Structure and Function of the Musculoskeletal System

A case study of a professional cyclist with a fractured clavicle. The aim of the following case study is to describe the structure and function of the musculoskeletal system using a 20 year old professional cyclist who sustained a fractured clavicle during a race. The author will discuss the effects of the injury on the normal functions of the systems of the body, and the Impact on his physical, psychological and social well-being. The author will also summaries the pathological changes that occurred.

The author will ensure local hospital confidentiality guidelines are followed (Hospital Confidentiality Policy 2006).

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The cyclist presented at clinic with a fractured clavicle two days after falling off his bicycle while he was competing In a race. The accident happened when he clipped his wheel with another cyclist which caused him to be thrown over the bike onto the ground landing onto his right side. He suffered a minor abrasion at the lateral aspect of his shoulder and some minor abrasions with the fracture but no other injuries. After the incident the team physic applied a sling to keep the arm immobilizers, and the patient has been taking anti-inflammatory pain relief.

The patient was quite irritable as he had been unable to sleep due to his holder, and felt frustrated because he had no control over the situation, he was also apprehensive of the time he would require away from his sport while he recovered. A clavicle fracture is sustained by a direct blow to the clavicle such as a fall or in an accident, a fall from a bike is a common mechanism. Clavicle fractures make up 5% of all fractures; it is a common injury in impact sports such as cycling (Funk, 2012).

The clavicle is an appendage to the axis, and runs horizontally from the base of the neck to the shoulder and is subcutaneous throughout; it has no medulla cavity and is ossified from a membrane (Gun, 2002). As stated by Hubbard and Mechanic (1997) “The clavicles are formed from primitive connective tissue that undergoes structural changes including visualization and the development of steamboats from the connective tissue cells” (page).

It’s positioned in the shoulder girdle with the shoulder blades that are known as the scapulae.

The clavicle provides a site for muscle attachment and helps brace the shoulder (Clan and Magical, 1995). The clavicle is a curved long bone with three parts, two ends and a middle portion. The lateral end articulates with the accordion of the shoulder blade, while the medial end articulates with the upper part of the sternum (Banterer and Lampoon, 2005). The clavicle provides the only bony link between the upper limb and the axial skeleton (Hugh and Grant, 2010).

Banterer and Lampoon, (2005) state a difference in size and shape of the clavicle exists between male and females.

In the female skeleton it Is shorter and less curved, while the male skeleton tends to be thicker and more curved, especially In heavily muscled males. Bone Is a living tissue that performs several functions; they malting posture and movement and help to protect Important organs from damage. The bone also produces red blood cells In the bone marrow (with exception the clavicle) and store mineral salts such as 99% of the body’s calcium (King, 2005: peg. 68).

The skeleton gives shape to the body Ana muscles are attached to Done, needling tenet movement.

Cells AT ten D are produced in the marrow of some of the bones cavities (Hubbard and Mechanic, (1997). Bone is very strong but it is also lightweight, it’s made up of a honeycomb of microscopic channels surrounded by a layer called the cortex. This in turn is surrounded by a tough outer layer called the peritoneum which contains two layers. The outer layer is tough and fibrous and protects the bone underneath. The inner layer contains the cells responsible for bone production and is important in the repair and remodeling of the bone (Hugh,; Grant, 2010).

The breakage of bone is a common occurrence but fortunately bone tissue has good powers of regeneration (Hubbard and Mechanic, 1997, peg. 94). When the body receives an injury such as a fracture, the body’s homeostasis system kicks in. Blood vessels are torn around the break and a collection of clotted blood forms, known as a hemostat. This forms between the two ends of the broken bone and the surrounding soft tissue. The resultant hemostat is invaded by ecosystem from the broken bone; these cells behave as steamboats and begin to deposit a new bony matrix around themselves (Clan and Magical, 1995).

Fibroblasts also migrate to the site causing granulation tissue that forms a type of scaffold between the two fragments. New bone forms as steamboats secrete spongy bone uniting the broken ends and are protected by an outer layer of bone and cartilage. These new deposits of bone and cartilage are called callus (Hugh and Grant, 2010). When a clavicle is fractured, it’s not Just the bone that is damaged; the surrounding soft tissue will be harmed also. This is when the homeostasis functions of tissue repair, regeneration and replacement are necessary to maintain the number of cells with-in their homeostasis limits.

The body also has to maintain cellular and tissue homeostasis system functions (Clan and Magical, 1995).

Homeostasis is the automatic self-regulation process that helps to maintain the normal state of the body’s internal environment. Physiological function and the maintenance of homeostasis levels enable the body to attain the basic needs for a healthy and normal life (Clan and Magical, 1995). The patient had chosen to see this particular consultant surgeon because he specializes in shoulder injuries and traumas of professional sports people.

He is aware of the increased urgency that recovering sports people are under to get back to their original levels of fitness and the eagerness to resume training and start competing again as soon as possible. There is a lot of anxiety around a professional athlete’s injury, not only from the athletes themselves but also from their coaches, dependents and their sports agent. Because of the professional demands an injury has on the career and the livelihood of a sports professional, the consultant works very fast in diagnosing and then treating the fracture (Funk, 2012).

Safeguarding the health and wellbeing of the patient and to do no harm is the responsibility of the professional by certifying they are a safe practitioner. Failure to comply with Nursing and Midwifery Council (NC) standards can Jeopardize professional registration (Nursing and midwifery Council, 2010, p. L). When a professional cyclist receives an injury it can have an effect not Just on his physical wellbeing but also his mental wellbeing. A professional sports person will have the added anxiety of whether they will be able to compete again and whether they will lose their place in the team.

Heel (1993) stated the stress of an injury can negatively affect four main areas of an athlete’s wellbeing.

It can affect Pensacola well-Dealing as ten tinplate wall nave ten pain AT Injury, Pensacola demands of treatment, rehabilitation and physical restrictions. It will affect his emotional wellbeing as he will be concerned about the threats to his future performances and the emotional demands of a vigorous rehabilitation programmer. His social well-being will be affected while he adjusts to the loss of an important social role, and his separation from team mates.

The necessity of depending on others will have a detrimental effect on his social well-being too. The fourth main area that will be affected is his self-concept, which is his loss of sense of control, and the threat to important life goals and values, also, the need to deal with his altered self-image. The consultant needs to be able to provide prompt treatment after diagnosing the best course of action, to eliminate the detrimental effects an injury such as this will have on his career.

The consultant initially requested an immediate x-ray to confirm the fracture.

The referral was checked to ensure it contained the relevant clinical and patient information following The Noising Radiation (Medical Exposure) Regulations guidelines ( IR(ME)R 2007). An x-ray is used as a diagnostic aid to visualize the bony anatomy structures inside the body following the 10 point critique as stated by Sloane et al, (2010). Bell and Finial, (1986) state the interrogatories (AP) position is usually easier for an injured patient then the postoperatively (PA) position.

An AP view using the middle of clavicle as the centering point with the direction of the central beam horizontal at 90 degrees to the film is a standard view. As a secondary view an axial view of the clavicle is recommended, the patient is positioned the same as in the AP view, but the x-ray beam is angled 15-30 degrees crucially.

The film is displaced upwards behind the patient to accommodate this insulation (Banterer and Lampooning, 2005). The consultant requested an axial AP with a 25-degree cranial insulation.

The aim of the cranial angle is to project more of the clavicle above the scapular and ribs as stated by Banterer and Lampooning, (2005) and Bell and Finial, (1986). (Appendix 1) The patient returned to the consultant to view the images and discuss treatment options. After reviewing the images, the consultant recommended an internal fixation of the clavicle. Once the operation is complete the fixation aids recovery and helps to speed up the healing process.

(Funk, 2012). The procedure is an open reduction and internal fixation that is performed for an acute fracture.

The operation proceeded as planned with no complications and the patient was discharged with a post-operative protocol to follow. (Appendix 3). He will return in two weeks for a post- pop follow up appointment, with an x-ray on arrival to assess how the fixation is progressing.

In conclusion the benefit of following this particular case study has enabled the author to gain an insight into the physiological and psychological well- being of a patient who has received an injury.

An important fact the author has learnt Is ten Detentes AT a cranial angled x-ray In order to produce a clear Image Tanat follows a 10 point critique to enable a good diagnostic image of the clavicle. The author has also learnt the importance of prompt treatment for professional athletes n order for them to be able to resume training and gain full fitness as soon as possible. The author has gained a deeper understanding on the effects an injury can have on an athlete and the anxiousness to return to full fitness as soon as possible.