spor ts injuries. objectives identify signs and symptoms of common sports injuries describe...
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SporSpor ts Injuriests Injuries
ObjectivesObjectives
Identify signs and symptoms of common Identify signs and symptoms of common sports injuriessports injuries
Describe priority nursing interventions for Describe priority nursing interventions for the major sports injury categoriesthe major sports injury categories
Types of Athletic InjuriesTypes of Athletic Injuries
Overuse or Chronic InjuryOveruse or Chronic Injury– BursitisBursitis– Tendinitis Tendinitis – Stress FractureStress Fracture
Acute Traumatic InjuriesAcute Traumatic Injuries– LacerationLaceration– AbrasionAbrasion– Sprains / Strains Sprains / Strains – Dislocations / SubluxationsDislocations / Subluxations– FracturesFractures
P-RICE-MM TreatmentP-RICE-MM TreatmentFor Acute Sports InjuriesFor Acute Sports Injuries
ProtectionProtection– Stabilize AreaStabilize Area
RestRest– Stop All ActivityStop All Activity
IceIce– 20 Min. Application20 Min. Application
CompressionCompression– Ace Wrap Under/Over IceAce Wrap Under/Over Ice
P-RICE-MM TreatmentP-RICE-MM TreatmentFor Acute Sports InjuriesFor Acute Sports Injuries
ElevationElevation– Above HeartAbove Heart
MedicationMedication– NSAIDs/NSAIDs/
AnalgesicsAnalgesics– Muscle RelaxantsMuscle Relaxants
ModalitiesModalities– Diagnostic TestingDiagnostic Testing– Physical TherapyPhysical Therapy
Upper Body InjuryUpper Body Injury
Head and Facial InjuryHead and Facial Injury Protective Sports EquipmentProtective Sports Equipment
– Blunt/Penetrating Eye Blunt/Penetrating Eye InjuryInjury
– LacerationsLacerations– FracturesFractures– Spinal Cord InjurySpinal Cord Injury– Closed Head InjuryClosed Head Injury
Acceleration/Acceleration/Deceleration ForcesDeceleration Forces
Rotational ForcesRotational Forces Coup-countercoup Coup-countercoup
InjuryInjury
Tetanus ImmunizationTetanus Immunization
Sports InjuriesSports Injuriesof the Spineof the Spine
Pinched Nerve SyndromePinched Nerve Syndrome Mechanism of InjuryMechanism of Injury
– Sudden Direct Blow to One Side of HeadSudden Direct Blow to One Side of Head
Clinical PresentationClinical Presentation– Paresthesia of Upper ExtremityParesthesia of Upper Extremity
Diagnostic TestingDiagnostic Testing– X-Rays / EMGs / NCS / Bone ScanX-Rays / EMGs / NCS / Bone Scan
Conservative TreatmentConservative Treatment– Initial ImmobilizationInitial Immobilization– P-RICE-MMP-RICE-MM– Protective Collars for Return to PlayProtective Collars for Return to Play
Cervical Sprains / StrainsCervical Sprains / Strains
Mechanism of InjuryMechanism of Injury– Direct Trauma – Whiplash EffectDirect Trauma – Whiplash Effect– Strain - Stretching or Tearing of MusclesStrain - Stretching or Tearing of Muscles– Sprain – Stretching or Tearing of Ligaments Sprain – Stretching or Tearing of Ligaments
Clinical PresentationClinical Presentation– Immediate Onset of Pain & Muscle SpasmsImmediate Onset of Pain & Muscle Spasms– Decreased Active Range of MotionDecreased Active Range of Motion
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Muscle RelaxantsMuscle Relaxants
Sports InjuriesSports Injuriesof theof the
Upper ExtremityUpper Extremity
Shoulder InjuriesShoulder InjuriesImpingement Syndrome Impingement Syndrome Rotator Cuff Injury Rotator Cuff Injury
Multifactoral Mechanism of InjuryMultifactoral Mechanism of Injury– Overuse SyndromeOveruse Syndrome
Clinical PresentationClinical Presentation– Pain Over the Lateral and Anterior Shoulder Radiating Into Pain Over the Lateral and Anterior Shoulder Radiating Into
DeltoidDeltoid– Initially Pain Occurs With Activity Especially Overhead Motions Initially Pain Occurs With Activity Especially Overhead Motions
– Progressing to Pain at Rest– Progressing to Pain at Rest– Decreased and Painful Range of MotionDecreased and Painful Range of Motion– May Feel Shoulder CatchMay Feel Shoulder Catch
Normal Shoulder AnatomyNormal Shoulder Anatomy
Shoulder InjuriesShoulder Injuries Rotator Cuff MusculatureRotator Cuff Musculature
– Four Distinct MusclesFour Distinct Muscles
– Supraspinatus Muscle Is Supraspinatus Muscle Is the First Damagedthe First Damaged
Physical ExaminationPhysical Examination
– + Impingement Sign+ Impingement Sign
– Painful Arc Over 90Painful Arc Over 90 Degrees / ABD / ADDDegrees / ABD / ADD
– + Hawkins Test – Cross + Hawkins Test – Cross Chest AdductionChest Adduction
– Tenderness With MovementTenderness With Movement
– + Drop Arm Test With + Drop Arm Test With Complete Rotator Cuff TearComplete Rotator Cuff Tear
Rotator Cuff Tear Rotator Cuff Tear
Shoulder InjuriesShoulder Injuries
Diagnostic TestingDiagnostic Testing– X-rays to Rule Out FractureX-rays to Rule Out Fracture– MRI scan to Rule Out MRI scan to Rule Out
Impingement Vs. Impingement Vs. Tendinopathy Vs. TearTendinopathy Vs. Tear
Conservative Tx.Conservative Tx.– P-RICE-MMP-RICE-MM– NSAIDsNSAIDs– Cortisone InjectionsCortisone Injections
Surgical InterventionSurgical Intervention– Arthroscopic Debridement & Arthroscopic Debridement &
Anterior Acromioplasty Anterior Acromioplasty Possible AC Joint ResectionPossible AC Joint Resection
– Open AcromioplastyOpen Acromioplasty– Rotator Cuff RepairRotator Cuff Repair– Mini Open Repair of the Mini Open Repair of the
Rotator CuffRotator Cuff
Question # 1 Question # 1
Injuries to the rotator cuff musculature initially involve damage to the
1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres minor
Answer # 1 Answer # 1
Injuries to the rotator cuff musculature initially involve damage to the
1. Supraspinatus
Shoulder InstabilityShoulder Instability
Mechanism of InjuryMechanism of Injury
Clinical PresentationClinical Presentation– Patient Reports a “Slipping” Within the JointPatient Reports a “Slipping” Within the Joint– Can Be In One or Multiple DirectionsCan Be In One or Multiple Directions– PE + Relocation Test + Sulcus SignPE + Relocation Test + Sulcus Sign
Diagnostic TestingDiagnostic Testing– X-Rays / MRI ScanX-Rays / MRI Scan
Shoulder InstabilityShoulder Instability
Conservative ManagementConservative Management– P-RICE-MMP-RICE-MM– Essential to Stop Essential to Stop
Overhead ActivitiesOverhead Activities
Surgical TreatmentSurgical Treatment– CapsulorrhaphyCapsulorrhaphy– Post-Op Rehab to Post-Op Rehab to
Progress SlowlyProgress Slowly– Return to PlayReturn to Play
AC Joint SeparationAC Joint Separation Mechanism of InjuryMechanism of Injury
– Direct BlowDirect Blow ClassificationsClassifications
– 11stst Degree - Stretching with Degree - Stretching with No SeparationNo Separation
– 22ndnd Degree - Degree - Clavicle/Scapula Clavicle/Scapula Attachments IntactAttachments Intact
– 33rdrd Degree - Complete Degree - Complete Separation AC Joint and Separation AC Joint and AttachmentsAttachments
Clinical PresentationClinical Presentation– Pain / SwellingPain / Swelling– Deformity in Higher DegreesDeformity in Higher Degrees– Decrease Range of MotionDecrease Range of Motion
AC Joint SeparationAC Joint Separation Conservative TreatmentConservative Treatment
– 11stst & 2 & 2ndnd Degree AC Joint Degree AC Joint SeparationsSeparations
P-RICE-MMP-RICE-MM
Surgical InterventionSurgical Intervention– 33rdrd Degree and Higher Degree and Higher
FixationFixation Ligament Ligament
ReconstructionReconstruction Resection of DistalResection of Distal
Clavicle Clavicle
AC Joint SeparationAC Joint Separation
Question # 2Question # 2
A female high school swim team student presents with A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important As the nurse taking the history, the most important piece of info would be: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
Answer # 2 Answer # 2
A female high school swim team student presents with A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. As anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important piece of the nurse taking the history, the most important piece of info would be:info would be:
2. Her swim stroke specialization and training routine
Question # 3Question # 3
A preliminary diagnosis of right shoulder instability is A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find:made. On physical examination you would expect to find:
1. A positive McMurray test1. A positive McMurray test
2. Unilateral positive Relocation Test2. Unilateral positive Relocation Test
3. Lack of tenderness over the affected joint3. Lack of tenderness over the affected joint
4. Unrestricted range of motion 4. Unrestricted range of motion
Answer # 3 Answer # 3
A preliminary diagnosis of right shoulder instability is A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find:made. On physical examination you would expect to find:
2. Unilateral positive Relocation Test2. Unilateral positive Relocation Test
Question # 4Question # 4
The patient was placed on a conservative course of The patient was placed on a conservative course of treatment. A primary nursing consideration for this treatment. A primary nursing consideration for this patient is:patient is:
1. Allow her to continue to swim without any change in 1. Allow her to continue to swim without any change in training training
2. Encourage her not to swim if pain is present2. Encourage her not to swim if pain is present
3. Order her to cease all swimming and overhead 3. Order her to cease all swimming and overhead activitiesactivities
4. Tell her to swim per her coach and parents dictate 4. Tell her to swim per her coach and parents dictate
Answer # 4 Answer # 4
The patient was placed on a conservative The patient was placed on a conservative course of treatment. A primary nursing course of treatment. A primary nursing consideration for this patient is:consideration for this patient is:
3. Order her to cease all swimming and 3. Order her to cease all swimming and overhead activitiesoverhead activities
Clavicle FracturesClavicle Fractures
Direct Blow to Clavicle RegionDirect Blow to Clavicle Region
PresentationPresentation– Disfigure /Pain / Movement with PalpationDisfigure /Pain / Movement with Palpation
Diagnostic TestingDiagnostic Testing– Radiograph R/O SC Joint DerangementRadiograph R/O SC Joint Derangement
Conservative TreatmentConservative Treatment– Figure of 8 HarnessFigure of 8 Harness
Surgical InterventionSurgical Intervention– Plate & Screw FixationPlate & Screw Fixation
Clavicle FractureClavicle Fracture
EpicondylitisEpicondylitis LocationLocation
– Medial - Golfers ElbowMedial - Golfers Elbow– Lateral - Tennis / Pitchers / Swimmer / Little LeagueLateral - Tennis / Pitchers / Swimmer / Little League
Mechanism of InjuryMechanism of Injury– Overuse SyndromeOveruse Syndrome
Differential DiagnosisDifferential Diagnosis– Obtain X-Rays to Rule OutObtain X-Rays to Rule Out
Loose BodiesLoose Bodies FractureFracture Occult InjuryOccult Injury ExostosisExostosis
– Radial Nerve EntrapmentRadial Nerve Entrapment– Radiocapitellar DegenerationRadiocapitellar Degeneration
EpicondylitisEpicondylitis
Clinical PresentationClinical Presentation– Well Localized Pain & SwellingWell Localized Pain & Swelling– Difficulty / Pain w/ Supination & PronationDifficulty / Pain w/ Supination & Pronation
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Cock-Up Splint for WristCock-Up Splint for Wrist
Lateral Epicondylitis Lateral Epicondylitis (Tennis Elbow)(Tennis Elbow)
Question # 5 Question # 5
Mr. Woods is a 38 year old tennis player who has developed lateral Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun conservative treatment to prevent epicondylitis and has begun conservative treatment to prevent progression of this condition. If left untreated, a potential long term progression of this condition. If left untreated, a potential long term effect of epicondylitis is:effect of epicondylitis is:
1. Compartment syndrome1. Compartment syndrome
2. Osteomyelitis2. Osteomyelitis
3. Flexion contracture3. Flexion contracture
4. Carpal Tunnel 4. Carpal Tunnel
Answer # 5 Answer # 5
Mr. Woods is a 38 year old tennis player who has Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun developed lateral epicondylitis and has begun conservative treatment to prevent progression of this conservative treatment to prevent progression of this condition. If left untreated, a potential long term effect of condition. If left untreated, a potential long term effect of epicondylitis is:epicondylitis is:
3. Flexion contracture3. Flexion contracture
Hand InjuriesHand Injuries Most Commonly Injured Body Most Commonly Injured Body
SiteSite– Least Protected / Padded Least Protected / Padded
AreaArea– Growth Plate DeformitiesGrowth Plate Deformities
Mechanism of InjuryMechanism of Injury– Direct Trauma Most Direct Trauma Most
CommonCommon
Hand InjuriesHand Injuries
TRIGGER FINGERTRIGGER FINGER
- Locking of Digit in Flexion- Locking of Digit in Flexion
- Often Self-Limiting- Often Self-Limiting
- Direct Trauma- Direct Trauma
- Stenosis of Tendon Sheath- Stenosis of Tendon Sheath- Conservative TreatmentConservative Treatment
- P-RICE-MMP-RICE-MM
- Surgical InterventionSurgical Intervention- A1 Pulley ReleaseA1 Pulley Release
MALLET FINGERMALLET FINGER
- Extensor Tendon Injury at - Extensor Tendon Injury at DIP Joint – Extensor LagDIP Joint – Extensor Lag
- Sudden Forced Flexion- Sudden Forced Flexion
- Conservative Treatment- Conservative Treatment- P-RICE-MMP-RICE-MM- 6-8 weeks immobilization6-8 weeks immobilization
- Surgical Intervention- Surgical Intervention- K Wire FixationK Wire Fixation- Rare – Open Cases OnlyRare – Open Cases Only
Hand InjuriesHand Injuries GAMEKEEPER THUMBGAMEKEEPER THUMB
- Stiff PIP Joint – Degenerative- Stiff PIP Joint – DegenerativeAbduction Deformity MP UCL Abduction Deformity MP UCL InsufficiencyInsufficiencyPossible Avulsion FracturePossible Avulsion Fracture
- Conservative Treatment- Conservative Treatment- P-RICE-MMP-RICE-MM
- Surgical InterventionSurgical Intervention- Early – UCL ReconstructionEarly – UCL Reconstruction- Late – MP Fusion & Late – MP Fusion &
ArthroplastyArthroplasty
NAIL BED INJURIESNAIL BED INJURIES
- Disfigurement- Disfigurement
- Avulsion of Nail - Avulsion of Nail
- Direct Trauma or Torsional - Direct Trauma or Torsional
- Conservative TreatmentConservative Treatment- P-RICE-MMP-RICE-MM- Drilling of Nail Drilling of Nail
- Protective Padding for - Protective Padding for Return to SportsReturn to Sports
Hand / Wrist FracturesHand / Wrist Fractures Boxer’s FractureBoxer’s Fracture
– Metacarpal Neck FractureMetacarpal Neck Fracture– Palmer Angulation of Palmer Angulation of
FractureFracture
Colles FractureColles Fracture– Distal Radial FractureDistal Radial Fracture– Silver Fork DeformitySilver Fork Deformity
Scaphoid FractureScaphoid Fracture– Difficult Fracture to HealDifficult Fracture to Heal
Sports InjuriesSports Injuriesof theof the
Lower ExtremityLower Extremity
Knee: Normal A & PKnee: Normal A & P
Knee – Ligamentous InjuriesKnee – Ligamentous Injuries
FunctionFunction– Attaches Bone to BoneAttaches Bone to Bone– Stabilizes KneeStabilizes Knee
Mechanism of InjuryMechanism of Injury– Torsional Injury Often with Torsional Injury Often with
Direct BlowDirect Blow
Medial & Lateral Collateral Medial & Lateral Collateral LigamentsLigaments– Grade 1Grade 1– Grade 2Grade 2– Grade 3Grade 3
ACL Substitution SurgeryACL Substitution Surgery
AUTOGRAFTAUTOGRAFT– Patient Graft Harvested Patient Graft Harvested
Bone / Middle 1/3 Patella Bone / Middle 1/3 Patella Tendon / Bone GraftTendon / Bone Graft
– ArthrotomyArthrotomy– Post-OpPost-Op
2 Areas for Healing2 Areas for Healing Potential for Scarring / Potential for Scarring /
Osteophyte Formation at Osteophyte Formation at PatellaPatella
ALLOGRAFTALLOGRAFT– Cadaver Bone / Patella Cadaver Bone / Patella
Tendon / Bone GraftTendon / Bone Graft
– Arthroscopically AssistedArthroscopically Assisted– Post-OpPost-Op
Fixation Site of AllograftFixation Site of Allograft Patella / Patella Tendon Patella / Patella Tendon
Complex Left UndisturbedComplex Left Undisturbed
ACL ArthroscopyACL Arthroscopy
Knee – Meniscal InjuriesKnee – Meniscal Injuries
FunctionFunction– Crescent Shaped Plates that Provide StabilityCrescent Shaped Plates that Provide Stability– Transmits Axial LoadsTransmits Axial Loads– Shock Absorbers / Joint FillersShock Absorbers / Joint Fillers
Mechanism of InjuryMechanism of Injury– Torsional / Rotational InjuryTorsional / Rotational Injury– ““Pop” or “Snap” Frequently Heard at ImpactPop” or “Snap” Frequently Heard at Impact
IncidenceIncidence– 3-7 X Incidence of Injury to Medial Meniscus3-7 X Incidence of Injury to Medial Meniscus
Meniscal InjuriesMeniscal Injuries
Clinical PresentationClinical Presentation– Exquisite Joint Line PainExquisite Joint Line Pain– Inability to Full Extend Lower Inability to Full Extend Lower
ExtremityExtremity– Buckling / Locking of Affected Buckling / Locking of Affected
JointJoint– (+) McMurray Test(+) McMurray Test
Diagnostic TestingDiagnostic Testing– X-Rays Rule Out Loose X-Rays Rule Out Loose
BodiesBodies– MRI scan / Diagnostic MRI scan / Diagnostic
ArthroscopyArthroscopy Conservative TreatmentConservative Treatment
– P-RICE-MMP-RICE-MM
Meniscal Injury Arthroscopic Meniscal Injury Arthroscopic SurgerySurgery
Meniscal RepairMeniscal Repair
– Smaller Vertical TearsSmaller Vertical Tears
– Surgically SuturedSurgically Sutured
Partial / Total Removal Partial / Total Removal (Meniscectomy)(Meniscectomy)
– Cut Out Tear – Back to a Cut Out Tear – Back to a Stable RimStable Rim
– Good For Large or Unstable Good For Large or Unstable TearsTears
Bucket Handle / VerticalBucket Handle / Vertical
AllograftingAllografting
Meniscal Injury Arthroscopic Meniscal Injury Arthroscopic SurgerySurgery
Question # 6Question # 6
You respond to an on field injury during a football game. You respond to an on field injury during a football game. The injured athlete reports hearing a “pop” in his knee. The injured athlete reports hearing a “pop” in his knee. He is now unable to fully extend his knee. You would He is now unable to fully extend his knee. You would suspect an injury to thesuspect an injury to the
1. Anterior Cruciate Ligament1. Anterior Cruciate Ligament
2. Iliotibial Band2. Iliotibial Band
3. Articular Cartilage3. Articular Cartilage
4. Meniscus 4. Meniscus
Answer # 6Answer # 6
You respond to an on field injury during a football game. You respond to an on field injury during a football game. The injured athlete reports hearing a “pop” in his knee. The injured athlete reports hearing a “pop” in his knee. He is now unable to fully extend his knee. You would He is now unable to fully extend his knee. You would suspect an injury to thesuspect an injury to the
4. Meniscus 4. Meniscus
ITB Friction SyndromeITB Friction Syndrome Iliotibial BandIliotibial Band
– Provides Lateral Stabilization Provides Lateral Stabilization to Knee Jointto Knee Joint
Overuse Syndrome From Excess Overuse Syndrome From Excess FrictionFriction
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM
Surgical InterventionSurgical Intervention– Targeted to Remove Targeted to Remove
Impinging Posterior FibersImpinging Posterior Fibers– RareRare
Iliotibial Band StretchIliotibial Band Stretch PurposePurpose: To gain flexibility in the : To gain flexibility in the
fibrous band of tissue that is located fibrous band of tissue that is located along the outside of the thigh and along the outside of the thigh and kneeknee
Start Position: Start Position: Lying on your back Lying on your back with a rope looped around the foot with a rope looped around the foot of the leg to be stretchedof the leg to be stretched
Action: Action: Using the rope, pull the leg Using the rope, pull the leg across your body at an angle across your body at an angle approximately 20-30 degrees from approximately 20-30 degrees from the floorthe floor
ParametersParameters: Hold stretch for 30 : Hold stretch for 30 seconds, Repeat 3-5 timesseconds, Repeat 3-5 times
Tips: Tips: Stabilize the hip of the side Stabilize the hip of the side being stretched firmly to the ground being stretched firmly to the ground so no rotation of your trunk occursso no rotation of your trunk occurs
PATELLAPATELLA
SUBLUXATIONSUBLUXATION
Medial Side Direct BlowMedial Side Direct Blow
Clinical PresentationClinical Presentation– May Spontaneously Reduce May Spontaneously Reduce – Unable to ExtendUnable to Extend– Muscle Spasms Muscle Spasms
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Knee Immobilization in Knee Immobilization in
ExtensionExtension
PATELLAPATELLA
DISLOCATIONDISLOCATION
Medial Side Direct BlowMedial Side Direct Blow
Clinical PresentationClinical Presentation– BucklingBuckling– Unable to ExtendUnable to Extend– Muscle SpasmMuscle Spasm– May Report “Pop”May Report “Pop”
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Knee Immobilization in Knee Immobilization in
ExtensionExtension
Patellar TendinopathiesPatellar Tendinopathies
Patellar TendinitisPatellar Tendinitis AKA Jumper’s KneeAKA Jumper’s Knee
Overuse SyndromeOveruse Syndrome
Pain at Tibial InsertionPain at Tibial Insertion
Localized SwellingLocalized Swelling
Conservative TreatmentConservative Treatment P-RICE-MMP-RICE-MM Chopat BraceChopat Brace
Patellar TendinopathiesPatellar Tendinopathies
Osgood Schlatter’s Disease
Tibial Tubercle ApophysitisTibial Tubercle Apophysitis
Point TendernessPoint Tenderness
Elevated Tibial TubercleElevated Tibial Tubercle
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Protective PaddingProtective Padding
Surgical Intervention Surgical Intervention – RareRare– Excision of OssicleExcision of Ossicle
Shin Splints / Stress FracturesShin Splints / Stress Fractures
Overuse SyndromeOveruse Syndrome
Micro Fractures Develop in TibiaMicro Fractures Develop in Tibia
Diagnostic TestingDiagnostic Testing– X-Rays Rule Out FractureX-Rays Rule Out Fracture– Bone Scan Differential Bone Scan Differential
Diagnosis of Stress FractureDiagnosis of Stress Fracture
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– OrthoticsOrthotics– PreventionPrevention
Question # 7Question # 7
What diagnostic examination patient teaching would an What diagnostic examination patient teaching would an office nurse need to conduct for a client having a work-office nurse need to conduct for a client having a work-up for shin splints?up for shin splints?
1. NPO for an arthroscopy1. NPO for an arthroscopy
2. Explanation of an orthotic evaluation2. Explanation of an orthotic evaluation
3. Determine potential allergies to arthrogram dye3. Determine potential allergies to arthrogram dye
4. Radioisotope injection for a bone scan4. Radioisotope injection for a bone scan
Answer # 7 Answer # 7
What diagnostic examination patient teaching would an What diagnostic examination patient teaching would an office nurse need to conduct for a client having a work-office nurse need to conduct for a client having a work-up for shin splints?up for shin splints?
4. Radioisotope injection for a bone scan4. Radioisotope injection for a bone scan
Ankle InjuriesAnkle Injuries
AnatomyAnatomy– The Ankle is a Hinged Joint The Ankle is a Hinged Joint
– Distal Tibia/Fibula/ Medial Distal Tibia/Fibula/ Medial & Lateral Malleolus/Talus& Lateral Malleolus/Talus
– 3 Planes of Motion3 Planes of Motion Dorsiflexion-Plantar Dorsiflexion-Plantar
FlexionFlexion Inversion-EversionInversion-Eversion Abduction-AdductionAbduction-Adduction
Ankle Sprain – Severity GuideAnkle Sprain – Severity Guide
GRADE IGRADE I GRADE IIGRADE II GRADE IIIGRADE III
MildMild ModerateModerate SevereSevere
Some Some Tearing of Tearing of Ligamentous Ligamentous FibersFibers
Some Some Tearing of Tearing of Ligamentous Ligamentous Fibers & Loss Fibers & Loss of Functionof Function
Complete Complete Rupture of Rupture of Ligaments. Ligaments. Loss of Loss of Function & Function & Instability of Instability of the Jointthe Joint
Ankle Sprain – Severity GuideAnkle Sprain – Severity Guide
Ankle SprainsAnkle Sprains Mechanism of InjuryMechanism of Injury
– Direct TraumaDirect Trauma
Clinical PresentationClinical Presentation– Athlete Report Tearing at Athlete Report Tearing at
Moment of ImpactMoment of Impact– Unable to Bear Weight on Unable to Bear Weight on
Affected AnkleAffected Ankle– Swelling/Stiffness (early) Swelling/Stiffness (early)
Ecchymosis (later)Ecchymosis (later)– Instability MedialInstability Medial
+ Anterior Drawer+ Anterior Drawer Medial Lateral Medial Lateral
Question # 8 Question # 8
Nursing assessment of a suspected ankle injury would Nursing assessment of a suspected ankle injury would include:include:
1. Neurovascular assessment1. Neurovascular assessment
2. Physical manipulation of the joint 2. Physical manipulation of the joint
3. Tetanus immunization status3. Tetanus immunization status
4. Application of heat for comfort 4. Application of heat for comfort
Answer # 8 Answer # 8
Nursing assessment of a suspected ankle injury Nursing assessment of a suspected ankle injury would include:would include:
1. Neurovascular assessment1. Neurovascular assessment
Ankle SprainsAnkle Sprains Diagnostic TestingDiagnostic Testing
– X-Rays Rule Out Fracture X-Rays Rule Out Fracture or Avulsion Fractureor Avulsion Fracture
– MRI / Arthrogram - MRI / Arthrogram - Ligamentous InjuryLigamentous Injury
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Initial ImmobilizationInitial Immobilization
Posterior Splint with Posterior Splint with Ace WrapAce Wrap
CastingCasting Ace Wrap and Air CastAce Wrap and Air Cast
Question # 9 Question # 9
After applying a posterior splint and ace wrap to a patient After applying a posterior splint and ace wrap to a patient with an ankle sprain, the nurse explains that they are with an ankle sprain, the nurse explains that they are used to allow:used to allow:
1. for bruising which will occur1. for bruising which will occur
2. for early mobilization2. for early mobilization
3. for swelling which will occur3. for swelling which will occur
4. to allow weight bearing on affected ankle 4. to allow weight bearing on affected ankle
Answer # 9 Answer # 9
After applying a posterior splint and ace wrap to a patient After applying a posterior splint and ace wrap to a patient with an ankle sprain, the nurse explains that they are with an ankle sprain, the nurse explains that they are used to allow:used to allow:
3. for swelling which will occur3. for swelling which will occur
Ankle SprainsAnkle Sprains
Surgical InterventionSurgical Intervention– Indicated for Complete Indicated for Complete
RupturesRuptures– Debridement of Joint / Debridement of Joint /
Suturing Torn Ligaments Suturing Torn Ligaments and Anterior Capsule For and Anterior Capsule For InstabilityInstability
Crisman Snook Crisman Snook ProcedureProcedure
Complications of Ankle SprainsComplications of Ankle Sprains
Scar Tissue Builds Scar Tissue Builds Risk of Risk of Recurrent Sprains Recurrent Sprains Leads Leads to Instability to Instability Requiring Requiring Surgical StabilizationSurgical Stabilization
Achilles TendinitisAchilles Tendinitis
Achilles Tendon - Poor Capacity Achilles Tendon - Poor Capacity to Repairto Repair
Common Overuse SyndromeCommon Overuse Syndrome
Direct Trauma Can Lead to Direct Trauma Can Lead to RuptureRupture
Clinical PresentationClinical Presentation– Pain StiffnessPain Stiffness
Conservative TreatmentConservative Treatment– P-RICE-MMP-RICE-MM– Daily StretchingDaily Stretching– Orthotics / Heel LiftsOrthotics / Heel Lifts
Imaging of Sports InjuriesImaging of Sports Injuries
For the Purpose of:For the Purpose of:– Differential DiagnosisDifferential Diagnosis
R/O Fracture / Loose BodiesR/O Fracture / Loose Bodies
– Gradation of InjuryGradation of Injury G2-G2 Sprain/SeparationG2-G2 Sprain/Separation
– Treatment ProtocolsTreatment Protocols ReductionsReductions Conserv Vs. Surg. InterventionConserv Vs. Surg. Intervention
– Post-Treatment StatusPost-Treatment Status ReductionsReductions Healing StatusHealing Status