DIAGNOSTIC PROCEDURES FOR

LOCOMOTION
Ms. Hassen Zabala, BSN, RN, MAN
February 26, 2013

NON-INVASIVE
RADIOGRAPHY
TOMOGRAPHY
CT
MRI
FLUOROSCOPY

RADIOGRAPHY
Exposing a part of the body to a small dose of ionizing
radiation to produce pictures
Indication
diagnose and stabilize fractured bones or joint dislocation.
guide orthopedic surgery.
look for injury, infection, arthritis, abnormal bone growths
and bony changes seen in metabolic conditions.
assist in the detection and diagnosis of bone cancer.
locate foreign objects in soft tissues around or in bones.

Prep
Remove jewelleries
Pregnancy test

TOMOGRAPHY
Indicated when x-ray is not conclusive
A CT imaging system produces cross-sectional
images or "slices" of anatomy, like the slices in
a loaf of bread

MRI
Magnetic resonance imaging (MRI) is a test
that uses a magnetic field and pulses of radio
wave energy to make pictures of organs and
structures inside the body. In many cases MRI
gives different information about structures in
the body than can be seen with an X-ray,
ultrasound, or computed tomography (CT)
scan

FLUOROSCOPY
Used in combination with other diagnostic
tests like myelography or arthroscopy
No special prep
Assess allergy

INVASIVE
RADIOGRAPHY
RADIONUCLIDE IMAGING
OTHERS

ARTHROGRAPHY

NO special prep
Assess allergy
Void before procedure
Duration: 1 hr

X strenuous acts/exercises

SINOGRAPHY
Visualization of sinus tracts for deep draining
wounds
SAME WITH MYELOGRAPHY EXCEPT SITE

MYELOGRAPHY
NPO post midnight
Void before procedure
Assess allergy

BONE SCANS
Void before procedure
Uses technetium 99

Drink fluids for 24-48 hrs

GALLIUM SCAN
Denser than technetium 99 so given 2-3 hrs
before scan
Specific to bone disorders
Duration: 30-60 mins

INDIUM IMAGING
Indium 111 tags to leukocytes to detect bone
infection
Leukocytes separated from blood sample then
tagged and reinjected again

ARTHROCENTESIS
POST: apply compression bandages and rest
joint for 8-24 hrs

ARTHROSCOPY
X for flexion <50% and with infection on site
NPO post midnight

Walking allowed unless contraindicated

X strenuous acts for a few days

BIOPSY
Duration: 30 mins
Elevate site for 24 hrs
Assess for bleeding, pain and infection + v/s

LABS
ANA
CRP
ESR
Ca
Alkaline Phosphatase
P
Aspartate Aminotransferase
Creatine Kinase
LDH4-5

ANA
Antinuclear antibodies are a unique
group of autoantibodies that have
the ability to attack structures in the
nucleus of cells.
Blood sample
NV: negative or at titer < 1:32
+ : SLE, RA, RF and Raynauds dss

CRP
C-reactive protein is produced by the
liver. The level of CRP rises when
there is inflammation throughout the
body.
Blood sample
NV: Trace amounts
+ : acute inflammation i.e. RA

ESR
Erythrocyte sedimentation rate is the rate at
which red blood cells sediment in a period of
one hour.
Blood sample
NV: Westergren M: 0-15 mm/hr
F: 0-20 mm/hr
Wintrobe M: 0-9 mm/hr
F: 0-15 mm/hr
I = arthritic conditions, infxn, inflammation, CA
& cell/tissue destruction

Calcium
Calcium helps build strong bones and
teeth. It is important for heart function,
and helps with muscle contraction, nerve
signaling, and blood clotting.
NV : 8.0-10.5 mg/dl or 4.5-5.5 mEq/L
I = bone tumor, Pagets dss, healing fx
D = osteomalacia, osteoporosis

Alkaline Phosphatase
Alkaline Phosphatases are a group of enzymes
found primarily in the liver (isoenzyme ALP-1)
and bone (isoenzyme ALP-2). This enzyme
works best at an alkaline pH (a pH of 10), and
thus the enzyme itself is inactive in the blood.
Alkaline phosphatases act by splitting off
phosphorus (acidic mineral) creating an
alkaline pH.
NV : 30-90 U/L
I = bone cancer, osteoporosis, osteomalacia,
Pagets dss

Phosphorus
Next to calcium, phosphorus is the most
abundant mineral in the body. These 2 important
nutrients work closely together to build strong
bones and teeth. It is also present in cells and
tissues throughout the body. It also helps reduce
muscle pain after a hard workout. Phosphorus is
needed for the growth, maintenance, and repair
of all tissues and cells, and for the production of
the genetic building blocks, DNA and RNA.
2.5-4.0 mg/dl
I = healing fx and osteolytic metastatic tumor dss

Aldolase A
Aldolase A is found in the developing
embryo and is produced in even
greater amounts in adult muscle. It is
repressed in adult liver, kidney, and
intestine.
NV : 1.3-8.2 U/dl
I = muscular dystrophy &
dermatomyositis

Aspartate Aminotransferase
AST is normally found in red blood cells, liver,
heart, muscle tissue, pancreas, and kidneys. It is
formerly called serum glutamic oxaloacetic
transaminase (SGOT).
Low levels are normally found in the blood. When
body tissue or an organ is diseased or damaged,
additional AST is released into the bloodstream.
After severe damage, AST levels rise in 6 to 10
hours and remain high for about 4 days.
NV : 10-50 U/L

Creatine Kinase
Creatine kinase is also known as creatine
phosphokinase or phosphocreatine kinase. An
enzyme involved in the synthesis and use of
energy-providing molecules, it's
predominantly found in the cells of the heart,
skeletal muscles and brain.
NV : 15-150 U/L
I = traumatic injuries, progressive muscular
dystrophy and poliomyositis

LDH4, LDH5
Lactate dehydrogenase is a safety valve in our
pipeline of energy production. It plays an
important role in cellular respiration (conversion
of glucose to usable energy .
Blood levels are normally low. However, when
tissues are damaged by injury or disease, they
release more LDH into the bloodstream.
NV : 60-150 U/L
I = skeletal muscle necrosis, extensive cancer,
progressive muscle dystrophy