MUSCULOSKELETAL

SYSTEM
ASSESSMENT
 RISK FACTORS
Autoimmune disorders
Calcium deficiency
Degenerative conditions
Falls
Hyperuricemia
Infection
 RISK FACTORS
Medications
Metabolic disorders
Neoplastic disorders
Obesity
Postmenopausal states
Trauma and injury
 X-RAYS
DESCRIPTION
– A commonly used procedure to diagnose
disorders of the musculoskeletal system
 X-RAYS
IMPLEMENTATION
– Handle injured area carefully
– Administer analgesics as prescribed prior
to the procedure
– Remove any radiopaque objects, such as
jewelry
– Shield client’s testes, ovaries, or pregnant
abdomen
– The client must lie still during an x-ray
– Inform the client that exposure to
radiation is minimal and not dangerous
– Health care provider is to wear a lead
apron if staying in the room with the client
 ARTHROCENTESIS
DESCRIPTION
– Involves aspirating synovial fluid, blood,
or pus via a needle inserted into a joint
cavity
– Medication may be instilled into the joint
if necessary to alleviate inflammation
 ARTHROCENTESIS
IMPLEMENTATION
– Obtain a consent form
– Apply a compress bandage
postprocedure as prescribed
– Instruct the client to rest the joint for 8
to 24 hours postprocedure
– Instruct the client to notify the physician
if a fever or swelling of the joint occurs
 ARTHROGRAM
DESCRIPTION
– A radiographic examination of the soft
tissues of the joint structures used to
diagnose trauma to the joint capsule or
ligaments
– A local anesthesia is used for the procedure
– A contrast medium or air is injected into
the joint cavity and the joint is moved
through range of motion as a series of x-
rays are taken
ARTHROGRAM OF THE KNEE

From Johnson LL (1981) Diagnostic and surgical orthroscopy: the knee and other joints (2nd ed.).
St. Louis: Mosby.
 ARTHROGRAM
IMPLEMENTATION
– Inform the client to fast from food and fluids
for 8 hours prior to the procedure
– Assess the client for allergies to iodine or
seafood prior to the procedure
– Obtain a consent form
– Inform the client of the need to remain as still
as possible, except when asked to reposition
– Minimize the use of the joint for 12 hours
following the procedure
 ARTHROGRAM
IMPLEMENTATION
– 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
– Inform the client that if edema and
tenderness last longer than 2 days to
notify the physician
– If knee arthrography was performed, an
Ace bandage over the knee may be
prescribed for 3 to 4 days
– If air was used for injection, crepitus
may be felt in the joint for up to 2 days
 ARTHROSCOPY
DESCRIPTION
– Provides an endoscopic examination of
various joints
– Articular cartilage abnormalities can be
assessed, loose bodies can be removed,
and the cartilage trimmed
– A biopsy may be performed during the
procedure
 ARTHROSCOPY

From Beare PG, Myers JL (1998): Adult Health Nursing, ed. 3 St. Louis: Mosby.
 ARTHROSCOPY
IMPLEMENTATION
– Instruct the client to fast for 8 to 12
hours prior to the procedure
– Obtain a consent form
– Administer pain medication as
prescribed postprocedure
– An elastic wrap should be worn for 2 to
4 days as prescribed postprocedure
 ARTHROSCOPY
IMPLEMENTATION
– Instruct the client that walking without
weight bearing is usually permitted after
sensation returns but to limit activity for
1 to 4 days as prescribed following the
procedure
– 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
 ARTHROSCOPY
IMPLEMENTATION
– Reinforce instructions regarding the use
of crutches, which may be used for 5 to
7 days postprocedure when walking
– Advise the client to notify the physician
of fever, increased knee pain, or if
edema continues for more than 3 days
postprocedure
 BONE SCAN
DESCRIPTION
– Radioisotope is injected IV and will
collect in areas that indicate abnormal
bone metabolism and some fractures, if
they exist
– The isotope is excreted in the urine and
feces within 48 hours and is not harmful
to others
 BONE SCAN
IMPLEMENTATION
– Hold fluids for 4 hours prior to the
procedure
– Obtain a consent form
– Remove all jewelry and metal objects
– Following the injection of the
radioisotope, the client must drink 32
ounces of water (if not contraindicated)
to promote renal filtering of the excess
isotope
– From 1 to 3 hours after the injection,
have the client void, and then the
scanning procedure is performed
 BONE SCAN
IMPLEMENTATION
– Inform the client of the need to lie supine
during the procedure and that the
procedure is not painful
– No special precautions are required after
the procedure because a minimal amount
of radioactivity exists in the radioisotope
– Monitor the injection site for redness and
swelling
– Encourage oral fluid intake following the
procedure
BONE OR MUSCLE BIOPSY
DESCRIPTION
– May be done during surgery or through
aspiration, or punch or needle biopsy
MUSCLE BIOPSY SHOWING
POLYMYOSITIS

From Perkin GD (1998) Mosby’s color atlas and text of neurology. London: Times Mirror
International Publishers.
BONE OR MUSCLE BIOPSY
IMPLEMENTATION
– Obtain a consent form
– Monitor for bleeding, swelling,
hematoma, or severe pain
– Elevate the site for 24 hours following
the procedure to reduce edema
BONE OR MUSCLE BIOPSY
IMPLEMENTATION
– Apply ice packs as prescribed following
the procedure to prevent the
development of a hematoma
– Monitor for signs of infection following
the procedure
– Inform the client that mild to moderate
discomfort is normal following the
procedure
 ELECTROMYOGRAPHY
(EMG)
DESCRIPTION
– 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
ELECTROMYOGRAPHY
(EMG)

From Mourad LA (1991) Orthopedic disorders. St. Louis: Mosby.

 ELECTROMYOGRAPHY
(EMG)
IMPLEMENTATION
– Obtain a consent form
– Instruct the client that the needle
insertion is uncomfortable
– Instruct the client not to take any
stimulants or sedatives 24 hours prior to
the procedure
– Inform the client that slight bruising
may occur at the needle insertion sites
 MYELOGRAM
DESCRIPTION
– Injection of dye or air into the
subarachnoid space to detect
abnormalities of the spinal cord and
vertebrae
 MYELOGRAM

From Herlihy B, Maebius NK: The human body in health and illness, Philadelphia, 2000,
W.B. Saunders.
 MYELOGRAM
PREPROCEDURE
– Obtain a consent form
– Provide hydration for at least 12 hours
before the test
– Assess for allergies to iodine
– Premedicate for sedation as prescribed
 MYELOGRAM
POSTPROCEDURE
– Perform vital signs and neurological
assessment frequently as prescribed
– If a water-based dye is used, elevate the head
15 to 30 degrees for 8 hours as prescribed
– If an oil-based dye is used, keep the client flat
6 to 8 hours as prescribed
– If air is used, keep the head lower than the
trunk
– Force fluids and monitor I&O