musculoskeletal injuries and disorders (McFalls

acute: less than 4 weeks

subacute: at least 4 weeks and up to 3 months

chronic pain: at least 3 months

how long does acute, subacute, and chronic pain last?

somatic pain

pain impulses are transmitted form peripheral nociceptors to the central nervous system (CNS) by nerve fibers

tendon

connects muscle to bone

ligament

connects bone to bone

histamine

bradykinin

serotonin

leukotrienes

prostaglandins increased

what are the mediators that cause infalmmation?

-inflammation of the bursa (fluid-filled sac between joint spaces) so like knee shoulder and big toe

what is the pathophysiology of Bursitis?

warmth, edema, erythema, possible crepitus (hear your shoulder grating)

-constant pain that worsens with movement or application of pressure

what is the clinical presentation of Bursitis?

-muscles

-systemic infections (influenza)

-chronic disorders (fibromyalgia)

-medications (HMG-CoA reductase inhibitors)

what is the pathophysiology of myalgia?

dull constant ache (not sharp just sore)

-weakness and fatigue

-example is sore from the gym

what is the clinical presentation of myalgia?

ligaments within a joint

-ex. twisted ankle/ankle sprain, ACL tear

what does a sprain concern?

I: excessive stretching

II: partial tear

III: complete tear of the tissue

describe each grade of a sprain:

swelling and bruising

-initial severe pain followed by pain, particularly with joint use

what is the clinical presentation of an ankle sprain?

muscle or a tendon

-twisting or pulling movements

-ex. pulled muscle, hamstring pain

what does a strain concern?

swelling and bruising

-initial severe pain with continued pain upon movement and at rest

what is the clinical presentation of an ankle strain?

inflammation of a tendon

-ex. carpal tunnel syndrome, tennis elbow, golfer's elbow

what does tendonitis concern?

warmth swelling, erythema

-mild-severe pain generally occurs after use

-loss of range of motion

what is the clinical presentation of tendonitis?

-severe pain with a pain score over 6

-pain that lasts longer than 10 days

-increased intensity or character of pain

-visually deformed joint or abnormal movement or numbness or weakness

-pregnancy

-less than 2

what are the exclusions to self treating?

-warm up before physical activity

-proper hydration

-appropriate footwear

-RICE therapy

-heat therapy

-TENS therapy

what are the nonpharmacologic therapies to aid in musculoskeletal pain?

Rest

Ice

Compression

Elevation

what does RICE therapy consist of?

15-20 minutes, 3-4 times a day

-do so for 1-3 days

how long should you ice for?

relieves stiffness with pain of a noninflammatory nature

-warm compress, heating pad, hot water bottle, ThermaCare

how does heat therapy help with musculoskeletal pain?

15-20 minutes, 3-4 times a day

how long should you apply heat to an injury for?

false

TRUE OR FALSE: heat therapy should be use on body parts with broken skin

Transcutaneous Electrical Nerve Stimulation Therapy

-sore muscles, joint pain, chronic pain

-increase the production of natural endorphins

-electrode pads are placed on various areas of the body (no open wounds or infalmmed skin)

what is TENS therapy?

pacemakers/defibrillators

pregnant

pediatric

when can someone NOT use TENS therapy?

15-30 minutes up to 3 times daily

how long should you do TENS therapy for?

Systemic analgesics

-acetaminophen

-NSAIDs (ibuprofen, naproxen sodium)

what meds can be used in the initial symptoms of musculoskeletal injuries?

limit use to 10 days

-taper as injury improves

-on day 4 switch to prn

how long can systemic analgesics be used to treat musculoskeletal injuries?

minor to moderate aches and sprains of muscles and joints

when would you recommend topical counterirritants to patients?

counterirritation

paradoxical pain-relieving effect

produces a less severe pain to counter a more intense one

what is the mechanism of action for topical counteriritants?

methyl salicylate

camphor

menthol

methyl nicotinate

capsaicin

what are the active ingredients in topical counterirritants?

skin irritation and rash

what are the adverse effects with topical counterirritants?

-do not bandage area

-don't use heat on the area

-don't apply to wounded broken or irritated skin

what are the warnings that come with topical counterirritants?

use 3-4 times daily

what is the dosing for topical irritants?

hot sensation, redness of skin

what does methyl salicylate do?

cold followed by a warm sensation

what does camphor and menthol do?

warm sensation

what does methyl nicotinate do?

-burning sensation

-depletion of substance P

-pain relief within 14 days and can be delayed up to 4-6 weeks

what does capsaicin do?

-pediatrics: only capsaicin for 18 and older and older than 2 for counterirritants

-geriatrics: yes; watch over methyl salicylate

-pregnant: camphor and capsaicin is good

-lactating: camphor and capsaicin are good but avoid breastfeeding on capsaicin treatment days

what are the special populations with topical counterirritants?

Bengay Vanishing Scent Non-Greasy Pain Relief Gel

Icy Hot No Mess Applicator

Mineral Ice

types of menthol containing topical counterirritant products:

menthol

Bengay Vanishing Scent Non-Greasy Pain Relief Gel

menthol

Icy Hot No Mess Applicator

menthol

Mineral Ice

JointFlex Arthritis Pain Relieving Cream

type of camphor containing topical counterirritant product:

camphor

JointFlex Arthritis Pain Relieving Cream

Capzasin-HP Arthritis Pain Relief Cream

Zostrix Maximum Strength Cream

type of capsaicin containing topical counterirritant product:

capsaicin

Capzasin-HP Arthritis Pain Relief Cream

capsaicin

Zostrix Maximum Strength Cream

Arthritis pain in the hand, wrist, elbow, foot, ankle, or knee

when would you recommend the use of topical NSAIDs in patients?

inhibit prostaglandins

what is the mechanism of action of topical NSAIDs?

Diclofenac sodium 1%

what is the active ingredient in topical NSAIDs?

must be 18 and older

on hand, wrist, elbow: 2.25 inches (2g) four times a day

on foot, ankle, knee: 4.5 inches (4g) four times a day

what is the dosing of topical NSAIDs?

-takes up to 7 days to work

-stop using after 21 days

how long can you use a topical NSAID and how long until you see an effect?

pediatrics: must be 18 and older

geriatrics: yes

pregnant: yes but avoid in third trimester

lactating: yes

what are the special populations for topical NSAIDs?

Aleve Arthritis Pain Gel

Salonpas Arthritis Pain Relief Gel

Voltaren Arthritis Pain Gel

types of topical NSAIDs for musculoskeletal injuries:

Diclofenac sodium

Aleve Arthritis Pain Gel

Diclofenac sodium

Salonpas Arthritis Pain Relief Gel

Diclofenac sodium

Voltaren Arthritis Pain Gel

for neuropathic/nerve pain

itching

when would you recommend a topical anesthetic?

inhibits the conduction of nerve impulses

what is the mechanism of action for topical anesthetics?

lidocaine

what is the active ingredient in topical anesthetics?

at least 18 years ol

-every 6-8 hours as needed

-do not exceed 3 applications in 24 hrs

what is the proper dosing for topical anesthetics?

pediatrics: at least 18

geriatrics: yes

pregnant: yes

lactating: yes

what are the special populations for topical anesthetics?

Aspercreme With Lidocaine Maximum Strength

Lidocaine Patch

types of lidocaine containing topical anesthetic products:

Lidocaine HCl 4%

Aspercreme With Lidocaine Maximum Strength

Lidocaine 4%

Lidocaine Patch

Arthritis Hot Cream

Bengay Ultra Strength Cream

Icy Hot Lidocaine Cream

Salonpas Pain Relief Patch

types of combination products:

Methyl salicylate 15%

menthol 10%

Arthritis Hot Cream

Methyl salicylate 30%

menthol 10%

camphor 4%

Bengay Ultra Strength Cream

lidocaine HCl 4%

menthol 1%

Icy Hot Lidocaine Cream

Methyl salicylate 10%

menthol 3%

Salonpas Pain Relief Patch

pain lasts over 10 days without any improvement

when do you refer a patient?