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Musculoskeletal Trau
Med-Surg 5 Part I
| Question | Answer |
|---|---|
| Contusion | Soft tissue injury produced by blunt force (blow, kick, fall) causing small blood vessels to rupture and bleed into soft tissues. |
| Contusion symptoms | Local symptoms, pain swelling, and discoloration. Limit joint function near the injury and injured muscle feels weak and stiff. Most resolvec1-2 weeks |
| Strain | Injury to a muscle or tendon from overuse, overstretched, or excessive stress |
| First Degree Strain | Mild stretching of muscle/tendon with no range of motion loss. Signs and symptoms: gradual onset of palpation induced tenderness and mild muscle spasm |
| Second-Degree Strain | Moderate stretching and/or partial tearing of the muscle or tendon. Signs and Symptoms include acute pain during the event followed by increased pain with passive range of motion, edema, muscle spasms, ecchymosis. |
| Third-Degree Strain | Severe muscle or tendon stretching with rupturing and complete tearing of involved tissue. Signs and Symptoms are immediate pain described as tearing, snapping, burning, muscle spasm, ecchymosis, edema and loss of function. |
| Avulsion Fracturre | Bone fragment is pulled away fron the bone by a tendon needs x-ray and is also associated with a 3rd degree strain |
| What diagnostic tests can identify a tendon injury ? | MRI Ultrasound |
| Injured ligaments cause what? | Joint instability. The most vulnerable areas of the body are ankles, knees, and wrists |
| Grade I Sprain | Stretching or slight tearing off the ligament with mild localized hematoma formation |
| Grade II Sprain | Involves partial tearing of the ligament. Symptoms of increased pain with motion, edema, tenderness, joint instability, ecchymosis, and partial loss of joint function |
| Grade III Sprain | Complete tear or rupture of the ligament. Symptoms include severe pain, edema, tenderness, ecchymosis, unstable joint motion |
| The goal of treatment for contusions, strains and sprains is | guided by the severity of injury with the goal to protect from further injury. |
| Treating contusions, sprains and strains to protect from further injury is achieved by | supporting the affected area with slings, braces, splinting, taping, and compression bandages. |
| The RICE method is used for what reason? | Control pain, bleeding and inflammation for contusions, strain, and sprains. The R-I-C-E method stands for Rest, Ice, compression, and Elevation |
| What nursing interventions are used for treatment of strains, sprains, and contusions? | 1.Rest prevents additional injury and promotes healing 2. Intermittent use of cold/ice the first 24-72 hours after injury decreases bleeding, edema, and discomfort. 3. Elastic compression bandage controls bleeding, reduces edema, and provides support for injured tissues 4. Elevation at or above the heart controls swelling |
| What treatment is considered for a severe grade or degree of sprain or strain? | Immobilization by a splint, brace, or cast |
| What focused assessment is important for contusions, strains, or sprains? | Neurovascular Focused Assessment |
| What is included in the neurovascular assessment? | Motor, Sensory, and vascular function of the involved limb |
| Joint dislocation occurs when | the articular surfaces of the distal and proximal bones that form the joint are no longer in anatomical alignment. The bones are completely "out of joint." |
| Traumatic dislocation signs and symptoms include | acute pain, change in or awkward positioning of a joint, and decreased range of motion |
| Traumatic joint dislocationscare an orthopedic emergency because | the associated joint structures, blood supply and nerves are displaced and may be entrapped with extensive pressure on the nerves leading to vascular necrosis. |
| Avascular necrosis | is caused by ischemia which leads to necrosis (death) of the bone cells |
| Treatment priorities for joint dislocation include | Avoid neurovascular complications Reduce the joint as a traumatically as possible Immobilize the joint at the scene and during transport to hospital Obtain informed consent at the hospital Promptly reduce the dislocation so the displaced parts are put back in proper anatomical position to preserve joint function. Closed reduction requires analgesia, muscle relaxants and possible anesthesia Immobilize the joints with splints, cast, or traction to maintain the joint in a stable position. |
| After successful joint reduction surgery the nurse shall | assess neurovascular status a minimum of every 15 minutes until stable. Provide gentle progressive passive and active range of motion exercises to preserve range of motion and restore strength. Support the joint between exercise sessions. |
| What is assessed initially when a rotator cuff tear is suspected? | Physical exam includes bilateral evaluation of the jointound /Comprehensive pain assessment MRI, Ultrasound |
| Rotator cuff treatment modalities include | Modalities are dependent on duration of symptoms, hand dominance, type of tear, and patient characteristics including age, general health and activity level. Conservative Treatment: Physical Therapy, Injury surveillance,NSAIDS, Rest, modification of activities, corticosteroid injections When conservative methods fail; surgery is warranted. Surgical modality dependent on surgeon as limited evidence if surgery provides clinical improvement benefits |
| Rotator Cuff Post-op care includes | shoulder mobilization with a sling and supportive arm bandage for 4-6 weeks (time is determined on severity of injury); physical therapy with shoulder exercises Rehab time is 3-6 months. Rehab success is dependent on patient commitment to rehab regimen |
| Lateral and medial epicondylitis | Chronic painful condition caused by excessive and repetitive extension, flexion, pronation and supination motions of the forearm resulting in inflammation and minor tears in the tendons of the muscles on the lateral or medial epicondyles. There is no universal accepted regimen of treatment. Rest and elimination of the aggravating action is first line treatment Ice and NSAIDS, Physical therapy, Tens unit, ultrasound extracorporeal shock wave therapy and laser therapy may provide limited benefit |
| Lateral and Medial Collateral Ligament Injuries | The medial and lateral collateral ligaments provide knee stability. When the injury occurs it is due to the foot being firmly planted and the knee is struck medially or laterally causing stretching and tearing to the Lateral collateral ligament or the medial collateral ligament. |
| MCL or LCL injury signs include | Acute onset of pain Joint tenderness Joint Instability Inability to walk without assistance |
| MCL and LCL early management includes | RICE Analgesics Protection of joint from further injury Evaluation for fracture Hemarthrosis (blood in joint) If occurs; fluid aspiration to relieve pressure Further treatment depends on severity of injury Weight bearing as tolerated Hinged-brace for support Crutches until weight bearing is tolerated Exercises to straighten support muscles without straining ligaments |
| Severe MCL injuries are treated with | Non-weight bearing status Progression to weight bearing status as tolerated with hinged-brace for prolonged period. Healing may take 8-12 weeks |
| Severe LCL injuries are treated with | Surgical intervention Bracing Physical Therapy Progressive Rehab Derotational brace to prevent re-injury |
| Cruciate Ligament is responsible for what? | The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) stabilize the anterior and posterior motion of the tibia articulating the femur. These ligaments cross each other in the center of the knee. |
| How do ACL or PCL injuries occur? | Injury occurs when the foot is firmly planted and the leg sustains direct force; forward or backward, If forward, ACL suffers the impact. If from behind, the PCL suffers the impact. Symptoms include hearing a "pop" and significant swelling within 2 hours after the injury. A torn cruciate ligament produces pain, joint instability and pain with weight bearing. |
| Immediate treatment for a PCL or ACL injury includes | RICE protocol Use of NSAIDS Stabilization of joint until evaluated for fracture Severe joint effusion and hemarthroses may require joint aspiration and wrapping Crutches for non-weight bearing if joint is unstable |
| Cruciate Ligament Injury treatment includes what? | Based on injury severity, patient characteristics, and effect of injury on daily activities. Younger people and athletes may opt for surgery due to risk of reinjury and osteoarthritis. Older clients and less active clients may opt for non-surgical therapy |
| Meniscal injuries | When torn, the synovial membrane secretes additional synovial fluid due to the irritation and the knee becomes edematous. Conservative management is rest, immobilization, ice, crutches, NSAIDS, analgesics, modification of activity; home exercises and physical therapy |
| Achilles tendon rupture | Vulnerable to injury due to decreased blood supply and the high tension the tendon endures. Occurs with unexpected dorsiflexion of the foot and ankle. The ability to plantar flex is diminished and dorsiflexion is improved. Non-operative treatment includes cast immobilization for 2-8 weeks with boot and heel lift to increasing weight bearing status. Progressive physical therapy. Total rehab is six weeks. Surgery usually reserved for athletes |
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lygervase
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