Sprains, Strains, Amputation

Soft Tissue Injuries Overview: traumatic injuries

• Sprains

• Strains

• Dislocations

• Subluxations

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)

Sprains and Strains: Clinical Manifestations

• Bruising

• Decreased sensation

• Decreased movement/function

• Peripheral Vascular

  • Decreased pulse, Cool extremity, Pallor

  • Edema, Capillary refill > 3 seconds

• Pain or muscle spasm

Sprains and Strain DX and Complications

• Diagnosis

  • X-ray

• Complications:

  • Avulsion fracture

  • Subluxation

  • Dislocation

  • Hemarthrosis (bleeding into a joint)

Sprains and Strain Complications

• Subluxation 

• Dislocatins 

Sprains and Strains: teach 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

Amputation

• Traumatic or surgical removal of an extremity

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

• Diagnostic Studies

  • 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.

Amputation: clinical manifestions

• 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

Amputation Collaborative Care: postop 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 

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

  • Physical therapy

Amputation Collaborative Care Post-op

• Compression bandage until limb shrinks

• 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 

Amputation Collaborative Care Post-op

• Patient and caregiver education

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

  • Inspect limb daily, report changes

  • Wash limb daily

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

Amputation Collaborative Care Post-op: prevent 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. 

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

The nurse suspects an ankle sprain when a person at the Urgent Care describes which of the following?

Being hit by another soccer player during a game

Having ankle pain after sprinting around the track

Dropping a 10 pound weight on his lower leg at the gym

Twisting his ankle while running bases at a baseball game.

A patient has a severely sprained ankle from a sports injury. What should the nurse teach the patient prior to discharge from the urgent care center?

Alternate cold and heat for 30 minutes each until symptoms are relieved. 

Apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days. 

Use continuous cold for the first 24 hours and then continuous heat until the symptoms are relieved.

Apply continuous heat to the ankle for the first 24 hours and then continuous cold until the symptoms are relieved.

What are the key components of RICE therapy that should be implemented when caring for a patient with a muscle strain, and how should each component be applied?

What is the most appropriate way to manage phantom limb pain in a patient who recently underwent a below-the-knee amputation?