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assic fitness and health white logoassic fitness and health white logoAcute Injury ManagementAcute Injury Management

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Acute Injury Management

Categories
  • Articles
  • Muscle
  • Muscle Injury
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Muscle

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

Bone anatomy
Bone anatomy
Bone Structure

Acute bone fracture management

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

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 fibers

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

Ice injured muscle area
Ice injured muscle area
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.

Strengthening: hamstring conditioning

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
applying ice to the muscle

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.

dislocation of the knee

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

Range of motion: Full

Function: Knee pain and proprioception

compression bandage around the knee joint
An example of compression bandage around the knee joint

Bracing may facilitate support to the knee ligaments while maintaining ROM

brace that allow Range of motion (ROM) with flexion and extension
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 tendon injury: ice followed by compression and elevation.
Acute tendon injury: ice followed by compression and elevation.

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.

Achilles tendon problems

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

Related posts

Muscle
December 4, 2020

Delayed Onset Muscle Soreness (DOMS)


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Muscle
March 10, 2020

Hamstring Muscle Injury


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Ankle
July 24, 2018

Return to Sport Guidelines after Ankle Rehabilitation


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Knee Anatomy & Examination
July 23, 2018

Return to play: After knee injury


Read more
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