MUSCULOSKELETAL INJURIES

MUSCULOSKELETAL INJURIES



OVERUSE SYNDROMES


Whenever a muscle is overused—that is, exercised past its state of conditioning—there is actual destruction of the muscle tissue and generation of lactic acid. Given a reasonable rest period, the products of metabolism are carried away in the circulation and the muscle tissue regenerates to a healthy, sometimes even stronger, condition. However, if the exercise has been vigorous and unrelenting, the participant may suffer from a variety of aches and pains that are generally categorized as overuse syndromes.







Plantar Fasciitis


Plantar fasciitis is inflammation of the fascia (tough connective sheath tissue) that encloses the muscles and tendons that traverse the bottom of the foot. It is a syndrome of overuse, caused by excessive walking or running, particularly associated with repetitive impact on the bottom of a foot that is improperly cushioned or without appropriate arch support. Symptoms include pain in the bottom of the foot (ball, arch, and/or heel), worsened by repetitive weight bearing. The pain is often worse with the first steps in the morning or after a period of inactivity. It occurs commonly in athletes and long-distance hikers, particularly if they wear poorly fitting shoes or boots. When examining the foot, pain may be elicited by applying pressure to the forward-inside area of the heel.


Treatment consists of rest, elevation of the foot with cold (ice packs) applied to the tender areas at the end of the hiking day, wearing orthotics, gentle stretching (e.g., pulling back the toes and front part of the foot), and administration of an oral nonsteroidal antiinflammatory drug, such as ibuprofen. Worn at night, a splint that holds the foot in neutral position—thus keeping the plantar fascia slightly stretched—may help, as may avoiding walking barefoot or in flat-soled shoes.


If the victim must continue to walk on the painful foot, it can be taped to provide arch support; this can do much to reduce pain. It is accomplished as follows: Apply a thin layer of benzoin or spray tape adhesive onto the bottom of the foot. Fix an anchor strip of ¾ in (1.9 cm) adhesive tape in a U shape around the heel from just under the malleoli (prominences of the ankle) up to just behind the level of the “knuckles” of the toes (Figure 169, A). Next, lay fairly tight cross-strips of ½ in (1.3 cm) tape across the bottom of the foot, with their ends torn to lay on the anchor strip (Figure 169, B). This creates a “sling” of tape under the foot for support. Finally, apply another U-shaped piece of tape around the heel that crosses under the center of the arch and locks down the crosspieces (Figure 169, C).




Torn Muscle


A torn muscle (“pulled” muscle) is recognized as sudden pain in a muscle group associated with a particular vigorous exertion, such as sprinting or lifting a heavy object. Depending on the severity of the injury, there may be associated bruising, swelling, loss of mobility, and/or weakness. For instance, a small tear in the deltoid muscle of the shoulder may cause minor discomfort on lifting the arm over the head, while a complete separation of the quadriceps group in the anterior thigh will cause inability to straighten the leg at the knee, extreme local pain, blue discoloration of the knee, and a defect in the shape of the muscles above the knee that is easily felt and seen.


In general, a minor muscle injury can be distinguished from a bone injury by evaluating active and passive range of motion. Active range of motion is the range of normal activity the victim can manage without rescuer assistance; this will be painful with both muscle and bone injuries. Passive motion is movement of a body part performed only with the aid of the rescuer; no effort is provided by the victim, who should attempt to relax the muscle completely. If there is no pain on passive (assisted) motion, but pain is present on active motion, the injury is most likely muscular, because an injured bone will hurt no matter how it is moved. If there is pain on passive motion, with or without pain on active motion, suspect a bone injury.


Minor muscle injuries should be treated in the first 24 hours with immobilization, the application of cold (insulated ice packs or chemical cold packs, for example; do not apply ice directly to the skin) for 30 to 45 minutes every 2 to 3 hours, and elevation. After 48 to 72 hours, the application of heat (warm water or a heating pad, not ointments) and gentle movement should be started. If a significant injury is suspected (for example, complete tear of the biceps muscle or quadriceps muscle group), the injury should be immobilized as for a fracture (see page 74) and the victim transported to a physician.


The best way to prevent a pulled muscle is to stretch and warm up adequately. This allows the local blood flow to increase and minimizes the risk for small tears that can cause spasm, which in turn leads to decreased flexibility.

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Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on MUSCULOSKELETAL INJURIES

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