DA

Musculoskeletal Issues Notes (Week 9)

Skeletal Muscle Structure

  • Epimysium

  • Perimysium

  • Endomysium

  • Muscle fascicle

  • Muscle fiber

  • Sarcolemma

Bone Structure

  • Articular cartilage

  • Cancellous bone

  • Epiphyseal plate

  • Marrow cavity

  • Periosteum

  • Compact bone

  • Epiphysis, Head, Diaphysis (shaft)

Conceptual Focus

  • Functional ability

  • Infection

  • Mobility

  • Pain

  • Perfusion

  • Safety

Soft Tissue Injury (Table 67.2 – Key Injuries and Management)

  • Anterior cruciate ligament (ACL) tear

    • Cause: deceleration with pivoting

    • Management: physical therapy with rehab, knee brace; reconstructive surgery if instability persists

  • Impingement syndrome / rotator cuff issues

    • Management: rest, NSAIDs, gradual ROM; surgical repair if persistent

  • Meniscus injury

    • Management: rest, NSAIDs, gradual ROM; MRI if persistent; possible arthroscopic surgery

  • Shin splints

    • Management: rest, ice, elevation, NSAIDs; gradual return to activity; proper footwear

  • Tendonitis

    • Management: rest, NSAIDs, gradual strengthening

  • Periostitis (periosteal inflammation)

    • Management: rest, ice, NSAIDs; gradual activity; brace if recurrent

Emergency Management (Table 67.3 – Acute Soft Tissue Injury)

  • Causes include crush injuries, direct blows, falls, MVCs, sports injuries

  • Assessment findings: bruising, edema, pain, tenderness, pallor, limited movement, sensory changes

  • Interventions (Initial):

    • Ensure airway, breathing, circulation; neurovascular assessment

    • Elevate involved limb; apply compression if no dislocation; apply ice

    • Immobilize in position found; do not realign protruding bones

    • Obtain x-rays; provide analgesia; tetanus prophylaxis for open injuries

    • Antibiotic prophylaxis for open fractures or mangled injuries

  • Ongoing Monitoring: monitor neurovascular status; apply weight-bearing restrictions as ordered; monitor for compartment syndrome if concerns arise

Clinical Manifestations of Fractures

  • Bruising: discoloration distal to injury; usually normal and resolves

  • Crepitation: grating/crunching; may indicate risk of nonunion if moving ends excessively

  • Deformity: abnormal position; may impair bony union if not corrected

  • Edema and swelling: may indicate bleeding; risk of compartment syndrome if unchecked in closed spaces

  • Loss of function: impaired use of limb

  • Muscle spasm: protective response; may displace nondisplaced fractures

  • Pain & tenderness: due to tissue trauma and fragment movement

Diagnostic Tests for Fractures and Soft Tissue Injuries

  • Laboratory tests: CBC, BMP/CMP, CRP & ESR, PT/PTT, UA

  • Imaging:

    • X-ray: plain view, usually 1-view or 2-view; fracture/subtle fractures vs soft tissue injury; 2D picture

    • CT: detailed bone assessment; 2D/3D views for complex fractures; can show bleed

    • MRI: soft tissue, ligament, tendon, and occult fractures; show small details

Imaging Views

  • X-ray

  • CT

  • MRI

Types of Fractures

  • Open vs Closed

    • Open: skin broken; bone exposure with high infection risk

    • Closed: skin intact

  • Displaced vs Non-displaced

    • Displaced: bone ends off alignment; may be comminuted or oblique

    • Non-displaced: alignment preserved; often transverse, spiral, or greenstick

  • Complete vs Incomplete

    • Complete: break through entire bone

    • Incomplete: partial crack (e.g., bending/crushing)

Management and Interventions

  • Fracture Reduction

    • Closed reduction (manual) or Open reduction (surgical)

    • Traction as needed (skeletal/traditional)

  • Fracture Immobilization

    • Casting or splinting; external fixation; skeletal traction

  • Open Fractures

    • Surgical debridement and irrigation; antibiotics; tetanus immunization

  • Prophylaxis

    • Antibiotics for open fractures; tetanus/diphtheria vaccination as indicated

  • Internal/External Fixation

    • Open reduction internal fixation (ORIF); external fixation if needed

Emergency Management – Fractured Extremity (Table 67.7)

  • Initial: treat life-threatening injuries first; assess circulation, airway, and breathing

  • If deformity present: evaluate and monitor distal pulses; avoid realignment of joints; immobilize

  • Do not straighten fractured/dislocated joints; do not manipulate protruding bone ends

  • Apply ice; obtain x-rays; tetanus prophylaxis if skin breach

  • Mark pulses and monitor neurovascular status distal to injury

  • Ongoing: monitor vital signs, consciousness, oxygen saturation, pain

  • Monitor for compartment syndrome (pain with passive stretch, pallor, paresthesia, paralysis, pulselessness)

  • Monitor for fat embolism syndrome (dyspnea, chest pain, fever)

Nursing Management

  • Cardiovascular: assess distal pulses, skin temperature, cap refill

  • Neurovascular: assess sensation, paresthesia; monitor changes

  • Skin: look for lacerations, pallor, edema distal to injury

  • Functional status: resistance loss, deformity, limited movement

  • Diagnostics: X-ray, bone scan, CT, or MRI as indicated

Complications to Anticipate and Monitor

  • Infection: open fractures and soft tissue injuries have higher infection risk

  • Compartment syndrome: swelling increases pressure; monitor for 6 P's (pain, pressure, paresthesia, pallor, paralysis, pulselessness)

  • Venous thromboembolism (VTE): high risk with immobilization; initiate prophylaxis

  • Fat embolism: long bone fractures; monitor for respiratory symptoms; supportive care (O2, possible ECMO/Vasodilators)

  • Early detection and management are critical to reduce morbidity

Questions

  • Review key terms, injury mechanisms, and the corresponding urgent management steps for quick recall