MUSCULOSKELETAL

SYSTEM
Relates to the
muscles and
the skeleton.
1. Bone X-ray
2. CT scan & MRI
3.Bone Scan / Nuclear Scan /
Scintigraphy
3. Bone biopsy
4. Muscle biopsy
5. Electromyography (EMG)
6. Arthrogram/ Arthrography
7. Arthroscopy
8. Arthrocentesis
Bone X-ray
-observations of bone density, alignment & swelling, &
intactness are made
-conditions of joints like: size of the joint space,
smoothness of articular cartilage & synovial swelling
can be determined

Nursing considerations:
inform client that there is low radiation exposure & not dangerous
remove all jewelry
instruct to remain still during the filming process
inform the health care provider if pregnant
---pregnant women and children are more sensitive to the risks of
the x-ray, a protective shield may be worn over areas not being
scanned (like pregnant abdomen, testes, ovaries)
Bone Scan
-done to evaluate damage to the bones, detect
cancer that has spread (metastasized) to the bones,
and monitor conditions that can affect the bones
(including infection and trauma).

A bone scan can often detect a problem days to months

earlier than a regular X-ray test.

"cold" spots - areas that absorb little or no amount of tracer

appear as dark which may indicate a lack of blood supply to
the bone (bone infarction) or the presence of certain types of
cancer.
"hot" spots - areas of rapid bone growth or repair, absorb
increased amounts of the tracer and show up as bright. This
may indicate the presence of a tumor, a fracture, or an
infection.
Bone scan of the spread of prostate cancer

Figure 1 shows a normal whole-body scan.

Figure 2 shows cancer of the prostate that has
spread to the spine.
Nursing considerations:
BEFORE:
consent form
tell your doctor if you are pregnant
limit your fluids for up to 4 hours before the
test
-because you will be asked to drink extra fluids after the
radioactive tracer is injected (about 4 to 6 glasses of water to
help eliminate any of the radioactive substance that does not
collect in your bones.
empty your bladder
-to prevent any radioactive urine from blocking the view of your
pelvic bones during the scan
patient may want to bring some reading
materials or a project to pass the time during
the waiting period
-they have to wait 1 to 3 hours after the radioactive tracer is
injected before their bone scan is done
remove any jewelry that might interfere with
the scan
may need to take off all or most of their
clothes, depending on which area is being
examined
AFTER:
some soreness or swelling may develop
at the injection site= relieved by applying
moist, warm compresses to the arm
encourage the client to increase fluid
intake to facilitate urinary excretion
-isotope excreted in the urine and feces within 48 hours;
not harmful to others
Bone biopsy
-to tell the difference between cancerous and non-
cancerous bone tumors and to identify other bone
problem
The sample of bone can be removed by:
-Inserting a needle through the skin and directly into the bone
(closed, needle, or drill biopsy); local anesthetic; IV pain
medication and sedative may be given.
-Making an incision through the skin to expose an area of
the bone (open biopsy); general anesthesia, spinal
anesthesia or nerve block is given for this procedure.
Nursing considerations:
consent form
For a closed biopsy (needle biopsy), no
special preparation is needed.
Before the test, you will be asked to undress and put on a
hospital gown. You will be awake during the procedure.
You may go home shortly after a closed bone biopsy is done.
If you have received a sedative, you may need to stay longer
and have someone drive you home.
For an open biopsy, certain preparation is
needed.
Do not eat or drink anything for 8 to 12 hours before the
biopsy. You can resume normal eating after the procedure.
If an open biopsy is done, you may need to stay in the
hospital overnight.
AFTER:
a bandage will be placed over the biopsy
site
 keep the biopsy site covered, elevated for
24 hrs. and dry for 48 hours.
ice packs can prevent the development of
hematoma
monitor for edema, bleeding & pain
Muscle biopsy
may be done to identify or detect:
-muscular disorders such as muscular
dystrophy or congenital myopathy
-metabolic defects of the muscle
-infections that affect the muscles
-difference between nerve and muscle disorders
More than one needle insertion may be needed to get a
large enough sample.

Nursing considerations:
no fasting or other special preparation is
usually necessary for closed biopsy
aftercare is the same as bone biopsy
Electromyography
-measures electrical potential associated with
skeletal muscle contraction

Nursing considerations:
consent form
avoid using any creams or lotions on the
day of the test
-no other special preparation is usually necessary-

AFTER:
the muscle may feel tender or bruised for a
few days=rest; ice
 Arthrogram / Arthrography

During arthrography, a contrast material is injected to enable the

radiologist to study the joint space that appears on the x-ray
image.
Nursing considerations:
notify physician if patient is pregnant
remove jewelries
generally, you can resume your usual
activities immediately

This arthrogram of the shoulder

shows a rotator cuff tear.
 Arthroscopy

> both as diagnostic test and surgical procedure

-endoscopic examination of various joints
-articular cartilage abnormalities can be assessed,
loose bodies can be removed
-large bore needle is inserted into the joint under
GA or local anesthesia
Nursing considerations:
consent form
do not consume any food or fluid for 8-12 hours before the
procedure
you may be instructed to shave your joint area
given a sedative before leaving for the hospital
hospital gown
AFTER:
limit activity for 1-4 days, walking w/o weight bearing is
usually permitted
elastic wrap is worn for 2-4 days
elevate extremity and place ice on the site
Arthrocentesis
(Closed Joint Aspiration)
Reasons for Procedure:

-diagnose and/or treat a painful, swollen, fluid-filled joint

-diagnose the specific type of arthritis occurring within a joint
like rheumatoid arthritis (RA)
-check for crystals in the joint fluid, which could be a sign of
gouty arthritis (GA) / gout
-reveal the presence of hemarthrosis (bleeding into the joint
cavity) which suggests trauma or tendency to bleed
-verify the presence of an infection, identify the causative
agent, and follow the progress of antibiotic therapy
-inject medications into the joint space, such as an
anti-inflammatory agent (e.g. cortisone)
Nursing considerations:
consent form
AFTER:
compression bandage post procedure,
it may take about 5 -10 mins.
rest joint for 8-24 hrs.
take acetaminophen, ibuprofen, or some
other relatively mild pain killer for a day or
two after the procedure
instruct client to notify physician if fever or
swelling occurs
MUSCULO-
SKELETAL
DISORDERS
warm, red, and swollen joints
-Tx: Rest of the extremity
Intermittent ice & heat
NSAIDs

Arthroscopic synovectomy
-a surgery in which the
swollen lining of the joint
is removed using
arthroscope to see
inside the joint like
the knee.
 CONTUSIONS, STRAINS & SPRAINS

is a soft tissue injury produced by blunt force, such as blow, kick
or fall
many small blood vessels rupture and bleed into soft tissues =
ecchymosis / bruising
sxs; pain, swelling & discoloration
resolves in 1-2 weeks
There are three types of bruises:
Subcutaneous -- beneath the skin,
Intramuscular -- within the belly of the underlying muscle
Periosteal -- bone bruise

Bruises can last from days to months, with the bone bruise being
the most severe and painful.
a bone bruise a muscle bruise
a skin bruise
a “muscle pull”
caused by improper use, overuse, overstretching or excessive stress
microscopic, incomplete muscle tears w/ some bleeding into the tissue
sxs: soreness, sudden pain, local tenderness on muscle use
injury to the ligaments surrounding a joint that is caused by a
twisting motion
blood vessels rupture & edema occurs
sxs: joint is tender & movt becomes painful
pain ↑ during the first 2-3 hrs. after the injury bec of swelling and bleeding
x-ray is needed to R/O bone injury
On the outside of the ankle, there
are three main ligaments which
help to stabilize the ankle:
Anterior talofibular
Posterior talofibular
Calcaneofibular

The front band (anterior talo-

fibular ligament) is most
commonly injured during severe
sprains.
Management
R- rest =to prevent addtnal injury & promote healing
I- ice =moist/ dry cold applied intermittently for 20-30 mins during the
first 24-48 hrs after injury produces vasoconstriction
►  bleeding,edema & discomfort
C- compression =elastic compression bandage controls bleeding,
reduces edema & provides support for the injured
tissues
E- elevation = controls swelling

If sprain is severe, like torn muscle fibers & disrupted ligaments:
-surgical repair
-cast mobilization
Neurovascular status (circulation, motion, sensation) of the injured
extremity is monitored frequently.
After the acute inflamm stage (24-48 hrs), heat may be applied
intermittently, for 15-30 mins, 4x a day to relieve muscle spasm & to
promote vasodilation, absorption & repair.
Depending on the severity of the injury, passive & active exercises may
begin in 2-5 days.
Severe sprains may require 1-3 wks of immobilization.
-a condition in which the articular surfaces of the bones
forming the joint are no longer in anatomic contact
-traumatic dislocations are orthopedic emergencies bec the
associated joint structures, blood supply & nerves are distorted &
severely stressed
-if not treated immediately, avascular necrosis & nerve palsy may
occur
-s/sxs: pain, change in contour of the joint, change in the length of
extremity, loss of normal mobility, change in the axis of the
dislocated bones
-x-ray confirms the dx & shows any assoc fracture
Dislocation of the hip Shoulder joint
PARTIAL DISLOCATION “OUT OF JOINT”
Scoliosis is a curving of the spine.
The spine curves away from the middle or sideways.
MILWAUKEE BRACE
Kyphosis is a curving of the spine that causes a bowing of
the back, such that the apex of the angle points backwards
leading to a hunchback or slouching posture.
Lordosis is excessive curvature in the lumbar portion of
the spine, which gives a swayback appearance.
Spinal Instrumentation

-is the use of metal implants

fixed to the spine to improve
spinal deformity while the
fusion matures.
END