Musculoskeletal System
Common Diagnostic Tests
ANA, antinuclear antibodiesDetects SLE, a collagen disease
Arthritis can result from SLE
Normal = negative
Client prep
CRP, C-reactive proteininflammation and auto-immune disorders show abnormal protein
Normal = female 1-20, male 1-13mm/h Can get false negative
Client Prep, usually non-fasting blood draw
Uric Acid-BloodElevated with Gout and arthritis
Normal = male 2.1-8.5, female 2.0-6.6 mg/dl
Client prep: usually non-fasting blood draw
Uric Acid-Urine (24 hour collection)
Normal = 250-750 ml/24hr
Client prep
CBC
HemoglobinIncrease can mean CHF
Decrease can mean SLE or sarcoidosis
Normal = male 14-18, female 12-16 g/dl
Client prep
CBC
WBCelevated with infection/inflammation
Normal + 5,000 – 10,000/mm3
Client prep
ESR, Erythrocyte Sedimentation RateRBC descent in saline in 1 hour
Increases with inflammation, infection, necrosis, or cancer
Normal = male up to 15, female up to 20 mm/hr
Client prep
RF, Rheumatoid Factor (IgM)Elevated with autoimmune disease such as Rheumatoid arthritis and SLE
Normal = < 60 U/ml or negative
Client prep
Serum Calcium, detects calcium metabolismIncrease may indicate: metastatic bone tumor, Paget’s disease, acromegaly
Decrease may indicate: rickets, osteomalacia, vitamin D deficiency
Normal = 9.0 – 10.5 mg/dl< 6mg/dl may lead to tetany (cramps, convulsions, twitching)
> 14mg/dl may lead to coma
Client prep
Radiologic StudiesArthrogram/Arthrography-Xray with contrast dye into joint to visualize soft tissue of joints (meniscus, ligaments, cartilage)
Arthrogram
Client prep
Arthrogram Procedure:Cleanse & anesthetize area
Insert needle into joint space
Aspirate fluid to minimize dilution of dye
Leave needle in, replace syringe with dye syringe
Inject contrast and remove needle
ROM to distribute dye
X-rays will be taken
Takes about 30 minutes
May experience some discomfort, pressure, tingling
Following Arthrogram:Assess for swelling
Apply ice, if needed
Mild analgesic
May hear crepitus after test. This is normal and will disappear in 1-2 days.
Instruct pt to call MD if pain or swelling occurs
CT ScanX-ray (body scanner) with contrast dye
Three-dimensional cross-sectional view of tissues at various angles
Can identify small differences: Detects edema, hemorrhage, blood flow, infarcts, tumors, infections, aneurysms, demyelinating disease, muscular disease, skeletal abnormalities, disk problems, causes of spinal cord compression
Takes about an hour
Findings as with arthrogram, but 3-D view
CT Scan
Client prep
Following CT Scan
Increase fluid intake to flush dye
Evaluate patient for delayed reaction to dye (usually occurs within 2-6 hours)
Treat with antihistamine and/or steroids, if indicated
CT Scan Procedure
Patient must lie still
Show picture of CT machine and discuss claustrophobia, may need antianxiety med
Performed by a radiologist
Takes 30-45 minutes
Discomfort includes lying still on a hard surface, peripheral venipuncture, mild nausea, salty taste, flushing, and warmth from dye
MRI
MRI/Magnetic Resonance ImagingMagnetic field and radio waves, noninvasive
Can evaluate soft & hard tissue, & blood vessels
Unique d/t no exposure to ionizing radiation
Advantages over CT
Disadvantages
MRI
Contraindications:> 300 lbs
Claustrophobia
Metal implants, clips, pacemaker, infusion pumps
Pregnancy (long-term effects not known)
If on continuous life support
Client prep:Obtain consentCan drive afterwards without assistanceAssess for contraindicationsShow picture of machine, discuss claustrophobiaRemove all metal objects from body (create artifacts, can go flying, damages credit cards)Must remain motionless in supine positionWill hear thumping sound, ear plugs availableEmpty bladder prior to test for comfortNo food or fluid restrictions prior to testExplain procedure
MRI Procedure
Lie flat on hard table that slide into a tubeMust lie stillCan talk to or listen to staffMagnevist (contrast agent) may be used via IVPerformed by radiologistTakes 30 to 90 minutesDiscomfort from lying on hard surface, possible venipuncture, possible tingling in teeth (metal fillings)No postprocedural care needed
MRI
Detects: edema, hemorrhage, blood flow, infarcts, tumors, infections, aneurysms, demyelinating disease, muscular disease, skeletal abnormalities, disk problems, causes of spinal cord compression
X-ray
X-ray, electromagnetic radiation passes photons (light particles) through the body onto film
Bone (very dense) blocks photons, appears white
Air appears black
Muscle, fat, and fluid appear as various shades of gray
Metal and contrast block almost all photons and appear bright white
X-ray
Client prepNonfastingPosition determined by area to be x-rayedPatient should be still, usually hold breathContraindicated if pregnantMay need to remove jewelry & don a gownNo discomfort except r/t position
Detects fractures and some joint abnormalities
Myelogram
MyelogramX-ray with contrast dye of spinal subarachnoid spaceDetects spinal tumors, herniated discs, bone spurs, cervical ankylosing spondylosis, arthritic lumbar stenosisContraindications: Multiple sclerosis patients (may cause exacerbation), ICP, infection near lumbar puncture sight, allergy to shellfish
Myelogram
Client prep
Myelogram ProcedureEmpty bladderA lumbar puncture is performed
15 ml CSF removed15 ml of radiopaque dye injected
Patient will be tilted up and down to spread dye (prone position)Lights are off, dye followed with fluoroscopyX-ray films takenNeedle remains in place until exam concludedDone by radiologist and takes 45 minutesDiscomfort varies from mild to severe
Following Myelogram
Bed rest for several hours
Head position varies per dye used, per MD order
Monitor for bleeding, fever, headache, photophobia, seizure, VS, ability to void, reaction to dye
Possible med restrictions
Push fluids
Bone ScanBone Scan
Radioactive isotope intravenous
They use a gamma camera to detect “hot spots” of activity where the isotope collects
Can detect tumor, arthritis, fracture, necrosis, degenerative changes, osteomyelitis
Normal = uniform distribution
Abnormal = area of higher concentration
Contraindicated in pregnancy, breastfeeding
Bone Scan
Advantages:
Disadvantages:
Bone Scan
Client prep:Explain procedure, is non-fasting, no sedation required
Arrive at Nuclear Medicine department 4 hours prior to test
Dye given IV, takes 4 hours to travel to bones
Push fluid to aid in dye distribution
Empty bladder upon return to avoid artifact
You may be asked to wear a gown
Done in supine, prone, & lateral position, takes an hour
Takes 6-24 hours for dye to leave system (push fluids)
Discomfort is needle stick for dye infusion, and hard surface
Bone Mineral Density/BMD
BMDMeasures bone mass
The only test to diagnose osteoporosis
Normal is comparative to same age, sex, size. Lower density = higher risk for fractures
-1 to –2, Osteopenia
< -2.5, Osteoporosis
Client prep: Non-fasting, non-invasive, do Q2 yrs
Other Tests
ArthrocentesisObtain synovial fluid from a joint
Needle aspiration
Sterile procedure
Detects infections, synovitis, crystal-induced arthritis, tumors, joint degeneration
Inject anti-inflammatory medications
Normal= Clear, straw-colored fluid, no crystals
Contraindicated if infection near joint being tested
Arthrocentesis cont’dInformed consent
Explain procedure
May or may not be fasting
Local anesthetic
Aseptic procedure
Fluid may be removed, Steroid may be injected
Apply pressure dressing following procedure
May do venipuncture to compare chemical content
Doctor office or bedside, by MD, takes 10 minutes
Pain may worsen after test
Following Arthrocentesis Assess for pain, fever, swelling
Apply ice
Apply pressure dressing to decrease reaccumulation of fluid or hematoma
Avoid strenuous use of joint for several days
Arthroscopy-used most often for kneeSmall incision, endoscope
Examine the inside of a joint
Diagnose disease, meniscus problems, torn cartilage, remove small bodies, do biopsy
Advantage: allows direct visualization, can perform surgery, can monitor disease progress, can attach video camera; can examine, biopsy, or do surgery
Contraindications:Infection or ankylosis in joint
ArthroscopyClient prep:
Obtain consent
NPO at midnight
Teach crutch use for post procedure use
Shave 6” above and below joint
May use local or general anesthesia
Pressure wrap or tourniquet
Knee at 45 degree angle
May have 2-3 small incision sights
Sutured with dressing applied
Done by orthopedic surgeon, takes 15 to 30 minutes
Arthroscopy Follow-upAsses neurologic status and circulatory status
Assess for sxs of infection, for drainage
Teach to elevate & ice to decrease swelling
May walk with crutches if MD order
Suture removal in 7-10 days