Strains, Sprains, and Dislocation

What is a strain?

excessive stretching of muscle and fascia that may/may not involve tendon

• there are three degrees:

  • 1st degree - mildly/slightly pulled

  • 2nd degree - moderately torn muscle

  • 3rd degree - severely torn or ruptured muscle

What is a sprain?

Injury to the ligaments around a joint, usually caused by wrenching or twisting motion

• there are 3 degree of sprains

  • 1st degree - few fiber tears, mild tenderness/swelling

  • 2nd degree - partial disruption of tissue, increased tenderness/swelling

  • 3rd degree - complete tear w/moderate-to-severe swelling

What it the tx for sprains/strains?

• usually self limiting and returns to full function w/in 3-6wks

• For acute phase - RICE

  • Rest

  • Ice - reduces pain, spasms, inflammation, and edema

    • apply immediately after injury and 24-48hrs after for no more than 20-30mins at a time

  • Compress - decreases edema and pain

    • wrap starting distally and progressing proximally

    • leave on for 30mins then remove for 15

  • Elevate - to prevent edema

    • elevate above heart for 24-48hrs

• After acute phase - moist heat to reduce swelling and discomfort

  • application should not exceed 20-30mins

  • use limb if it is protected by cast/brace/splint/taping

• Analgesics may be used to manage discomfort

What is the nursing management for strains/sprains?

• education

  • warm muscles prior to exercise and other vigorous activity

  • stretch muscles after exercise

• Administer analgesics

What is disclocation?

An orthopedic emergency that consists of the complete displacement/separation of the articular surfaces of the joint

What are the clinical manifestations of dislocation?

• Deformity

• Local pain and tenderness

• Loss of function

• Swelling

What is the management of dislocation?

• Realign dislocation to original positioning with a:

  • closed reduction with anesthesia

  • open reduction

• After alignment, immobilize with brace/splint/sling/taping

• Neurovascular assessments

What are the potential complications of dislocation?

• Vascular injury

• open joint injury

• avascular necrosis

• compartment syndrome