Transcript for:
Understanding Soft Tissue Injuries

in this presentation we will discuss the muscular skeletal system in regards to soft tissue injuries before you dive into this content be sure you are free from distractions and can give it your full attention be sure that you have read the textbook pages that are associated with this content be prepared to actively learn I will will be sharing my knowledge and understanding with you but you must do the learning participate in your learning you will be the nurse next to that patient not me you need to acquire the knowledge skills and attitudes to take care of that patient safely competently and compassionately think beyond your next classroom exam rather think about being that nurse taking care of that patient that is what you are preparing for not classroom examinations listen with curiosity asking questions seeking answers imagine being the nurse responsible for the care of this patient imagine being the patient needing this nursing care think about your prior experiences that are related to this content from both the healthc care provider's point of view and or or the patient point of view think about building knowledge on the foundation of what you already know be prepared to change your understanding of this content if new information is presented take advantage of this recorded Source pause as needed to think about the content or write down notes or questions be curious about learning more review the content and your notes as as needed to gain understanding that you seek test yourself on the content to determine if you really learned it or not the first thing I want you to do is pause and reflect I want you to start by stopping the recording and thinking and writing down in these three areas I want you to think about what you already know about this topic and write down at least three to five items I want you to stop and think about any of your prior experiences related to the content I want you to write down your thoughts and feelings related to your experiences lastly I want you to think about what you don't know about this content think about your gaps of knowledge and understanding and things that you're curious about learning write down at least three to five items then you'll be ready to dive into the content this slide contains learning objectives that you should meet upon completion of this content I recommend that you pause the recording read these carefully and make sure that you understand the purpose of this learning session and that you can measure that you have accomplished them at the end when we're talking about the soft tissues as related to the muscular skeletal system we're talking about muscles tendons and ligaments I want you to recall that uh tendon is um a fibrous tissue that attaches a muscle to a bone and a ligament is a fibrous tissue that attaches one bone to another uh these each play a part in movement positioning and Joint Mobility each of these types of tissue can be injured and their injuries are considered to be soft tissue injuries we'll start uh discussing soft tissue injuries uh with a contusion a contusion is a soft tissue injury that is produced by a blunt force like uh being hit with something falling being kicked that is a blunt force and that causes the small blood vessels in that tissue to rupture and then they bleed into the tissue causing ecosis also called bruising this bleeding leads to uh the bruising and the pain and the edema that is seen in this condition and that's all just local to that area contusions can be either minor or severe they can be isolated like a simple contusion where you run into something and and you now have a contusion on your leg uh or it can be something more severe where it is in conjunction with other injuries like you had a fall and now you have multiple contusions or you were in a motor vehicle accident and you have contusions and um other injuries like fractures and such so they can be in conjunction with other things um they can limit The Joint range of motion that that's near that area and the injured muscle often feels weak and stiff most contusions will resolve within one to two weeks and severe ones may take longer than that to heal the next one we'll discuss is a strain a strain is an injury to a muscle or a tendon from overuse overstretching or excessive stress it is often referred to as a pulled muscle strains often occur in tendons of the foot and or the leg and in the back consider that the muscles ligaments and tendons all work together to support the body and provide movement and therefore when one of these elements of the system is injured the other elements also suffer with it an injury to a tendon will impact the stability of the muscle and the bones that it connects this tion increases the risk for other injuries and for Falls strains can be categorized as acute often as a result from a single incident or chronic from repeated insults to the same tissues uh strains are also graded in severity based on the post injury symptoms and the loss of the function of that area next we'll discuss sprains a sprain is an injury to a ligament and the tend that surround a joint it is caused by a twisting motion or hyper extension and that would be like forcible hyperextension like a sudden movement that um causes your wrist to bend back more than it should hyperextends it um and that's kind of a forcible sudden movement uh of that joint uh this causes stretching and weakening of these tissues remember that these are fibrous uh joining connecting tissues and they're really not designed to stretch they're supposed to hold steady and so when you got um a sprain from either um High powerered twist to that Mo um joint or uh ex hyperextension then that causes those tissues to stretch in a way that they're not designed to stretch um then the function of the ligament to support the joint becomes impaired uh it causes joint instability with the most vulnerable areas of the body that this can happen to would be your ankles your knees and your wrists um and the severity of the sprain is also graded according to how badly the LI ligament has been damaged and whether or not the joint is uh stable or unstable next we'll talk about dislocation that's a condition in which the articular surfaces of the distal and proximal bones that form a joint are no longer in anatomical alignment this often happens in a shoulder and the basically it's it's we talk about a joint being popped out of its socket or it's out of joint okay um and if it's only partially out of joint that's called a subluxation that's an incomplete dislocation um but remember that when a bone is out of its joint dislocated it is not being supported by the surrounding structures and all of these are designed to work together so the muscles and the ligaments and the tendons support the bone and the bone also supports them and providing structures so when one of these parts fails the other parts will suffer for as well so when the bone is out of joint then the um weight of that extremity and the malos of the bone can cause damage to other tissues um the situation can cause blood vessels and nerves in that area to become entrapped causing pain and damage to the nerves the vessels and the distal tissues so consider um your shoulder let's say your shoulder has become dislocated so the bone that's holding your shoulder into its socket is now separated from its joint so the bones are uh the weight of that is now hanging now you can probably still move at the elbow you can move your fingers you can move your wrist but you can't holder and the whole weight of your arm off of um of that that area so that whole weight hanging down can cause the blood vessels and the nerves within that area to become entrapped so if that happens then the distal tissues can suffer from nerve damage and blood loss blood flow loss okay they're not getting the nourishment of the blood flow as they ought to and they become es schic so for this reason a dislocation can be considered an emergency situation if the vessels and the nerves are not freed from their entament the damage can become extensive including the loss of the limb when blood flow is impaired or completely lacking a condition called avascular necrosis occurs avascular just simply means no blood flowing through the the vessels and necrosis means tissue death so the um the impairment of the blood flow or the complete lack of it can cause avascular necrosis which leads to tissue death of the soft tissue and sometimes of the bone um signs and symptoms of a traumatic dislocation include pain uh acute um pain a change in or awkward positioning of the joint and decreased range of motion now remember that muscles are attached by tendons to Bones connective tissue and other muscles soft tissues and skin the muscles of your body are composed of parallel groups of muscle cells called fuli and these are encased in a fibrous tissue called AP fascia each muscle or muscle group is encased within its own fascia the fascia has a very limited ability to stretch therefore when a muscle is injured if it becomes emitus or the vessels within it become damaged leading to bleeding within those tissues the fascia um can fill up with this extra fluid from the edema or the blood and it can build up pressure causing um a compartment syndrome okay compartment syndrome is when within a Muscle fascia there is too much pressure building up and that can lead to damage to the muscles the nerves and the blood vessels within the compartment and then anything that's distal to it that's being fed by that blood flow or the nerves that are supposed to inovate it are now trapped that tissue distal to that can be affected um acute compartment syndrome is a time sensitive surgical emergency it is characterized by elevation of pressure within the anatomic compartment it is above the normal profusion pressure um acute compartment syndrome arises from an increase in compartment volume like I said from edema or bleeding or it also can happen from a decrease in compartment size which can come from having a splint or a cast that is too restrictive and that compresses the compartment or it can be a combination of both of these when the pressure within the effective compartment arises above normal then profusion to the tissues that's impaired causing cell death which may lead to tissue necrosis and permanent dysfunction the most common cause of compartment syndrome is fractures and usually tibial fractures are the ones that have the highest risk of this occurring um therefore any time you're talking about having a a muscular skeletal injury then one of the things we really need to focus on is doing neurovascular assessments frequent assessments of the neurovascular function is essential and it focuses on the six PS the six PS are pain poar pulselessness paresthesia paralysis and poilo thermia and that simply means cold the initial presenting symptoms for compartment syndrome tend to be severe pain pain that is out of proportion to the injury or pain that suddenly increases in severity so the pain usually will not respond to the previously effective pain medication management techniques the and I want you to think about what's causing this pain this compartment is filling up with either inflammation or blood it's compressing all the tissues within the compartment it is compromising the blood flow to all the tissues in the compartment and they are becoming es schic necrosis will follow if this problem is not corrected Additionally the blood vessels that pass through that compartment are also being compressed so think about if we're dealing with a compartment syndrome in the uh upper leg and it has um filled up with blood from a broken bone and now the tissues are compressed by the pressure of this extra blood in there and you've got veins and arteries that pass through that on their way to the distal part of your body so the lower leg and the the foot are now not receiving their blood flow because those vessels that pass through that compartment are compressed and they lead to aeia uh in the distal extremities okay so that's why you'll see p so you'll start seeing that the foot is pale you'll also have pain because tissues are dying because they're es schic you'll have the poal thermia because without blood flow our body gets cold okay and then pulselessness because the Pulses from those uh arteries are not coming through okay everything distal to that compartment also the nerves that run through this compartment are now being compressed and their function is being com compromised and compromised nerve function will lead to paresthesia which means that tingling in numbness because the nerves are compressed and the body's not getting its signaling correctly and then you're also see paralysis because over time when the nerve can't function anymore it can't send in signals and nerve signals is what causes the movement okay so then it becomes paralized distal to the injury um it is really important for you to understand the patho of this condition and why the patient presents with these classic signs and symptoms you need to be sure that you understand why each of these signs and symptoms are present in this condition and understand the importance of a complete and thorough neurovascular assessment here's an opportunity for you to pause and think about this content and apply it to your nursing care of patients with these kinds of problems I want you to consider the causes of soft tissue injuries and what assessments would be the priority for a patient who presents with one of these injuries what systems would you prioritize when conducting your assessment what history questions would be the most important to ask I would encourage you to stop the recording and list your three top systems to be assessed and your three top history questions that you would want to ask this patient reflect on what assessments you should prioritize for a patient with with a soft tissue injury what history question should you ask this patient I will not list all the assessments and questions you should perform or ask because you should know this information but I will suggest a few that are important and that the nurse might not always consider if the injury is from a fall or a trauma always ask if the patient hit their head and assess for head injuries also ask what caused or prompted the fall where they busy did they trip were they pushed also ask about how this injury will impact their home and their work life once the nurse has completed a thorough assessment it time to determine the priority Problem and come up with appropriate interventions some potential nursing problem statements for this kind of an injury might be risk for Falls acute pain or risk for impaired tissue profusion for every problem statement there must be a related two statement that identifies the pathophysiology of the problem for example risk for Falls related to Joint instability of the left lower extremity secondary to a sprained left ankle or acute pain related to soft tissue injury to the left upper arm or risk for impaired tissue profusion related to edema secondary to blunt force trauma to the right upper leg for every problem statement that is an actual current problem not a risk for there must be a list of the evidence supporting this problem this is the abnormal data from the assessment that indicates this is a problem for this patient for for example acute pain related to soft tissue injury to the left upper arm as evidenced by patient stating pain 7 out of 10 and throbbing guarding of the extremity and the inability to perform active range of motion if the problem is a risk for like risk for Falls there's no evidence because the fall has not happened so we are just on the alert to prevent one from happening following assessment and diagnosis of the problem we begin to formulate interventions for soft tissue injuries the medical and nursing care revolve around symptom management and protection from further injury while the patient's body does the healing to recover from the injury symptom management will include immobilization of the injured area protecting from further injury with supportive devices like splints slings braces or compression bandages often we provide pain management in the form of pharmacological and non-pharmacological methods medications might include over-the-counter meds like acetominophen or ibuprofen or prescription medications like hydrocodone Tramadol or morphine the provider will determine the appropriate medication for the severity of the injury and the needs of the patient we are responsible for doing a thorough pain assessment and ensuring that the medication is administered safely additional interventions might be resting and elevating the injured area patients may need assistance from a nurse or a caregiver or an ambulation device to move about safely you may remember these interventions in the acronym Price p r i c e which stands for protect rest ice compress and Elevate be sure that you understand the purpose of each of these interventions and can determine if they are appropriate for a given patient one of the most important tasks that nurses complete is determining if the interventions ordered by the provider are appropriate and safe for this patient Never follow in order blindly always know the what and why for every intervention you perform and keep patient safety as your first priority expected orders um and testing would probably include an x-ray to ensure that there are no fractures present a negative result would indicate that only the soft tissues have been damaged and there are no blood tests necessary to diagnose a soft tissue injury um in regard to some of the specific injuries uh medical management for a dislocation is going to include a priority to avoid neurovascular complications and reduce the joint as at traumatically as possible which means put it back in place without causing more Jam damage the affected joint needs to be immobilized at the scene and during transport to the hospital remember we're trying trying to protect them from getting damage to the blood vessels and the nerves informed consent for the procedure is going to be obtained and then the dislocation will be promptly reduced so that the displaced parts are placed back in proper anatomic position to prevent joint um dysfunction the joint is then going to be immobilized with a splint maybe a cast or even traction and is maintained in a stable physici while the healing goes on neurovascular status has to be assessed at a minimum of every 15 minutes until the patient is stable and the joint is stable after rejection if the joint is stable then the um provider May order gentle Progressive active and passive movement to begin to preserve the range of motion and restore strength the The Joint should be supported between these exercise sessions which may include you know going back on the brace or the splint whatever device is helping to support that joint while it heals um a couple of brief mentions about what to do if a patient develops compartment syndrome it is really important that we promptly manage this so that we can relieve the pressure in that compartment department and save that muscle and maybe that entire lmb an orthopedic surgeon will need to be notified if neurovascular compromise is suspected uh any delay in treatment can result in permanent nerve and muscle damage necrosis infection rabdom myosis and even acute kidney injury and perhaps even amputation of the limb um if conservative measures do not rest tissue profusion and relieve pain than a fomy which is a surgical procedure where they go in and slice through the fascia of that muscle in the which the compartment is is under pressure and that relieves the pressure um after fasciotomy the wound is not sutured but it's left open so that the muscle tissues can continue to expand as needed so we don't want to close it back up in which case that would just cause pressure to build up again so this wound is left unsutured it is covered with moist sterile saline dressings or sometimes an artificial skin is applied uh often a negative pressur wound VAC will be used to help to um pull fluids from that and decrease the time to primary closure the affected arm or leg would be splinted W in a functional position and elevated to the Heart level and prescribed intermittent passive range of motion exercises uh in a couple of days when the swelling has resolved in the tissue profusion has been restored the wound will often be debed and closed and maybe have to have some skin graphs um some of the potential complications that we're looking at for a patient with soft tissue injury would be compartment syndrome um the possibility of Falls due to changes in Gate or balance and this is can be the case even if the injury is in the upper extremity because we use our our upper extremities for our balance so if I'm used to swinging my arms when I walk but my arm is um immobilized in a sling because of an injury now that changes my balance and I'm more prone to fall so we still have to Pro protect these kind of patients from Falls as well and then another uh potential complication could be activity intolerance and immobility due to the pain and the difficulty with movement here is another opportunity for you to pause and think about this content the nurse must always understand the rationale for every Intervention when caring for every patient failing to know the why can lead to patient safety issues and poor patient outcomes consider what the rationale is for each of these interventions that are often utilized when caring for a patient with soft tissue injury you should be able to know why each is used and if they are appropriate for your patient consider the educational needs for a patient with the soft tissue injury most patients will be discharged home to recover from this type of injury they may be scheduled follow-up appointments to be further evaluated and some patients will require physical or occupational therapy their education should include caring for the injury at home discussion of their weightbearing status proper application of cold therapy proper pain management considerations use of any Mobility devices that they might be needing um any dietary considerations and the signs and symptoms associated with potential complications such as compartment syndrome and psychosocial considerations include dealing with the pain and their limited Mobility patients May may be concerned about being able to perform their ADLs to care for their children or their parents uh their ability to drive using ambulation equipment might be a concern for them um further or additional injuries might be something they're worried about or concerned about they might be concerned about being able to work while they have this injury um those kind of things um just remember we do not have to have all the answers to all the patients concerns but we do need to always listen teach and support as we are able and then find other resources to fill in areas where we're not able to meet those needs you may have to contact a case manager or a social worker to help the patient obtain a walker or to contact a chaplain to help with their spiritual concerns um we may need to provide printed resources for dietary or medication concerns just always think about listening to their concerns they are legitimate especially to the patient and we need to respect them and try our best to meet their needs this pause and think is designed for you to consider that nurses nurses working in all settings face hazards while performing their routine duties the nursing profession is consistently ranked among the top 10 occupations that are most involved in occupation related injuries and illnesses and these can often result in Lost days of work or maybe permanent injury that puts you out of commission to continue in this job that you have set out to do um nurses experience a higher than average incident of muscular skeletal disorders that come from overexertion and strain due to heavy patient loads and unsafe patient handling techniques taking care of ourselves is important because if we're injured and out of the game then we can't be there to take care of our patients so I want you to stop and consider caring for yourself while you are caring for others consider how nurses must balance the needs of the patients with their own needs and how can nurses protect themselves from injury while caring for patients that have muscular skeletal injuries and Mobility problems now it's time for you to review the content review your notes review your readings test yourself to see if you have met these learning objectives if you still have gaps then you need to dig in deeper and look for the answers to the question so that you can say that you have mastered this content and achieved these learning objectives