Ch 3 & 4: Musculoskeletal System - Injuries

Strain

twisting of the muscle, often seen in lower back or hamstrings

What treatment is used for strains?

NSAIDs for pain, rest, ice, compression, elevation, potentially crutches, casting, or surgical repair; rehabilitation/physical therapy after intervention

What are symptoms associated with strains?

pain, muscle weakness, muscle spasms, inflammation

Sprain

injury to a ligament, often seen in ankle or knee joints

damage to blood vessels, muscles, tendons, and nerves

What are common symptoms of a sprain?

swelling, redness or bluish discoloration of area due to vessel rupture, inability to move affected area

What treatment options are used for sprains?

NSAIDs for pain, RICE therapy

Dislocation

injury to joint in which bones no longer align properly, often occurs in shoulder/hip joints (also called luxation)

What is an dislocation where the bones are not completely out of alignment also called?

subluxation

What are symptoms of a dislocation?

pain, possible crepitation (dry, crackling sound or sensation)

What are the treatment options for dislocations?

immediate reduction and immobilization, surgical reduction might be required

Fracture (And Symptoms)

complete or partial break in bone

pain, swelling, bleeding, inability to move, bone misalignment, discoloration/bruising

Closed (Simple) Fracture

broken bone that does not come through skin

Open (Compound) Fracture

bone is broken and pierces through skin

increased risk of infection because the skin involved (wound)

Longitudinal Fracture

fracture extends along the length of the bone

Impacted Fracture

caused by strong forces that drive the bone fragments together

Comminuted Fracture

caused by severe, direct force, fracture with multiple fragments

Pathologic Fracture

break in the bone due to weakening of bones caused by disease

Greenstick Fracture

break in bone caused by compression of long bones in children under 10 years old

Avulsion Fracture

caused by forceful contractions of muscle against resistance

Compression Fracture

break caused by forces that drive bones together, typically seen in vertebrae

Depression Fracture

occurrs when bone fragments of skull are driven inwards

Non-Displaced Fracture

occurs when the bone end remains in alignment but other parts of the bone are fractured

What are some of the most common causes of musculoskeletal injuries?

physical injury, aging, disease progression

What details should an MA collect about musculoskeletal injuries from a patient?

patient description of pain and symptoms/feelings of the pain (e.g. burning, dull) and associated problems (e.g. numbness), pain time of onset, measures taken to alleviate, current concerns of patient, probable/exact anatomical location, pain scale 1-10, OTC and prescription meds taken (drug name, dosage, frequency, date and time of last dose)

How can an MA assist before and during an examination?

assist patient to exam room, help into comfortable position, may assist with changing into exam gown, educate patient about exam procedure, may demonstrate position patient must assume during exam

notify provider when patient exam-ready, take notes during exam, assist in handling equipment

Goriometer

hinged instrument with a scale to determine range of movement

What steps may an exam include (with some specific actions for examining joint movement)?

inspection, palpation, gait analysis, range of motion (ROM) of joints, measures of joint movements in a single plane

Range-Of-Motion (ROM) Evaluation

to evaluate range of motion of specific joints, two types

Active ROM

ask patient to move joint as far as comfortably possible

Passive ROM

patient relaxes, provider moves joint as far as possible

What does an MA do while the provider conducts a ROM test?

records degree of motion, note any pain, tenderness, or crepitation

Muscle Strength Evaluation

strength of muscle tested, normally strength equal bilaterally

Give an example of a muscle strength evaluation and describe the steps

comparing grip strength of both hands using blood pressure cuff

1. roll up aneroid blood pressure cuff and have patient hold it in one hand

2. inflate cuff to 20 mmHg pressure, lock valve

3. ask patient to squeeze cuff as tightly as possible

4. note dial pressure increase

5. record hand tested and results

6. repeat for other hand

X-Rays

used to diagnose fractures, dislocations, bone and joint diseases, monitor healing

Arthrogram

visualizes joints with X-rays after radiopaque dye injection

Bone Scan

evaluates areas of bone growth, tumors, other bone disease patterns, requires injected dye/isotope

Dual Energy X-Ray Absorptiometer (DEXA or DXA) Scan

assesses bone density, diagnoses and manages osteoporosis

CT Scan

diagnose tumors, lesions, some spinal injuries

Electromyography (EMG) and Nerve Conduction Velocity (NCV) Studies

evaluate muscle and nerve response to stimulus

Bone/Muscle Biopsy

identify malignant tumors, neoplasms, pathogens

Physical Treatment Methods (Modalities)

application of cold, heat, electric currents, therapeutic ultrasonography, massage therapy, therapeutic exercises, etc. to treat pain

Cold Application

recommended in first 48 hours after injury to control bleeding, pain, swelling

Heat Application

used after cold application to improve circulation, reduce pain, maintain muscle and joint function

Therapeutic Ultrasonography

uses ultrasound waves causing tissue to vibrate and generates heat, leading to increased metabolism and helps body’s healing process

high water content allows it to travel through muscles

Massage and Exercise

both non-invasive techniques to relax muscles

Massage

therapeutic stroking of body part to relieve localized and referred pain

Exercise/Stretching

help with muscle relaxation, promote healing, pain relief (as prescribed by physician)

Transcutaneous Electric Nerve Stimulation (TENS)

produces low-voltage current that stimulated motor and sensory nerves that affect muscles

What reactions does the body have to cold application? How does this help?

vasoconstriction, contraction of involuntary muscles of skin to reduce blood supply to area and produce sensory numbness

helps control bleeding, reduce further swelling, pain, inflammation

What precautions should you take before cold application?

check ice pack for leaks, place on area for 10 minutes then off for 10 minutes and repeat, inspect skin for color/feelings/pain after ice

What reactions does the body have to heat application? How does this help?

vasodilation, muscle relaxation, local warmth to increase blood flow and help reduce muscle spasm and pain

What precautions should you take before heat application? What should you not use it for/on?

inspect heating pad (don’t use if cord frayed), keep removable cover on while applying, place heating pad on top (don’t sit/lay on it because heat gets trapped), unplug when not in use

don’t use on sleeping/unconscious person, person who cannot feel the temperature, don’t use on infants, don’t use near O2 tank, don’t use longer than 30 minutes

Paraffin Bath

heat application method that treat chronic joint inflammation, helps get relief from conditions like rheumatoid arthritis

Ambulatory Assist Devices

aid in mobility

Wheelchairs

help patients who cannot walk/can only walk short distances

Mas lock wheels before transferring patient

Crutches

prevent weight-bearing on affected leg, foot, ankle

MAs advice patient to wear flat non-skid shoes

Canes

for individuals who need minimal assistance while walking

MAs advise patient to use cane on opposite side of affected leg, base careful about balance, support, and reduce weight-bearing

Walker

help balancing and supporting, especially for geriatric patients

MAs advise take first step with weaker leg and lift walker about arms length while proceeding

How do you properly fit crutches to a patient?

ensure crutch tips, axillary pads, and handgrip pads always in good condition

fit to patient 1-1.5 inches (2 finger widths) below armpits when standing straight

adjust handgrips so elbows close to body and bent ~30 degrees while holding

crutch tips ~2 inches to side of each foot

advice look straight while walking, not at feet

bear weight on hands and handgrips

remove rugs or any tripping hazards

report any numbness/tingling of arms/upper body to provider

Two-Point Crutch Gait

used if both legs weak, move left crutch and right foot together, right crutch and left foot together

Three-Point Crutch Gait

used if patient unable to bear weight on one leg, move both crutches and affected leg forward, then bear weight down through crutches and move unaffected leg forward

Four-Point Crutch Gait

best stability, helpful if both legs weak, move right crutch forward then left foot, followed by left crutch and right foot