Orthopedic Trauma

RLE 4

Welcome, to Bone
Trauma Support Group

Patient #1: Modern Writer

CASE SCENARIO: famous novel writer used
to spend long hours typing away in his
laptop. For several months a numbness
and tingling pain was felt in his right hand.
One day woke up to severe pain on the
right hand and consulted a physician.
Diagnosed with carpal tunnel syndrome.

CARPAL TUNNEL SYNDROME

median nerve

becomes compressed
= pain and numbness
Cause: pressure on
median nerve
High risk people:
repetitive wrist
movements

Pathophysiology

Signs & Symptoms

Pain and numbness in palmar side of

fingers
Weakness of thumb
Clumsiness in fine hand movements

Diagnostic Studies
X-ray
Electromyogram
Nerve Conduction Study

Nursing Care:
1. Ensure effectiveness of splint to prevent
2.
3.
4.
5.
6.

flexion and hyperextension.

Administer glucocorticoid injections as
prescribed.
Post-operatively monitor color and
temperature of hand constantly.
Notify surgeon of pallor, cyanosis, or
numbness.
Administer analgesics as prescribed.
Explain importance of keeping the
affected hand immobilized.

Question #1:
Whats the nerve compressed
during carpal tunnel syndrome?
a. Carpal nerve
b. Median nerve
c. Femoral nerve
d. Phrenic nerve

Patient #2: Good bye tennis

CASE SCENARIO: a 22-year old tennis player
has been a player since she was 5 years
old. Last month she was training when she
experience severe pain on her right
shoulder. She experience decreased ROM,
weakness and was brought to the hospital.
She was diagnosed with rotator cuff injury.

ROTATOR CUFF INJURY

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

ROTATOR CUFF

Causes:

Aging
Repetitive stress/motion
Falling
Heavy lifting
Blow to the upper arm

Manifestations:

Shoulder weakness
Pain
Decreased ROM

DIAGNOSTIC TESTS
Drop Arm Test
X-ray
Magnetic

resonance
imaging (MRI)
Ultrasound

DIAGNOSTIC TESTS

DIAGNOSTIC TESTS

NURSING CARE
Rest
Ice
NSAIDS
Assist Physical

Therapy
Prevention

QUESTION 2
What occurs in rotator cuff injury?
a. Tearing
b. Shredding
c. Hardening
d. Crumbling

Patient #3: Gymnastics Girl

CASE SCENARIO: 19-year old Olympicswinning gymnast was practicing a tricky
routine when she tripped and landed on her
left knee. She was rushed to the hospital
and complained that she felt her knee
give away and was feeling immense pain.
She was diagnosed with meniscus injury
and cannot perform gymnastics for the
time being.

Menisci
- are crescent-shaped pieces of
fibrocartilage in the knee.
- are also found in other joints

2/16/15

Meniscous injuries
- are closely associated with ligament
sprains commonly occuring in athletes
engaged in sports such as basketball,
rugby, football, soccer and hockey.
Causes:
- rotational stress when the knee is in
varying degrees of flexion and the foot is
planted or fixed.
- a blow to the knee can cause the meniscus
to be sheared between the femoral
condyles and tibial plateau, resulting in a
torn meniscus
2/16/15

Who are at Risk?

- athletes, people who work in occupations that
require squatting or kneeling
-older patients are risk for degenrative tears.

2/16/15

MENSICUS INJURY
Tests: MRI and Arthroscopy
Medical mgt: Surgical repair by

arthroscopy, Excision of part of the

meniscus (meniscectomy), NSAIDS

Pathophysiology

Signs and Symptoms

Localized tenderness
Pain during flexion, internal

rotation and extension of

knee (McMurrays test)
Effusion
Quadriceps atrophy
feels knee is unstable
knee may click, pop,
lock, or
give way

Nursing Care:
1. Apply ice to minimize pain.
2. Administer analgesics as prescribed.
3. Emphasize importance of immobilization.
4. Explain that weight bearing is done as

tolerated with crutches.

5. Explain use of knee brace or immobilizer.

6. Teach athletes to do warm-up activities

before.
7. Give importance of physical therapy
(quadriceps and hamstring strengthening
exercises and ROM).
8. Explain that normal activities may resume
when patients strength is regained.

Question 3:
What is the test for meniscus injury called?
a. McMarys test
b. McDonalds test
c. McMurreys test
d. McMalleys test

Patient #4: Swimmer

Bummer
CASE SCENARIO: a 31-year old marathon
swimmer practices everyday with repeated
strokes. One day while swimming he felt
intense pain on both of his shoulders. After
a few days he couldnt take it anymore and
went to get a consult. He was diagnosed
with repetitive strain injury.

REPETITIVE STRAIN INJURY

Also called work-related upper limb

disorder
It is a potentially debilitating
condition resulting from overuse,
repetitive, forceful, or awkward
hand movements.
Not a specific medical diagnosis,
but rather a family of disorders.

 The result is damage to muscles, tendons, and

nerves of the neck, shoulder, forearm, and

hand, which can cause pain, weakness,
numbness, or impairment of motor control.
Causes:
Poor posture
Poor technique
Overuse
Stress

Pathophysiology
Prolonged force,
repetitive movements,
or awkward posture

Strain on the
tendons, ligaments
and muscles
Tiny tears in
tendons, ligaments
and muscles

Inflammation,
swelling and
pain

Signs and
Symptoms
Pain, aching or

tenderness
Weakness
Throbbing
Numbness
Impairment of
motor function

Diagnostics
No specific test

can diagnose RSI

and it is usually
diagnosed when
symptoms
develop after a
repetitive task
and fade when
the task is
stopped.

Management
1. Identify the precipitating activity and
2.
3.
4.
5.

modify the activity

Heat/cold application
NSAIDs can also be used for pain
management
Encourage patient to get adequate rest
Emphasize the need for physical
therapy for strengthening and
conditioning exercises.

STRAINS AND SPRAINS

Strain pulled muscle or tendon

caused by overuse, overstretching, or
excessive stress.
Three types of Strain:
1. First-degree strain mild stretching of
the muscle or tendon.
2. Second-degree strain partial tearing
of the muscle or tendon.
3. Third-degree strain severe muscle or
tendon stretching with rupturing and
tearing of the involved tissue.

Sprain an injury to the ligaments and

tendons that surround a joint. It is caused by
a twisting motion or hyperextension of the
joint.
Three types of Sprain:
1. First-degree sprain caused by stretching
the ligamentous fibers, resulting in minimum
damage.
2. Second-degree sprain involves partial
tearing of the ligament.
3. Third-degree sprain occurs when a
ligament is completely torn or ruptured

Pathophysiology
Abnormal stretching
or twisting forces
(wrenching or twisting
motion)

Injury to
ligamentous
structures/
Excessive stretching
of muscles
Tears in
fibers/Disruption of
tissue

Tenderness and
swelling

Signs and Symptoms

Pain
Swelling
Bruising
Limited movement at affected

joint (or muscle)

Diagnostics

X-ray

Immediate Action

Stop activity and limit movement

Apply ice compress to injured area
Compress the involved extremity
Elevate the involved extremity
Provide analgesia/pain reliever

Management/care
Mild use of analgesics
Encourage patient to get

adequate rest
Encourage physical therapy for
strengthening and conditioning
Doctor may immobilize the area
with a brace or splint.
Surgery may be an option for torn
ligament or ruptured muscle.

Question 4:
What occurs in a sprain?
a. Hyperflexion of joint
b. Plantar flexion of joint
c. Abduction of joint
d. Hyperextension of joint

Facilitator: Frustrated
artist
CASE SCENARIO: Fell down a flight of stairs
last September 2014 and anterior right
shoulder was dislocated. Still has pain
when painting for long hours.

DISLOCATION
Is a severe injury of the ligamentous

structures around a joint

Types:
a. Complete separation of articular
surfaces of joint
b. Incomplete/Subluxation partial
displacement of joint surface
. Tests: x-ray studies, fat cells in joint
aspiration indicates fracture
. Complications: greater risk for repeated
dislocations

Nursing Care: Dislocated anterior

right shoulder
1. Instruct patient the importance of maintaining the affected
2.
3.
4.
5.
6.
7.

8.

shoulder immobilized.
Administer pain medications as ordered by the physician.
Encourage the use of ice pack, which may be placed on the
shoulder for 15-20 minutes to help reduce pain and swelling.
Protect site of injured joint by maintaining the brace or splint
in proper condition.
Instruct relatives of patient to avoid moving the affected
shoulder and arm.
Ensure patient eats a high calorie and high protein diet with
sufficient vitamin-rich food included.
Instruct the patient and relatives to report increased pain,
numbness or tingling sensations, and edema on the affected
area.
Provide daily skin care to prevent ulcerations and maintain
hygiene.

QUESTION 5
What is the most common clinical
manifestation of a dislocation?
a. Deformity
b. Avascular necrosis
c. Loss of function
d. Hemarthrosis

Patient #5:
CASE SCENARIO: a 20-year old basketball
player woke up to intense right knee pain.
Diagnosed with ACL.

Arterior Cruciate Ligament (ACL)

Injury Signs and Symptoms
1. Unstable knees
2. Acute knee pain
3. Swelling
4. Partial tear,complete

tear,or avulsion
(tearing away) from
bone attachments that
form the knee

Diagnostic Procedures:
Positive Lachmans test- This test is

performed by flexing the knee 15-30

degrees and pulling. The tibia forward while
the femur is stabilized. The test is
considered positive for an ACL tear if there
is forward motion of the tibia with the
feeling of a soft or indistinct endpoint.
X-rays
MRI

Nursing Care:
1. Conservative treatment: Rest, Ice,

2.
3.
4.
5.

6.

NSAIDs,Elevation,and ambulation as
tolerated with crutches
Aspiration of painful effusion
Knee immobilizer or hinged knee brace for
knee support
Physical therapy for maintaining knee
joint motion and muscle tone
Reconstructive surgery- torn ACL tissue is
removed and replaced with autologous or
allograft tissue.
Range of motion is encouraged soon after

QUESTION 6
What test when positive indicates
ACL diagnosis?
a. Stellars test
b. Lachmans test
c. McMurrays test
d. Rombergs test

THANK YOU FOR

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