med surge

• strains
• injury to muscle when stretched/pulled
• sm. blood vessels rupture & muscle fibers get sm. tears
• s/s- inflammation, tenderness, & mscle spasm

• contusion
• soft tissue injury from blow/blunt trauma, doesnt affect muscleskeletal structuresm. vessels rupture
• s/s- ecchymosis (bruise), hemotoma, swelling, pain

• sprains
• injury to ligamemts around joint (knees, wrist, ankle, & elbow), from sudden/unusual movement (falls), when severe the ligament attached to bone chips & becomes detached & becomes a avulsion fracturecervicle sprain(whipklash)

• pain & swells
• avoid full wt
• ecchymoses
• joints unstable until healed

• DX- visual exam,
• x-ray- see larger than usual joints 2 check 4 fracture
• Arthrography- check asymmetry
• Arthroscopy- check trauma 2 joint capsule

• medical & surgical manag
• R- rest
• I- ice- 24-48hrs
• C- compression
• E- elevation
• S- stability

• when swellin wont increase more apply heat & relieves edema by improving circulation
• restrict movement or could lead 2 perm. unstable joint or formation of fibrous adhesions that may llimit ROM
• NSAIDS
• splint/light cast 4 several wks,
• cervicle collar

articular surface joints not intact, interfers w/ normal use & appearance usually shoulder, hip, knee, partial dislocation AKA subluxation

• P&E- usually in adults, could result from diseases when joint stretched/torn/relaxed, inljury disrupts blood supply 2 joint, cartilage leading 2 degeneration, chronic pain, & restrict movement
• compartment syndrome- tendon/nerve constricted in confined space, affects nerve innervation leading 2 subsequent palsy (decreased sensation/movement), if CS 2 upper extremites leads 2 Volkmens contracture-clawlike deformatiy to hand from obstucted arterial blood flow 2 forearm/hand, pt cant move fingers & has pain especially when stretching hand
• other compication is low deposit of collagen in repair stage resulting in reduced tensile strength & reoccuring dislocations

• Assess- pt hears popping when it happens they say joint gave out, if b/c trauma high pain happens, altered appearance, if dislocation in extremities injured one could be shorter, ROM limited, swellling, coolness, numbness, tingle, pale/dusky @ distal tissue
• X-ray, arthoscopy, arthrography

Medical/surgical manag.- dr. manipulates joints w/ anesthetic, then immobilizes it w/ bandage/cast,splint 4 wks, or surgery

• nursing manag.- give RX, elevating & immobilzing, applies cold pack, do neurovascular assessment q 30min 4 several hrs, then q 2-4hrs 4 1-2days 2 detect complications like CS, instructs pt 2 certain activities
• teaching by nurse
• use of proper equipment @work/althletic activites, & do warm-ups & stretching
• clear envioment 2 reduce injury
• exercise reg. to maintain joint/muscle strength
• healthy wt
• relax, stretch, & position changes q 2hrs
• after exercise allow cool off time & stretch
• if pain/discomfort occurs rest until symtoms subside then slowly reintroduce activity
• if symptoms persist see DR.

from overuse, trauma, repeated stress

Epicondylities(tennis elbow)- tennis, pitching, rowing

Ganglioncyst- cystic mass near tendon sheaths & joints capsule seen more in women 50y

Carpal tunnel- narrow inelastic canal thru where carpal tendons & median nerve pass, cashiers, typist, musicians, assemblers,

• S/S
• epicondylitis- radiating pain in forearm, weak grasp
• ganglioncyst- pain, tenderness
• carpal tunnel- pain, burning 1-2 arms, radiates to forearm & shoulder, worsty @ nite & early morning, shaking hands can reduce pain by movement of edematous fluid from carpal canal, sansation of fingers could b reduces/loss,

• DX-x-ray 4 abnormalites & rule out fracture
• carpal tunnel- could have electromyography- 2 stimulates nerve, Tinel's sign- elicits tingle, numbness, & pain, phalen's sign- flexing wrist 30sec. 2 check 4 pain/numbness itz + 4 carpal tunnel, & percussing median nerve (inner wrist) 2 chck 4 response

• Medical & surgical manag.- cold pack, heat, exercise, steroidal anti-inflammatory meds, injection of corticosteroids, analgesics, NSAIDS, rest, surgeries when tears/ruptures, physical therapy
• Epicondylities splinting/support of joint, corticosteroids injected
• Ganglioncyst- aspiration of ganglion, corticosteriod, surgical excision
• Carpal tunnel- rest, slpinting hand/wrist, NSAIDS, carticosteriod injection, surgery to lower pressure of ligament

• Nursing manag.
• info bout meds (if NSAIDS stress 2 take w/ food), if injection explain ? 2 expect & that injection could cause discomfort
• how 2 care 4 splints
• perform ROM
• some hand exercise less painfull if done under warm water
• how to to ADL/jobs activities
• rest/position of joint to reduce stress
• support joints on pillow while sleep
• apply cold 4 24-48hrs 4 swelling & pain
• slowly increase joint movement
• avoid workin/lifting above shoulder, dont push objects w/ arm joints

• made up of complexity of muscles & tendons that connect the proximal humerus, clavical, & scapula in turn connect w/ sternum & ribs
• from traumatic injury or chronic overuse or irritation of shoulder joint

S/S- pain w/ movement worst @ night, limit mobility of shoulder/arm, especially when activity above head

• DX- physical exam, tenderness on acromioclavicular joint
• x-ray, arthrography, MRI 2 see extent of tear/ injury

• Tx- starts w/ NSAID, motify activities, rest joints, corticosteriods injection 2 shoulder w/ exercise & stretching
• surgical procedures:
• Arthroscopic debridement of devitalized tissue
• Arthroscopic tendon repair
• Open acromioplasty w/ tendon repair
• pt need to immobilize shoulder 4 days 2 wks, & therapy 4 wk 2 mon.
• full recovery w/i 6-12mon.

• 2 knee from trauma
• occur 2 lateral/medial collateral ligaments which provide stability 2 side of knee or 2 anterior or posterior cruciate ligaments (ACL &PCL) stability 4 forward & backward movement

• P&E
• occurs when standing firmly & get blow/twist in differant direction

S/S- pain, instabilityof joint, hard 2 ambulate, when ACL/PCL tears pt reports popping/tearing sensation, meniscal, knee may click when walking, knee might lock

• medical & surgical manag.- depends on injury, 1st tx immobilizing % limiting wt, then NSAID, ice 1st 48hr, slow increase of activity
• surgical tx- repair of ligament/tendon
• torn meniscal they remove damged cartilage(meniscetomy), recovery takes 3-12mon.

• 2ndary 2 trauma
• calf muscle contracts suddenly while foot grounded firmly in place, hear a loud sound, severe pain, & cant planter flex foot

surgery need then pt wears cast/brace 6-8wks, physical therapy

• nurse teaches:
• activity restrictions
• use of ambulatory devices
• pain management
• pre/post operative instructions

• direct blow or when seizure, weakness of bones, tumors, more bone reabsorption then production (when pt inactive/elders)
• 10-40min after fracture mucles around bone flacid, going into spasm increasing deformity & interfering w/ vascular & lymphatic circulation
• healin starts when blood in area clots & fibrin network form between broken bone, fibrin network turns into grandulation tissue, osteoblast which proliferates in clot increase secretion of emzyme that restores alkalin PH leading to calcium deposit & true bone forms, healin mass called callus (holds bone 2gether but cant sustain strain)
• take bone 1yr to fully heal & get all fat & marrow cells

complications- compartment syndrome, thromboembolism, fat embolism, delayed healing, nonunion, malunion, infection, & avascular necrosis(death of bone from low blood supply), pt prone 2 pneumonia, thrombophlebties, pressure sores, UTI, renal canculi, constipation, muscle atrophy, wt gain, depression

• pain
• loss of function- depends on intact bone
• deformity
• false motion- unusual motion @ site
• crepitus- grating sound of bones rubbing 2gether, also heard as popping by air trapped in soft tissue
• edema
• spasm-muscle near fracture, reason 4 pain, may cause limb shorten when long bone involved

if nerve damage could lead to paralysis

DX- x-ray, some stress factures may not show by x-ray for few wks, CT, MRI

• medical & surgical mang- goal 2 reestablish function
• tx- traction, open/closed reduction, internal/external fixation, cast application, tx depends on 1st aid given, location, severity, age, physical condition

• nursing mana.
• assess neurovacular & systemic complication, administer analgesic, provide comfort, assist w/ ADL, preventing constipation, promoting physical mobility, preparing pt 4 self-care, family teaching, instuct on devices used, exercise, when in traction info should be kept simple & direct, activites allowed & restricted

common in car accidents, falls, gunshots, always peeps have other fractures b/c of severity

Assess: pain, swelling, ecchymosis, pt cant move hip or knee, if compound fracture open wound or protrusion of bone seen, x-ray done 2 show type & location

• medical & surgical manag.- traction to prevent deformaties
• skeletal tration & external fixation 2 align fracture in prep 4 future reduction if occured in lower 2/3 of femur, once aligned spica cast used

nursing manag.- prevent complication of immobility or inactivity, correct positioning during traction, clean pin sites

• affect proximal end of femur
• results from falls or osteoporosis
• occur in femoral neck (intracapsular or inside hip joint capsule), between trochanters(intertrachanters-extracapsular)

assess:severe pain w/ leg movemets, pain radiates to knee, sensation pressure in outer aspect of hip, discontinuity & spasm shorten & external rotation of leg, large blood loss accompany subtrochanteric & intertrochanteic factures lead 2 hypovolimic shock, bruising, swelling of hip, groin, thigh, femoral neck fracture are intercapsular so bleeding more likely to b contained w/i joint capsule, x-ray- show location

medical & surgical manag.- intracalsular factures prone 2 nonunion & avascular necrosis, fractured head/neck replaced by metal device (austin-moore or thompson prosthesis) referred 2 hemiarthroplasty faster then traction, plates, bands, screws, & pins & could b removed when healed, but could perm., precaution w/ hemiarthroplasty r greater b/c they dislocate hip to replace head, pt may have total hip arthroplasty

• nurses manag.- measure 2 prevent skin breakdown, infection, pneumonia, constipation, urinary retention, muscle atrophy, & contractures, pt usually has wound drainage for 1-2 days after surgery, monitor drainage & give antibiotic med, show pt to use trapeze, placements of trochanter roll, abductors pillow between legs when turning pt., instruction hip prosthesis, avoid adduction till healed
• after surgery assist w/ ambulation, chair should b elevated either w/ structures or pillows so hips dont flex beyond 90*

Avolusion:a pulling awa of a fragment of bone by a ligament or tendon and its atachment.

Compound:a fracture in which damagealso involves the skin or mucous membranes

Depressed:a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bones)

Greenstick:a fracture in which one side of the bone is broken and the other side is bent

Oblique:a fracture occurring at anangle across the bone (less stable than transverse)

Simple:a fracture that remains contained; does not break the skin

Transverse:a fracture that is straight across the bone