Complications of Immobility
Anatomy and Physiology
● Musculoskeletal system plays a critical role in:
○ Maintaining body structure and posture
○ Enabling movement
○ Protecting internal organs
○ Storing minerals (calcium, phosphate, magnesium)
○ Producing blood cells via hematopoiesis
○ Storing energy as triglycerides in yellow bone marrow
● Bones
○ The skeleton consists of 206 bones and is divided into:
■ Axial skeleton: Skull, vertebral column, ribcage
■ Appendicular skeleton: Limbs, shoulder, and pelvic girdles
○ Bone Classification
■ Long Bones – Humerus, femur, tibia, radius. Act as levers.
■ Short Bones – Carpals, tarsals. Provide stability and limited motion.
■ Flat Bones – Skull, sternum, ribs. Protect soft organs.
■ Irregular Bones – Vertebrae, pelvis. Provide protection and support.
■ Sesamoid Bones – Patella. Develop in tendons to reduce friction.
○ Bone Tissues and Cells
■ Cortical Bone: Dense, outer layer for structural strength.
■ Cancellous Bone: Spongy, inner layer for shock absorption.
■ Bone Marrow: Red marrow produces blood cells; yellow marrow stores fat.
■ Bone Cells:
● Osteoblasts: Form bone tissue.
● Osteocytes: Maintain bone homeostasis.
● Osteoclasts: Break down bone for remodeling.
○ Bone Remodeling and Hormonal Regulation
■ Continuous Process: Bone fully remodels every ~10 years.
■ Hormones Involved:
● Parathyroid Hormone (PTH): Increases serum calcium by stimulating
osteoclasts.
● Calcitonin: Reduces serum calcium by inhibiting osteoclasts.
● Growth Hormone (GH): Stimulates bone growth in children.
● Vitamin D: Enhances calcium absorption in intestines.
○ Laboratory Values Affecting Bone Health
Lab Test Normal Range Clinical Implications
Calcium 9-10.5 mg/dL Bone formation, muscle activity, nerve signaling
,Vitamin D 25-65 ng/mL Promotes calcium absorption and bone mineralization
CK-MM 30-170 U/L Elevated in muscle injury
LDH 60-160 U/L Increased in tissue breakdown and inflammation
AST <35 U/L Elevated in muscle damage (e.g., rhabdomyolysis)
● Joints
○ Joints connect bones and facilitate movement. They are classified based on structure and
mobility.
○ Joint Classifications
Type Description Mobility Examples
Fibrous Dense connective tissue, no Immovable Skull sutures
cavity
Cartilaginous Connected by cartilage Partly movable Intervertebral discs, pubic
symphysis
Synovial Joint cavity with synovial fluid Freely movable Knees, shoulders, hips
○ Types of Synovial Joints
■ Planar Joints – Side-to-side motion (carpals)
■ Hinge Joints – Flexion & extension (elbows, knees)
■ Pivot Joints – Rotation (radioulnar joint)
■ Condyloid Joints – Multi-directional movement (wrist)
■ Saddle Joints – Greater range than condyloid (thumb)
■ Ball & Socket Joints – Greatest mobility (hip, shoulder)
● Muscles
○ Muscles facilitate movement, maintain posture, stabilize joints, and generate heat.
○ Muscle Structure
■ Skeletal Muscle: Voluntary, striated, responsible for movement.
■ Myofibrils: Contain thick (myosin) and thin (actin) filaments.
■ Tendons: Connect muscle to bone.
■ Ligaments: Connect bone to bone.
○ Sequence of Muscle Contraction
■ Action potential travels down neuron.
■ ACh release triggers sodium influx, generating muscle action potential.
■ Action potential propagates down T-tubules.
■ Calcium release from sarcoplasmic reticulum.
■ Actin & myosin interaction leads to contraction.
■ Muscle fiber shortens, producing movement.
, Etiology of Immobility
● Musculoskeletal System
○ The ability to move freely depends on intact musculoskeletal and nervous systems.
○ Musculoskeletal alterations leading to immobility:
■ Sprains – ligament injuries.
■ Strains – muscle or tendon injuries.
■ Fractures – broken bones.
■ Diseases of bones, muscles, or joints:
● Osteoporosis & Osteopenia – bone density loss.
● Sarcopenia – age-related muscle loss, reducing strength.
● Neurological System
○ Neurological conditions affecting movement may cause excessive or restricted
movement.
○ Etiology of movement disorders:
■ Genetic causes:
● Huntington’s disease
● Wilson’s disease
■ Degenerative disorders:
● Ataxia
● Multiple system atrophy
■ Medication-induced:
● Tardive dyskinesia – results from prolonged use of certain medications.
■ Neurodegenerative:
● Parkinson’s disease – slowly progressive degeneration.
Risk Factors for Mobility Alterations
● Age:
○ Reduced muscle tone, force, and power lead to decreased mobility.
○ Older adults may have difficulty walking or climbing stairs.
● Physical factors:
○ Pain from injury, disease, or surgery.
○ Medical devices (IV lines, monitoring cords) limit movement.
● Psychosocial factors:
○ Fear of being a burden to staff.
○ Depression and anger.
○ Loss of dignity and confidence in mobility.
Comorbidities and Immobility
● Mobility problems can occur independently or due to an existing disease/procedure.
● Risk factors:
Anatomy and Physiology
● Musculoskeletal system plays a critical role in:
○ Maintaining body structure and posture
○ Enabling movement
○ Protecting internal organs
○ Storing minerals (calcium, phosphate, magnesium)
○ Producing blood cells via hematopoiesis
○ Storing energy as triglycerides in yellow bone marrow
● Bones
○ The skeleton consists of 206 bones and is divided into:
■ Axial skeleton: Skull, vertebral column, ribcage
■ Appendicular skeleton: Limbs, shoulder, and pelvic girdles
○ Bone Classification
■ Long Bones – Humerus, femur, tibia, radius. Act as levers.
■ Short Bones – Carpals, tarsals. Provide stability and limited motion.
■ Flat Bones – Skull, sternum, ribs. Protect soft organs.
■ Irregular Bones – Vertebrae, pelvis. Provide protection and support.
■ Sesamoid Bones – Patella. Develop in tendons to reduce friction.
○ Bone Tissues and Cells
■ Cortical Bone: Dense, outer layer for structural strength.
■ Cancellous Bone: Spongy, inner layer for shock absorption.
■ Bone Marrow: Red marrow produces blood cells; yellow marrow stores fat.
■ Bone Cells:
● Osteoblasts: Form bone tissue.
● Osteocytes: Maintain bone homeostasis.
● Osteoclasts: Break down bone for remodeling.
○ Bone Remodeling and Hormonal Regulation
■ Continuous Process: Bone fully remodels every ~10 years.
■ Hormones Involved:
● Parathyroid Hormone (PTH): Increases serum calcium by stimulating
osteoclasts.
● Calcitonin: Reduces serum calcium by inhibiting osteoclasts.
● Growth Hormone (GH): Stimulates bone growth in children.
● Vitamin D: Enhances calcium absorption in intestines.
○ Laboratory Values Affecting Bone Health
Lab Test Normal Range Clinical Implications
Calcium 9-10.5 mg/dL Bone formation, muscle activity, nerve signaling
,Vitamin D 25-65 ng/mL Promotes calcium absorption and bone mineralization
CK-MM 30-170 U/L Elevated in muscle injury
LDH 60-160 U/L Increased in tissue breakdown and inflammation
AST <35 U/L Elevated in muscle damage (e.g., rhabdomyolysis)
● Joints
○ Joints connect bones and facilitate movement. They are classified based on structure and
mobility.
○ Joint Classifications
Type Description Mobility Examples
Fibrous Dense connective tissue, no Immovable Skull sutures
cavity
Cartilaginous Connected by cartilage Partly movable Intervertebral discs, pubic
symphysis
Synovial Joint cavity with synovial fluid Freely movable Knees, shoulders, hips
○ Types of Synovial Joints
■ Planar Joints – Side-to-side motion (carpals)
■ Hinge Joints – Flexion & extension (elbows, knees)
■ Pivot Joints – Rotation (radioulnar joint)
■ Condyloid Joints – Multi-directional movement (wrist)
■ Saddle Joints – Greater range than condyloid (thumb)
■ Ball & Socket Joints – Greatest mobility (hip, shoulder)
● Muscles
○ Muscles facilitate movement, maintain posture, stabilize joints, and generate heat.
○ Muscle Structure
■ Skeletal Muscle: Voluntary, striated, responsible for movement.
■ Myofibrils: Contain thick (myosin) and thin (actin) filaments.
■ Tendons: Connect muscle to bone.
■ Ligaments: Connect bone to bone.
○ Sequence of Muscle Contraction
■ Action potential travels down neuron.
■ ACh release triggers sodium influx, generating muscle action potential.
■ Action potential propagates down T-tubules.
■ Calcium release from sarcoplasmic reticulum.
■ Actin & myosin interaction leads to contraction.
■ Muscle fiber shortens, producing movement.
, Etiology of Immobility
● Musculoskeletal System
○ The ability to move freely depends on intact musculoskeletal and nervous systems.
○ Musculoskeletal alterations leading to immobility:
■ Sprains – ligament injuries.
■ Strains – muscle or tendon injuries.
■ Fractures – broken bones.
■ Diseases of bones, muscles, or joints:
● Osteoporosis & Osteopenia – bone density loss.
● Sarcopenia – age-related muscle loss, reducing strength.
● Neurological System
○ Neurological conditions affecting movement may cause excessive or restricted
movement.
○ Etiology of movement disorders:
■ Genetic causes:
● Huntington’s disease
● Wilson’s disease
■ Degenerative disorders:
● Ataxia
● Multiple system atrophy
■ Medication-induced:
● Tardive dyskinesia – results from prolonged use of certain medications.
■ Neurodegenerative:
● Parkinson’s disease – slowly progressive degeneration.
Risk Factors for Mobility Alterations
● Age:
○ Reduced muscle tone, force, and power lead to decreased mobility.
○ Older adults may have difficulty walking or climbing stairs.
● Physical factors:
○ Pain from injury, disease, or surgery.
○ Medical devices (IV lines, monitoring cords) limit movement.
● Psychosocial factors:
○ Fear of being a burden to staff.
○ Depression and anger.
○ Loss of dignity and confidence in mobility.
Comorbidities and Immobility
● Mobility problems can occur independently or due to an existing disease/procedure.
● Risk factors:
