Types of Injuries and Patient Assessment

Types of Injuries

• Acute Traumatic injuries have a sudden onset with a clear cause.
• Examples include ankle sprains (grades I, II, III), tendinitis (elbow strain), and muscle tears.
• Sprains involve stretching or tearing ligaments.
• Tendinitis is inflammation of a tendon.
• Myalgia, or muscle pain, can have various causes and presentation.

Patient Assessment

• PQRST method is used for pain assessment.
• Precipitating factors, Quality, Region, Severity, and Time of pain are assessed.
• Modifying factors and other symptoms are also considered.

Self-Care Exclusion of Sprains and Strains

• Severe pain or tenderness lasting more than 10 days or greater than 7 days with topical analgesic use are causes for concern.
• Increased pain intensity or a change in pain character, along with accompanying symptoms (nausea, vomiting, fever, infection), are reasons for concern.
• Pelvic or abdominal pain, weakness/numbness, or the inability to bear weight on the injured joint warrant further medical attention.
• Pregnancy and young children (< 2 years) require special consideration.

Preventative Strategies

• Warm-up and stretching before activities, and cooling down afterwards, are important preventive measures.
• Maintaining a healthy weight and good footwear are essential for injury prevention.
• Appropriate pacing in exercise intensity, duration, and frequency is important.

Nonpharmacologic Therapy

• RICE: rest, ice, compression, elevation (use as soon as possible or within 12-24 hours).
• Ice is best applied 15-20 minutes at a time 3-4 times a day; for more severe injuries or if swelling subsides, apply 48-72 hours later.
• Compression is from elastic bandages or wraps for support.
• Elevate the injured part 2-3 hours a day.
• Heat therapy is used for 15-20 minutes to relieve stiffness and pain, most effective for chronic conditions.

Disposable Heating Patches/Pads

• Provide low-level topical heat for at least 8 hours.
• Heat reaches a specified temperature within 30 minutes.
• Simple application involves placing the pouch with the heat disc over the affected area.

External Analgesics (Counterirritants)

• These are approved for minor muscle/joint aches.
• They trigger a paradoxical pain relief effect by reducing pain sensation.
• They may stimulate sensations of heat, cold or itching.
• External analgesics have limited absorption through the skin (percutaneous absorption).
• Tight bandages and thermotherapy should not be used with external analgesics in case of burned or damaged skin.
• They are not recommended for children under 2 years old.

Topical Anesthetics

• Topical anesthetics, such as lidocaine (0.5-4%), can relieve pain and itching.
• Topical anesthetics are often creams, patches, or gels.
• They are primarily used in neuropathic pain from injuries.
• Topical anesthetics should only be used with a duration of 7 days max.

Osteoarthritis

• Osteoarthritis involves gradual cartilage destruction.
• It mostly affects weight-bearing joints like knees, hips, hands, and lower back.
• Symptoms include dull pain relieved by rest, joint stiffness, and localized inflammation.
• Cartilage fibrillation, meniscal degeneration, and osteophyte formation are common manifestations.

Guidelines for Osteoarthritis

• Treatments vary based on the location of the affected joint (knee, hip, hand).
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) are frequently recommended for knees and hips. Acetaminophen is sometimes used as well.
• Topical NSAIDs might be considered initially due to their localized effects.

Diclofenac Gel

• This is a topical NSAID.
• Use as directed by product instruction/dosing card.
• Follow use for a maximum of 21 days and consult a medical professional afterwards.
• Not for immediate pain relief

Complementary Therapies

• These encompass various methods, including exercise, weight loss, canes, heat therapy, tai chi, knee braces, and fitting.
• These methods help treat osteoarthritis and improve ambulation.

Back Pain

• Acetaminophen is no longer the first-line treatment for back pain.
• NSAIDs are an alternative.
• Nonpharmacological treatment alongside NSAIDs is highly recommended.
• Heat therapy is a nonpharmacological strategy for pain relief.