Arthroscopy- visual of internal structures of joint, most common for knee and shoulder joints, performed in OR with local/general
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● Contraindications: infection, lack of joint mobility
● Indications: tell the extent of damage so the dr can repair a torn ligament or meniscus or synovial biopsy
○ Pt presentation: joint swelling, pain, crepitus (Creaky joints) , joint instability
● Considerations:
○ Pre op
■ Pt ed: pt might need to do post op joining exercises (straight leg, raises, quadriceps setting isometrics)
○ Post op
■ N/A
● Depends on sedation
● Assess neurovascular status and dressing on limb every hour
○ Pain, Sensation, Motor function, Perfusion (color, temperature, capillary refill, swelling, pulses)
● Mild analgesic but opioids if op was corrective
■ Pt ed: ice for first 24 hrs, elevate 12-24 hours
○ Complications: tell dr if swelling, redness, or fever Nuclear Scans-
● Bone scan- entire skeletal system
○ Inject radioactive isotope 2-3 hrs before scan
■ Abnormal bone formation will appear brighter
■ Scan for: hairline bone fractures, tumors, fractures and disease
● osteomyelitis, osteoporosis (bones to become weak and brittle), vertebral compression fractures
● Gallium & thallium scan- more sensitive for detecting bone problems than a bone scan
○ Radioisotope migrates to tissues of
■ brain , liver, breast to help find disease
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● ○ Radioactive injection 4-6 hrs before scan
○ Scan takes 30-60 minutes, can require sedation
■ Repeat scanning at 24, 48, 72 hrs
● Indications: diagnosis: degenerative bone diseases and their progression, osteomyelitis (infxn of bone), stress/vertebral compression fractures, or non healing fractures, osteoporosis, primary or metastatic bone cancer, bone pain of unknown area, aseptic necrosis
○ Pt present: bone pain
● Considerations
○ Preop:
■ No pregnancy, lactation, kidney disease
■ Pt.ed: remain still during procedure, pt MUST VOID before procedure so tech can see better
○ Postop:
■ Pt. ed: no need to take radioactive precautions, drink fluids to increase excretion of radioscope
Dual-energy x-ray absorptiometry-estimates density of bone mass, usually in hip/spine and in when osteoporosis happens. Pt given score
● Score range
○ Greater than or equal to -1.0: normal.
○ Less than -1.0 to greater than -2.5: osteopenia.
○ Less than or equal to -2.5: osteoporosis.
○ Less than or equal to -2.5 plus fragility fracture: severe osteoporosis.
■ **don’t need to know these for exam**
● Indications
○ Osteoporosis, post menopause state, baseline testing: females in their 40s
○ Pt presen. Bone pain
● Considerations:
○ Pre Op ed.- not for preg/lactating
■ Remove metallic objects
○ Post es-maybe supplements and meds if there is bone loss Electromyography and nerve conduction
studies-determine presence and cause of muscle weakness
● EMG-bedside/ EMG lab
○ Thin needles in muscle then electrodes attached to an oscilloscope, which records activity during a muscle contraction
● Nerve conduction study
○ Tech attaches surface or needle electrodes to the skin, low electrical currents go thru electrodes to produce a recording if the muscle response to stimulus
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