NUR 317 Exam 5 - Trauma and Orthopedic Surgery (Sprains and Strains)

Soft tissue injury usually results from trauma which includes...

• Sprains

• Strains

• Dislocation

• Subluxation

Sprain

Injury to a ligament surrounding a joint

• Caused by wrenching, twisting motion

• Most commonly affects the ankle, followed by the knee and wrist

First degree sprain

• Mild sprain – few fibers torn

• Mild tenderness and minimal edema

Second degree sprain

• Moderate sprain – partial ligament tissue disruption

• Swelling and tenderness present

Third degree sprain

• Severe sprain – complete tearing of ligament

  • Gap in muscle may be palpable

  • Risk of avulsion fracture

• Moderate to severe swelling

• Extreme pain

Strain

• Excessive stretching of muscle

• Most commonly affects lower back, calf, and hamstring

First degree strain

Mild – slightly pulled muscle

Second degree strain

Moderately torn muscle

Third degree strain

Severely torn or ruptured muscle

Sprain and strain clinical manifestations

• Pain

• Edema

• Contusion

• Tiny hemorrhage within tissues/bruising

• Decreased function

Sprain and strain recovery

• Mild sprains and strains are usually self-limiting

• Full function usually returns within 3-6 weeks

• X-rays of the affected part may be taken to rule out a fracture

  • Severe sprain can cause

• Severe strains may need surgical repair of the muscle, tendon, or surrounding fascia

Sprains and strains health promotion interventions

Before exercise:

Proper fitting shoes

Improve strength, balance, and endurance

Weight control

Sprains and strains injury interventions (ambulatory and home care)

Rest, ice, compression, and elevation for 24-48 hours

Medications:

Prevent reinjury with strength and conditioning exercises

Referral to physical therapy if needed

Repetitive strain injury

• Cumulative trauma disorder

  • Tiny tears in tendon, ligament, muscle leading to inflammation

• Etiology

  • Prolonged force

  • Repetitive motion – “Nintendinitis”

  • Awkward posture

  • Poorly designed workspaces

  • Repetitive heavy lifting

• Prevention

  • Education

  • Ergonomics

Dislocation and subluxation

• Result of joint instability

• Symptoms similar between dislocation and subluxation

  • Pain

  • Soft tissue swelling

  • Loss of functionality

  • Deformity

• Common areas of dislocations:

  • Upper body – thumb, elbow, shoulder

  • Lower body – hip, kneecap

Which has less severe symptoms – dislocation or subluxation?

Subluxation

Dislocation and subluxation complications

• Fractures within the joint

• Blood vessel and nerve damage of adjacent area

• Avascular necrosis

• Compartment syndrome

Dislocation and subluxation surgery

Open and closed reduction

Dislocation and subluxation nursing care

• Dislocation – prompt attention!

• Support and protection of injured area

• Pain management

• Incision/dressing assessments and management

• Appropriate positioning/mobility

• Coordination with therapy (rehab programs?)

Carpal tunnel syndrome (CTS)

• Most common upper extremity compression neuropathy

• Compressed median nerve (which passes through carpal tunnel)

• Women more likely than men to develop CTS – often occurs during premenstrual period, pregnancy, and menopause

Carpal tunnel syndrome diagnostics

• H & P

• ↓ sensation to light touch in affected fingers

• Inflated BP cuff >SBP for 1-2 min

• EMG (electromyography)

  • Median nerve motor conduction

• Tinel’s Sign

  • Tingling over the median nerve on light percussion

• Phalen’s Maneuver

  • Flexion at the wrist for 1 minute and tingling over the median nerve

• Thenar muscle atrophy

  • Seen in about 50% of cases

What does Tinel’s Sign and Phalen’s Maneuver test for and how are they performed?

Tinel's sign is performed by tapping over the median nerve at the wrist to check for tingling sensations, while Phalen's maneuver involves holding the hands in a forced flexed position for 30-60 seconds to see if symptoms are triggered

What does Thenar muscle atrophy indicate?

The wasting of the muscles in the base of the thumb due to carpal tunnel syndrome

Carpal tunnel syndrome management

• Prevention - adaptive devices, ergonomic considerations

• NSAIDS

• Physical therapy exercises

• Corticosteroid Injection

• Surgery

  • If symptoms last longer than six months

  • Full recovery may take months

Anterior cruciate ligament (ACL) injury

• Usually occurs from noncontact injury

  • Athlete pivots, lands from a jump or slows down when running

• Knee may feel unstable after coming down on it, twisting it, or hearing a “pop”

  • Acute pain, edema

Anterior cruciate ligament injury diagnosis

• Lachman’s Test:

  • Positive if forward motion of the tibia is detected when the knee is flexed 15-30 degrees and tibia is pulled forward while femur is stabilized

• Injury confirmed with MRI

Anterior cruciate ligament injury treatment

• Conservative treatment

• Aspiration of effusion

• Immobilizer/brace

• Physical therapy

• Reconstructive surgical repair – severe injury, graft tissue replaces torn ACL