A sprain is an injury to the ligaments surrounding a joint, usually caused by a wrenching or twisting motion. Most sprains occur in the ankle, wrist, and knee joints

A strain is an excessive stretching of a muscle, its fascial sheath, or a tendon. Most strains occur in the large muscle groups, including the lower back, calf, and hamstrings.

Nursing Management: Sprains and Strains:

(1) Health Promotion

Warming up muscles before exercising and vigorous activity, followed by stretching, may significantly reduce the risk of sprains and strains. Strength, balance, and endurance exercises are also important. Strengthening exercises 1464that involve working against resistance build muscle strength and bone density. Balance exercises, which may overlap with some strengthening exercises, help to prevent falls. Endurance exercises should start at a low level of effort and progress gradually to a moderate level.

(2) Acute Care

If an injury occurs, immediate care focuses on (1) stopping the activity and limiting movement, (2) applying ice packs to the injured area, (3) compressing the involved area, (4) elevating the extremity, and (5) providing analgesia as needed.

Causes:

Falls

• Direct blows

• Crush injury

• Motor vehicle crashes

• Sports injuries

Assessments:

• Edema

• Bruising (contusion)

• Pain, tenderness

• Decreased sensation with severe edema

• Decreased pulse, coolness, capillary refill >2 sec

• Decreased movement

• Pallor

• Shortening or rotation of extremity

• Inability to bear weight with lower extremity involvement

• Limited or decreased function with upper extremity involvement

• Muscle spasms

Interventions:

Initial [PRIORITY]

• Ensure airway, breathing, and circulation.

• Perform neurovascular assessment of involved limb.

• Elevate involved limb. Elevate the injured part above heart level, even during sleep, to help mobilize excess fluid from the area and prevent further edema.

• Apply compression bandage unless dislocation present.

• Apply ice packs to affected area. Cold is most useful when applied immediately after the injury has occurred. Apply ice no more than 20 to 30 minutes at a time; avoid applying ice directly to the skin.

After the acute phase (usually 24 to 48 hours), apply warm, moist heat to the affected part to reduce swelling and provide comfort. Heat applications should not exceed 20 to 30 minutes, allowing a “cool-down” time between applications.

• Immobilize affected extremity in the position found. Do not attempt to realign or reinsert protruding bones.

• Anticipate x-rays of injured extremity.

• Give analgesia as necessary.

• Administer tetanus and diphtheria prophylaxis if there is an open fracture.

• Administer antibiotic prophylaxis for open fracture, large tissue defects, or mangled extremity injury.

Ongoing Monitoring

• Monitor for changes in neurovascular condition.

• Implement weight-bearing restrictions as ordered for lower extremity involvement.

• Anticipate compartment pressure monitoring if neurovascular assessment changes and compartment syndrome suspected.

	Created by Kalyn S over 8 years ago

Nursing Note on Application of the Nursing process of clients experiencing Musculoskeletal Trauma, created by Kalyn S on 05/03/2018.