Acute Injuries. Learning Objectives. 1. Definition

Transcription

1 Acute Injuries Learning Objectives 1. Distinguish between intrinsic and 2. List the major acute injuries according to tissue type 3. Discuss common examples of how acute injuries present - GP role 4. Preview the principles of treatment of acute injuries 1. Definition Extrinsic direct contact with opponent or equipment Intrinsic e.g. ligament sprain, muscle strain 1

2 Why Make The Distinction? Reflects the different mechanisms of injury which means that prevention will have a different focus, even if the diagnosis is the same Example, intrinsic vs extrinsic ACL rupture Intrinsic: prevention relies on proprioceptive training Extrinsic: may require rule changes to decrease risk of this condition Classification By Tissue Type Ligament Muscle Tendon Bone Sprain / tear (grades I to III) Strain / tear (grades I to III) Contusion Cramp Acute compartment syndrome Tear (complete or partial) Fracture Periosteal contusion Classification By Tissue Type Articular cartilage Joint Nerve Skin Osteochondral, chondral fractures Minor osteochondral injury Dislocation Subluxation Neuropraxia Minor nerve injury / irritation Laceration, abrasion, 2

3 Learning Objectives 1. Distinguish between intrinsic and 2. List the major acute injuries according to tissue type 3. Discuss common examples of how acute injuries present - GP role 4. Preview the principles of treatment of acute injuries Acute knee injury Can be extrinsic (opponent falls across leg and causes medial ligament to tear) Or intrinsic (ACL rupture, 70% are noncontact) GP may see the patient within a few hours (golden period) but more likely within a few days Goal of GP Appointment Diagnosis (where possible) Investigation (where appropriate) Early management including RICE and rehabilitation Bracing (mostly not required) Referral if required 3

4 Acute ankle sprain Very common presentation Differentiate between simple and difficult Simple = the first presentation of an acute sprained ankle Difficult = physio referral or patient selfreferred after ankle sprain not getting better Goal of GP Appointment Simple ankle sprain Diagnosis Reassure that no #, if this is possible Investigation (where appropriate) Early management including RICE and rehabilitation Ankle brace or tape Referral to physiotherapy Acute tendon rupture Achilles tendon most common Classic history may be relatively painfree rather quickly May retain some active plantarflexion Calf squeeze test has 100% sensitivity! Key is to consider the diagnosis 4

5 Goal of GP Appointment Diagnosis Referral for urgent surgery for Achilles tendon rupture Ultrasound / MR imaging useful for various tendons Explanation of the prognosis, likely timeline Explain about the importance of postoperative physiotherapy Acute muscle strain Diagnosis RICE Early start on rehabilitation including strengthening Physiotherapy referral Return to sport progression based on clinical progress and natural history Cramps Increasingly recognised to be associated with neural tone Not directly associated with dehydration etc. Treatment includes stretching to change the neural threshold for contraction 5

6 Learning Objectives 1. Distinguish between intrinsic and 2. List the major acute injuries according to tissue type 3. Discuss common examples of how acute injuries present - GP role 4. Preview the principles of treatment of acute injuries Preview of Treatment Principles Minimise the bleeding and inflammation associated with the acute trauma (RICE) Protect the part while allowing early range of motion exercises to continue (i.e., brace, splint, tape) Early mobilisation as appropriate Early rehabilitation, physiotherapy Strengthening can start early in many cases Summary 1. Distinguished between intrinsic and 2. Discussed several major acute injuries according to tissue type 3. Discussed common GP presentations and the role of the GP 4. Previewed the principles of treatment of acute injuries and emphasised protected early mobilisation 6

7 Accurate diagnosis Conclusion Explanation Early mobilisation where appropriate Avoid complications of immobilisation 7