RY AND DIAGNOSTI C TESTS

(MUSCULO-SKELETAL SYSTEM ) Salimo, Axl Rose P. BS Nursing III

ASPIRATION & ENDOSCOPIC STUDIES:

ARTHROSCOPY
The

word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint." Is a procedure that allows direct visualization of a joint to diagnose joint disorders. Treatment of tears, defects, and disease processes. May be performed through the

ARTHROSCOPE

INDICATIONS:
Through

the arthroscope, a final diagnosis is made, which may be more accurate than through "open" surgery or from Xray studies. and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:
For

Disease

Inflammation

example, synovitis is an inflammation of the lining in the knee,

 Acute

or Chronic Injury Shoulder:Rotator cuff tendon tears, impingement syndrome, and recurrent dislocations Knee:Meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability Wrist:Carpal tunnel syndrome Loose bodies of bone and/or cartilage:for example, knee, shoulder, elbow, ankle, or wrist

HOW IT IS PERFORMED?
Operating

Room

under

sterile

conditions. Injection of a local anesthetic into the joint or general anesthesia. A small incision (about the size of a buttonhole) will be made to insert the arthroscope. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.

oThe puncture wound is closed with adhesive strips or suture and covered with a sterile dressing. oComplications are rare but may include infection, hemarthrosis, stiffness, adhesion, delayed wound healing, effusion.

NURSING INTERVENTIONS
The joint is wrapped with a compression dressing to control swelling. Ice may be applied to control edema and discomfort. The joint is kept extended and elevated to reduce swelling. Explain when to resume activity and what weightbearing limits to follow, as prescribed by the orthopedic surgeon. Explain possible signs as signs of complications that should be immediately reported to the physician (swelling, numbness, cool skin). Explain physicians prescription for analgesic medication.

ASPIRATION & ENDOSCOPIC STUDIES:

ARTHROCENTESIS
Is

a procedure carried out to obtain synovial fluid for purposes of examination or to relieve pain to effusion. Examination of synovial fluid is helpful in the diagnosis of septic arthritis and other inflammatory arthropathies reveals the presence of hemarthrosis, which suggests trauma or bleeding disorders.

ARTHROCENTESIS

HOW IT IS PERFORMED?
The

skin over the joint is sterilized using a liquid, typically iodine solution (Betadine). Local anesthetic is used in the area of the joint; either by injection, topical liquid freezing, or both. A needle with a syringe attached is inserted within the joint an fluid is sucked back (aspirated) into the syringe. For certain conditions, the doctor will also inject medication into the joint after fluid removal. The needle is then removed and a Band-

SYNOVIAL FLUID ANALYSIS

Physical tests Straw colored Clear Moderately viscous drops of it from a syringe needle will form a string a few inches long. Changes in the physical characteristics may provide clues to the disease present such as: Less viscous fluid may be seen with inflammation. Cloudy synovial fluid may indicate the presence ofmicroorganisms, white blood cells, or crystals. Reddish synovial fluid may indicate the

Chemical tests tests that may be performed on synovial fluid samples may include: Glucosetypically a bit lower than blood glucose levels. May be significantly lower with joint inflammation and infection. Proteinincreased with bacterial infection. Lactate dehydrogenaseincreased LD (LDH) level may be seen in rheumatoid arthritis, infectious arthritis, or gout. Uric acidincreased with gout

Possible complications include local bruising, minor bleeding into the joint, and loss of pigment in the skin that was entered by the needle. A rare but serious complication of joint aspiration is infection of the joint (septic arthritis).

REFERENCES
Smeltzer S. C. et al (2008) Brunner and Suddarths Textbook of Medical Surgical Nursing Eleventh Edition. Philadelphia Lippincott Williams and Wilkins Chapter 66 pages 2350, 2351 Shiel W. C. (2008) Joint aspiration Online article retrieved from www.MedicineNet.com (01/11/12, 1132H)