Ch 67: Musculoskeletal Trauma

what are commonly causes of sprains and strains?

abnormal stretching or twisting forces during vigorous activities

where do sprains and strains typically occur?

around joints and in spinal muscles

what is a sprain?

an injury to the ligaments surrounding a joint caused by wrenching or twisting motions

which joints are most commonly affected by sprains?

ankle, wrist, and knee joints

what is a first-degree (mild) sprain?

tear in only a few ligament fibers with mild tenderness and minimal swelling

what is a second-degree (moderate) sprain?

partial disruption of the ligament with more swelling and tenderness

what is a third-degree (severe) sprain?

Complete tear of the ligament with moderate to severe swelling

what is a strain?

excessive stretching of a muscle and its fascial sheath, often involving the tendon

which muscle groups are most commonly affected by strains?

Lower back, calf, and hamstrings

what is a first-degree (mild) strain?

slightly pulled muscle

what is a second-degree (moderate) strain?

moderately torn muscle

what is a third-degree (severe) strain?

severely torn or ruptured muscle

how can a torn muscle sometimes be identified?

a defect in the muscle may be visible or palpable through the skin

why are sprains and strains often very painful?

because areas around the joints are rich in nerve endings

What are the manifestations of both sprains and strains?

pain, edema, decreased function, and bruising

What makes the pain of sprains and strains worse?

Continued use of the affected joint, tendon, or ligament.

What causes edema in sprains and strains?

local inflammatory response

How long does it usually take to recover from mild sprains and strains?

3 to 6 weeks

Why might an X-ray be done for a sprain or strain?

to rule out a fracture

What is an avulsion fracture?

A fracture where the ligament pulls loose a fragment of bone.

What joint complications can result from a severe sprain?

joint instability, subluxation, or dislocation

What are two possible complications at the time of injury?

hemoarthorosis (bleeding into the joint) and disruption of the synovial lining

What treatment might severe strains require?

surgical repair of the muscle, tendon, or surrounding fascia

Why should older adults use ramps instead of steps?

to prevent falls

What household item should be removed to prevent falls in older adults?

throw rugs

What are two key strategies for managing osteoarthritis discomfort in older adults?

rest in positions that decrease discomfort and take prescribed pain medications

How can mobility aids like walkers or canes help older adults?

they help prevent falls

Why should older adults maintain a healthy weight?

to avoid stress on joints and reduce the risk of osteoarthritis

What types of physical activity are recommended for older adults to maintain musculoskeletal health?

regular exercise, daily weight-bearing exercise (e.g., walking) and AD:s for range-of-motion

How can hobbies like jigsaw puzzles or needlework benefit older adults' joints?

they exercise finger joints and prevent stiffness

What type of shoes should older adults wear for musculoskeletal safety?

shoes with good support

Why should older adults rise slowly to a standing position?

to prevent dizziness, falls, and fractures

What types of surfaces should older adults avoid walking on?

uneven surfaces and wet floors

What are two key components of preventing sprains and strains before physical activity?

warming up muscles and stretching

What are the three types of exercises that help prevent sprains and strains?

strength, balance, and endurance exercises

what do strength exercises do?

build muscle strength and bone density

How do balance exercises help older adults?

they help prevent falls

How should endurance exercises be started and progressed?

start at a low level and gradually progress to moderate effort

What is the immediate focus when a sprain or strain occurs?

stop activity, limit movement, apply ice, compress area, elevate extremity, and give analgesics

What does the acronym RICE stand for?

rest, ice, compression, elevation

When should movement of the injured part be restricted?

as soon as pain is felt

How long should cold therapy be used after injury?

for the first 24-48 hours

how long should ice be applied at one time?

20-30 minutes per session

why should ice not be applied directly to the skin?

to prevent skin damage or frostbite

What does cold therapy (cryotherapy) do?

Causes vasoconstriction, reduces pain, muscle spasms, inflammation, and edema.

What is the purpose of compression in managing sprains and strains?

to decrease edema and pain

How should a compression bandage be applied?

start distally and wrap proximally toward the trunk

What are signs that a compression bandage is too tight?

numbness, tingling, increased pain, or swelling beyond the bandage

how long should a compression bandage be worn before removing it temporarily?

leave on for 30 minutes, then remove for 15 minutes

How long should the injured part be elevated and at what level?

For 24 to 48 hours above heart level, even during sleep.

What medications may be used to manage pain?

Mild analgesics and NSAIDs.

When should warm, moist heat be applied to the injury?

After the acute phase (usually after 24–48 hours).

How long should heat therapy be applied per session?

20 to 30 minutes

Why is joint movement encouraged after the acute phase?

to maintain cartilage nutrition and prevent contracture

What benefit does muscle contraction provide during recovery?

improves circulation and helps resolve bruising and swelling

Why are strength and conditioning exercises important during recovery?

to prevent rein jury

How can physical therapy support recovery?

With pain relief techniques and tailored exercises for flexibility and strength.

How does physical activity affect body weight?

it helps with weight management

What effect does physical activity have on body composition?

increases lean muscle and decrease body fat

How does physical activity affect bone health?

It helps maintain and improve bone mass.

What are three musculoskeletal benefits of physical activity?

Increases muscle strength, flexibility, and endurance.

How does physical activity help with blood pressure?

it prevents high blood pressure

What chronic diseases does regular physical activity help prevent?

heart disease, diabetes, and colon cancer

What mental health benefits does physical activity provide?

enhances sense of well-being and reduces risk for depression

what is a fracture?

a disruption or break in the continuity of bone.

what are the two main causes of fractures?

traumatic injuries and disease processes (e.g., cancer or osteoporosis)

what is a pathological fracture?

a fracture caused by a disease process such as cancer or osteoporosis

what is an open fracture?

A fracture in which the skin is broken and bone is exposed, causing soft tissue injury

what usually causes open fractures?

severe external forces

what is a closed fracture?

A fracture where the skin remains intact over the site

what is a complete fracture?

a fracture where the break goes entirely through the bone

what is an incomplete fracture?

a fracture that occurs partially in the bone shaft; bone remains intact

what typically causes incomplete fractures?

bending or crushing forces

what is a displaced fracture?

A fracture in which bone ends are out of alignment and separated.

What is a nondisplaced fracture?

a fracture in which bone fragments remain in alignment

What causes bruising after a fracture, and where might it appear?

extravasation of blood into subcutaneous tissues; may appear immediately and distal to injury

how should bruising after a fracture be addressed with the patient?

reassure them it is a normal process and discoloration will resolve

what is crepitation in a fracture?

A grating, crunching, or popping sensation caused by bony fragments rubbing together.

What is the clinical concern with crepitation in fractures?

excessive movement may increase risk of nonunion, though micro movement promotes osteogenesis

What is a deformity in the context of a fracture?

abnormal positioning due to muscle action or injury forces, seen as loss of normal bony contours

why is deformity considered a classic sign of fracture?

if uncorrected, it can lead to problems with bone healing and function restoration

What causes edema and swelling at a fracture site?

bleeding into tissues or skin/soft tissue disruption from bone fragments

What is a serious risk of unchecked swelling in a closed space after a fracture?

compartment syndrome due to vessel occlusion and nerve damage

What causes loss of function with a fracture?

disruption of the bone or joint preventing functional limb use

What must be done to restore limb function after a fracture?

proper management of the fracture

What causes muscle spasm after a fracture?

tissue irritation and protective muscular response

What complications can muscle spasms lead to in fractures?

displacement of a non displaced fracture or prevention of spontaneous reduction

What contributes to pain and tenderness in fractures?

Muscle spasm, tissue trauma, pressure on nerves, and fragment movement.

How does the body naturally respond to fracture-related pain and tenderness?

The patient splints the muscle to reduce motion and discomfort

What are the three overall goals of fracture treatment?

• Anatomic realignment of bone fragments (reduction)

• Immobilization to maintain realignment

• Restoration of normal or near-normal function of the injured part

What is closed reduction?

A nonsurgical, manual realignment of bone fragments to their anatomic position.

What may be used after closed reduction to maintain alignment?

Traction, casting, splints, or orthoses (braces).

What is open reduction?

Surgical correction of bone alignment, often with internal fixation devices.

What devices are used in open reduction internal fixation (ORIF)?

Wires, screws, pins, plates, rods, or nails.

What is traction?

Application of a pulling force to an injured or diseased body part to promote realignment, reduce pain/spasm, and immobilize

What are four primary purposes of traction?

• Prevent/reduce pain and muscle spasm

• Immobilize a body part

• Reduce a fracture/dislocation

• Treat a pathologic joint condition

What are four additional purposes of traction?

• Prevent soft tissue damage

• Promote exercise

• Expand joint space for arthroscopy

• Prepare for joint reconstruction

What are the two main types of traction?

skin traction and skeletal traction

What is skin traction used for?

Short-term treatment (48–72 hours) before surgery or skeletal traction.

What devices are used in skin traction?

tape, boots, or splints applied to the skin