Types of Injuries PDF

10/8/24 Types of Injuries Acute Traumatic: sudden onset and clearly defined cause Inflammation of a tendon from acute injury or chronic repetitive motion. Carpel tunnel...

10/8/24 Types of Injuries Acute Traumatic: sudden onset and clearly defined cause Inflammation of a tendon from acute injury or chronic repetitive motion. Carpel tunnel is an example. See Table 7-1 1 2 Patient Assessment PQRST For Pain assessment – Precipitating factors – Quality – Region – Severity – Time Modifying Factors Other symptoms 3 4 1  10/8/24 Self-Care Exclusion of Preventative Strategies Sprains and Strains USE COMMON SENSE!! Warm-up and stretch Severe pain or tenderness before activities Pain > 10 days >7 days if on a topical analgesic Cooling down after a Systemic analgesics should be limited to 10 days for self- workout care Increase the frequency, Increased intensity or change in character of pain duration, and intensity of Accompanying nausea, vomiting, fever or signs of exercise at an systemic infection appropriate pace Pelvic or abdominal pain Ergonomics Weakness or numbness in injured area Wear properly fitting Same area of injury shoes Cannot put any weight on injured joint Maintain a healthy Pregnancy weight < 2 years of age 5 6 Nonpharmacologic Therapy Disposable Heating Patches/Pads (Table 7-2) Disposable, air- – Rest activated wrap that – Ice (Cryotherapy) administers low-level Applied as soon as possible for 15-20 minutes 3-4 times a day topical heat for at 12-24 hours; 48-72 for more severe injuries or swelling subsides least 8 hours – Compression (elastic bandage or wrap) – Reaches temp within – Elevate injured area: 2-3 hours a day 30 minutes Heat (Thermotherapy): 15-20 minutes How to Use – Open airtight pouch – Helps relieve stiffness and pain – Center heat disc over – Non inflammatory area – Chronic conditions – Dry area 7 8 2  10/8/24 External Analgesics Counterirritants Counterirritants Do not use if skin is damaged or burned – Approved for minor aches and pains of Do not use tight bandages or thermotherapy muscles and joints – Increase absorption into skin – Paradoxical pain relief – Burning – Muscle necrosis, redness, blistering Produce less-severe pain to counter a more intense pain Not for children < 2 years of age – Stimulate, rather than suppress Dose: 3-4 times a day for up to 7 days sensations of cold, warmth, and itching Do not use salicylated formulas if on warfarin (methyl salicylate, trolamine salicylate) – Limited percutaneous absorption 9 10 — Clinical pearl: — Severe allergic reaction associated with capsaicin cream — Found in peppers, — Depletion of substance P spices and hot sauces — Test spot before use — 14 days for relief – up to 4-6 weeks in chronic pain — Best for knee — No evidence in — Must use 3-4 times per day hand 11 12 3  10/8/24 Topical Anesthetics — Lidocaine (0.5-4%) — Relief of pain and itching — Creams , patches, gels — Primary role in neuropathic pain for injuries — 7 days of use — Allergy to “caines” contraindicated 13 14 Osteoarthritis Guidelines — Gradual destruction of cartilage between bones — American college of Rheumatology and Arthritis Foundation — Weight bearing joints — Conditionally vs Strongly recommend — Knees, hips, hands, low back — Knee — Dull pain relived by rest, joint stiffness for 20-30 minutes, — Strongly recommend oral NSAIDS localized to joints — Topical NSAIDS- potentially before oral NSAIDS due to lack of systemic side effects — Self care after initial diagnosis — Hip — Treatment — Strongly recommend oral NSAIDS — Hip and knee — NSAIDS or Acetaminophen — Hand (historically) — Strongly recommend NSAIDS — Consideration for a PPI with a systemic NSAID if at risk — Conditionally recommend topical NSAIDS — Hand — NSAIDS — Acetaminophen of little value Kolasinki et al. 2019 Am erican College of Rheum atology/Arthritis Foundation guideline for the m anagem ent of osteoarthritis. Arthritis Care Res. 2020 15 16 4  10/8/24 Diclofenac Gel Complementary Therapies — Diclofenac Gel — Exercise — 4 Times a day — 2 grams vs 4 grams — Weight Loss — Dosing card — Cane — 1 or more joints causing significant — May take up to 1 week for impact on ambulation efficacy — Heat therapy — Stop using after 21 days and refer back to MD — Tai chi — Contraindications — Knee braces — Significant impact on ambulation — Osteoarthritis only — Fitting 17 18 Back Pain Cases — Acetaminophen no longer considered first line — No efficacy vs placebo — NSAID if no contraindication along with nonpharmacologic therapy — Heat therapy 19 20 5