due to disease process or by infection.
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 22
MUSCULO SKELTON DISORDERS
 Spiral- Circular fracture, occur in twisting.
 Transverse- Straight across, break in perpendicular.

 SPECIFIC NAME:-
 Monteggia Fracture – Proximal ulnar fracture.
 Galeggizer Fracture- Distal radius.
 Colles Fracture- distal radius with dorsal tilt.
 Smith Fracture- Distal radius with ventral tilt.
 Binet Fracture- 1stMetacarpel
 Boxer Fracture- 5th metacarpal
 Bumper- lateral tibia condyle
 Pott- Medial/lateral condyle of tibia
 Jufferson- Atlus
 Hangmen- Axis
 Manifestation includes pain, tenderness, swelling, decrease movement and function, edema,
bruising, neural-muscular impairment.

Management

Concurrent Surgical
 Rice
 Cast Reduction Arthroplasty
 Traction
Open Close THR TKR
(Hip) (Knee)

Fixation

 Basic 4 Strategies include Reduction, Fixation, Traction, cast.

Reduction
(Restore Proper Alignment)

Close Open
Non- Surgical, Manual Invasive, Surgical
Under anesthesia Fixator are used
After it use cast

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 23
MUSCULO SKELTON DISORDERS

Fixation

Internal External
Screw, Plate, Pin, road, Use of external frame
Remove fractured bone Attachment of pins
Replace by prosthetic More freedom then traction
Immediate bone strength In massive trauma

 Traction:-
 Application of pulling force with counter- traction.
 Reduce and immobilize the fracture
 Ensure weight hang freely without floor touching
 Skin traction apply by using elastic bandages adhesive and slings.
 Ideally 10% of body weight is calculated.
 Variety of traction include:-
 Cervical: Chin pad placement who attach with traction 30o-40o head elevation required.
 Bucks: applied over lower limb with elevated foot end.
 Russell’s: Useful in femur shaft fracture, horizontal force on tibia- fibula, vertical at knee.
 Pelvic: Used in lower back-HIP pain, traction belt and weight used.
 Dunlop: Horizontal traction in humours fracture vertical to maintain forearm.
 Balanced suspensions are used with-traction, in semi-fowler position.

 CAST:-
 Plaster of paris, caso4- ½ H2O.
 Cast is circumferential best method
 Slab is unilateral multilayer (12-16) in initial stage.
 Extremity elevation with turning 1-2 houriy.
 Clean dry and monitoring of infection.
 Access for circulation impairment.
 Impairment Indicatars:-
 Pain Swelling
 Tingling Numbness, Coolness
 Discolouration diminished pulse

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 24
MUSCULO SKELTON DISORDERS
 Complication in fracture:-
 Fat embolism:
 Originate in bone marrow released into blood within 48 to 72 hours.
 Patient may develop restlessness, hypoxemia, tachycardia, dyspnoea, hypotension.
 Notify- Oxygen-IV-Vital-intubate.

 Compartment Syndrome:-
Fascia Surround group make compartment Composed of artry, vein, nerve,

Pressure in one compartment decrease blood supply, induce ischemia, neural-vascular impairment.

After 4 to 6 hrs irreversible

Late sign involve pain, pale edematous, paresthesia, pulselessness.

Loose dressing- Notify-Fasciotomy

 Other includes infection, osteomyelitis, osteonacrosis, pulmonary embolism.


2. HIP FRACTURE:-
 In intracapsularFemoral head broken within capsule.
 In extracapsular fracture occure outside the capsule at greater trochantor level.
 Pre operatively skin traction is done
 THR (Total hip replacement) or ORIF (Open reduction internal Fixation) is planned.
 Post operat intervention:-
Proper alignment Hemovac (Jackson-Prott drain)
Head Elevation 30-45 Stocking
No weight Lifting Avoid Cross leg
Keep Extension Physiotherapy
3. POST-OPERATIVE INTERVENTION FOR KNEE AMPUTATION:-
 Monitoring of vitals, infection and hemorrage condition.
 Keep tourniquet available .
 Prevent contractures and monitor necrosis
 1st 24 Hr elevation for edema then flat position to prevent contractures.
 After 24 to 48 hours prone to stretch muscle.
 In below knee amputation don’t allow residual limb to hang over edge of bed.
 In above knee amputation prevent internal-external rotation place sendbag.
Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 25
MUSCULO SKELTON DISORDERS
III. ARTHRITIS
Disorder that affect joint cause pain/stiffness.
A. Rheumatic Arthritis
 Caused by rheumatic fever GABHS.
 Risk involve poor hygiene, poverty, overcrowd, recurrent infection, immune-compromised
person.
 Manifestation involve:-
 Hot, Swollen, red, tender joint
 Poly arthritis, poly arthralagia
 Synovial membrane inflammation
 Main effect on large joint
 Diagnose by X-ray, history, examination, increase WBC, ASO.
 Mangae by aspirin, NSAIDS, Penicillin rest.

B. Rheumatoid Arthritis
 Result from auto-immune reaction (auto-antibody)

Auto- Immune RXN

Cartilage and synovial membrane distruction

Synovial distruction Expose end of bones

Inflammation thickness Fibrous tissue originate immobility

Fluid accumulation Swan neck deformity of fingures

Increase pressure in cavity

Granular tissue PANNUS Lead to necrosis

Symptom involve:-
 Main affected Joint are interphalengeal wrist
 Pain, Swelling, tenderness, stiffness.
 Deformity and decrease ROM
 Soft feeling joint.
 Diagnose by increase ESR. X-Ray tissue biopsy.
 Blood test for rheumatoid factor

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 26
MUSCULO SKELTON DISORDERS

Non Reactive (0-39 IU/MI)


Rheumatoid factor Weak (40-70 IU/MI)
Strong (80 IU/MI)

NSAIDs (Ibuprofen, diclofen, aspirin)


Management Approach DMARDS (methotraxate, Sulfuselazine, Azathioprine)
Gluco- Corticoids (Prednisolone)

Synovectomy (Removal)
Surgical Approach Arthrodesis (Bony fusion of joint)
Athroplasty (Replacement)

C. Osteoarthritis/degenerative/wear end tear:-


 Most common degenerative joint disease in which gradual loss of joint cartilage occur.
 Etio - pathogenesis involve:-
 Exact unknown age, obesity, irritation of joint, muscle weakness.
 Wear closs of material from surface, abrasion (Scruping surface)
 Process involve degeneration of cartilage then inflammation of synovial membrane,
 Mani Festation involve:-
 Pain reduce by rest increase with activity.
 Humidity increase pain (Reduce flexibility)
 Haberden/Boucherd node.
 Difficult to get up with presence of crepitus.
 Disturb ADLwith spine compression.
 Management involve NSAIDS, steroid, immobilization, heat, rest, avoid flexion, diet.
 Surgery involve osteotomy and total replacement.

D. Gouty Arthritis:-
 Disorder of purine metabolism in which plasma uric acid increase that will deposit into joint
cause pain, swelling inflammation.
 Abnormal/Excessive Breaking of urine- due to increase activity of xanthine oxidase (XOA) or
dehydroginase.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 27
MUSCULO SKELTON DISORDERS
 XAO- Convert Hypoxanthine Xanthine Uric acid.
 Uric Acid
In joint Tophy (Mainely in feet/toes)
In kindey stone
 Type:-
 Primary (Direct Purine metabolism )
 Secoundry (Excess URIC acid by other disease)
 Phase involve asymptomatic, acute, intermittent, chronic.
 Tophi are hard, irregular nodules in skin due to deposition of sodium Urate.
 Intervention involve:-
 Steroids, NSAIDS, XAO inhibitor (Allopurinol)
 Colchicines and uricosurics (Probenacid, sulfinpurozone)
 Increase water, low purine diet, alkaline ash.
 In acute gout (NSAID/colochisine/steroid)
 In chronic gout (UricoSuric/ Allopurinol)
IV. METABOLIC BONE DISEASE

1. OSTEOPOROSIS:-
 Metabolic disorder characterized by bone demineralization loss of calcium, phosphorus lead to
fragility and fracture.
 Result of increase absorption, decrease deposition.
 Etio- Pathogenasis involve:-
 Excess calcium loss by urine, faeces, sweat.
 80% women after menopause.
 In Men due to decrease level of testosterone.
 Decrease calcium intake
 In male- female hormone depletion is primary cause.
 Secondaryto steroid, alcohol, malnutrition, history, age.

 Main festation involve asymptomatic, pain, kyphosis, pathological fracture, decrease height.
 Diagnose by X-Ray, BMD.
 Dietry treated by increase calcium, vitamin D, Vitc,
 Drugs involve (i) Biphosphonate
(ii) Estrogen receptor modulator
(iii) HRT

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 28
MUSCULO SKELTON DISORDERS
2. Paget Disease:-
 Also Called osteitis deformens, cotton wool spot found in latter stage.
 Result from excessive break and formation of bone.
 Patho- Physiology involve
 Osteoclast proliferation - increase reabsorption decrease - deposition, Weak new bone osteoblast
compensate-OsteolysisSe decrease Mineralization – Hollow cavity – pagetic bone.
Manifestation invole:-
 Increase alkaline phosphate
 Weak, pain, fracture. Arthritis, deformity.
 Nerve compression due to enlargement.
 Associated condition is stone and neuropathy.
Medication involve:-
 Biphosphonate ( decrease osteoclast)
 Etidronate/Pamidronate disodium.
 Calcitonin.
3. Osteomalacia
 Bone softening – due to impaired bone metabolism- Decrease, Calcuium, phosphate, vitamin D,
 Assess by bone pain, muscle weakness, gait problem, hypocalcaemia.
 10000 I.U./ W.K. vitamin D
 Vitamin D + Calcium

V. MUSCULAR DYSTROPHY
Group of disorder due to mutation of gene result in progressive degeneration of muscles groups.
1. Duchenee:-
 Most common variety, affected gene carried on long X chromosome.
 Mutation in dystrophine gene a protein present in sarcolema.
 Less severe variety is becker (Death 40Yr) and more severe is duchenne (Death 20-25
yr)
 Gower’s sign manifested when patient use hand four walking.
 Supportive prednisolone may give to improve muscle strength.
2. FSHD:-
Fasico Scapulo Humeral Muscular Dystrophy

Fascial Muscle Scapular Upper Arm Progressive Strength


Muscle Muscle Loss due to cell loss

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 29
MUSCULO SKELTON DISORDERS
 Mutation of chromosome No.04
 Autosomal dominant condition
 Usual symptom during 10-26 year, more in men.
 Manage by prednisolone, physical therapy, surgery walking aids.
3. Myotonic Dystrophy:-
 Chronic, slow progressive, highly variable, autosomal multisystem disease.
 Muscle are weak and slow to relax after contraction.
 Defected gene located on chromosome no 19.
VI. OTHERS DISORDERS
1. Vertebral colum Abnormality:-
 Scoliosis: Most common, lateral banding, usually in thorax.
 Kyphosis: Increase thorasic curve, hunchback, comman in female with osteoporosis.
 Lordosis: Increase lumbar curve, hollow back as in pregnancy, obesity.
 Intervention: neruro-Muscular assessment, medic alert braclet, antimyesthamic
2. CARPAL TUNNEL:-
 Compression of medial nerve mostly by hamete bone.
 Manifestation include muscle weakness, sharp pain, numbness- tingling- paresthesia in lateral 3
½ finger.
 Cause includes inflamed tendon, fluid retention, excercise, trauma, and repeated activities.
 Examination done by:-
 Phalen test: Wrist Flexion for 1 min, Numbness in hand show positive test.
 Tinel sign: Tapping carpel ligament with hammer, numbness in palm show positive test.
 Durken test: compress median nerve for 30 secound, numbness in finger show positive
test.
 NSAIDS, Splint, Steroid, Surgery involve cut down of flexor reticulum.
3. Osteo-Myelitis
 Infection, inflammation of bone marrow.
 Pyogenic infection by s. Aureus/Enterobactor/Salmonella.
 Non Pyogenic by mycobacterium cause vertebral infection (Pott disease)
 In child affect metaphyseal plate
 In adult affect vertebra and pelvis.
 Route of entry is blood, contagious, trauma, penetration.
 Main diagnose by WBC, MRI.
 Antibiotic recommendation.

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 30
MUSCULO SKELTON DISORDERS
4. Crush Syndrome:-
 Crushing accident’s like war, accident , disaster, long surgery result in muscle necrosis.
Crush injury

Ischemia (Compartment)

Muscle Necrosis

Myolysis Third space fluid shift Metabolic Acidosis DIC

 Infection by clostridium perfinges cause gas gangrene.


 Emergency fasciotomy and debridment of nacrotic area.
 Management approach involve fluid replacement, ventilator support, correction of acidosis and
dialysis.
CRUTCH WALK
Length measurement:-
 Total length of patient – 40.5 cm / 16 inch
 In standing posture with relax shoulder condition first confirm 2 fingure or 5 cm gap between
crutch and axilla then upto 14 cm sideways of heal.
GAITS:-
 Manner of walking have 5 varieties.
 Tripod position refers to angle between 2 crutch and one extremity
 Description :-
A. 4 Point
 Used when patient able to bear weight an both feets.
 Alternate use of one extremity then opposite crutch, next time second extremity
followed by another opposite crutch.
 Total 4 step’s
B. 2 Point:-
 Used when partial weight bearing on both extremity limited.
 I extremity along with opposite crutch followed by 2nd extremity along with next
opposite crutch.
 Total 2 Steps

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 31
MUSCULO SKELTON DISORDERS

C. 3 Point:-
 Orthopaedic gait when total body weight depends upon single normal extremity.
 1st use both crutch and affected extremity forward and at last weight bearing extremity.

D. Swing to:-
 Patient with strong arm and foot muscle.
 First place both crutches forward after that both extremities.
 Extremities remain behind crutches.

E. Swing Through:-
 Fastest Gait
 Same as swing to except extremities make a advance step.
 Extrimities are advanced to crutches.
 On Holding crutch elbow make an angle of 150- 250

Gurjar Ki Thadi, Opp. Metro Pillar No. 67, New Sanganer Road, Jaipur. Mob. No. 7426955591, 7426955593 32
MCQs
Q.1 Human skeleton is made of a total of ? Q.16 Sella Turcica is a part of :
(a) 201 bones (b) 206 bones (a) Ethmoid (b) Parietal
(c) 198 bones (d) 105 bones (c) Palatine (d) Sphenoid
Q.2 Spinal column has Vertebrae : Q.17 The longest and strongest bone of the
(a) 12 (b) 20 human body is :
(c) 25 (d) 33 (a) Humerus (b) Tibia
Q.3 Longest bone of the human body is : (c) Radius (d) Femur
(a) Femur (b) Humerus Q.18 Joints of skull are known as :
(c) Tibia (d) Fibula (a) Suture joints
Q.4 What is the correct equation of vertebral (b) Cartilaginous joints
column? (c) Synovial joints
(a) C7T12L5S5C4 (d) All of the above
(b) C7T12L5S4C4 Q.19 Osteochondroma is related to :
(c) C9T10L3S,C1 (a) Muscle (b) Heart
(d) None (c) Bones (d) Lungs
Q.5 Total number of vertebrae into human body; Q.20 Thoracic region of vertebral column contain
(a) 30 (b) 33 how many bones :
(c) 22 (d) 44 (a) 5 (b) 7
Q.6 Skull consists of : (c) 9 (d) 12
(a) 14 Bones (b) 22 Bones Q.21 Which carpal bone most commonly
(c) 12 Bones (d) 8 Bones fractured ?
Q.7 Lateral curvature of the spine is called is : (a) Lunate (b) Pisiform
(a) Kyphosis (c) Scaphoid (d) Hamate
(b) Lordosis Q.22 Haversian canal situated into :
(c) Scoliosis (a) Bone (b) Brain
(d) Pectus excavatum (c) Lungs (d) Kidney
Q.8 Abnormal lateral deviation of vertebral Q.23 In human body, the leg bones are :
column is : (a) Humerus and Femur
(a) Lordosis (b) Fibula and Tibia
(b) Kyphosis (c) Fibula and Ulna
(c) Scoliosis (d) Tibia and Radius
(d) Osteoporosis Q.24 Identify the hip bone from the following :
Q.9 Goniometer is used to assess : (a) Femur
(a) Auditory acuity (b) Humerus
(b) Muscle strength (c) Innominate
(c) Range of motion of joints (d) Sacrum
(d) Visual acuity Q.25 Potts fracture is the fracture of : N.
Q.10 Areas where two or more sutures meet are : (a) Spine (b) Ribs
(a) Sutures (b) Fontanelle (c) Ankle (d) Femur
(c) Vaul (d) Segregated Q.26 Fractures of the distal radius is called:
Q.11 Which of the following bone has a shape (a) Hume fracture
like that of a bat ? (b) Monteggia fracture
(a) Ethmoid bone (b) Sphenoid bone (c) Galeazzi fracture
(c) Temporal bone (d) Parietal bone (d) Colles' fracture
Q.12 The smallest bone of human body is : Q.27 Colle's fracture referred to the injury of :
(a) Stapes (b) Phalanges (a) Shoulder joint (b) Knee joint
(c) Metacarpals (d) Xiphisternum (c) Wrist joint (d) Elbow joint
Q.13 Which of the following is not part of the Q.28 The radius is located :
axial skeleton ? (a) In the upper part of the arm
(a) Femur (b) Sternum (b) On the thumb side of the lower arm
(c) Mandible (d) Sacrum (c) On the little finger side of the lower arm
Q.14 All the following are types of bones except : (d) At the shoulder arm
(a) Long bones (b) Short bones Q.29 Which bone is the largest bone in human
(c) Flat bones (d) Regular bones body :
Q.15 At which point humerus joins scapula : (a) Femur (b) Humerus
(a) Acetabulum (b) Glenoid (c) Tibia (d) Radius
(c) Popliteal fossa (d) Coronoid fossa

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 33
MCQs
Q.30 Tibia is expanded at lower end and offers Q.39 Commonest type of fracture seen in children
bearing surface to which bone ? is :
(a) Calcaneus (b) Femur (a) Colley's fracture
(c) Talus (d) Fibula (b) Pott's fracture
Q.31 Which of the following actions would a (c) Greenstick fracture
technician give priority in the emergency (d) Pathological fracture
care of a patient who had compound Q.40 All of the following are types of fractures
fracture of the femur ? except:
(a) Splint the leg in its present position (a) Simple (b) Impacted
(b) Place the leg in neutral alignment (c) Lacerated (d) Complicated
(c) Irrigate the wound with normal saline Q.41 Nursing assessment for neurovascular status
(d) Apph -essure directly over the wound of the extremity with a cast include the
Q.32 A fracture in which the broken end of bone following Answer
comes out through the skin is known as : (a) Pallor
(a) Simple (b) Range of motion
(b) Comminuted (c) Paresthesia
(c) Compound (d) Pain
(d) Impacted Q.42 The surgical procedure done to relieve
Q.33 A patient has fractured hip, is placed in pressure in compartment syndrome is :
Buck's traction. The purpose of Buck's (a) Open reduction with internal fixation
traction is to : (ORIF)
(a) Prevent contractures (b) Meniscectomy
(b) Promote circulation (c) Fasciotomy
(c) Conserve body energy (d) Arthroplasty
(d) Maintain body alignment Q.43 Which nursing intervention is appropriate
Q.34 Most common fracture into children : for a client with skeletal traction?
(a) Greenstick fracture (a) Prone positioning
(b) Potts fracture (b) Intermittent weights
(c) Colles' fracture (c) Pin care
(d) Pathological fracture (d) 5 pound weight
Q.35 The instruments used in plaster work are : Q.44 While nursing the patient with skeletal
(a) Plaster knife traction all the following should be kept in
(b) Plaster saw, plaster bender mind except:
(c) Plaster shears (a) Remove the weight while changing the
(d) All of these position
Q.36 Splints are rigid structure used to : (b) Maintain the accuracy of weight
(a) Support a broken bone (c) Ensure that weight does not touch the
(b) To give protection to part of the body floor
(c) To correct deformity (d) Remove the weight if required without
(d) All of these causing jerk
Q.37 The nurse can best prevent foot drops for Q.45 Which of the following symptoms are
the bed rest client by the use of- considered signs of a fracture?
(a) Traction (a) Tingling, coolness, loss of pulses
(b) Splint (b) Loss of sensation, redness, coolness
(c) Cradle (c) Coolness, redness, new site of pain
(d) Railing (d) Redness, warmth, pain at the site of
Q.38 To prevent foot drop in a leg with a cast, injury
which of the following interventions is an Q.46 The symptoms associated with the type of
appropriate? fracture would probably be :
(a) Encourage bed rest (a) Shock, pain and adduction with hip and
(b) Support the foot with 45 degree of knee
flexion (b) Pain, external rotation and lengthening
(c) Support the foot with 90 degree of of the extremity
flexion (c) Pain, external rotation and shortening of
(d) Place a stocking on the foot to provide the extremity
warmth (d) Shock, internal rotation and shortening
of the extremity

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 34
MCQs
Q.47 Gallows traction is used for : (BSF Staff Nurse 2015 )
(a) Fracture shaft of femur Q.55 Osteoporosis is disease of :
(b) Fracture neck of femur (a) Skin (b) Bones
(c) Fracture humerus (c) Brain (d) Muscles
(d) Fracture tibia Q.56 Osteoporosis is caused by deficiency of :
Q.48 After a long leg cast is removed, the male (a) Vitamin-A (b) Vitamin-B
client should : (c) Vitamin-C (d) Vitamin-D
(a) Cleanse the leg by scrubbing with a brisk Q.57 Which of the following are factors
motion contribution osteoporosis?
(b) Put leg through full range of motion (a) Hypothyroidism
twice daily (b) End stage renal disease
(c) Report any discomfort or stiffness to the (c) Cushing's Disease
physician (d) Diabetes
(d) Elevate the leg when sitting from long Q.58 All of the following are potentially
periods of time modifiable I factors for osteoporosis except;
Q.49 Which fracture or dislocation into an infant (a) Anorexia nervosa
gives Allis' sign : (b) Chronically low intake of calcium and
(a) Head of femur vitamin
(b) Developmental dysplasia of hip (c) Chronically low intake of vitamins C
(c) Dislocation of femoral head and B6
(d) All of above (d) Excessive alcohol consumption
Q.50 Main cause of fracture into female after Q.59 Complication of osteoporosis :
menopause : (a) Pathological fracture
(a) Hormone imbalance (b) Growth retardation
(b) Osteoporosis (c) Infection
(c) Both A and B (d) Muscular dysfunction
(d) None of above Q.60 After menopause in women the chances of
Q.51 Which of the following is a relevant clinical her developing osteoporosis increase
feature in a patient with fracture of neck of because of :
femur? (a) Decrease in oestrogen levels
(a) Abduction with internal rotation (b) Increase in oestrogen levels
(b) Abduction with external rotation (c) Decrease in LH levels
(c) Shortening of the affected extremity with (d) Decrease in FSH levels .
external rotation Q.61 Meaning of osteomyelitis means :
(d) Lengthening of the affected extremity (a) Severe pyogenic infection of bone
with internal rotation surroundings
Q.52 A child with femur fracture temporarily (b) Infection of eye
placed into skin traction. During assessment (c) Inflammation of bones
nurse note the absent dorsalis pedal pulse in (d) None of these
left foot. What wo be initial action taken by Q.62 Osteomyelitis most commonly results from
nurse : which of the following mechanisms?
(a) Administer pain killer (a) Immune suppression (b) IV drug
(b) Release the traction (c) Surgery (d) Trauma
(c) Inform the doctor immediately Q.63 Deep fascia which covers the thigh is called
(d) Apply hot bottle to affected leg as :
Q.53 Elderly people have a high incidence of (a) Fascia lata (b) Darto's fascia
fracture because of : (c) Scarpa's fascia (d) Campere's fascia
(a) Carelessness Q.64 End of two bones is connected by :
(b) Fragility of bone (a) Muscles (b) Tendons
(c) Sedentary existence (c) Ligament (d) Cartilage
(d) Rheumatoid diseases Q.65 The fibrous tissue connecting bone to bone
Q.54 The type of fracture which occurs is called :
commonly children is : (a) Cartilage (b) Tendon
(a) Colle's fracture (c) Muscle (d) Ligament
(b) Green stick fracture Q.66 The ligaments join :
(c) Pathologic fracture (a) Muscle to muscle (b) Bone to bone
(d) None of these (c) Muscle to bone (d) None of these

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 35
MCQs
Q.67 The position used to assess the extension of Q.79 The level of uric acid increases :
hip joint is : (a) In arthritis
(a) Supine (b) Prone (b) In gout
(c) Sitting (d) Dorsal recumbent (c) In myocardial infarction
Q.68 ……………is a ball and socket joint : (d) None of the above
(a) Hip joint (b) Elbow joint Q.80 What is Gout'
(c) Knee joint (d) None of these (a) A degenerative &scram
Q.69 Example of ball and socket joint is : (b) A vascular disorder
(a) Elbow (b) Hip joint (c) A renal disorder
(c) Thumb and fingers (d) A metabolic disorder
(d) Between wrist bones Q.81 Gout is a :
Q.70 For assessing range of joint movement the (a) Degenerative disorder
nurse will ask the patient to move away (b) Psychological disorder
from the body evaluating the movement of : (c) Neurological disorder
(a) Flexion (b) Extension (d) Metabolic disorder
(c) Abduction (d) Adduction Q.82 Most frequently and severely involved
Q.71 Bending of head towards chest is : joints in rheumatoid arthritis are :
(a) Flexion (b) Extension (a) Knees (b) Elbows
(c) Abduction (d) Supination (c) Interphalangeal (d) Sacroiliac
Q.72 Hip joint and shoulder joint are : Q.83 Allopurinol drug is used in the treatment of
(a) Saddle joint disease is :
(b) Ball and socket joint (a) Gouty arthritis
(c) Plane joint (b) Fracture
(d) Hinge joint (c) Spondylitis
Q.73 The client is being assessed for range-of- (d) Osteoporosis
joint movement. You ask the client to move Q.84 Which increased level cause gout?
the arm away from the body, evaluating the (a) Urea
movement of : (b) Uric acid
(a) Flexion (b) Extension (c) Ammonia
(c) Abduction (d) Adduction (d) Bile pigment
Q.74 Which muscle does not belong to hip joint? Q.85 A patient with gout should follow which
(a) Psoas Muscle (b) Gluteal Muscle type of diet
(c) Lliacu Muscle (d) Triceps Muscle (a) Potassium modified diet
Q.75 Meaning of articulation is : (b) Renal diet
(a) Joint of two muscles (c) Low purine diet
(b) Joint of two nerves (d) High calcium diet
(c) Joint of two bones RUHS Post B.Sc. NSG Entrance 2015
(d) Joint of two arteries Q.86 A nurse is caring for an old lady with
Q.76 Which of the following muscles do not form osteoarthritis and all the following facts are
muscles of mastication? true regarding osteoarthritis EXCEPT?
(a) Masseter (a) Crepitus
(b) Temporalis (b) Tophi
(c) Pterygoideus lateralis (c) Subcutaneous nodules
(d) Deltoid (d) Pain on moving the joint
Q.77 Pain, redness, warmth and swelling of knee Q.87 Which joint movement is restricted in a
joint in a patient indicates : patient with pericapsulitis of shoulder?
(a) Infection (b) Inflammation (a) Adduction
(c) Thrombosis (d) Degeneration (b) Abduction
Q.78 An old woman complains of pain. The nurse (c) Flexion
noticed that the knee is reddened, warm to (d) Extension
touch and swollen. The interpretation of Q.88 Which of the following is the modifiable
these signs and symptoms are likely related risk factor of osteoarthritis?
to : (a) Overweight
(a) Infection (b) Increasing age
(b) Thrombophlebitis (c) Previous joint damage
(c) Inflammation (d) Genetic susceptibilty
(d) Degenerative disease

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 36
MCQs
Q.89 In case of a patient with paraplegia, in order (d) All of the above
to prevent contractures of the joints of lower (AIIMS Staff Nurse, 2016)
extremities, which of the following is NOT Q.98 Decreased bone density is called
relevant? as…………..
(a) Hourly change of position. (a) Osteoporosis
(b) Using supportive devices to maintain (b) Osteomalacia
alignment. (c) Osteoarthritis
(c) Provide instructions for active exercise. (d) Rheumatoid arthritis
(d) Perform passive range-of-motion (AIIMS Staff Nurse, 2016)
exercise several times daily. Q.99 Most common sign of osteoarthritis
Q.90 In case of a patient with rheumatoid is……………..
arthritis, which of the following laboratory (a) Joint stiffness
test result to be reviewed? (b) Weakness improved in the evening
(a) Pancreatic lipase (c) Pain
(b) Bence-Jones Protein (d) Swelling
(c) Antinuclear antibody (AIIMS Staff Nurse, 2016)
(d) Alkaline Phosphatase
Q.91 Skeletal muscles under microscope have Q.100 Bow leg and wide wrist are the
cross-striations formed by dark and light characteristic of
bands. The dark bands are formed by the (a) Rickets (b) Osteomalacia
protein________________ (c) Polio (d) CDS
(a) Mysium (b) Myosin (AIIMS Staff Nurse, 2016)
(c) Actin (d) Coronin Q.101 Bow leg and wide wrist are the
(ESIC Delhi, 2016) characteristic of
Q.92 New growth in the bone marrow (a) Rickets (b) Osteomalacia
is_________ (c) Polio (d) CDS
(a) Osteoma (b) Myeloma (AIIMS Staff Nurse, 2016)
(c) Odontoma (d) Myoma Q.102 The part of the bone that enters into the
(ESIC Delhi, 2016) formation of a joint is called:-
Q.93 An opening in the bone through which (a) Articulating surface
blood vessels, nerves, and ligaments pass is (b) Bony sinus
called_____________: (c) Condyl
(a) Fossae (b) Sulcus (d) Facet
(c) Antrum (d) Foramen (AIIMS Raipur Staff Nurse, 2017)
(ESIC Delhi, 2016) Q.103 The repair and reconstruction of the joint is
Q.94 New growth in the bone marrow called:-
is________: (a) Arthrodesis (b) Arthrotomy
(a) Osteoma (b) Myoma (c) Arthroplasty (d) Amputation
(c) Myeloma (d) Odontoma (AIIMS Raipur Staff Nurse, 2017)
(ESIC Staff Nurse, 2016) Q.104 A strong weight bearing synovial joints with
Q.95 Skeletal muscles under microscope have irregular elevations and depressions that
cross-striations formed by dark and light produce interlocking of the bones is called:-
bands. The dark bands are formed by the (a) Vestigeal tail
protein________________ (b) Symphysism pubis
(a) Myosin (b) Mysium (c) Sacroiliac joints
(c) Coronin (d) Actin (d) Sacrococygeal joint
(ESIC Staff Nurse, 2016) (AIIMS Raipur Staff Nurse, 2017)
Q.96 All among the following are long bones, Q.105 Which of the following is known as bone
EXCEPT forming cells?
(a) Scapula (b) Tibia (a) Fibrinoblasts (b) Osteocytes
(c) Femur (d) Fibula (c) Osteoclasts (d) Osteoblasts
(ESIC Staff Nurse, 2016) (AIIMS Raipur Staff Nurse, 2017)
Q.97 Normal response to plantar reflex in adult Q.106 Which comfort device is used to prevent
is:- foot drop?
(a) Extention (a) Bed cradle (b) Foot board
(b) Flexion (c) Sand bag (d) Pillow
(c) Babinski response (AIIMS Raipur Staff Nurse, 2017)

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 37
MCQs
Q.107 Which of the following is NOT a long (AIIMS Bhubaneswar Staff Nurse, 2018)
bone? Q.116 ‘Knee Joint’ is the example of which of the
(a) Humerus (b) Stemum following joints?
(c) Tibia (d) Ulnar (a) Ball and socket joint
(AIIMS Raipur Staff Nurse, 2017) (b) Hinge joint
Q.108 Which among the following is the correct (c) Pivot joint
full form of MRI? (d) Saddle joint
(a) Magnetic Resonance Imaging (AIIMS Bhopal Staff Nurse Gr.2, 2018)
(b) Muscular Repeating Impulse Q.117 The long head of Biceps Brachii muscles
(c) Microscopic Result investigation arised from which of the following?
(d) Mobile Radiation Intercom (a) Supraglenoid tubercle of scapula
(Recruitment Tutor-Nursing, 2016) (b) Infraglenoid tubercle of scapula
Q.109 Polymyalgia rheumatic is associated (c) Coracoids process of scapula
with________. (d) Lateral epicondyle of humerus
(a) Raised cretinine kinase (AIIMS Bhopal Staff Nurse Gr.2, 2018)
(b) Increased alkaline phosphatase Q.118 Gleno-humeral joint is also called:
(c) Sudden loss of vision in one eye (a) Shoulder joint (b) Knee joint
(d) Erythematic nodosum (c) Elbow joint (d) Hip joint
(Recruitment Tutor-Nursing, 2016) (AIIMS Bhopal Staff Nurse Gr.2, 2018)
Q.110 The bone which is also known as ‘knee cap’ Q.119 The largest synovial joint in the body is:
(a) Tibia (b) Fibula (a) The knee joint
(c) Femur (d) Patella (b) The shoulder joints
(RUHS B.Sc. Nursing Exam., 2017) (c) The ankle joint
Q.111 Reduction of bone density leading to (d) The wrist joints
increased susceptibility to fracture is (AIIMS BHUBANESWAR 2019)
(a) Osteomalcia (b) Paget’s Disease Q.120 All of the following are sesamoid bone:-
(c) Osteoarthritis (d) Osteoporosis (a) Patella (b) Fabella
(RUHS B.Sc. Nursing Exam., 2017) (c) Calcaneum (d) Cyamella
Q.112 Which of the following is correct regarding (AIIMS New Delhi 2019)
tendon Q.121 Which of the following is an example of
(a) It connect bone to muscle Hinge joint?
(b) It possible strength to muscle (a) Wrist joint (b) Radioulnar joint
(c) It lubricate joints with synovial fluid (c) Shoulder joint (d) Elbow joint
(d) It relieve friction between moving parts (AIIMS Raipur Shift I 2019)
(RUHS B.Sc. Nursing Exam., 2017) Q.122 Which is the longest bone in the human
Q.113 Which of the following is a classic body?
symptoms of systemic lupus erythematosus (a) Patella (b) Tibia
(SLE)? (c) Femur (d) Fibula
(a) Fatigue and fever (AIIMS Raipur Shift I 2019)
(b) Weight loss Q.123 The function of pectoralis major muscle is:
(c) Shortness of breath (a) Flexion of elbow
(d) Superficial lesions over the cheeks and nose (b) Adduction of arm
(RUHS B.Sc. Nursing Exam., 2017) (c) Extension of elbow
Q.114 A client has his leg immobilized in a long (d) Abduction of arm
leg cast. Which of the following (AIIMS Bhopal Shift II 2018)
assessments would indicate the early Q.124 Gleno-humeral joint is also called:-
beginning of circulatory impairment? (a) Shoulder joint (b) Elbow joint
(a) Inability to move toes (c) Knee joint (d) Hip joint
(AIIMS Bhopal Shift II 2018)
(b) Cyanosis of toes
Q.125 Elevated levels of antistreptolysin O are
(c) Complaints of cast tightness
seen in:
(d) Tingling of toes
(a) Subacute endocarditis
(RUHS B.Sc. Nursing Exam., 2017)
(b) Ventricular septal defect
Q.115 ckDlj dh ekalis’kh ¼ckWDllZ ely½ ______ gSA
(c) Rheumatic fever
(a) czSfd;ksjsfM;kfyl
(d) Cardiomyopathy
(b) ckblsIl czSdkbZ (AIIMS Bhopal Shift II 2018)
(c)MsYVkWbM
(d) fljSVl ,aVhfj;j

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 38
MCQs
Q.126 An example for sesamoid bone is: Q.132 Type of Fracture shown in the image is:-
(a) Patella (b) Ribs
(c) Carpals (d) Sternum
(AIIMS Manglagiri Grade 2018)
Q.127 Among the following, the bone that belongs
to the axial skeleton is:
(a) Humerus (b) Patella
(c) Hyoid (d) Tarsals
(ESIC Shift I 2019)
Q.128 In rheumatoid arthritis, during the acute
phase the values which are significant
are_________
(a) ESR and C reactive Protein (CRP)
elevation
(b) RFT elevation (renal Function Test) (a) Greenstick fracture
(c) CBC elevation (Complete Blood Count) (b) Comminuted fracture
(d) LFT elevation (Liver Function Test) (c) Linear fracture
(ESIC Shift II 2019) (d) Oblique displaced fracture
Q.129 Which is the process of recording the (Safdarjung 2019)
electrical potential of skeletal muscles and Q.133 Which of the following is paired correctly
nerves supplying them by inserting small with its description about skeletal fracture?
needle electrodes into the muscles? (a) An avulsion fracture: A fracture that
(a) ECG (b) EMG extracts a part of bone from the ligament or
(c) ECT (d) EEG tendon
(Railway Recruitment Board Shift I 2019) (b) A greenstick fracture: This bends the
Q.130 What is the name of the muscle that extends bone but does not lead to a fracture
from the sphenoid bone to the mandible? (c) A complete fracture: The fractured bone
(a) Trapezius pierces to the skin surface through the skin
(b) Sternocleidomastoid (d) A pathological fracture: A fracture that
(c) Pterygoid occurs due to some physical trauma
(d) Masseter (GMCH 2019)
(Railway Recruitment Board Shift III 2019) Q.134 Which action by the nurse in charge is
Q.131 Name of this Fossa? essential when cleaning the area around a
Jackson-Pratt wound drain?
(a) Cleaning from the center outward in a
circular motion.
(b) Cleaning from periphery towards center
in circular motion.
(c) Cleaning briskly around the site from
left to right
(d) Cleaning briskly around the site from
right to left
(GMCH 2019)

(a) Antecubital fossa


(b) Olecranon fossa
(c) Popliteal fossa
(d) Fossa ovale
(Safdarjung 2019)

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 39
MCQs

1 B 2 D 3 A 4 A 5 B 6 B 7 C 8 C 9 C 10 B
11 B 12 A 13 A 14 D 15 B 16 D 17 D 18 A 19 C 20 D
21 C 22 B 23 B 24 C 25 C 26 C 27 C 28 B 29 A 30 C
31 A 32 C 33 D 34 A 35 D 36 D 37 B 38 C 39 C 40 C
41 B 42 C 43 C 44 A 45 D 46 C 47 A 48 D 49 D 50 C
51 C 52 C 53 B 54 B 55 B 56 D 57 A 58 C 59 A 60 A
61 C 62 D 63 A 64 C 65 D 66 B 67 D 68 A 69 B 70 C
71 A 72 A 73 C 74 D 75 C 76 D 77 B 78 C 79 B 80 D
81 D 82 C 83 A 84 B 85 C 86 B 87 B 88 A 89 C 90 C
91 B 92 B 93 D 94 C 95 A 96 A 97 B 98 A 99 A 100 A
101 A 102 A 103 C 104 C 105 D 106 B 107 B 108 A 109 B 110 D
111 D 112 A 113 D 114 D 115 D 116 B 117 A 118 A 119 A 120 A
121 D 122 C 123 B 124 A 125 C 126 A 127 C 128 A 129 B 130 B
131 C 132 B 133 A 134 A

Gurjar Ki Thadi, opp. Metro Pillar No. 67 New Sanganer Road, Jaipur. Mb. 7426955591, 7426955593 40

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