10D2023__MSK3_Soft_Tissue_Injuries.pptx

MSK Trauma: Soft tissue injuries Elizabeth Dee 2022 Revised & Presented Tania Di Tota 2023 Msk#3-soft tissue injuries – YouTube Learning objectives • Etiology and pathology of soft tissue injuries (including sports related injury and cumulative use injury) • Explain clinical manifestations o...

MSK Trauma: Soft tissue injuries Elizabeth Dee 2022 Revised & Presented Tania Di Tota 2023 Msk#3-soft tissue injuries – YouTube Learning objectives • Etiology and pathology of soft tissue injuries (including sports related injury and cumulative use injury) • Explain clinical manifestations of soft tissue injuries (including sports related injury and cumulative use injury) • Explain collaborative care of soft tissue injuries (including sports related injury and cumulative use injury) Causes Falls Motor vehicle acciden ts Crush injury Direct blows Sports injuries Cumula tive use Definitions Contusion Ecchymosis Hematoma Contusions ecchymosis Hemato mas Sprain • It is an injury related to the ligamentous structures surrounding a joint • Usually caused by a wrenching or twisting motion • Most occur in ankles, knees or wrists • Categorized by degree of tearing Sprain classification Grade 1 (first-degree) or mild • Joint remains functional • Mild tenderness • Mild swelling • Able to bear weight Grade 2 (second-degree) or moderate • Some loss of joint function • Increased tenderness • Increased swelling • Able to bear weight with pain/difficulty Grade 3 (third-degree) or severe • Severe tenderness • Moderate/severe swelling • Joint is unstable=subluxation/dislocation • Can result in avulsion fracture Ankle Avulsion Fracture|Symptoms|Causes|Treatment|Rec overy Time|Exercises (epainassist.com) Strain • An excessive stretching of a muscle, a muscle’s fascial sheath or a tendon • Occurs most often in the foot, leg or back • Also classified by amount of tearing Strain classification • First-degree involves mild or slightly pulled muscle • Second-degree Involves moderately torn muscle • Third degree Involves severely torn or ruptured muscle S tr a i n S p ra i n Clinical Manifesta tions: Sprains and Strains Very similar Includes: Pain • Edema • Bruising • Decrease in function • Nursing Management Sprains and Strains Nursing implementation Health promotion/prevention • Warm up exercises before activities/sports • Combination of strength/balance and endurance • 30 minutes/day of moderate intensity exercise • Wrapping before? Emergency Management Acute soft tissue injury Assessment Inspect Palpate Mobility Emergency Management Acute soft tissue injury Assessment Inspect contusions • Edema • Pallor • Shortening or rotation of extremity • Emergency Management Acute soft tissue injury Assessment Palpate • Neurovascular assessment Decreased pulse, coolness, and capillary refill >2 sec Emergency Management Acute soft tissue injury Assessment Mobility Decreased movement • Inability to bear weight when lower extremity involved • Limited or decreased function with upper extremity involvement • Emergency Management Acute soft tissue injury Assessment Subjective data Decreased sensation with severe edema • Muscle spasms • Pain, tenderness • Emergency Management Acute soft tissue injury Interventions 1.Stopping the activity and limiting movement 2.Application of ice compresses to the injured area 3.Compression of the involved extremity 4.Elevation of the extremity 5.Providing analgesia as necessary Interventions related to soft tissue injury R.I.C.E. Rest Ice Compression Elevation Interventi ons related to soft tissue injury Rest • Immediately after pain is felt • Limit Interventi ons related to soft tissue injury Ice (cold) • Decreases pain • Reduces swelling • Reduces muscle spasm • Should be limited to 20-30 Interventi ons related to soft tissue injury Compressio n • Use of compression bandage • Wrap distally → proximally Interventi ons related to soft tissue injury Elevation • Should be elevated above the level of the heart Interventions related to soft tissue injury Anticipate radiographs (Ottawa rules/guidelines) • medication for pain/muscle spasms/inflammatio n • Interventions related to soft tissue injury (cont’d) After the acute phase (24 to 48 hours) Warm moist heat can be applied • • Applications should not exceed 20-30 minutes • Encourage use of limb provided joint is protected using casts, splints etc… • medication for pain/muscle spasms/inflammation Medications used in MSK injury: Muscle Relaxants Causes skeletal muscle relaxation for localized muscle spasm produce effects through actions in the CNS • can be administered orally • Relieves symptoms of stiffness and rigidity • Ex: cyclobenzaprine (Flexeril), methocarbamol (Robaxin, Robaxacet) cyclobenzaprine (Flexeril): Mechanism of Action • Prevents reuptake of NE in brainstem and spinal cord, blocks Ach receptors, H1 histamine receptors and 5HT 2A receptors • Blocking 5HT2A receptor linked to reduction of excitatory inputs to alpha motor neurons • similar structure and function to tricyclic anti-depressants cyclobenzaprine (Flexeril): Adverse Effects Drowsiness , dizziness CV effects GI effects • Orthostatic hypotension, tachycardia, syncope • Nausea, vomiting, diarrhea, anorexia, flatulence cyclobenzaprine (Flexeril): Adverse Effects Miscellaneous • Facial edema • Xerostomia (dry mouth) • sweating Nursing Considerations for Patients Receiving Muscle relaxers (central) • Monitor • • • VS level of consciousness sedation • Assist with ambulation & changing positions to prevent dizziness • Avoid driving or other activities requiring alertness until response to the drug is known Topical Analgesics: Diclofenac (Voltaren emugel) useful for patients who are intolerant to the GI side effects of oral NSAIDs • 6-10% of topical gel is systematically absorbed • Topical Analgesics: Capsaicin topical preparations (OTC) made from cayenne pepper, hot chili peppers • interferes with the transmission of pain impulses • produces a burning sensation • effects may not be seen for 2-4 weeks • Other preparations can be a combination: Camphor • Menthol • Dislocatio ns & subluxati ons What is a dislocation? A complete displacement of a bone from its normal position within a joint because of severe injury of the Dislocatio ns & subluxati ons What is a subluxation? A partial or incomplete displacement of the joint surface. Dislocatio ns & subluxatio ns Joints most affected in upper extremities include Thumb • Elbow • Shoulder • Dislocatio ns & subluxatio ns Joints most affected in lower extremities include Hip • Patella (knee) • Dislocations and subluxations Clinical manifestations • Deformity • Local pain • Tenderness • Loss of function of the injured part • Swelling of the soft tissues surrounding joint Hip dislocati on Shoulder dislocation Dislocations and subluxations Nursing and collaborative management A dislocation is considered an emergency! The longer the joint remains unreduced (dislocated) the greater the risk of complications Dislocations and subluxations : Complicatio ns include: Avascular necrosis (AVN) Neurovascular compromise Open joint injuries fractures Dislocatio ns and subluxatio ns manageme nt First goal of management Open isClosed to realign the joint back reductio to its correctreductio position n n After reduction joint is immobilized Keep immobilized until cleared (by MD) for gentle ROM exercises Dislocatio ns and subluxatio ns manageme nt Following a physiotherapy/rehab program is recommended Pain control Patients who have dislocated a joint are at an increased for repeated dislocations due to loosened ligaments Rotator cuff Made up of four muscles Stabilizes head of the humerus May occur gradual degenerative process resulting from aging • repetitive stress • from falling • Sports injuries • Rotator cuff tears Rotator cuff tears In sports, overhead repetitive motions often cause injury Falling onto an outstretched arm and hand • Blow to the upper arm • Heavy lifting • Repetitive work motions • Rotator cuff injuries clinical manifestations Shoulder pain Decreased ROM Failed “drop arm test” Weakness Severe pain on abduction (60-120 degrees) Drop arm test (72) Shoulder Drop Arm Test for Rotator C uff Tear | Clinical Physio - YouTube Rotator cuff injuries Nursing and collaborativ e manageme nt Diagnosis is usually confirmed by MRI (arthrogram) Management of Partial tears (small) • Rest • NSAIDS • Ice • corticosteroid • Heat injections • physiotherapy Management of large Partial/complete tears Arthroscopy with repair • Conservative treatment doesn’t work (partial tear) Arthroscopy What is a Meniscus? Crescent shaped fibrocartilage Cushion Shock protection minimal edema Meniscus injury clinical manifesta tions Localized pain, tenderness Feels unstable “gives out” Meniscus injury clinical manifestat ions (cont’d) Positive McMurray •test Pain elicited by flexion • internal rotation • then extension McMurray test (72) McMurray Test | Meniscus Damage - Y ouTube Meniscus injury Nursing and collaborativ e managemen t MRI to confirm (before arthroscop Treatment y depends on performed) size and location of Meniscus injury management: Conservative • Partial weight bearing (crutches) • Ice • immobilization • NSAIDS • corticosteroid injections • physiotherapy Meniscus injury Surgical managem ent Meniscec tomy Sutured Anterior cruciate ligament (ACL)injury Most injured ligament of the knee In sports, usually non-contact ACL tears Pivots • Lands from jumping • Slows when running • Sudden stops/direction changes • ACL tears Clinical manifesta tions Report coming down on knee • Twisting • Hearing a pop • Acute knee pain • Swelling • unstable ACL Injuries: Nursing and collaborative management Diagnostics Lachman test performed Knee flexed 15 to 30 degrees, then tibia is pulled forward • If forward motion of tibia with a soft or indistinct end point • If Positive -> ACL tear • MRI arthrogram Lachman test (72) Lachman Test | Cruciate Ligament - Yo uTube ACL injuries: Nursing and collaborative management Minimal/partial tears • Rest • Ice • Elevation • NSAIDS • Physiotherapy • Use of knee brace/immobilizer ACL injuries: Nursing and collaborative management Severe injury • Reconstructive surgery needed • After surgery can take 6-8 months to heal ACL Nursing and collaborative management Reconstruction Torn ACL removed Graft used Inflammation of tendon as a result of overuse or incorrect use Tendinitis • Rest • Ice • NSAIDs • gradual return to sport activity • protective brace may be necessary if symptoms recur Bursitis Bursitis Repeated or excessive trauma • Friction • Gout • RA (rheumatoid arthritis) • Infection Bursitis clinical manifesta tions • Warmth • Pain • Swelling • Limited ROM Bursitis Nursing and collaborative management Identify and correct cause • Rest • Ice • NSAIDs • protective brace may be necessary • Corticosteroid injection bursectomy Can occur anywhere Injuries resulting from prolonged force repetitive movements and awkward postures Exact causes are unknown Repetitive Strain injury (RSI) Difficult to diagnose Repetitive Strain injury People at risk include (RSI) musicians dancers butchers grocery clerks • computer frequentl y • • • • Repetitive Strain injury (RSI) Other involved factors include: Poor posture and positioning • Poor ergonomics at work • Repetitive, heavy lifting • Repetitive Strain injury (RSI) Clinical manifestations Inflammation • Swelling • Pain • Numbness • Impaired motor function • Repetitive Strain injury (RSI) Nursing and collaborative management Treatment includes Identifying precipitating activity • Modification of activity • Pain management • Rest (or physiotherapy depending on severity) • Carpal tunnel syndrome Compression of the median nerve at the carpal tunnel • Inflammation, edema or injury by surrounding structures One of the most common workrelated injuries Associated with occupations (or Median nerve distribut ion Carpal tunnel syndrome Clinical manifesta tions Weaknes s (of the thumb) Burning pain Difficulty Numbnes with fine s and motor tingling Positivetasks Tinel’s sign, positive Phalen’s sign Tinel & Phalen signs https://youtu.be/6bOYvEADHyU Carpal tunnel syndrome Nursing and collaborative management Relieve underlying pressure • Rest, immobilization with hand splint • Gradual return with physiotherapy • Pain management • Steroid injections • Surgery if not relieved by other methods Carpal tunnel surgery Carpal tunnel syndrome Nursing and collaborative management Prevention is key • Special keyboards • Resting wrist as needed • Adaptive devices • Proper workplace ergonomics