In Partial Fulfillment of the Requirements

In NCM 116 – Care of Clients with Problems in Nutrition, and Gastro-Intestinal,

Metabolism and Endocrine, Perception and Coordination, Acute and Chronic
(LEC)

MUSCULSKELETAL DISORDERS

SUBMITTED TO:

Ma’am Renzi Pepito, RN, MN

Level III Clinical Instructor

SUBMITTED BY:

Abedin, Jamil L.
Alguzar, Odessa Gayle A.
Arpa, Courtney Joy L.
Bergonia, Toni Roselle A.
Bersola, Jean Dominique B.
Bonghanoy, Joshua Allen O.
Burgos, Andrew Kyril B.
Catiil, John Ivan E.
Daclag, Paolo Victor L.
Damasco, Kaye Ivee V.
Dela Cruz, Juan Miguel A.
Emano, Kathryna Marie P.
Galagar, Hannah Bea Franchesca G.

APRIL 18, 2021

 TABLE OF CONTENTS

IMMEDIATE AND DELAYED COMPLICATIONS OF FRACTURES ..................................... 1

Definition ........................................................................................................................... 1

Late complications of fractures ................................................................................... 1

Early complications: ....................................................................................................... 2

Prevention ........................................................................................................................ 4

Management .................................................................................................................. 4

ACUTE FRACTURE ................................................................................................................ 6

Definition ........................................................................................................................... 6

Signs & Symptoms ........................................................................................................... 6

SPORTS- RELATED MUSCULOSKELETAL DISORDERS ........................................................ 7

Definition ........................................................................................................................... 7

Signs & Symptoms ........................................................................................................... 7

Treatment ......................................................................................................................... 9

OCCUPATION-RELATED MUSCULOSKELETAL DISORDERS ........................................... 11

Definition ......................................................................................................................... 11

Signs & Symptoms ......................................................................................................... 11

Treatment ....................................................................................................................... 12

REFERENCES ....................................................................................................................... 14
 1

IMMEDIATE AND DELAYED COMPLICATIONS OF FRACTURES

Definition
- Acute complications are generally those occurring as a result of the initial
trauma and include neurovascular and soft tissue damage, blood loss and
localized contamination and infection. Delayed complications may occur
after treatment or as a result of initial treatment and may include malunion,
embolic complications, osteomyelitis and loss of function.

Late complications of fractures

- Local:
o Delayed union-failure of a fracture to consolidate within the
expected time - which varies with site and nature of the fracture and
with patient factors such as age. Healing processes are still
continuing, but the outcome is uncertain.
o Malunion-the bone fragments join in an unsatisfactory position,
usually due to insufficient reduction.
o Non-union-when there are no signs of healing after >3-6 months
(depending upon the site of fracture). Non-union is one endpoint of
delayed union. The distinction between delayed union and non-
union can be slightly arbitrary: whilst fractures can generally be
expected to heal in 3-4 months, this will vary in the case of open
fractures and those associated with vascular injury, and also in the
presence of patient risk factors described below. However, non-
union is generally said to occur when all healing processes have
ceased and union has not occurred.
o Joint stiffness.
o Contractures.
o Myositis ossificans-calcifications and bony masses develop within
muscle and can occur as a complication of fractures
 2

o Avascular necrosis
o Algodystrophy (or Sudeck's atrophy)-A continuous, burning pain
develops, accompanied at first by local swelling, warmth and
redness, progressing to pallor and atrophy. Movement of the
afflicted limb is very restricted
o Osteomyelitis.
o Growth disturbance or deformity

- Systemic:
o Gangrene, tetanus, septicemia.
o Fear of mobilizing.

Early complications:
- Life-threatening complications
o These include vascular damage such as disruption to the femoral
artery or its major branches by femoral fracture, or damage to the
pelvic arteries by pelvic fracture.
o Patients with multiple rib fractures may develop pneumothorax, flail
chest and respiratory compromise.
o Hip fractures, particularly in elderly patients, lead to loss of mobility
which may result in pneumonia, thromboembolic disease or
rhabdomyolysis.
- Local:
o Vascular injury.
o Visceral injury causing damage to structures such as the brain, lung
or bladder.
o Damage to surrounding tissue, nerves or skin.
o Haemarthrosis.
 3

o Compartment syndrome (or Volkmann's ischaemia)-caused by an

increased pressure within a closed anatomical space, which
compromises the circulation and function of the tissues within that
space. This may result in temporary or permanent damage to
muscles and nerves
o Wound Infection (more common for open fractures.)
o Fracture blisters-Fracture blisters form over the fracture site and alter
management and repair, often necessitating early cast removal and
immobilization by bed rest with limb elevation. They are believed to
result from large strains applied to the skin during the initial fracture
deformation, and they resemble second-degree burns rather than
friction blisters. They may be clear or hemorrhagic, and they may
lead to chronic ulcers and infection, with scarring on eventual
healing. Management involves delay in surgical intervention and
casting.
- Systemic:
o Fat embolism-occurs when embolic fat macroglobules pass into the
small vessels of the lung and other sites, producing endothelial
damage and resulting respiratory failure (acute respiratory distress
syndrome (ARDS-like) picture), cerebral dysfunction and a petechial
rash
 Shock.
 Thromboembolism (pulmonary or venous).
 Exacerbation of underlying diseases such as diabetes or
coronary artery disease (CAD).
 Pneumonia.
 4

Prevention
- Nutrition and sunlight – The human body needs adequate supplies of
calcium for healthy bones. Milk, cheese, yoghurt and dark green leafy
vegetables are good sources of calcium. Our body also needs vitamin D to
absorb calcium. By exposing to sunlight, as well as eating eggs and oily fish
are good ways of getting vitamin D.
- Physical activity – The more weight-bearing exercises the person does, the
stronger and denser their bones will be. Examples include skipping, walking,
running, and dancing any exercise where the body pulls on the skeleton.
Older age not only results in weaker bones, but often in less physical activity,
which further increases the risk of even weaker bones. It is important for
people of all ages to stay physically active.
- The (female) menopause – Hormones estrogen, which regulates a woman’s
calcium, starts to drop and continues to do so until after the menopause.
In other words, calcium regulation is much more difficult after the
menopause. Consequently, women need to be especially careful about
the density and strength of their bones during and after the menopause.

Management
- Fracture treatment is usually aimed at making sure there is the best possible
function of the injured part after healing. Treatment also focuses on
providing the injured bone with the best circumstances for optimum
healing.
o Cast Immobilization: After the bone is fractured and must aligned
while they heal
o Plaster casts or plastic functional braces – these hold the bone in
position until it has healed. Now a days porous casts are used. These
porous castes are easy to apply and are not uncomfortable.
 5

o Metal plates and screws – current procedures use minimally invasive

techniques.
o Intra-medullary nails – Internal steel rods are placed down the center
of long bones. Flexible wires may be used in children.
o External fixators – these may be made of metal or carbon fiber; they
have steel pins that go into the bone directly through the skin. They
are a type of scaffolding outside the body. Usually the fractured
bone area is immobilized for between two to eight weeks. The
duration depends on which bone is affected and whether there are
any complications, such as a blood supply problem or an infection.
- Pain management: Pain killers like ibuprofen, diclofenac is used to relieve
pain.
- Physiotherapy: Once the fracture is healed it is necessary to restore muscle
strength as well as mobility to the affected area. If the fracture occurred
near or through a joint there is a risk of permanent stiffness – the individual
may not be able to bend that joint as well as before.
- Surgery approach: If there is a damage to the skin and soft tissue around
the affected bone or joint, plastic surgery might be required.
- Bone grafting: Bone grafting is a surgical procedure that replaces missing
bone in order to repair bone fractures that are extremely complex, pose a
major health risk to the patient, or fail to heal properly.
 6

ACUTE FRACTURE
Definition
- Sudden or gradual pressure applied on the bone causing a break of any
size.
o Stable fracture. The broken ends of the bone line up and are barely
out of place.
o Open, compound fracture. The skin may be pierced by the bone or
by a blow that breaks the skin at the time of the fracture. The bone
may or may not be visible in the wound.
o Transverse fracture. This type of fracture has a horizontal fracture line.
o Oblique fracture. This type of fracture has an angled pattern.
o Comminuted fracture. In this type of fracture, the bone shatters into
three or more pieces.
Signs & Symptoms
- A visibly out-of-place or misshapen limb or joint
- Swelling, bruising, or bleeding
- Intense pain
- Numbness and tingling
- Broken skin with bone protruding
- Limited mobility or inability to move a limb
 7

SPORTS- RELATED MUSCULOSKELETAL DISORDERS

Definition
- Sport related injuries are common consequences of sport activities (Hinkle,
J.L. & Cheever, K.H., 2014). Sports injuries occur during exercise or while
participating in a sport. Children are usually at risk for these types of injuries,
but adults can get them too. People who are at risk for sport injuries haven’t
been regularly active, don’t warm up properly before exercise and those
who play contact sports (Heitz, 2018).

Signs & Symptoms

- Symptoms of a sports injury may occur suddenly at the time of the injury or
progressively over a few hours or days. Symptoms include the following:
o Pain - The most common symptom of a sports injury is pain. It's the
body's way of letting you know something's wrong, and it varies
depending on the type of injury. Often the onset of pain is delayed.
This is particularly true in cases of overuse injuries. After a sport, a joint
can feel a little sore, but the pain can gradually worsen over the next
few hours. Tenderness in the region when pressure is applied may be
an effective sign of a serious injury.
o Swelling - Swelling is a symptom of inflammation, which is your body's
attempt to respond to an injury and activate the immune system's
healing response. You do not experience any swelling or limitations
of your ability to function in the early stages of an injury. Swelling
usually happens over time when healing blood and fluid is sent to
protect and repair damaged tissue or bone.
o Stiffness - A restricted range of motion may indicate the seriousness
of an injury. In the case of acute injuries, a period of rest is usually
recommended first, accompanied by gentle movements that
gradually increase in intensity.
 8

o Instability - An unstable joint feels loose, as if it's about to buckle or

give way. Since the injured joint is not properly supported after it has
been affected, this is also a sign of a ligament injury (such as an ACL
tear).
o Weakness - A muscle or tendon injury that reduces the strength of the
injured area may indicate structural damage that prevents normal
function. Weakness that prevents you from lifting your arm or walking
should be examined by a medical professional, since there may be
other, more serious triggers.
o Numbness and tingling - Nerve pain or injury causes numbness or
tingling. Often nerves are actively damaged; other times, a nerve
may be irritated by swelling or inflammation in the surrounding area.
Mild tingling is rarely a problem, but the inability to feel an injured
body part is more concerning.
o Redness - Inflammation, abrasions, allergies, and infections can all
cause redness at the injury site. A medical professional should be
consulted if you have unexplained skin redness, especially if the area
is also hot to the touch.
o Confusion or headache - A concussion can be caused by even
minor head trauma, and it can cause cognitive symptoms including
confusion, trouble focusing, and memory loss, as well as headache,
dizziness, nausea, and irritability.
- Some signs that you should be seen by a medical professional include:
o Difficulty using the injured area (walking, lifting your arm, etc.)
o Inability to place weight on an extremity
o Limited mobility of a joint
o Deformity of the injured area
o Bleeding or skin injury
o Signs of infection (fevers, chills, sweats)
 9

o Headache, dizziness, confusion, or loss of consciousness following a

head injury

Treatment
- Initial treatment for many sports injuries is aimed at:
o Controlling inflammation
o Promoting the healing response
- The acronym R.I.C.E. is a helpful guide for the immediate treatment of most
acute injuries. When performing R.I.C.E. treatment, you will take the
following steps:
1. Rest: Limit the forces acting on the injured part of the body. This
generally means stopping your sports activity, and it may mean using
crutches, a sling, or another aid to fully rest the area.
2. Ice: Ice is helpful at controlling swelling and inflammation, and it can
also help tremendously with pain reduction.
3. Compress: Compression is performed by snugly, but not tightly,
wrapping the injured part of the body with a compression bandage.
Too-tight constriction can cause worsening of symptoms and other
problems.
4. Elevate: Elevating the injured extremity can also help reduce swelling
and inflammation and, in turn, reduce pain.
- After an initial period, rest should be replaced by protection and optimal
loading. This technique is known as P.O.L.I.C.E. (protection, optimal loading,
ice, compression, and elevation).
o Protecting the injured joint with an assistive device, such as crutches
or a sling, while gently moving the joint and gradually putting weight
on the injury will often help speed healing.
 10

- After the initial healing period, your doctor will determine what, if any,
additional treatment is needed and may refer you to a specialist for your
specific injury. Treatments include:
o Immobilization with a splint, cast, or brace
o Medication for pain
o Pain-relieving injections, such as a cortisone shot
o Physical therapy
o Surgery
 11

OCCUPATION-RELATED MUSCULOSKELETAL DISORDERS

Definition
- Muscle, nerve, tendons, joints, cartilage, and bone injuries or illnesses that
arise as a result of work-related hazards are known as occupational-
related musculoskeletal disorders (Hinkle, J.L. & Cheever, K.H., 2018).
Sprains, strains, and tears (40.8 percent), wounds, lacerations, and
punctures (9.6%), bruises and contusions (8.7%), fractures (7.8%), and
soreness and discomfort (5.3 percent), multiple injuries (4.1%), and back
pain (2.9%).

Signs & Symptoms

- Pain is the most common symptom associated with occupation-related
musculoskeletal disorders. In some cases there may be joint stiffness, muscle
tightness, redness and swelling of the affected area. Some workers may
also experience sensations of "pins and needles," numbness, skin colour
changes, and decreased sweating of the hands
- Occupation-related musculoskeletal disorders may progress in stages from
mild to severe.
o Early stage: Aching and tiredness of the affected limb occur during
the work shift but disappear at night and during days off work. No
reduction of work performance.
o Intermediate stage: Aching and tiredness occur early in the work shift
and persist at night. Reduced capacity for repetitive work.
o Late stage: Aching, fatigue, and weakness persist at rest. Inability to
sleep and to perform light duties.
 12

Treatment

ANATOMICAL AREA ACUTE MANAGEMENT

Clavicle fracture ● Sling or shoulder immobilizer

● Ice
● NSAIDs

Dislocated shoulder ● Closed reduction

● Immobilizer
● Pendulum exercises

Dislocated elbow ● Immobilization

● Ice
● ROM exercises

Wrist sprain or fracture ● Ice

● Elevation
● Immobilization
● Gentle ROM for 4 - 6 weeks (for sprain only)

Knee sprain ● Ice

● Elevation
● Compression wrap
● Active ROM exercises
● Isometric exercises
● May be immobilized

Knee strain ● Ice

● Elevation
● Rest
 13

● Gradual return to activities

Meniscal tears of knee ● RICE

● Exercising of quadriceps and hamstrings
● Resistive exercising
● NSAIDs
● Physical therapy
● Arthroscopy

Ankle sprain ● Immobilization in cast or brace

● Ice
● Elevation
● Rest

Ankle strain ● Immobilization in cast or brace

● Ice
● Elevation
● Rest

Ankle fracture ● Ice

● Elevation
● Cast (4 - 6 weeks)
● Surgery (If fracture is displaced or unstable)

Metatarsal stress fracture ● Rest

● Stop sports-related activity for 6 weeks
● Ice
● Weight bearing as indicated
 14

REFERENCES

Cheever, K.H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing

(14th ed.). Philadelphia: Wolters Kluwer.
Fracture : Diagnosis, Complications and Prevention -. (2017, July 25). AIMU.
https://www.aimu.us/2017/07/25/fracture-diagnosis-complications-and-
prevention/
Heitz, D. (2018, November 10). Sports injuries: Types, treatments, prevention, and
more. Retrieved April 15, 2021, from
https://www.healthline.com/health/sports-injuries
Hinkle, J.L. & Cheever, K.H. (2014). Brunner & Suddarth's Textbook of Medical-
Surgical Nursing (13th ed.). Philadelphia: Wolters Kluwer.Hinkle, J.L. &
Jonathan Cluett, M. (2020, December 08). What to do if you get injured playing
sports. Retrieved April 16, 2021, from
https://www.verywellhealth.com/sports-injuries-4013926#symptoms
Ma, B. C. (2002). Bone Fractures - Symptoms and Causes. Penn Medicine.
https://www.pennmedicine.org/for-patients-and-visitors/patient-
information/conditions-treated-a-to-z/bone-fractures
Willacy, H. (2019, May 13). Complications from Fractures. Patient Info.
https://patient.info/doctor/complications-from-fractures#nav-0
Work-related Musculoskeletal Disorders (WMSDs). (2019, September 12). What are
the symptoms of WMSDs? Retrieved April 16, 2021, from
https://www.ccohs.ca/oshanswers/diseases/rmirsi.html#:~:text=Pain%20is%
20the%20most%20common,decreased%20sweating%20of%20the%20hand
s.