Question

• Discuss the characteristics and therapeutic management of soft-tissue injuries such as contusions, dislocations, sprains, and strains. Review the acronyms RICE and ICES and the critical period for these injuries.
• Compare and contrast the various types of traction used to treat musculoskeletal disorders in children and how to assess the child in traction.
• Review the two major groups (idiopathic, teratologic) and three degrees of developmental dysplasia of the hip (DDH) (acetabular dysplasia, subluxation, dislocation), and discuss the treatments and management of the conditions.
• Identify the preoperative and postoperative nursing goals and responsibilities used in caring for a neonate with myelomeningocele.
• Review the causes, clinical manifestations (Box 49.10, Clinical Manifestations of Guillain-Barré Syndrome), therapeutic and care management, and prognosis of Guillain-Barré syndrome (GBS).
• Discuss emergency care, prognosis, and rehabilitation for the child with a spinal cord injury.

Answer 1

The most common soft tissues injured are muscles, tendons, and ligaments. These injuriesoften occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury. Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries.

A soft tissue injury generally involves one or more of the following structures via sprain, strain or direct blows:

• Muscle – muscles are made up of fibres that shorten and lengthen to produce movement of a joint. Muscles are attached to bone by tendons.
• Tendon – tendons are tough bone of slightly elastic connective tissue that connect muscle to bone.
• Ligament – ligaments are strong bands of inelastic connective tissue that connect bone to bone.

The biggest risk factor for soft tissue injury is a previous injury. A player returning from injury or illness should refrain from activity until declared fit to play by a sports medicine professional.

Types of soft tissue injuries include:

Acute injury

Injuries that occur from a known or sometimes unknown incident. Signs and symptoms develop rapidly.

Bruise (contusion, cork)

Bruises are caused by a direct force applied to the body such as being kicked or making contact with a player and result in compression and bleeding into the soft tissue (hematoma).

Signs and symptoms: Swelling and/or discolouration.

Sprain

Sprains are caused when the joint is forced beyond its normal range of motion resulting in overstretching and tearing of the ligament that supports the joint.

Signs and symptoms: Swelling, loss of power or ability to bear weight, possible discolouration and bruising and/or sudden onset of pain.

Strain

Strains are caused by muscles over-stretching or contracting too quickly, resulting in a partial or complete tear of the muscle and/or tendon fibres.

Signs and symptoms: Swelling, possible discolouration and bruising and/or pain on movement.

Overuse Injury

Overuse injuries occur as a result of repetitive friction, pulling, twisting, or compression that develops over time.

Signs and symptoms: Will develop slowly, inflammation, pain.

Immediate Management

The immediate treatment of any soft tissue injury consists of the RICER protocol – rest, ice, compression, elevation and referral. RICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage within the joint.

The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

This regime should be used for all ligament sprains, muscle sprains and muscle bruises. Referral for bumps and bruises which occur in sport or physical activity, other than those which are minor is recommended.

ICE will help to reduce the pain and enable you to optimally load the injuredjoint or muscle. COMPRESSION will help to keep swelling at bay when you're up and about and on the move. This can be as simple as using a tubigrip or compression bandage.