This document provides information on diagnostic tests and nursing interventions for musculoskeletal function assessment. It discusses tests such as arthrocentesis, arthroscopy, bone density tests, bone scans, CT scans, EMGs, MRIs, x-rays, and biopsies. For each test, it describes the purpose and relevant nursing interventions such as dressing care, activity restrictions, dietary restrictions, and monitoring for complications. It also discusses subjective and objective assessments including categories like history, symptoms, and physical exams of muscles, nerves, and vascular structures.

1. ASSESSING MUSCULOSKELETAL FUNCTION

2. Diagnostic Tests
Test Purpose
Nursing
Interventions
Arthroc
entesis
Obtain
synovial
fluid from
a joint for
diagnosis
or to
remove
excess
fluid.
After the
procedure,
apply a
compression
dressing and
tell the patient
to report any
bleeding and
leakage of
fluid.

3. Diagnostic
Tests
Test Purpose
Nursing
Interventions
Arthrosc
opy
 Used to perform
surgery and
diagnose
diseases of the
patella,
meniscus, and
synovial and
extrasynovial
membranes.
 Fluid may be
drained from
the joint and
tissue removed
for biopsy.
 If general anesthesia is
used, tell the patient
not to eat or drink fluids
after midnight prior to
the procedure.
 Following the procedure,
assess for bleeding and
swelling, apply ice to
the area if prescribed,
and instruct patient to
avoid excessive use of
the joint for 2 to 3 days.

4. Diagnostic Tests
Test Purpose
Bone density
(BD)
 Dual energy
x-ray
absorptiome
try (DEXA)
 Quantitative
ultrasound
(QUS)
 Bone mineral
density
(BMD)
 Bone
absorptiometry
 Evaluate bone
mineral density
and to evaluate
degree of
osteoporosis.
DEXA can
calculate the size
and thickness of
bone.
 Normal Value:
1 standard
deviation
below peak
bone mass.
Nursing
Interventions
 Instruct patient to
remove all metal
objects from the
area to be scanned.

5. Diagnostic Tests
Test Purpose
Bone scan
(Nuclear
medicine
scans)
 Uptake is increased
in osteomyelitis,
osteoporosis,
cancers of the
bone, and in some
fractures.
 Uptake is
decreased in
avascular
necrosis.
Nursing Interventions
 No special preparation
is needed; tell patient
to increase oral fluids
after the test to aid in
excretion of the
radioisotope.

6. Diagnostic Tests
Test Purpose
Computed
tomography
(CT) scan—
long bones
and joints,
spine
 Provides a three
dimensional picture
used to evaluate
musculoskeletal
trauma and bony
abnormalities.
 CT of the spine can
identify tumors,
cysts, vascular
malformations, and
herniated
intervertebral disk.
Nursing Interventions
 If contrast dye is
used, assess for
allergy to iodine,
seafood, or x-ray dye.
 Assess medications:
oral hypoglycemic
agents are
contraindicated for use
with iodinated
contrast.
 Have spine x-rays
available. If scheduling
myelogram and spine
CT, patient should have
myelogram first.

7. Diagnostic
Tests
Test Purpose Nursing
Interventions
Computed
tomography
(CT) scan—
long bones
and joints,
spine
 If long-bone and joint
CT, nuclear
medicine tests to
locate “hot spots”
should be done before
CT.
 After the test, if
contrast dye was used,
monitor for delayed
allergic reaction (rash,
itching, headache,
vomiting) and instruct
patient to increase fluid
intake.

8. Diagnostic
Tests
Test Purpose Nursing Interventions
Electromyog
ram (EMG)
 Measures
the
electrical
activity of
skeletal
muscles at
rest and
during
contractio
n.
 Tell the patient not to drink
fluids containing caffeine
or to smoke for 3 hours
before the test, and not to
take medications such as
muscle relaxants,
anticholinergics, or
cholinergics.
 If serum enzymes such as
SGOT, CPK, or LDH are
ordered, the specimen
should be drawn before the
EMG or 5 to 10 days after
the EMG.

9. Diagnostic
Tests
Test Purpose Nursing Interventions
Magnetic
resonance
imaging
(MRI)
 Used in
diagnosis and
evaluation of
avascular
necrosis,
osteomyelitis,
tumors, disk
abnormalities,
and tears in
ligament or
cartilage.
 Inform patient of need to
lie still during the
examination.
 Assess for any metallic
implants (such as
pacemakers, clips on brain
aneurysms, body piercings,
tattoos, shrapnel). If
present, notify imaging
physician.
 Remove transdermal
medication patches (both
OTC and prescribed) unless
otherwise ordered (FDA,

10. Diagnostic Tests
Test Purpose
Nursing Interventions
Magnetic
resonance
imaging
(MRI)
 Replace the patch
following the
procedure.
 Tell the patient to inform the
staff about the patch when
making the appointment and
when completing the
admission information.
 Ask if patient is pregnant; if
so the test is not performed.
Ask about claustrophobia; if
a problem request patient to
ask for a relaxing medication
to take prior to the MRI.

11. Diagnostic
Tests
Test Purpose Nursing Interventions
Skeletal x-
ray
 Identify
and
evaluate
bone
density and
structure.
 Ask women if they are
pregnant; x-rays should
be avoided during the
first trimester.
 No special
preparation is
needed for skeletal
x-rays.

12. Diagnostic Tests
Test
Purpose
Bone or
Muscle
Biopsy
 Involves
needle
aspiration
(closed) or
surgical
extraction
(open) of
bone or
muscle
tissue.
Nursing
Interventions
 Monitor site of
biopsy for
bleeding.
 Provide normal
wound care for
open biopsy.
 Perform
neurovascular
assessments as
needed.

13. Subjective Health Assessment
Category What to Ask Rationale
Demographi
cs
Age, gender,
socioeconomic
status
Increased age, being female,
and lower socioeconomic
status increase risk of
musculoskeletal
injury/problems.
Occupation Enables nurse to begin
planning for discharge
teaching if the patient has
to alter his or her
employment.

14. Subjective Health
Assessment
Category What to Ask Rationale
Previous
Health
History
Allergies
Activities
patient
participates
in
Prevents exposure to medication
or compounds used in
diagnostic tests, treatments,
and therapies.
Provides information regarding
level of activity the patient had
before the concern.
Smoking and a sedentary
lifestyle are
risk factors for musculoskeletal
problems.

15. Subjective Health
Assessment
Category What to Ask Rationale
Previous
Health
History
Diet
history
Dietary intake such as
calcium and vitamin D
influences some
musculoskeletal disorders.
Family history Some musculoskeletal
conditions have
genetic and familial
tendencies.

16. Subjective Health Assessment
Category What to Ask Rationale
History of Injury
or Present
Concern
one)
History of the Provides information that helps in
the
injury (if there
was
diagnosis of the
problem, as well as
making you aware of
possible complications of
the injury.
Pain (use pain
assessment
scale)
Provides information about severity
of
the condition and effectiveness of
the
treatment and
therapy.

17. Subjective Health Assessment
Category What to Ask Rationale
Psychosocial
Assessment
Determine if
deformities, changes
in body image, self-
concept,
socialization, or
employment are
present.
The patient may need
assistance with strategies
to cope with the stress of a
possible chronic
musculoskeletal condition.
Determine coping
skills.
Some musculoskeletal
conditions require lifestyle
alterations that
can cause increased stress
and
difficulties in coping.

18. Objective Health Assessment
Category
Physical
Examination
What to Ask
Inspect, palpate, and observe
range of motion
(ROM) of affected areas. and posture, effects on ADLs
can be contractures,
Assess color,
warmth,
circulation, and
movement of
affected areas.
Nerve function, sensation,
movement, weakness, and the
potential development of
compartment syndrome can be
determined.
Palpate all pulses
below involved area.
Alterations may indicate altered
vascular integrity of affected area
or demonstrate developing
compartment syndrome.
Altered gait, tone, size, shape,
Rationale
deformities, ROM, pain, determined.

19. Objective Health Assessment

20. Muscle Grading
Scale
Scale Assessment Description
0 (No visible) contraction; paralysis
1 Can feel contraction of muscle but there is no movement of
limb
2 Passive ROM
3 Full ROM against gravity
4
5
Full ROM against some resistance
Full ROM against full resistance

25. Neurovascular
Assessment
Monitor Report
Color Pallor, cyanosis, redness, or discoloration
Temperature Unusual coolness or warmth
Pain Pain that is worse on passive motion; pain that no longer
responds to analgesics
Movement Alterations in movement
Sensation Alterations in feeling; tingling or paresthesias
Pulses Diminished or absent distal pulses
Capillary refill Nail bed that does not blanch in 3–5 seconds