Structure and Function

The skeleton contains 206 bones that provide a strong, hard frame for the body. When bone tissue starts to develop in the unborn baby, it is cartilage in the shape of bones. Cartilage gradually absorbs

calcium and other minerals, which makes the bone become hard. Bone is made of two types of bone tissue: compact bone and spongy bone. The two types of bone make the bones strong yet lightweight. Bones are continuously going through a process of remodeling in which parts or all of the bones are replaced regularly. On average, the entire skeleton is replaced every two years. Vitamins, nutrients and hormones play a vital role in bone growth and maintenance. Calcium and vitamins A, D, C, K and B12 have major roles in bone structure and development.

Bones have many functions in the body. Bones form the body’s main framework of support. Bones also protect the body’s more delicate structures. Muscles are attached to bones, and together they allow the body to move. Bones store calcium. Blood cells are produced in the hollow center of some bones.

Joints are the places where bones join together. Some joints allow movement and some do not. Movable joints are padded with cartilage and lubricated with a thick, sticky liquid called synovial fluid. Ligaments are the structures that attach bones to bones across joints.

Muscle tissue makes up about 50 percent of the body’s weight. Contraction of the muscles (shortening) results in movement. There are three types of muscle in the body: skeletal, cardiac and smooth.

Skeletal muscles are those connected to bone. Skeletal muscles can be contracted voluntarily. Muscles are attached to bone with long, fibrous structures called tendons. There are three primary functions of skeletal muscles: movement, posture or muscle tone, and heat production.

Cardiac muscle is found only in the heart and performs the major work of the heart pumping blood throughout the body. Smooth muscle is found in the internal organs of the body. Smooth muscles are in areas such as the intestines, blood vessels and urethra. Smooth muscle contractions control movement of food through the intestines, blood pressure and even the amount of light allowed into the eye. Smooth muscle cannot be controlled voluntarily.

Age-Related Changes

age-related changes Bones become thinner and weaker in the normal aging process. Reduction in bone mass begins to occur between the ages of 30 and 40. Skeletons deteriorate between 3-8 percent every decade after age 40. Height decreases with age due to changes in the spinal column. Cartilage continues to grow, especially in the nose and ears. With age, the joints that contain synovial fluid experience fluid and cartilage loss. Some ligaments may shorten and decrease flexibility, and a decrease in range of motion may occur. Other ligaments may become stretched, making joints looser. With age, the joints have an increased risk of inflammation.

Muscle also changes with age. Lean muscle mass typically is lost. Muscle is not replaced as quickly and results in weak, thinning muscles. Muscle contraction slows down and rigidity increases, which decreases movement. Skeletal muscles become smaller and weaker, and tend to fatigue more rapidly. Muscles become less elastic with age, causing decreased mobility and flexibility. Tolerance for exercise is diminished due to rapid fatigue and a decrease in temperature regulation ability. The elderly have difficulty eliminating body heat and are prone to overheating. There is a decrease in ability to recover from muscle injuries as quickly, so scar tissue forms. Inactivity can result in muscle weakness and other complications. It is important to maintain an exercise program at all ages.

Disorders and injuries to the musculoskeletal system are common causes of disability in the elderly population. Loss of calcium from the bone makes the bones more brittle. Some chronic diseases such as arthritis are common. Pain from a disorder can result in less physical activity.

Pain

Pain is whatever the person experiencing it says it is and occurs whenever he/she says it does. Pain can be an unpleasant sensory or emotional experience, with or without physical identifiers. Pain assessment is an evaluation of reported pain and the factors that improve or worsen it, as well as the response to the treatment of pain. Pain assessment is considered the fifth vital sign. It should be routine to ask a resident about pain every time he/she is observed; however, it is especially important for those who are taking analgesics or pain relievers.

Pain assessment, at a minimum, includes three factors: (1) amount of pain (2) description of the pain (3) location of the pain. The amount of pain may be measured on a scale of 1 to 5 or 1 to 10. Use the same scale for the same resident every time. A description of the pain helps the health care professional know what kind of pain the resident is experiencing, which helps to treat it correctly. The location of the pain is recorded as specifically as possible.

There are two types of pain scales: the faces scale and the numeric scale. Being able to measure pain consistently improves the accuracy of the pain assessment.

Common Pain Descriptors

• Cramping
• Crushing
• Squeezing
• Throbbing
• Sharp
• Dull
• Pressing
• Numb
• Radiating
• Burning
• Shooting
• Stabbing
• Tingling
• Tender

Other symptoms may also indicate pain. Facial expression and body language can be related to pain. Other vital signs may be affected by pain. Guarding of a body part or abnormal body movements may show the resident has pain. Other signs may include agitation, combativeness, decreased appetite, withdrawal, changes in breathing patterns, crying and restlessness.

Treatment of Pain

Pain management is important in maintaining health and well-being throughout the lifespan. Treatment of pain can involve many levels of care. Treating the cause of the pain is the first priority. While the cause of the pain is being investigated and treatment is initiated, there are additional measures that may be included. Treatment of pain can involve both pharmacological and non-pharmacological approaches.

Non-pharmacological approaches may include exercise, heat or cold therapy, surgery, relaxation techniques, imagery, massage, aromatherapy, music therapy, and other complementary treatments not involving medication.

Pharmacological approaches to pain management include using various levels of medication in a logical pattern provided routinely and as needed. Routine, scheduled use of analgesics can reduce pain levels and reduce peaks of pain. PRN or as-needed medications are used to improve pain control and for breakthrough pain.

The World Health Organization (WHO) developed a recommended pain relief ladder. This recommendation identifies the use of drugs in a specific order: nonopioids, mild opioids and strong opioids until the person is free from pain. Additional drugs (adjuvant drugs) may be given for other pain related-issues such as anxiety, sleeplessness and spasms. Analgesics should be given around the clock to maintain pain control.

Drugs, Vitamins and Minerals for the Musculoskeletal System

1. Analgesics relieve pain.
2. Opioid analgesics are potent drugs similar to or derived from opium.
3. Non-opioid analgesics are related to opioid analgesics but appear to be less likely to result in dependence or addiction.
4. Adjuvant medications may complement or enhance the effects of analgesics and may reduce the need for high amounts of medications, or reduce side effects.
5. Non-steroidal anti-inflammatory drugs (nsaids) are most often used to treat inflammation.
6. Corticosteroids are used to treat inflammation.
7. Skeletal muscle relaxants act by suppressing the areas in the brain that control muscle movement.
8. Hormonal drugs may be used to delay the impact of bone loss after menopause.
9. Calcium and iron are two minerals commonly given as supplements. Calcium is most often given to prevent bone loss. Many calcium supplements can be purchased over the counter.
10. Iron is a necessary ingredient in blood. The bone marrow produces blood. If there is not enough iron available for red blood cell formation in the bone marrow, anemia can result. Anemia is a lack of blood or blood components. Side effects of iron deficiency include nausea, poor appetite, constipation, and dark, colored stools. 
11. Vitamin d is necessary to assist with transporting calcium into the bone. Vitamin D is made by the body in the presence of sunlight and can be found in many food products that contain calcium.