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