Special Procedures Flashcards
Medical imaging used to help evaluate and diagnose joint conditions and unexplained pain
Very effective at detecting disease within the ligaments, tendons and cartilage
Contrast material is injected into the joint
Fluoroscopy is used first
Contrast injected into joint
Followed by CT or MRI (MRI more common unless they can’t have one)
Arthrogram
6 joints arthrogram is most often used to identify abnormalities within
Shoulder Elbow Wrist Hip Knee Ankle
2 reasons for doing arthrogram
Arthrographic images help physicians evaluate alterations in structure and function of a joint and help to determine the possible need for treatment, including arthroscopy, open surgery or joint replacement
The procedure is also used to help diagnose persistent, unexplained joint pain or discomfort, or recurrent dislocations; in some cases, local anesthetic medications or steroids may be injected into the joint along with the contrast material, these medications may temporarily decrease joint-related pain or inflammation and provide physicians additional information about possible sources of joint pain
4 risks of arthrograms
Any procedure where the skin is penetrated carries a risk of infection; the chance of infection requiring antibiotic treatment appears to be less than one in 1,000
There is always the possibility of injuring a vessel or a nerve adjacent to the joint
Possible contrast reaction
Not recommended for people who have joint infections or woman who are pregnant
4 rotator cuff muscles
Supraspinatous muscle
Subscapularis muscle
Infraspinatous muscle
Teres minor muscle
Ring of fibrocartilage around the edge of the articular joint
Labrum
Superior Labrum tear from anterior to posterior; occurs where the biceps tendon anchors to the labrum
SLAP tear
Injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder; occurs in lower part of lebrum
Bankart tear
What is the most common hip tear?
Labrum
What is the most common wrist tear?
Triangular Fibrocartilage Complex (TFCC)
Syndrome usually located posteriorly or posterolateral following an ankle sprain, area of inflammation
Posterior impingement syndrome
Important test of female fertility potential
Radiology procedure usually done in the radiology department of a hospital or outpatient radiology facility
Radiographic contrast is injected into the uterine cavity through the vagina and cervix
The uterine cavity fills with dye and if the fallopian tubes are open, dye fills the tubes and spills into the abdominal cavity
This shows whether the fallopian tubes are open or blocked
Hysterosalpingogram (HSG)
4 reasons to do an HSG
Infertility (In Vitro Fertilization first steps)
The uterus is evaluated for the presence of fibroids, scar tissue, polyps, or congenital uterine anomalies
The fallopian tubes are also examined for defects within them, for suggestion of partial blockage, and for evidence of pelvic scar tissue in the abdominal cavity near the tube
Confirm Tubal Ligation
Egg production stimulated by hormone therapy
Egg retrieved from ovary
Sperm retrieved
Egg & sperm combined to allow fertilization via intracytoplasmic sperm injection (ICSI) = where sperm is injected into egg
Embryos are grown out to day five then transferred into the uterus
In Vitro Fertilization (IVF)
When is an HSG performed?
Best performed one week after menstruation but before ovulation to make certain that you are not pregnant during the exam = 7-10 days from the first day of their last period
What is the patient position for an HSG?
AP lithotomy
Diagnostic and/or therapeutic procedure performed by a doctor inserting a hollow needle into the subarachnoid space in the lumbar area of the spinal column
Lumbar puncture (LP) Spinal tap
Canal in the spinal column that carries cerebrospinal fluid (CSF) between the brain and the spinal cord
Subarachnoid space
How many cervical nerve pairs are there?
8, nerve above C1
Ligaments of the spine that connect the lamina of adjacent vertebrae, all the way from the second vertebra, axis, to the first segment of the sacrum
Ligamentum Flavum
3 reasons lumbar punctures are performed
Most common reason is to remove a small amount of CSF for examination and diagnosis of various disorders
CSF is tested for red and white blood cells, protein, glucose (sugar), clarity, color, and the presence of bacteria, viruses, or abnormal cells
Excess CSF may also be removed in patients who have an overproduction or decreased absorption of the fluid
8 things lumbar punctures are helpful in diagnosing
Meningitis Encephalitis Certain cancers involving the brain and spinal cord Bleeding in the subarachnoid space Myelitis Neurosyphilis Demyelinating diseases Headaches of unknown cause (after appropriate evaluation by a doctor and appropriate head imaging if necessary, certain inflammatory conditions that can result in a headache may be diagnosed by lumbar puncture and CSF analysis)
Inflammation of the membrane covering the brain and spinal cord usually the result of a viral, bacterial, or fungal infection, or the result of exposure to toxins or abnormal cells
Meningitis
Inflammation of the brain that is usually caused by a virus; may have to fracture skull so brain isn’t in too tight
Encephalitis
Inflammation of the spinal cord or bone marrow
Myelitis
Stage of syphilis during which the bacteria invades the central nervous system
Neurosyphilis
Diseases that attack the protective coating that surrounds certain nerve fibers (Multiple Sclerosis)
Demyelinating diseases
How long should a person not eat or drink before a lumbar puncture?
Do not eat or drink anything three hours prior to a lumbar puncture
Why will the patient lie flat for about one hour after the lumbar puncture?
This helps reduce the incidence of a headache, since there has been a disruption of CSF
What are spinal headaches caused by?
Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the tough membrane (dura mater) that surrounds the spinal cord; this leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache
Some of your own blood is injected into your back; the aim is that the blood seals the hole in the dura and stops the leak of fluid
Great care is taken to clean your arm and take blood in a fully sterile manner (his reduces the risk of infection)
Blood is carefully injected into your back using an epidural needle, near to the hole in the dura
The blood will clot and tend to seal the hole that has been made in the dura
As the fluid leak is stopped, the pressure around the brain will increase and the headache should improve
Blood patch for headache after an LP