1. Maria Carmela L. Domocmat, RN,MSNInstructorSchool of NursingNorthern Luzon Adventist CollegeArtacho, Sison, Pangasinan
2. Overview Part 1: Degenerative & Part 3: Muscular disorders Metabolic bone disorders Muscular dystrophy OA Rhabdomyolysis Gout and gouty arthritis Part 4: Disorders of the Osteoporosis hand Paget’s dse Carpal tunnel syndrome Osteomalacia Dupuytren’s contracture Part 2: Bone infections Ganglion Osteomyelitis Septic arthritis3/5/2012 Maria Carmela L. Domocmat, RN, MSN 2
3. Overview Part 5: Spinal column Corn deformities Callus Scoliosis Ingrown Nail Kyphosis Hypertrophic Ungual Labium Lordosis Osteogenesis imperfecta (OI) Part 7: Sports Injuries Sprain Part 6 : Disorders of foot Strain Hallux valgus (bunions) Tennis elbow Morton’s neuroma (plantar Impingement and rotator cuff neuroma) tears Hammer toe Knee injuries (ACL injury, Tarsal tunnel syndrome meniscal injury, overuse syndrome) Plantar Fasciitis3/5/2012 Maria Carmela L. Domocmat, RN, MSN 3
4. Sports Injuries Sprain Strain Tennis elbow Impingement and rotator cuff tears Knee injuries (ACL injury, meniscal injury, overuse syndrome)3/5/2012 Maria Carmela L. Domocmat, RN, MSN 4
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6. Sprain A sprain is a stretched or torn ligament. Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting hit can all cause a sprain. Ankle and wrist sprains are common. Symptoms include pain, swelling, bruising and being unable to move your joint. You might feel a pop or tear when the injury happens. A strain is a stretched or torn muscle or tendon. Tendons are tissues that connect muscle to bone. Twisting or pulling these tissues can cause a strain. Strains can happen suddenly or develop over time. Back and hamstring muscle strains are common. Many people get strains playing sports. Symptoms include pain, muscle spasms, swelling and trouble moving the muscle. At first, treatment of both sprains and strains usually involves resting the injured area, icing it, wearing a bandage or device that compresses the area, and medicines. Later treatment might include exercise and physical therapy. NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseaseshttp://www.nlm.nih.gov/medlineplus/sprainsandstrains.html
8. Ankle sprain An ankle sprain is a common injury to the ankle. The most common way the ankle is injured is when the ankle is twisted inward (inversion injury). With this injury, ligaments that support the ankle can be torn which lead to swelling, inflammation, and bruising around the ankle. An ankle sprain injury may take a few weeks to many months to fully heal.http://www.nlm.nih.gov/medlineplus/ency/imagepages/19577.htm
9. The most common way the ankle can be injured is byan ankle sprain.When an ankle is sprained ligaments on the ankle areeither stretched, partially torn or completely torn.The most common type of sprain is an inversioninjury, where the foot is rotated inward. http://www.nlm.nih.gov/medlineplus/ency/ presentations/100209_4.htm
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11. Ankle sprains can range from mild, to moderate, and severe. Type 1 ankle sprain is a mild sprain. It occurs when the ligaments have been stretched or torn minimally.3/5/2012 Maria Carmela L. Domocmat, RN, MSN 14
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14. Type II ankle sprain is a moderate level of sprain. Itoccurs when some of the fibers of the ligaments aretorn completely.
15. Type III ankle sprain is the most severe ankle sprain.It occurs when the entire ligament is torn and there isgreat instability of the ankle joint.
16. Grade III ankle sprain
17. Minor injuries like sprains may be treated at home ifbroken bones are not suspected.The acronym RICE is helpful in remembering how to treatminor injuries: "R" stands for rest, "I" is for ice, "C" is for compression, "E" is for elevationPain and swelling should decrease within 48 hours, andgentle movement may be beneficial, but pressure shouldnot be put on a sprained joint until pain is completely gone(one to several weeks). http://www.nlm.nih.gov/medlineplus/ency/imagepages/ 19396.htm
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25. Lateral epicondylitis inflammation, soreness, or pain on the outside (lateral) side of the upper arm near the elbow. There may be a partial tear of the tendon fibers, which connect muscle to bone. The tear may be at or near where these fibers begin, on the outside of the elbow.
26. Causes, incidence, and risk factors Tendon - part of the muscle that attaches to a bone Muscles in forearm attach to the bone on the outside of elbow. When these muscles are used over and over again, small tears develop in the tendon. Over time, this leads to irritation and pain where the tendon is attached to the bone.
27. Causes, incidence, and risk factors common in people who play a lot of tennis or other racquet sports, hence the name "tennis elbow." Backhand is the most common stroke to cause symptoms. However, any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to this condition. Common among painters, plumbers, construction workers, cooks, and butchers are all more likely to develop tennis elbow. This condition may also be due to constant computer keyboard and mouse use
28. Tennis elbow is most commonly seen in two groups ofpeople: Manual Laborers People who work with their hands are at greater risk of developing tennis elbow. Jobs that may lead to tennis elbow include plumbers, painters, gardeners, and carpenters. Sports Participants Sports participants, especially racquet sport players, are prone to developing tennis elbow. About a third of amateur tennis players experience tennis elbow at some point in their careers. In addition to racquet sports, tennis elbow is seen in golfers, fencers, and other sports participants.
29. Symptoms Elbow pain that gradually worsens Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting Weak grasp Pain over the outside of the elbow Pain when lifting objects Pain radiating down the forearm
30. Dx diagnosis is made based on signs and symptoms, because x-rays are usually normal. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow. pain near the elbow when the wrist is extended (bent backwards, like revving a motorcycle engine) against resistance. X-rays are rarely needed.
31. Treatment Rest arm avoid the activity that causes symptoms for at least 2 - 3 weeks. Put ice on the outside of elbow 2 - 3 times a day. NSAIDs ( ibuprofen, naproxen, or aspirin).
32. If due to sports activity Ask about any changes can make in technique. Check any sports equipment client is using to see if any changes may help. Ask about how often client have been playing and whether he/she should cut back.
33. occupational therapist can show exercises to stretch and strengthen the muscles of forearm.special brace for tennis elbow It wraps around the first part of forearm and takes some of the pressure off the muscles.cortisone injectionIf the pain continues after 6 - 12 months of rest andtreatment - surgery may be recommended
34. Surgical tx debridement of the diseased tissue of the extensor carpi radialis brevis (ECRB) muscle with decortication of the lateral epicondyle. performed through open, percutaneous, and arthroscopic approaches.
36. Expectations (prognosis) Most people improve with nonsurgical treatment. The majority of those who do have surgery show an improvement in symptoms.
37. Complications Failure to improve with nonsurgical or surgical treatment. This may be due to nerve entrapment in the forearm Recurrence of the injury with overuse Rupture of the tendon with repeated steroid injections
38. Prevention Apply an ice pack to the outside of the elbow Maintain good strength and flexibility in the arm muscles and avoid repetitive motions Rest the elbow when bending and straightening are painful
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42. ACL Injury Meniscal Injury Overuse Syndrome3/5/2012 Maria Carmela L. Domocmat, RN, MSN 53
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53. Overuse syndrome is a condition where a part of the body is injured by repeatedly overusing or exerting to much strain on that body part. The term overuse syndrome identifies a large group of conditions that result from using the body in a repetitious way and causing injury by the amount it is done. These conditions are often focused on a joint and usually affect the muscle, bone, tendon or bursa of the joint. However other anatomical features and areas can be stressed and their response to that strain can be an injury.3/5/2012 Maria Carmela L. Domocmat, RN, MSN 64
54. Some common examples of overuse syndrome are: Carpal Tunnel Syndrome Tendonitis Bursitis Tennis Elbow Trigger Finger Blackberry Thumb Vibration White Finger Shin Splints Calluses Bunyan3/5/2012 Maria Carmela L. Domocmat, RN, MSN 65
55. Bursitis A bursa is a fluid filled sac. They are located around joints and reduce friction and ease movement as tendons or muscles pass over bones or skin.3/5/2012 Maria Carmela L. Domocmat, RN, MSN 66
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