15 Muscloskeletal disorders.pdftggtefggb

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1. CHAPTER 15


Muscloskeletal disorders
BY: Endashaw F. (MSC in pedi& CH) 1

2. Osteomylitis
It is an inflammation of the bone.
 Mostly in long bone;
- Commonly in femur and tibia(50%).
- humerus, fibula, radius and ulna.
•common in children 3-12yrs.
• 1/3
rd
of cases <2yrs,
• ½ of cases in < 5yrs.
• 2x common in boys than girls.
•trauma is a common preceding event 1/3
rd
of case

2 BY: Endashaw F. (MSC in pedi& CH)

3. Sites of bone involvement by %
Bone % of involvement
tibia 24.3%
femur 23.8%
humerus 13.2%
fibula 5.9%
radius 3.9%
ulna 2.3%
vertebra 2%
BY: Endashaw F. (MSC in pedi& CH) 3

4. Etiology of Osteomylitis
• Staphylococcus aureus( most common in all age),
•Newborn: Group B streptococcus and
- gram-negative enteric bacilli;
- Group A streptococus
• After 6 yr age; S. aureus, streptococcus or
- P. aeruginosa.
•sickle cell anemia :Salmonella and S. Aureus
•Rarely: fungus and virus
 A microbial etiology is confirmed :75% of cases and
- 2/3 for septic arthritis.


4 BY: Endashaw F. (MSC in pedi& CH)

5. Osteomylitis ....
may occur by;
• haematogenous spread (most common),
•contiguous spread: surrounding infection
•direct inoculation: trauma

5 BY: Endashaw F. (MSC in pedi& CH)

6. Risk to skeletal infection
•Immunocompromised patients
•Trauma- penetrating injuries or open fractures
•orthopedic surgery
• arthroscopy,
•prosthetic joint surgery,
• intra-articular steroid injection

6 BY: Endashaw F. (MSC in pedi& CH)

7. Direct bone penetration
Bacteremia
(hematogenous)
Contiguous
Metaphyseal
Suppurative Inflamation (Metaph. Abscess)
Rupture into joints

Subperiosteal pus
Periosteal reaction
Arthritis
Osteoblastic activity
Involucrum
Ischemia and necrosis
of diaphysis
Rupture
Sinus tract Sequestrum
Pathogenesis of osteomylitis
7 BY: Endashaw F. (MSC in pedi& CH)

8. Clinical manifestation of osteomylitis
 pain to affected bone
 tenderness over the bone,
 bone: warmth, erythema, swelling, and
 decreased use of the affected extremity.
Fever, anorexia, irritability, and lethargy
Weight bearing and active and passive motion
are refused, which mimics paralysis
(pseudoparalysis)

8 BY: Endashaw F. (MSC in pedi& CH)

9. Diagnosis of osteomylitis:

HX and P/E,
CBC: increase WBC
ESR (98%)& CPR(90%) increased
 Gram stain
 bone culture(80 %)
x-ray,
 ultrasound,
 CT, MRI.
9 BY: Endashaw F. (MSC in pedi& CH)

10. DDX osteomylitis
Septic arthritis
Cellulitis
juvenile rheumatoid arthritis
Bone tumor
trauma,




10 BY: Endashaw F. (MSC in pedi& CH)

11. Treatment of osteomylitis
 Antibiotics: 4-6 weeks
• cloxacillin (200mg/kg in 4 divided) or
clindamycin.
• cefotaxime and ceftriaxone
Surgey: if pus, sequestrum is present,
• the disease is chronic ,
physical therapy: kept in extension with
sandbags, splints or casts.
•After 2-3 days, when pain is easing, passive range
of motion exercises.

11

12. Prognosis of osteomylitis
The prognosis varies but is markedly improved;
• with early diagnosis and
•aggressive therapeutic intervention.
When pus is drained and appropriate antibiotic
therapy is given,
- improvement is rapid.

12 BY: Endashaw F. (MSC in pedi& CH)

13. Prognosis of osteomylitis....
Failure to improve or worsening by 72 hr,
• requires review of the appropriateness of the
antibiotic therapy,
•the need for surgical intervention, or
• the correctness of the diagnosis.
CRP normalizes within 7 days after start of RX,
 ESR typically dropping sharply after 10-14 days
long-term follow-up is necessary
13 BY: Endashaw F. (MSC in pedi& CH)

14. septic arthritis
bacterial infection of the joint space.
Also called as, suppurative arthritis
The most commonly affected joints are;
- knees and hips (67%),followed by;
- ankle, elbow, wrist and shoulders.



14 BY: Endashaw F. (MSC in pedi& CH)

15. Epidemiology of septic arthritis
•½ of the cases occur by age 2yrs
•¾ of the cases occur by age 5yrs
•Joints of lower extremity constitute 75%
•Elbow, wrist, and shoulder joints :25% of cases

15 BY: Endashaw F. (MSC in pedi& CH)

16. Septic arthritis…..

Joint % involvement
Knee 40%
Hip 22%
Elbow 14%
Ankle 13%
Shoulder 5%
Wrist 4%
Others 3%
16 BY: Endashaw F. (MSC in pedi& CH)

17. Etiology of septic arthritis

•new born:Staphylococcus aureus ,
- Group B streptococcus and
- gram-negative enteric bacilli.
•Up to 5years:S.aureus,
- GA streptococcus ,
- Stre.pneumonia
- H.influenza
•>5 year: S. aureus and S. pyogenes
•Sexually active: gonococcus

17 BY: Endashaw F. (MSC in pedi& CH)

18. Pathogenesis of septic arthritis
Bacteria enter and invade the synovium
Migrate into joint space and multiply
Inflammatory response
Proteolytic enzymes Intra-articular pus
Destruction of articular
cartilage
Increase in intracapsular
pressure
Ischemic epiphyseal
damage
BY: Endashaw F. (MSC in pedi& CH) 18

19. Clinical manifestation of Septic arthritis
pain to affected limb(common),
fever ,
joint pain,swelling ,warmth,erythema.
tenderness over the affected joint,
 with a palpable effusion and
decreased range of movement.

19 BY: Endashaw F. (MSC in pedi& CH)

20. Diagnosis of Septic arthritis

•Hx and P/E
•CBC: Leukocytosis
• ESR and CRP common
•Blood or joint cultures are +Ve in 70% to 85%
•Synovial fluid analysis
•Imaging- radiography ,US,MRI

20 BY: Endashaw F. (MSC in pedi& CH)

21. condition appeara
nce
Mucin
clot
WBC Glucose
as % of
blood glu
Total %PM
N
Normal Clear,
yellow
good 0 -200 <25

100%
Septic A. turbid Curdled
milk
10,000-
250,000
>90 50-90%
TB.art. turbid Tight
rope
2,500-
100,000
>60 40-70%
JRA/react
ive
turbid Small
friable
masses
250-
80,000
>70 30%
Synovial fluid analysis


BY: Endashaw F. (MSC in pedi& CH) 21

22. Diagnosis
WBC/mm
3

(Typical) WBC/mm
3
(Range)
% PMNs
(Typical)
Normal < 150 — < 25
Bacterial
arthritis
> 50,000 2000-300,000 > 90
Tuberculous
arthritis
10,000–
20,000
40-136,000 > 50 (10-99)
Lyme arthritis 40,000–
80,000
180-140,000 > 75
Candidal
arthritis
- 7500-150,000 > 90
Viral arthritis 15,000 3000-50,000 < 50
(variable)
Rheumatoid
arthritis
- 2000-50,000 > 70
Rheumatic fever 25,000 2000-50,000 > 70

BY: Endashaw F. (MSC in pedi& CH) 22

23. DDX of septic arthritis

• rheumatoid disorders,
• rheumatic fever
• trauma.
•osteomyelitis,
•Tuberculosis Arthritis
•myositis,
•cellulitis, and
• soft tissue abscesses

23 BY: Endashaw F. (MSC in pedi& CH)

24. Treatment of septic arthritis
•Antibiotics : for 2-3 weeks
-usually cloxacillin
-Ampcillin+ gentamycin , ceftiraxone
•Surgery : if hip/shoulder joint involved
•Physical therapy
24 BY: Endashaw F. (MSC in pedi& CH)

25. Prognosis of septic arthritis
The prognosis varies but is markedly improved;
• with early diagnosis and
•aggressive therapeutic intervention.
 excellent outcome : 75% if symptoms < 4 days;
•15% if symptoms > 4 days.
Other poor prognostic indicators include:
•Young age
•Strain of organism e.g. Staphylococcus aureus.

25 BY: Endashaw F. (MSC in pedi& CH)

26. fracture

•fracture is a partial/complete break in the bone.
• Classified as:
Open fracture (also called compound fracture).
•The bone exits and is visible through the skin
Closed fracture (also called simple fracture).
- The bone is broken, but the skin is intact.

BY: Endashaw F. (MSC in pedi& CH) 26

27. Fracture....
•Fractures, common types are:
•Greenstick- A portion of the bone is broken,
causing the other side to bend(common).
•Transverse. The break is in straight line across the
bone.
•Spiral. The break spirals around the bone;
•Oblique. Diagonal break across the bone.
•Compression. The bone is crushed, causing the
broken bone to be wider or flatter in appearance.
•Comminuted. The break is in three or more pieces
•Less common in children.
BY: Endashaw F. (MSC in pedi& CH) 27

28. child bone
•presence of periosseous cartilage, physes, and
•a thicker ,stronger, more osteogenic periosteum
that produces new bone, called callus.
•low density and more porosity
•A child's bone heals much faster than an adult's
•This is due to children's growth potential and
active periosteum.
Physeal stimulation : bone healing overgrowth.
•Usually prominent in long bones( femur).
•Femoral fractures in <10 yr of age often overgrow
by 1-3 cm.

BY: Endashaw F. (MSC in pedi& CH) 28

29. child bone ...


•Bones are softer in children and tend to buckle or
bend rather than completely break.
•Children have open growth plates, also called
epiphysis, at the end of the long bones.
•Injury to the growth plate can lead to;
- limb length discrepancies or
- angular deformities.
BY: Endashaw F. (MSC in pedi& CH) 29

30. Pediatric Fracture Patterns
1.Plastic deformation is unique to children.
•most commonly in ulna and occasionally the fibula.
•microscopic failure on the tensile side of bone
and does not propagate to the concave side
2. Buckle or Torus Fracture:
• A compression failure of bone
•usually occurs at the junction of the metaphysis
and diaphysis,
• especially in the distal radius
BY: Endashaw F. (MSC in pedi& CH) 30

31. Pediatric Fracture Patterns…
3. Greenstick Fracture: occur when bone is bent.
The fracture line does not propagate to the
concave side of the bone.
4. Complete Fractures :Fractures that propagate
completely through the bone. These fractures may
be classified as spiral, transverse, or oblique

BY: Endashaw F. (MSC in pedi& CH) 31

32. Pediatric Fracture Patterns…
5. Epiphyseal Fractures
•The injuries to epiphysis involve the growth plate.
• There is always a potential for deformity to occur
•most commonly distal radial physis injured.
•Salter and Harris (SH) classified epiphyseal injuries
into 5 groups
BY: Endashaw F. (MSC in pedi& CH) 32

33. Epiphyseal Fractures…
SALTER-HARRI
TYPE
CHARACTERISTICS
I Separation through the physis
II
Fracture through a portion of the physis
but extending through the metaphyses
III
Fracture through a portion of the physis
extending through the epiphysis and into
the joint
IV
Fracture across the metaphysis, physis,
and epiphysis
V Crush injury to the physis
33

34. Cause of fracture
 when there is more force applied to the bone.
• falls,
•trauma, or
• direct blow or kick to the body.
Also 2ndry to infection, rickets and other
disease.

BY: Endashaw F. (MSC in pedi& CH) 34

35. Upper Extremity Fractures
Phalangeal Fractures: The mechanism of injury
is a direct blow to the finger.
•RX is splinting the digit in extension for 3-4 wk.
Forearm Fractures : wrist and forearm are very
common fractures in children,
•The most common mechanism of injury is a fall
on the outstretched hand.
•80% on distal radius and ulna

BY: Endashaw F. (MSC in pedi& CH) 35

36. Upper Extremity Fractures….
Distal Humeral Fractures :more attention because
more aggressive management is needed
Common fractures include;
• separation of the distal humeral epiphysis
(transcondylar fracture),
•supracondylar fractures of the distal humerus, and
•epiphyseal fractures of the lateral or medial condyle.
The mechanism of injury is a fall on an outstretched
arm.

BY: Endashaw F. (MSC in pedi& CH) 36

37. Upper Extremity Fractures….
•Proximal Humerus Fractures :
•<5% of fractures in children.
• usually result from a fall onto an outstretched arm.
•Children <5 yr of age have an SH I injury,
•5-10 yr of age have metaphyseal fractures, and
•children >11 yr have SH II injury.

BY: Endashaw F. (MSC in pedi& CH) 37

38. Upper Extremity Fractures….
Clavicular Fractures : Neonatal fractures occur as
a result of direct trauma during birth,
•most often through a narrow pelvis or
• following shoulder dystocia.
•Childhood fractures are usually the result of a fall
on the affected shoulder or direct trauma to the
clavicle.
•The most common site for fracture is the junction
of the middle and lateral 3rd clavicle.

BY: Endashaw F. (MSC in pedi& CH) 38

39. Fractures of Lower Extremity
Hip fractures : <1% of all children's fractures.
•Treatment of hip fractures in children entails a
complication rate of up to 60%,
•an overall avascular necrosis rate of 50%, and
•a malunion rate of up to 30%.

BY: Endashaw F. (MSC in pedi& CH) 39

40. Tibia and Fibula Shaft Fractures
•tibia is the most commonly from lower limb.
•This fracture results from a direct injury.
• Most tibial fractures are associated with a fibular
fracture, and
• the mean age of presentation is 8 yr.
•Closed reduction and immobilization are the
standard method of treatment.
•Open fractures : irrigation and debridement

BY: Endashaw F. (MSC in pedi& CH) 40

41. Fractures of Lower Extremity….
Femoral Shaft Fractures
•Fractures of the femur in children are common.
• All age groups, can be affected.
The mechanism of injury varies from;
• low-energy twisting type injuries to high-
velocity injuries in vehicular accidents.
 Femur fractures in children <2 yr should raise
the concern for child abuse.
BY: Endashaw F. (MSC in pedi& CH) 41

42. BY: Endashaw F. (MSC in pedi& CH) 42

43. Fractures of Lower Extremity…
•Metatarsal fractures are common in children.
They usually result from direct trauma to the
dorsum of the foot.
•Toe Phalangeal Fractures :Fractures of the lesser
toes are common
• are usually secondary to direct blows.
•They commonly occur when child is barefoot.
•lesser toes usually do not require closed reduction
•Casting is not usually necessary.
•Buddy taping of the fractured toe to an adjacent
stable toe.
•Crutches and heel walking 43

44. Clinical manifestations of a fracture
•Pain in the injured area,
• Swelling in the injured area,
•Obvious deformity in the injured area,
•Difficulty using or moving the injured area
•Warmth, bruising, or redness in the injured area

fracture healing process:
1.Inflammatory(remove debris)
2.reparative phases(proliferation)
3.Remodeling phase( greater in young children
BY: Endashaw F. (MSC in pedi& CH) 44

45. Acute complication of fracture

•Neurovascular injury
•Hemorrhage,
•Fat embolism,
•Compartment syndrome

BY: Endashaw F. (MSC in pedi& CH) 45

46. subactute/chronic complication of fracture

•Premature growth plate fusion
•Delayed union
•Nonunion/pseudarthrosis
•Malunion
•Osteomyelitis or septic arthritis
•Post-traumatic osteolysis
•Avascular necrosis
•Deep venous thrombosis

BY: Endashaw F. (MSC in pedi& CH) 46

47. Fracture....
Diagnosis: clinical, x-ray, MRI , CTscan
Treatement of fracture: based on: child's age,
•overall health, and medical history,
•Extent of the fracture,
• Expectations for the course of the fracture.
The goal of treatment is to control the pain,
•promote healing, prevent complications, and
• restore normal use of the fractured area.
Immobilization: Splint ,cast, Traction,
Antipain
Surgery(internal fixation)
BY: Endashaw F. (MSC in pedi& CH) 47

48. Initial RX of fracture
•RICE: rest, ice, compression, and elevation.
•Prevent movements of the injured parts and the
adjacent joint.
•Elevate involved extremities if possible without
disturbing the suspected fracture.
•Apply splint if ambulance service is not available
•Apply ice

BY: Endashaw F. (MSC in pedi& CH) 48

49. Rickets
•Bone consists of a protein matrix called osteoid
and a mineral phase, principally composed of
calcium and phosphate
•Rickets is a disease of growing bone that is due to
unmineralized matrix at the growth plates and
occurs in children only before fusion of the
epiphyses.
•Rickets is principally due to vitamin D deficiency.
• it is characterized by weakness and deformity of
bones.
BY: Endashaw F. (MSC in pedi& CH) 49

50. Etiology of rickets
•Risk for those non -exposure to sunshine
There are many causes of rickets including;
•vitamin D disorders( low intake of diet,
Malabsorbition …)
• calcium deficiency (diet….)
•phosphorous deficiency (diet…) and
•renal loss.
•Fat malabsorption resulting from hepatobiliary
disease ( vit D deficiency)
•Genetic cause(rare)


BY: Endashaw F. (MSC in pedi& CH) 50

51. Clinical manifestation of rickets
•Failure to thrive
•Fracture
•Craniotabes
•Frontal bossing
•Delay fontanel closure
•Delay dentation
• Harrison
groove(depressed chest)
•Soft rib (lung disease)


•rachitic rosary
•Lordosis, scolosis.
Kymphosis
•Deformity of
extremities
•Enlaged wrist & ankle
•Tetanic , seizure,
•laryngeal spasm
BY: Endashaw F. (MSC in pedi& CH) 51

52. Clinical manifestation of rickets…..
•malformation of joints or bones,
•lack of tooth development
•weak muscle, bowed legs, knocked knees and
•delayed fontanel closure
•Osteomalesia (adult rickets) ,
•muscles weakness and spasm and
•easily broken bone,
• Myopathies

BY: Endashaw F. (MSC in pedi& CH) 52

53. DX & RX of rickets
DX- clinically
•serum calcium, phosphate, vit D,
•bone x-ray
Treatements:
•Vit D,
•Exposure to sun light(daily for 10 minute),
•Diet: EBF, milk ,fish, egg, cereal
•Surgey if untreated (straighten leg)

BY: Endashaw F. (MSC in pedi& CH) 53

54. Bone tumor
•usually during rapid growth of bone
•two primary tumor of bone:
•Osteosarcoma - most common in children&
adolescents,
•followed by Ewing sarcoma(common < 10 year age).
Mostly osteosarcoma occur at end of long bone;
•distal femur or proximal tibia, and
•in the proximal humerus.

BY: Endashaw F. (MSC in pedi& CH) 54

55. cause of osteosarcoma is unknown, but;
•Genetic , radiation
•hereditary retinoblastoma
•retinoblastoma strongly associated with
osteosarcoma,
•Li-Fraumeni syndrome(familial cancer syndrome)

BY: Endashaw F. (MSC in pedi& CH) 55

56. C/M of bone tumor
Pain, limp, and swelling are the most common
Because these tumors occur most often in
active adolescents, initial complaints may be;
• attributed to a sports injury or sprain;
•any bone or joint pain not responding to
conservative therapy
limitation of motion, tenderness, and warmth
Ewing sarcoma( fever and weight loss)

BY: Endashaw F. (MSC in pedi& CH) 56

57. Bone tumor
diagnosis:
•clinical,
•CBC,
•radiography(x-ray ,MRI...),
•biopsy.

BY: Endashaw F. (MSC in pedi& CH) 57

58. Treatment of bone tumor

Complete surgical resection of the tumor is
important for cure.
Chemotherapy:doxorubicin, cisplatin,
methotrexate, and ifosfamide.
 radation
Long-term follow-up to monitor for late effects
of chemotherapy(cardiotoxicity….)

BY: Endashaw F. (MSC in pedi& CH) 58

59. Prognosis of bone tumor
•Up to 75% of nonmetastatic extremity
osteosarcoma are cured with current multiagent
treatment protocols.
Poor prognosis:
•pelvic tumors
•bone marrow metastases
•widespread lung metastases
BY: Endashaw F. (MSC in pedi& CH) 59

60. Spinal curvature defects
Abnormalities of the spine may be present;
• at birth (congenital),
•can develop during childhood or adolescence, or
• can result from traumatic injuries
Scoliosis,(lateral curvature of spine)
Lordosis,(anterior curvature of spinal cord)
Kyphosis(concave curvature of the thoracic spine)
BY: Endashaw F. (MSC in pedi& CH) 60

61. Scoliosis
- lateral curvature of the spine in the frontal plane.
•Most cases is idiopathic.
•The prevalence of scoliosis
•>10 degrees curvature is ∼2-3%;
•0.3% have a curve >30 degrees.
•girls have 10 times the risk of developing a
curvature >30 degrees.

BY: Endashaw F. (MSC in pedi& CH) 61

62. Scoliosis
BY: Endashaw F. (MSC in pedi& CH) 62

63. Idiopathic scoliosis is classified as;
A.infantile (rare, birth to 3 yr),
B.juvenile (3-10 yr), and
C. adolescent (≥11 yr) most common (∼70%).
•The etiology of Idiopathic scoliosis remains
unknown but;
•both genetic and environmental components.

BY: Endashaw F. (MSC in pedi& CH) 63

64. etiology of Idiopathic scoliosis
•genetic factors,
•metabolic dysfunction (melatonin deficiency,
calmodulin),
•neurologic dysfunction (craniocervical, vestibular
and oculovestibular), and
•biomechanical factors (asynchrony in spinal
growth, anterior spinal overgrowth, and others).
BY: Endashaw F. (MSC in pedi& CH) 64

65. Idiopathic scoliosis…
•Asymmetry of the posterior chest wall on
forward bending (the Adams test) is the earliest
abnormality
•The diagnosis is based on a coronal plane
curvature of >10 degrees.
•On the PA radiograph, the degree of curvature is
determined by the Cobb method,
•in which the angle between the superior and
inferior end vertebra (tilted into the curve) is
measured.
BY: Endashaw F. (MSC in pedi& CH) 65

66. Congenital scoliosis
•results from abnormal growth and development
of the vertebral column,
•due to intrauterine events at or about the 6th wk
of gestation.
•There can be a partial or complete failure of
formation (wedge vertebrae or hemivertebrae),
• a partial or complete failure of segmentation
(unilateral unsegmented bars), or a combination
of both
BY: Endashaw F. (MSC in pedi& CH) 66

67. Congenital scoliosis….
•Genitourinary abnormalities 20-40%
•20-40% have an intraspinal anomaly( Spinal
dysraphism)
•Cardiac anomalies 10-25% of patients.
•Thoracic insufficiency syndrome( inability of the
chest wall to support normal respiration).
BY: Endashaw F. (MSC in pedi& CH) 67

68. Thoracic Kyphosis (Round Back)
•20-50 degrees of curvature between T3 and T12
using the Cobb technique, and
• hyperkyphosis: Cobb angle of >50 degrees.
•flexible or postural Kyphosis that can be corrected
voluntarily.
BY: Endashaw F. (MSC in pedi& CH) 68

69. a structural hyperkyphosis is much more likely to
be associated with:
•Scheuermann disease(most common) or
• congenital kyphosis.
Congenital kyphosis can result from either a ;
•failure of formation (more progressive and
dangerous) or
• a failure of segmentation.
BY: Endashaw F. (MSC in pedi& CH) 69

70. Etiology of kymphosis
•injuries (compression or fractures),
•infections (bacterial, tubercular, fungal),
•metabolic diseases (osteogenesis imperfecta,
osteoporosis),
•Leukemia
•neuromuscular diseases, disorders of collagen
(Marfan syndrome), and
• a number of bone dysplasias (neurofibromatosis)
BY: Endashaw F. (MSC in pedi& CH) 70

71. Treatments of scoliosis & kymphosis
•Treatment is depends on the patient's degree of
skeletal maturity, the magnitude of the deformity,
and the presence of symptoms.
•observation
•Screening for other abnormality
•Bracing (23 hours in the brace per day), and
• surgical treatment
BY: Endashaw F. (MSC in pedi& CH) 71

72. Bracing
BY: Endashaw F. (MSC in pedi& CH) 72

73. Dislocation
•A dislocation is a displacement of a bone end
from the joint.
•particularly at the shoulder, elbow, fingers or
thumb usually as a result of a fall or a direct
blow.
Signs and symptoms of dislocation
• Swelling,
•Obvious deformity,
• Pain upon movement,
• Tenderness to touch,
•Discoloration.
BY: Endashaw F.(BSC,MSC) 73

74. RX of dislocation

•RICE: rest, ice, compression, and elevation.
•Splint and immobilize the affected joint in the
position in which it was found.
• Apply a sling if appropriate.
•Elevate the affected part if a limb is involved.by
•Trying to reduce by extension/flexion


BY: Endashaw F.(BSC,MSC) 74

75. Sprain
•A sprain is an injury to a joint, ligament or
muscle and tendon in the region of a joint.
•It occurs usually as result of forcing a limb
beyond the normal range of movement.
•The ankles, fingers, wrists and knees are most
often sprained.
Signs and symptoms of sprain
•• Swelling, Tenderness, Pain upon motion
•• Discoloration,
•It might be difficult to differentiate a sprain from
a closed fracture with out an X-ray.

75

76. RX of sprain
•RICE: rest, ice, compression, and elevation.
• If the victim’s ankle or knee is affected, do not
allow him to walk.
•splint and elevate the victim’s leg to prevent
swelling.
•Keep injured part raised for at least 24 hours.
•Apply cold wet pad or place a small bag of
crushed ice on the affected area over a towel
intermittently, to protect the victim’s skin.


BY: Endashaw F.(BSC,MSC) 76

77. Strain
•Strain are injuries to muscle resulting from over
stretching.
•The fibers are stretched and some times partially
torn.
•Commonly strains occur on the back muscles,
due to improper lifting technique.


BY: Endashaw F.(BSC,MSC) 77

78. RX of strain
• RICE: rest, ice, compression, and elevation.
•This should be followed for the first 48-72 hr
after the injury to minimize bleeding and edema
• Bed rest, heat and use of a board under the
mattress for firm support are recommended for
person with a strained back.
• Cool the area by applying an ice pack or cold
compress for the first 24 hours.
•After 24 hours, apply heat, warm, wet and rest
care.
BY: Endashaw F.(BSC,MSC) 78