Acute Musculoskeletal Flashcards
Sprain
ligament stretched beyond its capacity
typically occur when the joint is overextended
can cause over stretching of the joints, tear or slipping of the ligament
Sprain S/Sx
pain swelling ecchymosis decreased ability to move the limb if the ligament is ruptured, one may hear a popping sound difficulty using the affected extremity
Sprain Diagnosis
Assessment
Plain radiograph to rule our fracture
MRI to visualize injury (rare)
Sprain Severity: Grade 1
overstretching or slight tearing
no joint instability
minimal pain, swelling, and little or no loss of functional ability
bruising is absent or slight
usually able to put weight on the affected joint
Sprain Severity: Grade II
partial tearing of the ligament bruising, moderate pain, and swelling some difficulty putting weight on t he affected joint some loss of function an xray or MRI may be needed
Sprain Severity: Grade III
complete tear or rupture
pain, swelling, and bruising are usually severe
unable to put weight on the joint
radiograph is usually taken to rule out fracture
often requires immobilization and possibly surgery
can also increase the risk future muscles sprains in that area
Sprain Tx
RICE
Rest: no additional force should be applied on site of the sprain
Ice: applied immediately to reduce swelling pain (10-15 min, 3-4x a day)
Compression: used to immobilize the sprain and provide support (wrap distal to proximal, always check CMS after applied)
Elevate: above the level of the heart
NSAIDS: to control inflammation and pain
Therapeutic ultrasound can be used to breakd own poorly healed muscle strains and permit them to heal properly
Limit time of immobilization so that we limit muscle weakening
Strain
result of muscular-fiber tears due to overstretching
can happen while doing everyday activities
athletes are more at risk due to increased muscle use
Strain: First Degree
sudden overstretch or contraction of the muscle (when the muscle is either not warmed up enough or not flexible enough)
eccentric (lengthening) loading of the muscles is the major cause of this type of injury (ex. sprinting puts a lot of strain on the hamstrings because they work eccentrically to slow down the leg as it moves forward)
Strain: Second Degree
partial tear of the muscle
bleeding within the muscle
- leads to more scarring
- more functional loss
- will not return to its original state
Strain: Third Degree
complete tear of the muscle
usually occurs when a muscle has been previously injured
steroids also make muscle more susceptible to tear
Dislocation
occurs when bones in a joint become displaced or misaligned
often caused by a sudden impact to the joint
ligaments always become damaged as a result of dislocation
most can be reduced
- ASAP
- blood supply to the joint (or distal anatomy) may be compromised
Subluxation
partial dislocation
Fractures
break in the continuity of the bone
result of high force impact or stress
certain medical conditions that weaken the bones (pathologic)
- osteoporosis
- bone cancer
- osteogenesis imperfecta
Fracture Healing
- fracture hematoma
- fiberous network forms
- deposition of calcium
- callous ossification
- remodeling
Bryant’s Traction
mainly used in young children who have fractures of the femur or congenital abnormalities of the hip
- both pt’s limbs are suspended in the air vertically at 90 degree angle from the hips and knees slightly flexed
- over period of days, the hips are gradually moved outward from the body using a pulley system
- the pt’s body provides the countertraction
Buck’s Traction
longitudinal traction of the leg
proper alignment of a leg fracture
application of force through a cord over a pulley, suspending a weight, elevation fo the foot of the bed allows the body to act as a coutnerweight
non-constricting boot with weights is worn
Russell’s Traction
- unilateral or bilateral
- combines suspension and traction to immobilize, position, and align the lower extremities
- tx of fractured femurs, hip and knee contracture
- applied as adhesive or non-adhesive skin traction
- uses a sling to relieve the weight of the lower extremities
- jacket restraint is often incorporated to help immobilize the pt
Dunlop’s Traction
- immobilize the upper arm in the treatment of contracture or supracondylar fracture of the elbow
- uses a system of traction weights, pulleys, and ropes
- skeletal traction is usually applied unilaterally but may also be applied bilaterally
Therapy
Collaborative care:
drug therapy
-muscle relaxants (to help with muscle spasms that can be very painful)
-narcotics
-antibiotics for open fracture
-tetanus immunoglobulin for open fractures (always err on side of admin it over not)
Nutritional therapy:
- protein
- calcium
- vitamin D
- Vitamin C
- magnesium
Fractures: Nursing Implementation
ambulatory and home care cast care (cast needs to be changed every 2 weeks, due to muscle atrophy) psychosocial problems ambulation assistive devices counseling and referrals
Compartment Syndrome
- limb threatening and life threatening
- compression of nerves, blood vessels, and muscle inside a closed space
- leads to tissue death from lack oxygenation
- most often involves the forearm and lower leg
- acute, subacute, and chronic
Compartment Syndrome: 5 P’s
Pain (out of proportion to what is expected)
Paresthesia
Pallor
Paralysis
Pulselessness
*sometimes a 6th P, for polar/poikilothermia (failure to thermoregulate)
Fasciotomy
surgical procedure
- fascia is cut to relieve tension or pressure
- treat the resulting loss of circulation to an area of tissue or muscle
- limb-saving procedure
- has a very high rate of success
- most common problem being accident damage to a nearby nerve
Joint Replacement Surgery
arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis
tx when severe joint pain or dysfunction is not alleviated by less-invasive therapies
more than 1 million americans have a hip or knee replaced each year
Joint Replacement Surgery: Causes
OA RA Avascular necrosis or osteonecrosis (part of bone dies, can be caused by steroid use) Congenital dislocation of the hip joint Hip dysplasia Acetabular dysplasia Trauma
Joint Replacement Surgery: Conservative Measures
NSAIDS Physical Therapy (water therapy) Joint Injection (steroid - localized anti-inflammatory) v. Viscosupplimentation Arthroscopy (scope procedure where joint is cleaned and edges are smoothed)
Joint Replacement Surgery: Risks
Infection (pneumonia, UTI, surgical site infection)
Anesthesia risk
Thrombolytic
Nerve/blood vessel damage
