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SportsInjuries[1].ppt
- 2. Objectives Identify signs and symptoms of common sports injuries Describe priority nursing interventions for the major sports injury categories
- 3. Types of Athletic Injuries Overuse or Chronic Injury – Bursitis – Tendinitis – Stress Fracture Acute Traumatic Injuries – Laceration – Abrasion – Sprains / Strains – Dislocations / Subluxations – Fractures
- 4. P-RICE-MM Treatment For Acute Sports Injuries Protection – Stabilize Area Rest – Stop All Activity Ice – 20 Min. Application Compression – Ace Wrap Under/Over Ice
- 5. P-RICE-MM Treatment For Acute Sports Injuries Elevation – Above Heart Medication – NSAIDs/ Analgesics – Muscle Relaxants Modalities – Diagnostic Testing – Physical Therapy
- 7. Head and Facial Injury Protective Sports Equipment – Blunt/Penetrating Eye Injury – Lacerations – Fractures – Spinal Cord Injury – Closed Head Injury Acceleration/ Deceleration Forces Rotational Forces Coup-countercoup Injury Tetanus Immunization
- 8. Sports Injuries of the Spine
- 9. Pinched Nerve Syndrome Mechanism of Injury – Sudden Direct Blow to One Side of Head Clinical Presentation – Paresthesia of Upper Extremity Diagnostic Testing – X-Rays / EMGs / NCS / Bone Scan Conservative Treatment – Initial Immobilization – P-RICE-MM – Protective Collars for Return to Play
- 10. Cervical Sprains / Strains Mechanism of Injury – Direct Trauma – Whiplash Effect – Strain - Stretching or Tearing of Muscles – Sprain – Stretching or Tearing of Ligaments Clinical Presentation – Immediate Onset of Pain & Muscle Spasms – Decreased Active Range of Motion Conservative Treatment – P-RICE-MM – Muscle Relaxants
- 11. Sports Injuries of the Upper Extremity
- 12. Shoulder Injuries Impingement Syndrome Rotator Cuff Injury Multifactoral Mechanism of Injury – Overuse Syndrome Clinical Presentation – Pain Over the Lateral and Anterior Shoulder Radiating Into Deltoid – Initially Pain Occurs With Activity Especially Overhead Motions – Progressing to Pain at Rest – Decreased and Painful Range of Motion – May Feel Shoulder Catch
- 14. Shoulder Injuries Rotator Cuff Musculature – Four Distinct Muscles – Supraspinatus Muscle Is the First Damaged Physical Examination – + Impingement Sign – Painful Arc Over 90 Degrees / ABD / ADD – + Hawkins Test – Cross Chest Adduction – Tenderness With Movement – + Drop Arm Test With Complete Rotator Cuff Tear
- 16. Shoulder Injuries Diagnostic Testing – X-rays to Rule Out Fracture – MRI scan to Rule Out Impingement Vs. Tendinopathy Vs. Tear Conservative Tx. – P-RICE-MM – NSAIDs – Cortisone Injections Surgical Intervention – Arthroscopic Debridement & Anterior Acromioplasty Possible AC Joint Resection – Open Acromioplasty – Rotator Cuff Repair – Mini Open Repair of the Rotator Cuff
- 17. Question # 1 Injuries to the rotator cuff musculature initially involve damage to the 1. Supraspinatus 2. Infraspinatus 3. Subscapularis 4. Teres minor
- 18. Answer # 1 Injuries to the rotator cuff musculature initially involve damage to the 1. Supraspinatus
- 19. Shoulder Instability Mechanism of Injury Clinical Presentation – Patient Reports a “Slipping” Within the Joint – Can Be In One or Multiple Directions – PE + Relocation Test + Sulcus Sign Diagnostic Testing – X-Rays / MRI Scan
- 20. Shoulder Instability Conservative Management – P-RICE-MM – Essential to Stop Overhead Activities Surgical Treatment – Capsulorrhaphy – Post-Op Rehab to Progress Slowly – Return to Play
- 21. AC Joint Separation Mechanism of Injury – Direct Blow Classifications – 1st Degree - Stretching with No Separation – 2nd Degree - Clavicle/Scapula Attachments Intact – 3rd Degree - Complete Separation AC Joint and Attachments Clinical Presentation – Pain / Swelling – Deformity in Higher Degrees – Decrease Range of Motion
- 22. AC Joint Separation Conservative Treatment – 1st & 2nd Degree AC Joint Separations P-RICE-MM Surgical Intervention – 3rd Degree and Higher Fixation Ligament Reconstruction Resection of Distal Clavicle
- 24. Question # 2 A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important piece of info would be: 1. Her overall grown and physical maturation in the past six months 2. Her swim stroke specialization and training routine 3. Her weight loss or gain in the past six months 4. Her plans for a college swimming scholarship
- 25. Answer # 2 A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important piece of info would be: 2. Her swim stroke specialization and training routine
- 26. Question # 3 A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find: 1. A positive McMurray test 2. Unilateral positive Relocation Test 3. Lack of tenderness over the affected joint 4. Unrestricted range of motion
- 27. Answer # 3 A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find: 2. Unilateral positive Relocation Test
- 28. Question # 4 The patient was placed on a conservative course of treatment. A primary nursing consideration for this patient is: 1. Allow her to continue to swim without any change in training 2. Encourage her not to swim if pain is present 3. Order her to cease all swimming and overhead activities 4. Tell her to swim per her coach and parents dictate
- 29. Answer # 4 The patient was placed on a conservative course of treatment. A primary nursing consideration for this patient is: 3. Order her to cease all swimming and overhead activities
- 30. Clavicle Fractures Direct Blow to Clavicle Region Presentation – Disfigure /Pain / Movement with Palpation Diagnostic Testing – Radiograph R/O SC Joint Derangement Conservative Treatment – Figure of 8 Harness Surgical Intervention – Plate & Screw Fixation
- 32. Epicondylitis Location – Medial - Golfers Elbow – Lateral - Tennis / Pitchers / Swimmer / Little League Mechanism of Injury – Overuse Syndrome Differential Diagnosis – Obtain X-Rays to Rule Out Loose Bodies Fracture Occult Injury Exostosis – Radial Nerve Entrapment – Radiocapitellar Degeneration
- 33. Epicondylitis Clinical Presentation – Well Localized Pain & Swelling – Difficulty / Pain w/ Supination & Pronation Conservative Treatment – P-RICE-MM – Cock-Up Splint for Wrist
- 35. Question # 5 Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun conservative treatment to prevent progression of this condition. If left untreated, a potential long term effect of epicondylitis is: 1. Compartment syndrome 2. Osteomyelitis 3. Flexion contracture 4. Carpal Tunnel
- 36. Answer # 5 Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun conservative treatment to prevent progression of this condition. If left untreated, a potential long term effect of epicondylitis is: 3. Flexion contracture
- 37. Hand Injuries Most Commonly Injured Body Site – Least Protected / Padded Area – Growth Plate Deformities Mechanism of Injury – Direct Trauma Most Common
- 38. Hand Injuries TRIGGER FINGER - Locking of Digit in Flexion - Often Self-Limiting - Direct Trauma - Stenosis of Tendon Sheath - Conservative Treatment - P-RICE-MM - Surgical Intervention - A1 Pulley Release MALLET FINGER - Extensor Tendon Injury at DIP Joint – Extensor Lag - Sudden Forced Flexion - Conservative Treatment - P-RICE-MM - 6-8 weeks immobilization - Surgical Intervention - K Wire Fixation - Rare – Open Cases Only
- 39. Hand Injuries GAMEKEEPER THUMB - Stiff PIP Joint – Degenerative Abduction Deformity MP UCL Insufficiency Possible Avulsion Fracture - Conservative Treatment - P-RICE-MM - Surgical Intervention - Early – UCL Reconstruction - Late – MP Fusion & Arthroplasty NAIL BED INJURIES - Disfigurement - Avulsion of Nail - Direct Trauma or Torsional - Conservative Treatment - P-RICE-MM - Drilling of Nail - Protective Padding for Return to Sports
- 40. Hand / Wrist Fractures Boxer’s Fracture – Metacarpal Neck Fracture – Palmer Angulation of Fracture Colles Fracture – Distal Radial Fracture – Silver Fork Deformity Scaphoid Fracture – Difficult Fracture to Heal
- 41. Sports Injuries of the Lower Extremity
- 42. Knee: Normal A & P
- 43. Knee – Ligamentous Injuries Function – Attaches Bone to Bone – Stabilizes Knee Mechanism of Injury – Torsional Injury Often with Direct Blow Medial & Lateral Collateral Ligaments – Grade 1 – Grade 2 – Grade 3
- 44. ACL Substitution Surgery AUTOGRAFT – Patient Graft Harvested Bone / Middle 1/3 Patella Tendon / Bone Graft – Arthrotomy – Post-Op 2 Areas for Healing Potential for Scarring / Osteophyte Formation at Patella ALLOGRAFT – Cadaver Bone / Patella Tendon / Bone Graft – Arthroscopically Assisted – Post-Op Fixation Site of Allograft Patella / Patella Tendon Complex Left Undisturbed
- 45. ACL Arthroscopy
- 46. Knee – Meniscal Injuries Function – Crescent Shaped Plates that Provide Stability – Transmits Axial Loads – Shock Absorbers / Joint Fillers Mechanism of Injury – Torsional / Rotational Injury – “Pop” or “Snap” Frequently Heard at Impact Incidence – 3-7 X Incidence of Injury to Medial Meniscus
- 47. Meniscal Injuries Clinical Presentation – Exquisite Joint Line Pain – Inability to Full Extend Lower Extremity – Buckling / Locking of Affected Joint – (+) McMurray Test Diagnostic Testing – X-Rays Rule Out Loose Bodies – MRI scan / Diagnostic Arthroscopy Conservative Treatment – P-RICE-MM
- 48. Meniscal Injury Arthroscopic Surgery Meniscal Repair – Smaller Vertical Tears – Surgically Sutured Partial / Total Removal (Meniscectomy) – Cut Out Tear – Back to a Stable Rim – Good For Large or Unstable Tears Bucket Handle / Vertical Allografting
- 50. Question # 6 You respond to an on field injury during a football game. The injured athlete reports hearing a “pop” in his knee. He is now unable to fully extend his knee. You would suspect an injury to the 1. Anterior Cruciate Ligament 2. Iliotibial Band 3. Articular Cartilage 4. Meniscus
- 51. Answer # 6 You respond to an on field injury during a football game. The injured athlete reports hearing a “pop” in his knee. He is now unable to fully extend his knee. You would suspect an injury to the 4. Meniscus
- 52. ITB Friction Syndrome Iliotibial Band – Provides Lateral Stabilization to Knee Joint Overuse Syndrome From Excess Friction Conservative Treatment – P-RICE-MM Surgical Intervention – Targeted to Remove Impinging Posterior Fibers – Rare
- 53. Iliotibial Band Stretch Purpose: To gain flexibility in the fibrous band of tissue that is located along the outside of the thigh and knee Start Position: Lying on your back with a rope looped around the foot of the leg to be stretched Action: Using the rope, pull the leg across your body at an angle approximately 20-30 degrees from the floor Parameters: Hold stretch for 30 seconds, Repeat 3-5 times Tips: Stabilize the hip of the side being stretched firmly to the ground so no rotation of your trunk occurs
- 54. PATELLA SUBLUXATION Medial Side Direct Blow Clinical Presentation – May Spontaneously Reduce – Unable to Extend – Muscle Spasms Conservative Treatment – P-RICE-MM – Knee Immobilization in Extension PATELLA DISLOCATION Medial Side Direct Blow Clinical Presentation – Buckling – Unable to Extend – Muscle Spasm – May Report “Pop” Conservative Treatment – P-RICE-MM – Knee Immobilization in Extension
- 55. Patellar Tendinopathies Patellar Tendinitis AKA Jumper’s Knee Overuse Syndrome Pain at Tibial Insertion Localized Swelling Conservative Treatment P-RICE-MM Chopat Brace
- 56. Patellar Tendinopathies Osgood Schlatter’s Disease Tibial Tubercle Apophysitis Point Tenderness Elevated Tibial Tubercle Conservative Treatment – P-RICE-MM – Protective Padding Surgical Intervention – Rare – Excision of Ossicle
- 57. Shin Splints / Stress Fractures Overuse Syndrome Micro Fractures Develop in Tibia Diagnostic Testing – X-Rays Rule Out Fracture – Bone Scan Differential Diagnosis of Stress Fracture Conservative Treatment – P-RICE-MM – Orthotics – Prevention
- 58. Question # 7 What diagnostic examination patient teaching would an office nurse need to conduct for a client having a work- up for shin splints? 1. NPO for an arthroscopy 2. Explanation of an orthotic evaluation 3. Determine potential allergies to arthrogram dye 4. Radioisotope injection for a bone scan
- 59. Answer # 7 What diagnostic examination patient teaching would an office nurse need to conduct for a client having a work- up for shin splints? 4. Radioisotope injection for a bone scan
- 60. Ankle Injuries Anatomy – The Ankle is a Hinged Joint – Distal Tibia/Fibula/ Medial & Lateral Malleolus/Talus – 3 Planes of Motion Dorsiflexion-Plantar Flexion Inversion-Eversion Abduction-Adduction
- 61. Ankle Sprain – Severity Guide GRADE I GRADE II GRADE III Mild Moderate Severe Some Tearing of Ligamentous Fibers Some Tearing of Ligamentous Fibers & Loss of Function Complete Rupture of Ligaments. Loss of Function & Instability of the Joint
- 62. Ankle Sprain – Severity Guide
- 63. Ankle Sprains Mechanism of Injury – Direct Trauma Clinical Presentation – Athlete Report Tearing at Moment of Impact – Unable to Bear Weight on Affected Ankle – Swelling/Stiffness (early) Ecchymosis (later) – Instability Medial + Anterior Drawer Medial Lateral
- 64. Question # 8 Nursing assessment of a suspected ankle injury would include: 1. Neurovascular assessment 2. Physical manipulation of the joint 3. Tetanus immunization status 4. Application of heat for comfort
- 65. Answer # 8 Nursing assessment of a suspected ankle injury would include: 1. Neurovascular assessment
- 66. Ankle Sprains Diagnostic Testing – X-Rays Rule Out Fracture or Avulsion Fracture – MRI / Arthrogram - Ligamentous Injury Conservative Treatment – P-RICE-MM – Initial Immobilization Posterior Splint with Ace Wrap Casting Ace Wrap and Air Cast
- 67. Question # 9 After applying a posterior splint and ace wrap to a patient with an ankle sprain, the nurse explains that they are used to allow: 1. for bruising which will occur 2. for early mobilization 3. for swelling which will occur 4. to allow weight bearing on affected ankle
- 68. Answer # 9 After applying a posterior splint and ace wrap to a patient with an ankle sprain, the nurse explains that they are used to allow: 3. for swelling which will occur
- 69. Ankle Sprains Surgical Intervention – Indicated for Complete Ruptures – Debridement of Joint / Suturing Torn Ligaments and Anterior Capsule For Instability Crisman Snook Procedure Complications of Ankle Sprains Scar Tissue Builds Risk of Recurrent Sprains Leads to Instability Requiring Surgical Stabilization
- 70. Achilles Tendinitis Achilles Tendon - Poor Capacity to Repair Common Overuse Syndrome Direct Trauma Can Lead to Rupture Clinical Presentation – Pain Stiffness Conservative Treatment – P-RICE-MM – Daily Stretching – Orthotics / Heel Lifts
- 71. Imaging of Sports Injuries For the Purpose of: – Differential Diagnosis R/O Fracture / Loose Bodies – Gradation of Injury G2-G2 Sprain/Separation – Treatment Protocols Reductions Conserv Vs. Surg. Intervention – Post-Treatment Status Reductions Healing Status