MSK injuries Flashcards
What is the difference between a strain and a sprain
Sprain = overstretching/tearing of ligaments
- feeling of instability
- pain, tenderness, swelling bruising
- pain on weight bearing, moving
Strain = overstretched or torn tendon/muscle
- muscle spasm, cramping, weakness
- inflammation, bruising, swelling
- limited motion
How common are MSK injuries
Lateral ankle and knee sprains = most common MSK injury in physically active people
Back and hamstring sprains = most common in active people
Elbow strains = in people who do racket sports
Risk factors that increase the risk of injuries
Types of sports
- lack of regular exercise weakens muscles and joints
- inappropriate footwear
- insufficient warmup and cool down
Increasing age
Previous strain or sprain
Sudden trauma
Reduced balance and postural control due to
- neuropathy
- alcohol
- overweigh/obese/unerweight
What are the complications of MSK injuries
More common with more severe injuries
- Chronic instability and pain =>
- increased risk of reinjury
- post traumatic ankle osteoarthritis
Muscle atrophy, fibrosis, compartment syndrome
Haemarthrosis, septic arthritis
-joint swelling and tenderness
If they are diabetic => Charcot arthropathy
-when joint injury goes untreated due to peripheral neuropathy => foot bone deformity/disability
What is the prognosis for a MSK injury
Mild => few weeks with conservative treatment
Moderate => few weeks but high risk of reinjury
Severe => months, may need surgical treatment, complications may arise
What would you ask about in a history
-what would you need to rule out immediately
POTENTIAL DOMESTIC VIOLENCE?
Mechanism, timing of injury
- sudden rapid inversion/medial rotation => lateral ankle sprain?
- sprints => hamstring strain?
- repetitive swinging in racquet sports => elbow sprain
Duration of symptoms
-increased => more likely to be severe
Usual physical activity level/occupation?
Risk factors?
Symptoms?
Sprain
- pain, tenderness, swelling, bruising of joint
- pain on weight bearing
- decreased function
Strain
- muscle cramping, spasm, pain
- muscle weakness, inflammation, bruising
Pain, tenderness around joint
Swelling, bruising
Pain on weight bearing
Decreased function
Signs of chronic joint insability
Examination findings
Inspect
- antalgic gait
- swelling, bruising, deformity, asymmetry
Palpation
- point and joint line tenderness
- replication of pain on palpation/stressing the ligament => ligament injury?
Movement
- ability to weight bear, gait, instability
- range of movement
- strength testing
In thigh injuries, assess hip and lumbar to rule out other potential causes
Neuro exam
- peripheral nerve injury
- peripheral pulses intact, symmetrical
What are the differentials
Vascular
-DVT
Trauma
- fractures
- tendon rupture
- meniscus injury
Infective/inflammatory
- tendinitis
- bursitis
- Osgood Schlatter (inflammation of patellar ligament)
Neoplastic
-tumours
Degenerative
- achilles tendinopathy
- back pain
- sciatica
Congenital
- Ehlers Danlos (joint hypermobility, pain)
- osteoarthritis
What are the red flag conditions
Suspected fractures or dislocation=> unable to take body weight, bone tenderness
Damage to nerves, circulation
Tendon rupture, complete tear of muscle
Intramuscular hematoma
Haemarthrosis, septic arthritis
How would you manage a suspected strain/sprain
- conservative
- pharmacological
- lifestyle
Conservative
- Protection from further injury
- Rest by avoiding activity for 2-3 days
- Ice for 15-20 mins every few hours
- Compression with elastic bandage during the day for support
- Elevation to control swelling
Pharmacological
-paracetamol, NSAIDs
Lifestyle
-active mobilisation and flexibility exercises as soon as tolerated
When would you escalate to other specialities
Physio
-ongoing symptoms that aren’t improving despite self management
Orthopedics
- recovery slower than expected
- new or worsening symptoms that are out of proportion to injury
How would you prevent future injury
Exercise
- warm up and cool down
- proper equipment, shoes
- schedule rest days
Falls risk assessment
Alcohol risk assessment
Obesity risk assessment
