NCM 109: Musculoskeletal

• Sports Injuiries

  • Include a wide range of organized activities
• Sports Injuiries

  • 6x higher in men
• Sports Injuiries

  • Mostly common occurs during sports or exercise
• Acute Injuries

  • Occurs when there's a sudden stress on the body
• Main causes of acute Injuries

  • Collision with opponent or obstacle
  • Struck by an object
  • Falling from a height or speed
• Chronic Injuries

  • Caused by continuous on the body part for long period of time
• Causes of chronic Injuries

  • Training too hard, not allowing time for recovery, poor footwear and incorrect technique
• Causes of chronic Injuries

  • Over use injuries occurs due to a repeated powerful muscle movements
• Soft Tissue Injury

  • Most sport injury in older children and adolescents are not skeletal but rather injuries to soft tissues
• Types of Soft Tissue Injury

  • Sprains
  • Strains
  • Muscle Contusion
• Sprains

  • Stretching or tearing of a ligament from injury from joint; occur during forceful sports activities (Football and wrestling)
• Strains

  • Stretching or tearing of muscles or tendons due to over-stretching; excessive physical activity or effet
• Muscle contusion / Contusion

  • Damage to soft tissue (bruise) contact or collision type
• Clinical Manifestation of Sprains

  • Mild - Local tenderness, minimal swelling
  • Moderate - Partial joint instability, immediate pain, moderate swelling ecchymosis
  • Severe - Less pain, diffuse swelling, severe ecchymosis (black or blue discoloration)
• Clinical Manifestation of Strains

  • Mild - Local tenderness, minimal swelling, ecchymosis
  • Moderate - Pop is felt, small defect upon palpation
  • Severe - Popping or snapping sound, severe pain, marked ecchymosis, loss of function
• Clinical Manifestation of Contusion

  • Painful
  • Ecchymosis
  • S/ Sx of Inflammation (Swelling, Redness, and Warm temperature)
• Treatment for soft tissue injuries

  • Rest (24 - 48hrs)
  • Ice (15 - 20 min)
  • Compression
  • Elevation (30 min compression, 50 min Rest)
• Soft Tissue Treatment

  • Analgesic
  • Application of bandage or splints
  • Casting or bracing
  • Surgery
  • Physical Therapy
• Monitor Neurovascular status

  • Skin color
  • Capillary Refill
  • Skin temperature
  • Presence of pulses in the distant extremities
• Nursing Management

  • Crutch - Walking principle (if necessary)
• Dislocation

  • Displacement of two bones end or of a bone from its articulation with a joint
• Incidence and Etiology

  • Nursemaid's elbow - Stretching of baby's body part
• Treatment of Dislocation

  • Closed reduction - realignment of the bone without any surgical incision
• Fractures

  • Break or disruption in the structure of the bone when subjected to more energy that it can absorb
• Classification of Fractures

  • Upper Extremities fracture
  • Lower Extremities fracture
• Upper Extremity Fracture

  • Finger/Hands - Most frequent site of fracture in the children and adolescents; sports and direct trauma
• Upper Extremity Fracture

  • Clavicle - Common in children, neonates; Heals spontaneously without complication; Uses arm sling for 2-3 weeks
• Upper Extremity Fracture

  • Proximal humerus - Occurs with the shoulder injuries among children 9 -15 years
• Upper Extremity Fracture

  • Elbow Fracture - Cartilage slowly ossifies at the age of 11 in most children
• Upper Extremity Fracture

  • Supracondylar Fracture - involves malunion or displacement, neurovascular injuries are expected
• Upper Extremity Fracture

  • Distal Radius Fracture - Most common long bone fracture in children and adolescents
• Lower Extremity Fracture

  • Pelvic and Tibia eminence avulsion Fracture - Involves ligature attachments which tear away small fragments of the bone from the epiphyseal growth plate
• Lower Extremity Fracture

  • Femoral shaft - Requires hospitalization, treated with closed reduction and spica casting (younger children)
• Lower Extremity Fracture

  • Femoral shaft - Flexible/rigid intramedullary nailing (older adults and adolescent)
• Lower Extremity Fracture

  • Metatarsal/ Phalanx - 5th most common, followed by 1st metatarsal
• Lower Extremity Fracture

  • Tibia Fracture - Occur in trauma (fall vehicular accidents, sparing accidents)
• Lower Extremity Fracture

  • Femoral neck Fracture - Uncommon in children, associated with high energy trauma
• Lower Extremity Fracture

  • Ankle - one or more of the bones that make up the ankle joint are broken
• Types of break of the bone

  • Transverse
  • Oblique
  • Spiral
  • Greenstick
  • Buckle (torus)
  • Comminuted Fracture
• Transverse

  • Fracture line is at the right angle of the long axis of the bone