Diagnostic Procedures in Musculoskeletal Conditions:
Imaging Procedures:
1. Myelogram: Injection of a radiopaque dye in to the subarachnoid space at
the lumbar spine to x-ray the spinal cord and the vertebral column.
Used to diagnose: Herniated disk, tumors, or the presence of an infection
After the procedure
Oil-based dye: 6-8 hrs on bedrest ( 6-12 hours): takes longer to excrete oil
based dye
Water soluble : 2-6 hours on bedrest
NI: 1.Stay in bed with HOB slightly elevated at 30 degrees = to keep dye in
lower spine to prevent headache
2. 6-8 hours on bedrest
3. Increase fluid intake = excrete dye [ LT : pt lie FLAT on bed ]
2. CT Scan: A narrow xray beam, produces a three dimensional picture of the
structure being studied.
Preop
Sign consent: 4 criteria in IC: 1. What is the procedure, 2) what are the
complications RT procedure, 3) alternative procedures 4) complications if
NONE o the procedures are down * Right to refuse the procedure EVEN IF
the consent has been signed
Check allergies: iodine based
NPO : decrease the risk for aspiration
Baseline vs
Remove all metal articles (if MRI with CM)
Post
Watch for allergic reaction (may be delayed)
Encourage fluids: to facilitate excretion of the dye
3. Bone scan: Nuclear medicine procedure in which amount of radioactive
isotope taken up by bones is evaluated = Scanning camera reveals the
degree of radionuclide uptake
Areas of concentrated nuclide uptake may represent a tumor or other
abnormalities
These areas are detectable days or weeks before they would show up on
ordinary xrays. (See HO)
Aspiration Procedures:
1. Arthrocentesis: The puncture of a patient’s joint with a needle and the
withdrawal of synovial fluid for diagnostic purposes. AKA joint aspiration.
Normal synovial fluid color Straw color, clear, or slightly cloudy (Turbid)
Trauma or disease present cloudy, milky, sanguineous (bloody), yellow,
green or gray
Post procedure
 Place on pillow: promote circ back to the heart = decrease swelling
 Rest affected joint for 12 hours
 Apply ice for 24 to 48 hours : vasoconstriction = 1)decrease
swelling// 2) numbs area = decrease pain sensation: decreased need
for pain meds = dec complications RT to use of pain meds
 Anti-infective (infection) or corticosteroid (anti inflammatory effect )
Endoscopic Procedures:
1. Arthroscopy: Flexible fiberoptic endoscope used to view joint structures
and tissues (See HO)
1.
2.
3.
4.
5.
Used to identify:
 Torn tendon and ligaments
 Injured meniscus
 Inflammatory joint changes
 Damaged cartilage
 Drain fluid
After Procedure:
Neurovascular checks : CMS
Elevate : dec swelling
Ice : vasoconstriction ( dec swelling /pain sensation)
Elastic compression stockings : circulation
Avoid weight bearing : esp if the knee was involved
Other Procedure:
1. EMG: Electromyogram
 Insertion of needle electrodes into the skeletal muscles // Oscilloscope
 Muscle activity will produce an electrical current
No special prep: no lotion on the skin