Musculoskeletal Management
S&S of osteoporosis
- porous, brittle, and fragile bones - loss of height - fractures - back pain - kyphosis - constipation
S&S of Septic (Infectious) Arthritis
- warm, painful, swollen joint - joint has decreased ROM - chills, fever, and leukocytosis (high WBC)
after foot surgery, swelling & neurovascular assessment of the exposed toes should be performed every ____
1-2 hours for the first 24 hours
daily recommended intake of calcium
1000-1300 mg
Because sunlight is necessary for synthesizing vitamin D, patients should be encouraged to spend ____ each day in the sun
15-30 minutes
For a patient w/ low back pain, sitting should be limited to ____ based on level of comfort
20-50 minutes
daily recommended intake of vitamin D
400-1000 IU daily
antibiotic therapy for osteomyelitis typically lasts from ____
6-12 weeks
OA occurs most frequently in which patient population?
65+ y, women
carpal tunnel syndrome
A condition caused by compression of the median nerve in the carpal tunnel
Osteoporosis
A condition in which the body's bones become weak and break easily
osteomalacia
A metabolic bone disease characterized by inadequate bone mineralization & deficiency of activated vitamin D
A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? A. Apply a trapeze to the bed frame. B. Instruct to use the elbows to reposition. C. Remove the weights prior to repositioning. D. Remind to use the heel of the unaffected foot to reposition.
A. Apply a trapeze to the bed frame.
Which of the following type of fracture is associated with osteoporosis? A. Compression B. Stress C. Oblique D. Simple
A. Compression
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? A. Decrease in estrogen B. Increase in calcitonin C. Decrease in parathyroid hormone D. Increase of vitamin D
A. Decrease in estrogen
A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? A. Degenerative joint disease B. Muscular dystrophy C. Scoliosis D. Paget's disease
A. Degenerative joint disease
causes of osteomalacia
GI disorders, severe renal insufficiency (can't convert to active form), hyperparathyroidism, and dietary deficiency
cauda equina syndrome
compression of lower spinal cord (risk of paralysis in legs); medical emergency
medications associated w/ osteoporosis
corticosteroids, anticonvulsants, aluminum-containing antacids
Most common form of joint disease
OA
diet high in vitamin D & calcium recommendations
dairy, broccoli, salmon, egg yolk, fortified OJ & cereals
complications of THA
dislocation of the hip prosthesis, excessive wound drainage, VTE, infection, heel pressure injury, immobility, heterotopic ossification, avascular necrosis, and loosening of the prosthesis
Paget disease (osteitis deformans)
disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae
S&S of Dupuytren Disease
dull and aching discomfort, morning numbness, and stiffness in the affected fingers
S&S of impingement syndrome
edema, pain, shoulder tenderness, limited movement, muscle spasm, eventual disuse atrophy, partial or complete rotator cuff tear
Pes planus
flatfoot; is a common disorder in which the longitudinal arch of the foot is diminished
Bursae
fluid-filled sacs that prevent friction between joint structures during joint activity and are painful when inflamed
____ is the precursor to osteoporosis
osteopenia
____ is the most prevalent bone disease in the world
osteoporosis
radiculopathy
pain radiating down the leg; disease of the nerve roots
Sciatica
pain radiating from an inflamed sciatic nerve
Myelogram
permits visualization of segments of the spinal cord that may have herniated or may be compressed (infrequently performed; indicated when MRI scan is contraindicated)
MRI scan
permits visualization of the nature and location of spinal pathology
cause of Osteoporosis
rate of bone resorption is greater than the rate of bone formation
Total Hip Arthroplasty (THA)
replacement of a severely damaged hip with an artificial joint
Total joint arthroplasty
replacement of all components of an articulating joint
Dupuytren Disease
results in a slowly progressive contracture (an abnormal shortening) of the palmar fascia that causes flexion of the fourth, fifth, and, sometimes, middle finger, rendering these fingers more or less useless
The nurse instructs the patient with low back pain to get out of bed by ____
rolling to one side and placing the legs down while pushing the torso up, keeping the back straight
ganglion
round, firm, cystic swelling, usually on the dorsum of the wrist
Septic (Infectious) Arthritis most commonly occurs in ____
single knee and hip joints
S&S of osteomalacia
softening & weakening of the bone, pain, tenderness, and deformities (bowing of bones)
ostetomy
surgical cutting of the bone
Joint arthroplasty
surgical removal of an unhealthy joint and replacement of joint surfaces with metal or synthetic materials
Morton neuroma (plantar digital neuroma, neurofibroma)
swelling near the third (lateral) branch of the median plantar nerve
S&S of ganglion
tender swelling, aching pain
If kidney disease prevents activation of absorbed vitamin D, then supplementation requires ____
the activated form of vitamin D (calcitriol)
hammer toe
a toe that is curled (flexed) due to a bend in the middle joint of the toe
Osteoarthritis (Degenerative Joint Disease) (OA)
noninflammatory degenerative disorder of the joints
S&S of low back pain
- Acute or chronic back pain - Fatigue - Radiculopathy - Sciatica - Affected gait, spinal mobility, reflexes, leg length, leg motor strength, and sensory perception - Paravertebral muscle spasm - Possible spinal deformity
Work Modifications for low back pain
- Adjust height of chair using a footstool to position knees higher than hips - Adjust height of work area to avoid stress on back - Avoid bending, twisting, and lifting heavy objects - Avoid prolonged standing and repetitive tasks - Avoid work involving continuous vibrations - Use lumbar support in straight back chair with arm rests - When standing for any length of time, rest one foot on a small stool or box to relieve lumbar lordosis - When sitting, the knees and hips should be flexed, with the knees in level with the hips or higher to minimize lordosis
common upper extremity disorders
- Bursitis and tendonitis - Loose bodies (joint mice) - Impingement syndrome - Carpal tunnel syndrome - Ganglion - Dupuytren disease
TKA postop
- Compression bandage - Ice/cold packs - NV status q 2-4 h - ROM exercises - Should ambulate by first postop day - Total recovery takes 6 weeks+
Treatment of osteoporosis
- Diet high in vitamin D and calcium - Use of calcium supplements to ensure adequate calcium intake: take in divided doses with vitamin C - Magnesium supplements - Avoid smoking, alcohol, caffeine, and carbonated beverages - Regular weight-bearing exercises: 20-30 minutes a day
pain relief measures after foot surgery
- Elevate foot - Use of intermittent ice - Medications; oral analgesics
Postop THA
- Keep the knees apart at all times. - Put a pillow between the legs when sleeping. - Never cross the legs when seated. - Avoid bending forward to pick up an object on the floor. - Use a high-seated chair and a raised toilet seat. - Dorsi- and plantar flex the ankles and the toes 10-20 times every half hour while awake - Never flex hip >90 degrees - Maintain abduction
Risk Factors for OA
- Older age, female gender, and obesity - Certain occupations (e.g., those requiring laborious tasks) - Engaging in sport activities - History of previous injuries, muscle weakness, genetic predisposition, and certain diseases - Most prominent modifiable risk factor for OA is obesity - Diet and exercise can help minimize symptoms of OA in patients with obesity
nursing interventions for low back pain
- Pain management - Exercise - Body mechanics - Work modifications - Stress reduction - Health promotion; activities to promote a healthy back - Dietary plan and encouragement of weight reduction
S&S of carpal tunnel syndrome
- Pain, numbness, paresthesia, and weakness along the median nerve distribution (thumb, index, and middle fingers) - Night pain and/or fist clenching upon awakening - Positive Tinel sign
S&S of OA
- Pain, stiffness, functional impairment - Morning stiffness is present; usually brief, lasting less than 30 minutes - Enlarged joint, decreased ROM - Joint pain aggravated by movement or exercise and relieved by rest - No systemic s/s - Most often in weight-bearing joints (hips, knees, cervical and lumbar spine)
body mechanics for low back pain
- Practice good posture - Avoid twisting, lifting above waist level, and reaching up for any length of time - Push objects rather than pull them - Keep load close to your body when lifting - Lift with the large leg muscles, not the back muscles - Squat while keeping the back straight when it is necessary to pick something up off the floor - Bend your knees and tighten abdominal muscles when lifting - Avoid overreaching or a forward flexion position - Use a wide base of support - Avoid lifting more than one third of their ideal weight without help to prevent injury.
prevention of low back pain
- Weight reduction as needed - Stress reduction - Avoid high heels - Walk daily and gradually increase the distance and pace of walking - Avoid jumping and jarring activities - Stretch to enhance flexibility, Do strengthening exercises
Diagnostic Procedures for Low Back Pain
- X-ray of the spine - Bone scan and blood studies - Computed tomography (CT) scan - Magnetic resonance imaging (MRI) scan - Electromyogram (EMG) and nerve conduction studies - Myelogram - Ultrasound
diagnostic findings of osteomalacia
- low serum calcium and phosphorus levels - moderately elevated ALP - low excretion of calcium and creatinine - bone biopsy: increased amount of osteoid
S&S of Paget disease
- often asymptomatic - skeletal deformities - enlarged cranium - waddling gait - tenderness and warmth over bones - mild to moderate aching pain - tinnitus
A client is diagnosed with several fractured ribs after a motor vehicle crash. Which actions will the nurse take when caring for this client? Select all that apply. A. Provide analgesics as prescribed. B. Apply a chest binder as prescribed. C. Instruct on the use of an incentive spirometer. D. Demonstrate the use of a pillow to splint the area. E. Remind to take deep breaths and cough every hour.
A. Provide analgesics as prescribed. C. Instruct on the use of an incentive spirometer. D. Demonstrate the use of a pillow to splint the area. E. Remind to take deep breaths and cough every hour.
Which term refers to a disease of a nerve root? A. Radiculopathy B. Involucrum C. Sequestrum D. Contracture
A. Radiculopathy
A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following instructions should the nurse provide? (Select all that apply.) A. Take medication in the morning before eating. B. Chew tablets to increase bioavailability. C. Drink an 8 oz glass of water with each tablet. D. Take medication with an antacid if heartburn occurs. E. Avoid lying down after taking this medication.
A. Take medication in the morning before eating. C. Drink an 8 oz glass of water with each tablet. E. Avoid lying down after taking this medication.
Which is not a guideline for avoiding hip dislocation after replacement surgery. A. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. B. Keep the knees apart at all times. C. Put a pillow between the legs when sleeping. D. Never cross the legs when seated.
A. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.
Which is not a risk factor for osteoporosis? A. being male B. small-framed, thin White or Asian women C. being postmenopausal D. family history
A. being male
What food can the nurse suggest to the client at risk for osteoporosis? A. Carrots B. Broccoli C. Chicken D. Bananas
B. Broccoli
Which group is at the greatest risk for osteoporosis? A. Men B. European American women C. Asian American women D. African American women
B. European American women
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? A. "After age 40, height may show a gradual decrease as a result of spinal compression" B. "After menopause, the body's bone density declines, resulting in a gradual loss of height." C. "There may be some slight discrepancy between the measuring tools used." D. "The posture begins to stoop after middle age."
B. "After menopause, the body's bone density declines, resulting in a gradual loss of height."
Which action would be most important postoperatively for a client who has had a knee or hip replacement? A. Providing crutches to the client. B. Assisting in early ambulation. C. Using a continuous passive motion (CPM) machine. D. Encouraging expressions of anxiety.
B. Assisting in early ambulation.
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury? A. Cardiogenic B. Hypovolemic C. Neurogenic D. Septic
B. Hypovolemic In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.
A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply. A. Elevate the arm above the heart. B. Prepare to remove the cast. C. Provide support to the injured extremity. D. Assess neurovascular status every 8 hours. E. Apply ice to extremity.
B. Prepare to remove the cast. C. Provide support to the injured extremity. The nurse should anticipate immediate removal of the cast and provide support to the injured extremity. Neurovascular status should be assessed more frequently than every 8 hours. If the client's neurovascular status is not improving, then a fasciotomy may be needed. Waiting 8 hours to assess neurovascular status may cause permanent damage to the extremity. To promote arterial blood flow, the arm should be elevated to the heart level, not above. Ice should not be used, as it could further decrease blood flow to the extremity.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? A. High-Fowler's to allow for maximum hip flexion B. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees C. Prone, with a pillow under the shoulders D. Supine, with the bed flat and a firm mattress in place
B. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? A. Increase fiber in the diet B. Walk or perform weight-bearing exercises outdoors C. Reduce stress D. Decrease the intake of vitamin A and D
B. Walk or perform weight-bearing exercises outdoors
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? A. Yoga B. Walking C. Bicycling D. Swimming
B. Walking
The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? A. Body aligned opposite to line of traction pull B. Weights hanging and touching the floor C. Pulleys without evidence of the obstruction D. Ropes freely moving over pulleys
B. Weights hanging and touching the floor
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client A. reaches over the head with the arms fully extended. B. places the load close to the body. C. uses a narrow base of support. D. bends at the hips and tightens the abdominal muscles.
B. places the load close to the body.
A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse? A. "CTS is a neuropathy that is characterized by bursitis and tendinitis." B. "CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." C. "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." D. "CTS is a neuropathy that is characterized by pannus formation in the shoulder."
C. "CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? A. "I will lie prone with my legs slightly elevated." B. "I will bend at the waist when I am lifting objects from the floor." C. "I will avoid prolonged sitting or walking." D. "Instead of turning around to grasp an object, I will twist at the waist."
C. "I will avoid prolonged sitting or walking."
On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? A. "Bunions are congenital and can't be prevented." B. "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." C. "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." D. "Bunions are caused by a metabolic condition called gout."
C. "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
Which client would the nurse identify as having the greatest risk for osteoporosis? A. A 40-year-old overweight African American woman B. A 16-year-old male with a history of asthma C. A small-framed, thin 45-year-old white woman D. A 20-year-old male athlete with repeated injuries
C. A small-framed, thin 45-year-old white woman
The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? A. Bunion B. Clawfoot C. Corn D. Hammer Toe
C. Corn
The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? A. Do not flex the hip more than 30 degrees. B. Do not flex the hip more than 60 degrees. C. Do not flex the hip more than 90 degrees. D. Do not flex the hip more than 120 degrees.
C. Do not flex the hip more than 90 degrees.
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? A. Comminuted B. Compression C. Impacted D. Greenstick
C. Impacted
Which nursing diagnosis takes highest priority for a client with a compound fracture? A. Imbalanced nutrition: Less than body requirements related to immobility B. Impaired physical mobility related to trauma C. Infection related to effects of trauma D. Activity intolerance related to weight-bearing limitations
C. Infection related to effects of trauma
Which nursing intervention is essential in caring for a client with compartment syndrome? A. Keeping the affected extremity below the level of the heart B. Wrapping the affected extremity with a compression dressing to help decrease the swelling C. Removing all external sources of pressure, such as clothing and jewelry D. Starting an I.V. line in the affected extremity in anticipation of venogram studies
C. Removing all external sources of pressure, such as clothing and jewelry
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct? A. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. B. To prevent fractures, the client should avoid strenuous exercise. C. The recommended daily allowance of calcium may be found in a wide variety of foods. D. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
C. The recommended daily allowance of calcium may be found in a wide variety of foods. Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.
A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? A. "Use your continuous passive motion machine for 2 hours each day." B. "You need to perform weight-bearing exercises twice a week." C. "You need to limit the amount of protein and calcium in your diet." D. "You will receive IV antibiotics for 3 to 6 weeks."
D. "You will receive IV antibiotics for 3 to 6 weeks."
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? A. Open reduction B. Needle aspiration C. Arthroplasty D. Arthroscopy
D. Arthroscopy
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? A. Compound B. Depressed C. Impacted D. Comminuted
D. Comminuted
A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? A. A ganglion is the most common benign soft-tissue mass in the foot. B. A ganglion is a precursor to a primary bone tumor. C. Surgical excision is the treatment of choice for a ganglion. D. Dorsiflexion exacerbates signs and symptoms of a ganglion.
D. Dorsiflexion exacerbates signs and symptoms of a ganglion.
What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A. Callus B. Hammertoe C. Hallux valgus D. Dupuytren contracture
D. Dupuytren contracture
A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? A. Examine the surgical dressing every hour. B. Administer pain medication per client request. C. Monitor vital signs every 4 hours. D. Perform neuromuscular assessment every hour.
D. Perform neuromuscular assessment every hour.
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? A. Wound packing B. Wound irrigation C. Vitamin supplements D. Surgical debridement
D. Surgical debridement In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? A. Sleep on the stomach to alleviate pressure on the back. B. A soft mattress is most supportive by conforming to the body. C. Avoid twisting and flexion activities. D. Use the large muscles of the leg when lifting items.
D. Use the large muscles of the leg when lifting items.
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? A. Bind the toes so that they will straighten. B. Do active range of motion on the toes. C. Have surgery to fix them. D. Wear properly fitting shoes.
D. Wear properly fitting shoes.
diagnostic test for osteoporosis
DEXA scan
Septic (Infectious) Arthritis
Infection of the joint space
risk factors for osteomyelitis
Older adult, obese, RA, DM, steroids, post-op 30 days
OPQRST for pain assessment
Onset, Provoke/Palliate, Quality, Region/Radiation, Severity, Time
impingement syndrome
Pain caused by tendon running up against the shoulder blade; impaired movement of the rotator cuff of the shoulder
S&S of osteomyelitis
S&S of infection (chills, high fever, rapid pulse, general malaise), localized pain, edema, erythema, drainage
loose bodies (joint mice)
Small pieces of bone or cartilage within a joint space; locking of a joint
____ stimulates bone mineral density (BMD)
Weight training
S&S of Pes planus
a burning sensation, fatigue, clumsy gait, edema, and pain
Common side effects of calcium supplements
abdominal distention and constipation
In most patients with OA, the initial analgesic therapy is ____
acetaminophen
treatment of OA
acetaminophen, NSAIDs (COX-2), weight loss, assistive devices, exercise (walking)
Generally, back pain due to musculoskeletal disorders is ____, whereas pain due to other conditions is ____
aggravated by activity; not aggravated by activity
corn
area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure
Hallux valgus
bunion; deformity in which the great toe deviates laterally
____ is a potential cause of low back pain
cauda equina syndrome
Pes cavus
clawfoot; a foot with an abnormally high arch
Paravertebral muscle spasm
greatly increased muscle tone of the back postural muscles
Neurovascular assessment following hand or wrist surgery should be performed every ____
hour for the first 24 hours
Total knee arthroplasty (TKA)
implanting a prosthetic knee joint
osteomyelitis
infection of the bone that results in inflammation, necrosis, and formation of new bone
Bursitis
inflammation of a bursa
Tendonitis
inflammation of a tendon
Plantar fasciitis
inflammation of the foot-supporting fascia
Bursitis and tendonitis
inflammatory conditions that commonly occur in the shoulder
Onychocryptosis
ingrown toenail
why is magnesium beneficial for bone strengthening?
it converts vitamin D into its active form so that it can help calcium absorption
acute back pain
lasts <3 months
chronic back pain
lasts >3 months
osteopenia
low bone mineral density [BMD])
X-ray of the spine
may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis
Bone scan and blood studies
may disclose infections, tumors, and bone marrow abnormalities
pain control measures following hand or wrist surgery
medication, elevation, intermittent ice or cold
Paget disease is more common in ____, and risk increases with ____
men; aging
callus
thickened area of the skin that has been exposed to persistent pressure or friction
Electromyogram (EMG) and nerve conduction studies
used to evaluate spinal nerve root disorders (radiculopathies)
diagnostic tests of OA
used to rule out other issues
Ultrasound
useful in detecting tears in ligaments, muscles, tendons, and soft tissues in the back
CT scan
useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs
treatment of Onychocryptosis
washing the foot twice a day
diagnostic test for osteomyelitis
x-ray, wound & blood culture, bone scans, ESR &WBC