NUR 317 Sprain/Strain/Dislocation/Subluxation/CTS/ACL

What are common types of soft tissue injuries?

Sprains, strains, dislocations, and subluxations

Sprains

An injury to a ligament caused by stretching or tearing

Strain

Overuse, overstretching, or trauma that damages a muscle or TENDON

What is a dislocation?

A complete displacement of the bones forming a joint

What is a subluxation?

A partial displacement of the bones forming a joint

A sprain is an injury to a ______ surrounding a joint

Ligament

What causes a sprain?

A wrenching or twisting motion that overstretches or tears a ligament

What joints are most commonly affected by sprains?

Ankles, wrists, and knees

What is a first-degree sprain?

A mild sprain in which only a few ligament fibers are torn

What are the expected findings with a first-degree sprain?

Mild tenderness and minimal edema (swelling)

What is a second-degree sprain?

A moderate sprain involving partial disruption of ligament tissue

What are the expected findings with a second-degree sprain?

Swelling and tenderness

What is a third-degree sprain?

A severe sprain involving complete tearing of the ligament

What are the expected findings with a third-degree sprain?

Moderate to severe swelling and extreme pain

What complication is associated with a third-degree sprain?
Avulsion fracture

What is an avulsion fracture?

A fracture that occurs when a ligament or tendon pulls a piece of bone away from the main bone

A strain is excessive stretching of what structures?

Muscle, tendon, or fascial sheath

What areas are most commonly affected by strains?

Lower back, calf, and hamstring

What is a first-degree strain?

A mild strain involving a slightly pulled muscle

What is a second-degree strain?

A moderately torn muscle

What is a third-degree strain?

A severely torn or ruptured muscle

What are common clinical manifestations of sprains and strains?

Pain, edema, contusion, tiny hemorrhage/bruising, and decreased function

How long does it usually take for full function to return after a mild sprain or strain?

Approximately 3–6 weeks

What may be taken to rule out a fracture?

X-ray (severe sprain can cause an avulsion fracture)

What may be required for a severe strain?

Surgical repair of the muscle, tendon, or surrounding fascia

How long should RICE generally be used for acute sprains and strains?

24–48 hours

How does ice help an injury?

It helps decrease swelling, inflammation, and pain

How does compression help an injury?

It helps limit edema/swelling and provides support

How does elevation help an injury?

It helps reduce swelling by promoting venous return

Health promotion interventions to prevent sprain and strains

warm up before exercise, proper fitting shoes, improve/strength/balance/endurance, weight control

What medications may be used for pain and inflammation associated with sprains and strains?

NSAIDs

What causes dislocations and subluxations?

Joint instability, often resulting from trauma

What symptoms are common with both dislocations and subluxations?

Pain, soft tissue swelling, loss of functionality, and deformity

What are common upper-body sites of dislocation?

Thumb, elbow, and shoulder

What are common lower-body sites of dislocation?

Hip and kneecap (patella)

Why does a dislocation require prompt attention?

Can cause fractures within the joint, blood vessel & nerve damage of adjacent area, avascular necrosis, compartment syndrome

What are the two types of reduction used to treat a dislocation?

Open reduction (surgery) and closed reduction (no surgery)

Nursing care - dislocation and subluxation

support and protection of injured area, pain management, incision/dressing assessments & management, appropriate positioning/mobiliting, coordination with therapy

What is carpal tunnel syndrome?

A compression neuropathy caused by pressure on the median nerve as it passes through the carpal tunnel

Who is more likely to develop carpal tunnel syndrome?

Women

When may carpal tunnel syndrome commonly occur in women?

During the premenstrual period, pregnancy, and menopause

History and Physical CTS diagnostics

decreased sensation to light tough in affected fingers, inflated BP cuff > SBP for 1-2 min

What diagnostic test evaluates median nerve motor conduction?

EMG (electromyography)

What is Tinel's sign? CTS diagnostics

Tingling over the median nerve when it is lightly percussed

What is Phalen's maneuver? CTS diagnostics

A test in which the patient flexes the wrists for about 1 minute to assess for tingling over the median nerve

What does thenar muscle atrophy indicate in CTS?

It indicates median nerve compression/dysfunction and may occur in about 50% of cases according to your notes

Tinel's = Tap

Tap/percuss over the median nerve → tingling?

Phalen's = Flex

Flex wrist for 1 minute → tingling?

Carpal Tunnel Syndrome Management (Prevention)

adaptive devices, ergonomic considerations (work), NSAIDs, physical therapy exercises, corticosteroid infections

When might surgery be considered for CTS?

if symptoms are persistent; full recovery may take months

What does ACL stand for?

Anterior cruciate ligament

How does an ACL injury usually occur?

Often through a noncontact injury

What activities commonly cause ACL injuries?

Pivoting, landing from a jump, or suddenly slowing down while running

What might a patient report immediately after an ACL injury?

knee may feel unstable after coming down on it, twisting it, or hearing a “Pop”; acute pain, edema

What is the Lachman's test?

A test used to assess ACL integrity by evaluating forward movement of the tibia

How is the Lachman's test performed?

The knee is flexed approximately 15–30°, the femur is stabilized, and the tibia is pulled forward

What makes a Lachman's test positive?

Excessive forward movement of the tibia while femur is stabilized

What imaging study can confirm an ACL injury?

MRI

What are conservative treatments for an ACL injury?

Aspiration of effusion, immobilizer/brace, and physical therapy

When may reconstructive surgery be needed for an ACL injury?

severe injury, graft tissue replaces torn ACL