Transcript PPT
Adult Medical-Surgical Nursing Musculo-skeletal Module: Sports/ Soft Tissue Injuries Musculo-skeletal Trauma/ Common Sports Injuries Contusion: soft tissue bruising Strain: pulled muscle Sprain: damaged joint ligaments Dislocation: joint out of position Subluxation: partial dislocation Tendonitis: inflammation of tendons Ruptured tendon Torn meniscus Fracture (see lecture) Soft Tissue Injuries: Pathophysiology Sudden strain, twisting, tearing or dislocation (trauma) leads to: Inflammatory response to neutralise, control and wall-off the injured area and prepare for repair Soft Tissue Injuries: Inflammatory Response Mediated by chemicals, histamine, kinins (bradykinin), prostaglandin from injured tissue. Leads to: Vasodilation/ increased blood supply Increased vascular permeability and infiltration of leucocytes for phagocytosis of debris/ pathogens Fibrinogen to fibrin for clotting (to wall-off/ prevent systemic infection) Inflammatory Response: Clinical Effects The clinical effects of the increased blood flow and vascular permeability are: Pain (congestion of the area/ kinins) Heat Swelling Redness Loss of function Soft Tissue Injury/ Sprain Sprain: Description Damage to the ligaments of a joint as a result of sudden abnormal or amplified, extended movement Soft Tissue Injury/ Sprain: Clinical Manifestations Pain on movement Pain at rest Swelling Bruising Restricted range of movement from pain and oedema General symptoms: nausea, faintness at time of injury Soft Tissue Injury/ Sprain: Diagnosis Usually diagnosed by patient history and clinical picture Soft Tissue Injury/ Sprain: Management Rest Ice Compression Elevation Analgesia and anti-inflammatory drugs Gradual exercise with rehabilitation Joint Dislocation/ Subluxation Joint Dislocation: Description Damage with displacement of a joint as a result of sudden abnormal or amplified, extended movement Involves muscles, ligaments, tendons Joint Dislocation: Clinical Manifestations Severe acute pain on slightest movement with faintness, nausea Dull ache or pain at rest Deformity of joint Possible swelling or bruising Reduced range of movement Possible numbness, tingling, coolness, discoloration of affected limb (neurovascular involvement) Joint Dislocation: Diagnosis Patient history Clinical picture Xray MRI for soft tissue injury Joint Dislocation: Management Immobilisation Reduction under anaesthesia (displaced parts into position) Support in correct position (bandages, slings, splints) Analgesia, anti-inflammatory drugs, muscle relaxants Observe neurovascular status Gradual rehabilitation exercises Injury to Tendons Common Injury to Tendons: Classification Ruptured Achilles tendon (calf) Rotator Cuff tears (acromioclavicular joint/ shoulder): acute injury or chronic joint stress Tendonitis: “Tennis Elbow” (affects wrist grasp also) Ruptured Achilles Tendon Ruptured Achilles Tendon: Description A sudden acute tear of the Achilles tendon usually in a sports activity Ruptured Achilles Tendon: Clinical Manifestations Sudden area Inability Shock, acute, extreme pain in calf to plantar flex nausea, faintness Ruptured Achilles Tendon: Diagnosis Patient history Clinical Picture Xray: exclude bony injury Ruptured Achilles Tendon: Management Immediate analgesia Prompt repair under anaesthesia Immobilise with plaster cast Elevate and rest Observe circulation to toes Static quads exercises: improve circulation/ muscle tone Progressive physio: promotes ankle strength/ movement until full weight-bearing Rotator Cuff Tears: Rotator Cuff Tears: Description Acute injury or chronic shoulder tendon Rotator Cuff Tears: Clinical Manifestations Painful shoulder joint Limited range of movement Some joint dysfunction/ muscle weakness Unable to perform over the head activities Night pain: unable to sleep on affected side Acromioclavicular joint is tender Rotator Cuff Tears: Diagnosis Patient history Clinical picture Xray (joint structure) Arthrography MRI (soft tissue/ extent of rotator cuff tear) Rotator Cuff Tears: Management Anti-inflammatory drugs Rest and modify activity Local corticosteroid injection (joint) Progressive strengthening exercises Surgery if unresolved: arthroscopic debridement or tendon repair Immobilisation of shoulder up to 4 weeks then physio “Tennis Elbow”: Tendonitis “Tennis Elbow”/ Tendonitis: Description Excessive repetitive activities of the forearm causing inflammation and minor tears of the tendons (affecting elbow and wrist grasp) A chronic painful condition “Tennis Elbow”/ Tendonitis: Clinical Manifestations Pain which characteristically radiates down the dorsal surface of the forearm Weakened Diagnosis picture grasp from history and clinical “Tennis Elbow”/ Tendonitis: Management Rest and avoid aggravating activity Anti-inflammatory drugs Immobilisation in splint may be helpful Corticosteroid injection locally if other measures not effective Rehabilitation exercises to gradually stretch the tendons Support strap to prevent recurrence Meniscal Injury Meniscal Injury (Torn Meniscus): Description The menisci are the 2 semi-lunar cartilages of the knee joint attached to the head of tibia allowing articulation with the femur Meniscal Injury: Aetiology Injury and tearing away from the tibia occurs with: Excessive twisting of the knee Repetitive squatting and impact Mostly sports injury Meniscal Injury: Pathophysiology Loose cartilage in knee joint slips between tibia and femur interfering with movement Inflammatory response process set up in Meniscal Injury (Knee Joint): Clinical Manifestations Inability to fully extend the leg If happens during walking/ running: leg “gives way”. It is painful and unexpected Clicking of the knee on extension/ weight-bearing Locking of the knee Inflammation and swelling/ effusion of knee joint (torn cartilage) Meniscal Injury (Knee Joint): Diagnosis Patient history and clinical picture Meniscal Injury (Knee Joint): Management Conservative management: Immobilisation of the knee Crutches and modification of activities Anti-inflammatory medications If symptoms persist: Arthroscopy to determine damage and surgery: Meniscectomy (removal of torn cartilage) Meniscectomy: Post-operative Care Pressure dressing applied to knee to prevent effusion Immobilisation with splint Rest with leg elevated Static quads/straight-leg-raising exercises If effusion occurs (painful): Aspirated to relieve pressure Usually able to resume normal activities in days Sports/ Soft Tissue Injuries: Nursing Considerations Emotional/ psychological support throughout care Stay with patient at time of injury Ensure prompt analgesia/ comfort Observe vital signs/ neurovascular function of affected limb Hand-washing and aseptic technique Encourage appropriate exercises