Acute Injury Management

Acute injury

Assess life & limb threatening injury and manage according to ATLS principles.
Local Musculoskeletal Injury: assess muscle, tendon, ligament, bone and neurovascular assessments.

Assessment protocol:

Look
Feel
Assess
Ice
Immobilize
Definitive management

Managing acute bone injury

Acute bone fracture management

Follow ATLS principles especially if poly-traumatic injury
Splint injured area
Analgesia
Definitive treatment: surgery versus non-surgery management

Bone fractures

Surgery
Non-surgery: splint area ± traction

Managing muscle injury

Muscle fiber types: slow twitch & fast twitch muscle.

Muscle is covered by an epimysium sheath.
Muscle consists of groups of fascicles.
Each fascicle consists of muscle fibers.
Each muscle fiber is made up of a continuum of sarcomeres that are the basic muscle unit structures.
Each sarcomere is made up of myosin & actin units.
Myosin & actin units shorten & elongate thereby controlling muscle contraction &/or length.
Ca2 containing structures are called sarcoplasmic reticulum & regulate the release of Ca2 responsible for muscle contraction.

Muscle injury site

Muscle injury can occur in the muscle belly or at the myotendinous junction

Sites of muscle injury:

Muscle belly
Myotendinous junction

Acute muscle injury management

muscle injuries — Diagram showing the 2 common sites of muscle injury: Top arrow: myotendinous junction Bottom arrow: injury at muscle belly.

Treatment principles of acute muscle injury

Avoid NSAIDs or any medication that may cause muscle bleeding in the first 24 hrs.
Rest the injured area.
Intermittent ice to reduce swelling.
Compression bandage to reduce swelling.
Elevation to reduce swelling.
Splint is a consideration in select circumstances.
Assess the severity of injury: it is unusual for isolated muscle injury to present with compartmental syndrome. If this occurs, then the acute muscle injury compartment syndrome requires surgery.
Rehabilitation principles: a range of motion & regain muscle strength while maintaining neurological proprioception function & fitness levels.
Resume functional activity after satisfactory rehabilitation.

Hamstring strengthening modalities

Hamstring strengthening progression during rehabilitation starting from ROM (range of motion) to resistance training using body mass to the final stage using higher resistance modalities like theraband & weights.

Managing joint injury

Acute joint injury requires rest, ice and compression.
Minor injuries can be managed non-operatively, however acute complete tears may require surgery for repair or reconstructive surgical intervention in the functionally unstable joint.

Treatment of joint injury

Avoid NSAIDs or any medication that may potentiate muscle bleeding in firsts 24 hrs
Rest injured joint
Intermittent ice to reduce swelling
Compression bandage is amenable if able to compress
Elevation to reduce swelling
Splint is a consideration if possible
Assess severity of injury: surgery versus non-surgery
Rehabilitation principles: range of motion & regain muscle strength while maintaining neurologic function especially proprioception
Resume functional activity after satisfactory rehabilitation

Knee ligament injury

An example of acute knee ligament injury with collateral and cruciate ligament injury.
Knee instability in an active athlete may require surgery followed by rehabilitation before return to competition.

Knee bracing may facilitate stability while reduction in swelling in the acute injury

Range of motion: Full

Function: Knee pain and proprioception

An example of compression bandage around the knee joint

Bracing may facilitate support to the knee ligaments while maintaining ROM

An example of brace that allow Range of motion (ROM) with flexion and extension. Function: Indicated for combined knee ligament instabilities

Managing tendon injury

Avoid NSAIDs or any medication that may potentiate muscle bleeding in firsts 24 hrs
Rest anatomical area
Intermittent ice to reduce swelling
Compression bandage is amenable if able to compress
Elevation to reduce swelling
Splint is a consideration if possible
Assess severity of injury: surgery versus non-surgery.
Rehabilitation principles: range of motion & regain muscle strength while maintaining neurologic function especially proprioception
Resume functional activity satisfactory rehabilitation

Acute tendon injury

Partial tendon tears can be managed non-operatively, however complete tendon ruptures with loss of function may require surgery.

Acute Achilles tendon rupture

Acute Achilles tendon rupture is a common tendon injury, that especially occurs in unconditioned athletes. The diagnosis can be delayed as the intact associated muscles around the ankle that also provide foot plantarflexion masks the severity of the acute Achilles tendon rupture.

Injury principle management

Acute injury management
Surgery or non-surgery
Maintain range of motion where applicable
Strengthening anatomical area
Proprioception exercises
Sport specific exercises
Maintain fitness throughout the treatment & rehabilitation phases
Resume play after completing battery of fitness testing