Assessing and managing patients with musculoskeletal conditions

¶ … Judge, N.L. (2007). "Assessing and managing patients with musculoskeletal conditions," Nursing standard, 22(1)

The musculoskeletal system is one of the most extensive in the human body, performing many of the basic functions necessary to a functional life and comprising the majority of the human body's mass (Judge 2007). Made up of the bones, muscles, and joints, the musculoskeletal system provides the maintenance of body shape, supports and protects other systems and structures within the body, allows for movement -- including breathing, stores calcium and phosphate, and produces essential blood cells (Judge 2007). Of course, each of the vital functions performed by the musculoskeletal system is also susceptible to degeneration and disease, leading to a variety of symptom presentations. In her 2007 Nursing standards article, Nicola L. Judge provides an excellent overview of the anatomy, functions, and various common diseases and presentations of the musculoskeletal system, allowing the working nurse to more efficiently diagnose and treat patients who present with musculoskeletal conditions.

The three elements of the musculoskeletal system -- bones, joints, and muscles -- are highly interconnected and interrelated in the body, both in function and in direct physical structure. The underlying physical cause of a disease, then, often results in symptoms affecting each component of the musculoskeletal system. In her explanation of various diseases and the methods for assessing patients with musculoskeletal complaints, Judge does not often point out this relationship explicitly. Instead, by using rather broad but to-the-point descriptions of some of the more common conditions arising within the musculoskeletal system, an understanding of the entire system and the possible presented symptoms is allowed to emerge gradually.

This is certainly the case with the first condition listed by the author, osteoarthritis. Affecting an estimated eighty-five percent of the population at some point in their lives, this condition is marked by a reduction in joint tissue, leading to the eventual exposure of bone and a lack of articular cartilage, which cause pain, reduced mobility in the affected joints, and thus reduced functional ability (Judge 2007). This information is presented succinctly and clearly in the article, followed by the standard diagnostic procedure (a simple X-ray of the affected joint) (Judge 2007). It seems to have been the author's intent with this article to eliminate any interpretation in favor of a comprehensive (though not exhaustive) understanding of the simple facts surrounding common musculoskeletal diseases and complaints, which has surprisingly little or no detrimental effect on the article's overall readability.

There is also a heavy emphasis on the functionality of the information presented, and it is for that reason that Judge devotes the bulk of her article not to a discussion and description of various issues that can arise within the musculoskeletal system, but to a general method of assessing and treating the majority of musculoskeletal complaints. While less than a full page is devoted to actual diseases and conditions and specific mention of diagnostic methods and treatments of these conditions, over three pages are given over to a general discussion of assessment and treatment (Judge 2007). Though there are conditions that might not present in ways conducive to these general methods, Judge notes that the bulk of musculoskeletal conditions often have similar complaints, especially with range of motion and pain (Judge 2007). The consistent symptom presentation and other related factors makes this approach most efficient.

The similarities can also make the correct diagnoses of a specific musculoskeletal condition in contrast to another somewhat difficult. Judge lays out a careful yet efficient assessment procedure that quickly determines the underlying cause of the most commonly presented musculoskeletal symptoms, giving the working nurse an excellent and handy practical guide in providing the most help to patients. One of the most common symptoms presented with a musculoskeletal condition, and on of the most essential to diagnosis and treatment, is a limitation in the range of movement in one ore more joints, which often also affects other muscle groups and even bones (Judge 2007). There are a number of factors that could result in a limited range of motion, and determining which one(s) led to the specific patients symptoms helps to determine the actual condition present in the patient and thus the proper course of treatment. For many injuries and other non-chronic conditions, the acronym RICE -- rest, ice, compression, elevation -- provides the proper way to treat musculoskeletal conditions (Judge 2007).