Musculoskeletal Trauma, Carpal Tunnel & More

Safety and Prevention of Musculoskeletal Trauma

• Safety education for patients should include home, work, and driving safety.
  • Consistent use of seat belts.
  • Adhering to speed limits.
  • Stretching before exercise.
  • Using protective gear like helmets and elbow pads.
  • Avoiding drinking and driving.

Fall Prevention in the Elderly

• The elderly population is at high risk for falls.
• Environmental modifications:
  • Secure rugs with adequate lining to prevent slips.
  • Ensuring appropriate footwear.
  • Keeping pathways clear of obstacles.
• Adequate intake of calcium and vitamin D is crucial to combat bone density loss.

Contusions (Soft Tissue Injuries)

• Contusions result from blows or blunt force trauma, causing bleeding under the skin and potential hematoma formation.
• Brain contusions are the most serious.
• Large contusions can lead to extensive soft tissue bleeding and potentially develop into cellulitis.
• Treatment:
  • Apply ice or cold compresses for 15-20 minutes over 12-36 hours for vasoconstriction.
  • Elevate the affected extremity to reduce edema and pain.

Whiplash

• Whiplash involves injury to the cervical spine, often from rear-end car accidents.
• Symptoms:
  • Pain in the cervical area, which can radiate down to the arms and fingers.
  • Paresthesia (numbness or tingling).
  • Dizziness, blurred vision, and headaches.
  • Potential edema in the spinal area.
• Monitoring:
  • Vital signs for increased intracranial pressure.
  • Neurological assessments.
• Medical Management:
  • Analgesics and muscle relaxants for pain.
  • Surgery may be necessary depending on the extent of the injury.
  • Special exercises and heat therapy.
  • Soft brace collar.
• Interventions:
  • Immobilization and rest.
  • Cervical traction if needed.

Sprains

• Sprains involve wrenching or twisting of a joint, leading to ligament damage (twisting or tearing).
• Symptoms:
  • Rapid swelling.
  • Muscle spasms.
  • Pain with movement and tenderness to touch.
  • Limited range of motion and function.
  • Ecchymosis (bruising).
• Diagnosis:
  • X-ray.
  • Surgical intervention for severe cases.
• Treatment:
  • RICE: Rest, Ice, Compression, Elevation.
    • Ice application for 15-20 minutes intermittently during the first 12-36 hours to reduce edema.
    • Mild heat can be applied after 24 hours to promote absorption of blood and fluid.
    • Compression with dressing and splinting to support the area and aid healing.

Strains

• Strains involve minute muscle tears and overstretching of tendons.
• Symptoms: Similar to sprains, including pain and edema.
• Diagnosis: Ruled out via X-ray; surgical repair for severe cases.
• Interventions: Similar to sprains; ice application.
• Back Strains: The most common type.
  • Avoid strenuous activities.
  • Use a firm chair with back support.
  • Avoid high-heeled shoes and soft mattresses; use firm mattresses instead.
  • Avoid sleeping on the abdomen.

Sprains vs. Strains

• Strains involve muscle tears and tendon overstretching.
• Sprains involve joint twisting.

Dislocations

• Dislocations are visibly noticeable and cause shortening of the affected area.

Fall Prevention

• Maintain an accident-free environment by removing rugs and obstacles.
• Ensure proper use of gait enhancers.
• Advise against climbing on ladders.

Carpal Tunnel Syndrome

• A painful disorder involving the wrist and hand, common in professions with repetitive motions (e.g., computer work, hairdressing).
• Inflammation and edema of the synovial lining of the tendon sheath.
  • Symptoms
    • Gradual to increased numbness and tingling in the thumb, index, and middle fingers.
    • Burning or tingling pain, often relieved by shaking the hands.
    • Intermittent or constant pain, typically more intense at night.
    • Numbness in the affected extremity.
  • Diagnostic Tests
    • Positive Tinel's sign: increased tingling with gentle tapping over the tendon sheath.
    • Evaluation for edema of the fingers.
    • Electromyogram and MRI.
  • Treatment
    • Splint or immobilizer.
    • Hydrocortisone acetate injections into the carpal tunnel.
  • Interventions
    • Wrist splint to relieve pressure and lessen flexion.
    • Range of motion exercises to reduce stiffness.
    • Restriction of twisting and turning activities.

Herniated Discs

• Herniated nucleus pulposus can result from sudden movements, trauma, or gradual degeneration due to aging, osteoporosis, or chronic diseases.
  • Clinical Manifestations
    • Radicular pain radiating down the leg along the sciatic nerve.
    • Numbness and tingling in the affected leg.
    • Activity intolerance and changes in bowel or bladder elimination.
    • Neck pain, headache, and rigidity.
    • Loss of strength in the arms.
  • Diagnostic Tests
    • History and physical examination (H&P).
    • Radiographic examinations (CT, MRI, electromyography, myelography).
  • Treatment
    • Pain medication, NSAIDs, physical therapy, and TENS units.
    • Injections and various surgical procedures (artificial disc replacement, chemonucleolysis, discectomy, endoscopic spinal microsurgery, laminectomy, and spinal fusion).
  • Interventions
    • Inform the family and patient about the condition and treatment.
    • Administer medications as prescribed.
    • Use distraction, heat or ice application, log rolling, and repositioning every two hours unless contraindicated.
    • High protein, iron, and vitamin-enriched diet.
    • Monitor dressings for bleeding or cerebrospinal fluid (CSF) leakage.
    • Apply anti-embolism stockings and document intake and output meticulously.
    • Ensure the patient voids within the first 6-8 hours post-surgery.
    • Encourage sitting in a straight, firm chair for no longer than 30 minutes at a time.
    • Monitor for distress and paralytic ileus, which are complications associated with laminectomies.
    • Activity: Out of bed as early as one day after a simple laminectomy, or two to four days after a fusion.
    • Braces or corsets (TLSO braces) may be required.
    • Do not lift or carry anything heavier than 5-10 pounds for at least eight weeks.
    • Avoid driving and twisting motions of the trunk until permitted.

Amputation

• Removal of a portion or the entire extremity due to tumors, injuries, or impaired circulation (e.g., diabetes).
  • Postoperative Assessment and Interventions
    • Amputation of long bones can result in postoperative anemia.
    • Observe for phantom pain, which is a normal sensation where the patient feels pain as if the missing limb is still there.
    • Observe for signs of hemorrhage (low blood pressure, high heart rate, tachypnea, pallor) and monitor urinary output.
    • Perform neurological assessments.
  • Nursing Interventions
    • Pain management and prevention of deformity.
    • Care of the stump, avoiding prolonged hip flexion (do not elevate on a pillow after surgery).
    • Encourage movement from side to side and place the patient in the prone position at least twice a day.
  • Patient Education
    • Reiterate that phantom limb sensation is normal.
    • For persistent severe phantom pain, potential interventions include stump revision, local infiltration with propane, mechanical percussion, nerve blocks.
    • Encourage sharing feelings about the loss of the extremity and allow the grieving process.
    • Discuss the importance of allowing that grieving process to occur. (Ethical and psychological implications: the significance of validating the patient's grief and loss, and the need for emotional support and counseling to facilitate adjustment and acceptance.)