1) risk factors associated with musculoskeletal disorders
calcium deficiency, hypercalcemia
obesity
infection
postmenopausal states
autoimmune disorder
metabolic disorder
neoplastic disorder
medication
falls, trauma, and injury
2. diagnostic test
1) radiography
Handle injured areas carefully and support extremities above and below the joint.
Administer analgesics as prescribed before the procedure, particularly if the client is in pain.
Inform the client that exposure to radiation is minimal and not dangerous.
2) arthrography
Arthrography is a radiographic examination of the soft tissues of the joint structures. A contrast medium or air is injected into the joint cavity, and the joint is moved through the range of motion as a series of x-rays are taken.
Minimize the use of the joint for 12 hours after the procedure.
Instruct the client that the joint may be edematous and tender for 1 to 2 days after the procedure and may be treated with ice packs and analgesics as prescribed. Instruct the client that if edema and tenderness last longer than 2 days, the HCP should be notified.
If knee arthrography was performed, an elastic compression wrap over the knee may be prescribed for 3 to 4 days and ice applied to decrease pain and swelling.
3) arthrocentesis
Arthrocentesis involves aspirating synovial fluid, blood, or pus via a needle inserted into a joint cavity. Medication, such as corticosteroids, may be instilled into the joint if necessary to alleviate inflammation.
Obtain informed consent.
Instruct the client to rest the joint for 8 to 24 hours post-procedure. Use ice to decrease pain and swelling. Apply an elastic compression bandage postprocedure as prescribed. Administer analgesics may be prescribed. Instruct the client to notify the HCP if a fever or swelling of the joint occurs.
4) arthroscopy
Arthroscopy provides an endoscopic examination of various joints. A biopsy may be performed during the procedure.
Obtain informed consent. Instruct the client to NPO for 8 to 12 hours before the procedure.
Assess the neurovascular status of the affected extremity. Instruct the client that walking without weight-bearing usually is permitted after sensation returns but to limit activity for 1 to 4 days as prescribed following the procedure. Reinforce instructions regarding the use of crutches, which may be sued for 5 to 7 days postprocedure for walking. An elastic compression bandage should be worn post-procedure for 2 to 4 days as prescribed. Instruct the client to elevate the extremity as often as possible for 2 days following the procedure and to place ice on the site to minimize swelling. Administer pain medication as prescribed postprocedure. Advise the client to notify the HCP if fever or increased knee pain occurs or if edema continues for more than 3 days postprocedure.
5) bone scan
The radioisotope is injected intravenously and will collect in areas that indicate abnormal bone metabolism and some fractures if they exist.
Obtain informed consent. Food and fluids may be withheld for 4 hours before the procedure.
Following the injection of the radioisotope, the client must drink 32 oz (1L) of water to promote renal filtering of the excess isotope. From 1 to 3 hours after the injection, have the client void to clear excess isotope from the bladder before the scanning procedure is completed. Inform the client of the need to lie supine during the procedure and that the procedure is not painful.
Encourage oral fluid intake following the procedure.
6) bone biopsy
Obtain informed consent.
Monitor for bleeding, swelling, or severe pain. Monitor for signs of infection following the procedure. Apply ice packs as prescribed following the procedure to prevent the development of a hematoma and decrease site discomfort. Elevate the site for 24 hours following the procedure to reduce edema.
7) BMD (Bone Mineral Density)
Dual-energy x-ray absorptiometry measures the bone mass of the spine, wrist, and hip bones, total body.
Quantitative ultrasound evaluates the strength, density, and elasticity of various bones, using ultrasounds rather than radiation.
8) EMG (Electromyography)
EMG measures electrical potential associated with skeletal muscle contractions. Needles are inserted into the muscle, and recordings of muscular electrical activity are traced on recording paper through an oscilloscope.
Obtain informed consent. Instruct the client not to take any stimulants or sedatives for 24 hours before the procedure. Instruct the client that the needle insertion is uncomfortable.
Inform the client that slight bruising may occur at the needle insertion sites. Mild analgesics can be used for the pain.
