13.2 Musculoskeletal Part 2 Flashcards
Soft Tissue Injuries
Affects tendons, ligaments, and muscles
Includes strains, sprains, dislocations, repetitive motion stress, tissue inflammation
Sprains/Strains
Sprain - Injury to ligament surrounding a joint often caused by twisting motion.
First degree - Little pain/swelling, minimal tearing of ligaments
Second degree - Disruption to adjacent tissue (increased pain and swelling)
Third degree - Completely torn ligament (Extremely Painful
Strain - Excess stretching of muscle (mainly effects tendons) 1st degree, 2nd degree and 3rd degree are same descriptions as sprains
MANIFESTATIONS
- Pain, swelling, decrease in function due to pain and swelling. May also be discolored/contusion.
DIAGNOSIS
- X-ray to rule out fracture then history of events and physical exam
EDUCATION
- 1st and 2nd degree heal without formal treatment.
- NSAID’s for pain with rest and elevation of extremity
- ADL’s should be continued as much as possible
- Intermittent icepack followed by intermittent heat pack
- Stretching
COMPLICATIONS
- Fractures
- Hemarthrosis (bleeding into the joint)
Repetitive Strain Injury
- Result of prolonged forceful movements causing strain to ligaments/tendons
- These movements cause small tears which overtime develop into scars
Common sites - Neck, spine, shoulder, forearm, and hand
Nursing Care
- Education and physical therapy
Carpal Tunnel Syndrome
- Compression of median nerve that overtime causes neuropathy
- Carpenters, secretaries, musicians and others are HIGH RISK
- Women are affected worse during premenstrual period (due to hormones)
MANIFESTATIONS
- Thumb weakness
- Causalgia (Burning Pain)
- Numbness
- Positive Phalen’s Test and Tinel’s Sign (tingling when preforming phalen test)
TREATMENT
- Changing activity patterns
- Cortisone injection to decrease inflammation
- Surgery to decompress median nerve
Rotator Cuff Injury
- Damage to the 4 stabilizing muscles of the shoulder (commonly results from injury/overuse)
MANIFESTATIONS
- Shoulder weakness, decreased ROM, pain
DIAGNOSIS
- X-ray or MRI
- Drop Arm Test
Treatment
- Rest, Ice, Heat, NSAID’s, Steroid injections
- SEVERE INJURIES REQUIRE SURGERY (ACROMIOPLASTY)
Meniscus Injury
- Meniscus is a crescent shaped cartilage in the knee. Usually damaged through sports
MANIFESTATIONS
- Mild swelling and pain when flexion. “Pop or Click can be heard”
DIAGNOSIS
- MRI followed by arthrogram or arthroscopy
TREATMENT
- Rest, ice, elevation, nsaids followed by exercise to strengthen muscle around the joint
- Arthroscopic Meniscectomy is surgery
EDUCATION
- Stretch before exercise to warmup muscles
Dislocation/Subluxation
Dislocation - Complete separation of joint and involves ligaments
Subluxation - Incomplete dislocation (same signs and symptoms but to a lesser degree)
COMMON IN THUMB, SHOULDER, HIP
MANIFESTATIONS
- Deformity seen, pain, loss of function, tenderness, swelling
COMPLICATIONS
- Long term injury to soft tissue, fractures, AVASCULAR NEROSIS
DIAGNOSIS
- X-ray
ASSESSMENT
- Peripheral nerve sensations, capillary refill, pulses distal to injury
DESIRED OUTCOME
- Pain relief, prevention of vascular damage, restoration of strength and joint mobility
TREATMENT
- Reduction of joint (relocation)
- Immobilize the joint
- Manage pain and swelling
ONCE A PATIENT HAS A DISLOCATION/SUBLUXATION THEY ARE AT HIGH RISK FOR REOCCURENCE
Fractures
ENVIRONMENTAL FACTORS
Open Fracture - Break in the skin (possibly with bone sticking out). Can also be penetration of something else through the skin to the bone
Closed Fracture - Skin is not broken and fracture remains internal.
LOCATION OF FRACTURES
- Location is the bone itself
- Proximal, distal, midshaft, or through the epiphyseal plate (growth plate)
STABILITY OF FRACTURE
Stable - Able to withstand pressure (transverse, spiral, greenstick fractures)
Unstable - Unable to handle pressure and affects nearby muscles/blood vessels (comminuted or oblique fractures) RISK OF INJURY IS HIGH IN UNSTABLE FRACTURES
Types of Fractures
Avulsion - Small piece of bone attached to tendon/ligament is pulled away from the bone
Comminuted - Bone breaks into pieces (3 or more fragments)
Displaced - Fractured bone ends are out of alignment
Greenstick - Incomplete fracture where bone bends and cracks (common in children under 10)
Impacted - Bone ends are crushed together from force of injury
Intra-Articular - Fracture crosses joint surface and damages cartilage
Longitudinal - Fracture occurs along the length (axis) of the bone
Oblique - Fractures occur at an angle to the axis of the bone (diagonal)
Pathologic - Caused by underlying disease (osteoporosis)
Spiral - Fracture results from twisting force (may indicate child abuse)
Stress - Small cracks in bones from repetitive stress
Torus (Buckle Fracture) - Compression of bone on one side while other side remains intact. Looks like its bulging
Transverse - Fracture is 90 degree angle to axis of bone.
Manifestations of Fractures
- Pain, swelling, spasms, deformities, ecchymosis distal to fracture, loss of function, bony crepitation from bone fragments rubbing against each other
Complications of Fractures
- Closed injury becomes opened injury due to excessive movement
- Delayed union (healing)
- No Union (no fusion of fracture) which can result in pseudo arthritis (false joint created while healing)
- Malunion (heals in proper amount of time but in wrong position)
- Angulation (Abnormal angle of healing)
- Compartment Syndrome
- Osteomyelitis
Treatment for Fractures
- Goal is to realign the bone (reduction)
- Immobilize the bone (maintain realignment)
- Restore function
Closed Reduction
- Manual realignment of bone with traction and countertraction (requires 2 people)
- Done with moderate sedation
- Complications include damage to surrounding tissue and potential refracture
Open Reduction
- ORIF (Open Reduction and Internal Fixation)
- Surgical realignment of bone
- Usually requires plates or screws to maintain alignment
- ONGOING NEUROVASCULAR CHECKS ARE IMPORTANT
- Medicare will cover 3 nights in the hospital
COMPLICATIONS
- Infection/Bleeding
- PAIN CONTROL POST-OP IS NECESSARY with opiates and muscle relaxants (to prevent spasms)
Connective Tissue Disorders
- Usually caused by inflammation to the joints
