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Chapter: Medicine Study Notes : Musculo-Skeletal

Soft Tissue Injury

Treat for bleeding: expose wound to assess for blood loss, cover, direct pressure, elevate, pad and bandage

Soft Tissue Injury

 

Prevention of Sport Injuries

 

·        Proper warm up

·        Cooling down

·        Protective equipment

·        Good technique and sensible training schedules

 

Ligament Injuries

 

·        Sprain: partial tear of ligament or joint capsule but the joint is still stable. Site of tear is tender and there may be bruising. Symptomatic treatment and protection from stress until healing is complete

 

·        Partial Rupture: If rupture is incomplete, treat conservatively (ranging from rest and analgesia to casting for 6 weeks). Recurrence common

 

·        Complete Rupture: Poor healing as scar tissue is not as tough as the ligament. May attempt surgical repair – but it may not help

 

Tendon Injuries

 

·        Due to sudden, violent contraction

o   Most common is Achilles Tendon Rupture. 

·        Can also rupture long head of biceps and supraspinatus

·        Other tendon injuries: 

o   Paratendonitis: Inflammation due to friction of the paratendon (fatty tissue in the fascial compartment through which a tendon runs). Usually Achilles or wrist tendons. Try good footwear or rest in a splint. Steroid injection (but not into the tendon itself) may be effective. NB steroid injections around the Achilles are controversial – may weaken the tendon 

o   Tendonitis: irritation/tearing of fibres due to repeat trauma. Pain worse on contraction. Rest + NSAIDs

 

Frost Bite

 

·        Formation of ice-crystals in the skin and soft tissues when temperature < -3 ºC

·        Presentation: tissue is pale, grey, and doughy – or frozen solid.  May develop without person knowing

·        Treatment:

o   Warm slowly – this will be painful

o   Blisters may form over several days.  May develop blackened shell as blisters burst

o   Dry, non-adherent, strictly aseptic dressings and prevention of further trauma (tissues are numb)

o   Recovery takes weeks.  Surgery may be required

 

Contusion

 

·        Characterised by direct trauma to a muscle group with subsequent pain and swelling due to bleeding within the muscle

·        Management:

o   Rest, ice, mild compression and elevation to control swelling, bleeding and pain

o   Intermittent icing for up to 48 hours

o   Maybe NSAIDS – but may increase the bleeding

o   Exclude other injuries, including compartment syndrome 

o   Once swelling has settled, aim is to restore function, beginning with gentle isometric muscle exercises

 

Lacerations

 

·        Torn, ragged wound

 

·        Treat for bleeding: expose wound to assess for blood loss, cover, direct pressure, elevate, pad and bandage

 

·        If severe then sutures. However, muscle divided transversely will not hold sutures well enough to stop muscular contraction pulling the edges apart

 

Enthesitis

 

·        Inflammation at the site of attachment of bone to a tendon, ligament or joint capsule 

·        Elbow: See Tennis and Golfer‟s Elbow. Treatment: rest and strapping. Steroid injection if severe

·        Plantar Fasciitis:

o   Insertion of the tendon into the calcaneum

o   Pain on standing and walking

o   Is isolated, or with sero-negative arthritis

o   Treatment: heel pads, reduced walking, steroid injection

 

Chronic Compartment Syndrome

 

·        Caused by ­ tissue pressure in a closed fascial space ® ¯ circulation to muscles and nerves

 

·        Presentation: pain or deep ache over compartment. Usually after prolonged exercise. Usually bilateral. May have palpable muscle hernias

 

·        Diagnosis: difficult. Elevated pressure within the compartment during/after exercise with slow return to resting pressure

 

·        Treatment: decrease exercise (® ¯muscle bulk) or elective fasciotomy (can affect muscle strength)

 

·        „Shin Splints‟: Shin soreness in unfit runner: can be due to a combination of muscle tears, mild anterior compartment syndrome or stress fracture

 

Causes of Non-traumatic Limb Pain

 

·        Muscle disease: polymyositis, polymyalgia rheumatica, tendon inflammation, compartment syndrome

·        Bone disease: osteomyelitis, osteomalacia, osteoporosis, tumours

·        Vascular disease: Arterial or venous (eg DVT)

·        Neuropathy: nerve entrapment, neuropathy

 

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Medicine Study Notes : Musculo-Skeletal : Soft Tissue Injury |


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