sprains, strains, and amputations

what is a sprain and a strain

• Sprain: injury to ligaments (connect bones together at joints) around a joint

  • Wrenching or twisting motion   

• Strain: excessive stretching of muscle and fascia sheath; may involve tendon (connect muscle to bone)

clinical manifestations of sprains and strains

• Bruising

• Decreased sensation

• Decreased movement/function

• Peripheral Vascular

  • Decreased pulse

  • Cool extremity

  • Pallor

  • Edema

  • Capillary refill > 3 seconds

• Pain or muscle spasm

sprains and strains dxcs

X-ray

complications of sprains and strains

• Avulsion fracture: tendon of ligament tightly attached to bone that when sprain happens a piece becomes out of place

• Subluxation bone: slightly outta socket 

• Dislocation bone: fully outta socket

• Hemarthrosis (bleeding into a joint): pierced the blood vessels that run around muscle/ligament

sprains and strains health promotion

• Warm up exercises and stretching

• Strength, balance, and endurance exercises

sprains and strains acute care

• RICE: rest, ice, compression, and elevation

• Rest: Stop activity and limit movement

• Ice: 24 to 48 hours; 20 to 30 minutes at a time

• Compression: elastic bandage; apply distal to proximal to immobilize. Numbness and tingling if wrapped too tight.

• Elevate: above the heart

• Analgesia

what is an amputation

• Traumatic or surgical removal of an extremity

  • Many amputations done because of PVD, diabetes, osteomyelitis, trauma

dxc that indicates an amputation is needed

Ultrasonic Doppler studies

amputation collaborative care

• Address infection and chronic illnesses before amputation

• Surgical goal

  • Preserve as much extremity length and function as possible while removing infected,  pathologic, or ischemic tissue

  • If residual limb is weight bearing, the incision will not be on the weight bearing area.

types of amputations

• above elbow amputation

• below elbow amputation

• above the knee amputation

• below the knee amputation

after amputation clinical manifestations

• Vascular changes 

• Neurologic changes

amputation priority problems

• Disturbed body image 

• Impaired tissue integrity

• Chronic pain

• Impaired mobility

amputation collaborative care

• Communication

  • Psychological and social implications of amputation: Counseling or support groups

  • Body image

post op amputation care

• Phantom limb sensation…True pain

  • Shooting, burning, or crushing pain and feelings of coldness, heaviness, and cramping

  • May subside or be chronic

  • Give pain medication, antidepressants or anticonvulsants specf. nerves

  • Mirror therapy: visual information replaces sensory feedback in the brain

  • Physical therapy

• Compression bandage until limb shrinks immediately

• Active ROM and strengthening exercises daily

• Prepare for mobility; altered balance, proprioception, and coordination are addressed to prevent falls and injury

• Crutch walking until prosthesis (later)

• Prevent flexion contracture

post op amputation teaching

• Residual limb care, ambulation, contracture prevention, recognition of complications, exercise, safety precautions, and follow-up care

• Prevent flexion contracture by having pts avoid sitting in a chair for more than 1 hour with hips flexed or elevating amputated limb with pillows.  Teach pt to lie on abdomen for 30 minutes, 3 or 4 times a day, unless contraindicated.

• Inspect limb daily, report changes

• Wash limb daily

• No lotions, alcohol, oil, or powders on residual limb

amputation rehabilitation and evaluation

• Accept changed body and integrate changes into lifestyle

• Have no evidence of skin breakdown

• Have reduction of absence of pain

• Become mobile within limitations imposed by amputation