Muscle

MUSCLE
CONTUSION




What is a muscle contusions?
Muscle contusions are extremely common injuries especially in contact sports and sports
that involve collisions for example football, hockey, basketball etc.
Contusions normally occur as a result of a result of a direct blow or repeated blow from an
opposition player, contact with equipment including sticks or the ball or by falling or
jamming part of your body against a hard surface, crushing underlying muslce fibres and
connective tissue without breaking the skin. The direct blow causes local damage to the
muscle with bleeding occurring at the site of the blow. This often results in a blood clot
within the muscle belly (haemotoma). The most common place for a contusion to occur is
in the thigh (quadriceps) and is known as a
'cork thigh', 'corkie' or 'charlie horse'.
Most contusions are minor and heal quickly
without taking you out of the game. But
severe contusions can cause deep
tissue damage and lead to complications and
may keep you out of sports for months.
Muscle contusions can sometimes be mistaken
for muscular tears; however they can be easily
distinguished by the mechanism of injury. A
contusion is the result of a direct blow and a
tear normally occurs from an
acceleration/deceleration event.
Your physiotherapist should also be able to
distinguish the difference by the feel of the affected muscle.
How can they be prevented?
Athletes playing sports that have a high risk of a contusion in specific areas, for example
the thigh in football codes, should consider the use of protective equipment such as
padding. This however can reduce mobility.
How are they managed?
Management of contusions and haematomas
 Firstly minimising the bleeding and swelling
 This is followed by resorption of the blood clot with electrotherapeutic modalities
 Carefully controlled soft tissue massage
 Stretching
Most of these injuries are only minor and do not prevent participation in sport. Large
contusions can result in a large amount of bleeding, especially if the player continues to
play after sustaining the injury.
Heat, alcohol and vigorous massage increase bleeding after a contusion and must be
avoided.
.
First aid for abrasions

An abrasion means that the surface layers of the skin (epidermis) has been broken. Thin-
skinned bony areas (like knees, ankles and elbows) are more prone to abrasions than
thicker, more padded areas. The scraped skin of an abrasion can contain particles of dirt.

First aid treatment includes:
 Clean the wound with a non-fibre shedding material or sterile gauze, and use an
antiseptic such as Betadine. If there is embedded dirt, Savlon may be used as it
contains an antiseptic and a surfactant to help remove debris. Rinse the wound after
five minutes with sterile saline or flowing tap water.
 Don’t scrub at embedded dirt, as this can traumatise the site even more.
 Cover the cleaned wound with an appropriate non-stick sterile dressing.
 Change the dressing according to the manufacturer’s instructions (some may be left
in place for several days to a week). If you reapply antiseptic, wash it off after five
minutes and then redress the wound.
















Causes of sprains and strains

Soft tissue is made from bundles of fibres. Muscle and tendons contain specialised cells
that monitor the degree of contraction and stretch. With general use, muscles and tendons
use soft contractions to resist overstretching. However, sudden twists or jolts can apply
greater force than the tissue can tolerate. The fibres overstretch beyond their capacity and
tear. Bleeding from broken blood vessels causes the swelling.

Injuries to soft tissues such as ligaments and tendons can come on suddenly or may get
worse gradually. A sudden injury is related to a specific incident and is often called an
acute soft tissue injury. This means it has occurred within the previous 24 to 72 hours. An
injury that gets worse over time (for example, over three months) is often referred to as a
chronic soft tissue injury. These are commonly caused by overuse or changes in normal
tissue stress.
Sprains

Joints are held together and supported by tough bands of connective tissue called
ligaments. The entire joint is enclosed inside a membrane filled with lubricating synovial
fluid, which helps to nourish the joint and provide extra cushioning against impact. A
sprain is a joint injury that typically involves small tears (micro-trauma) of the ligaments
and joint capsule. Common sites for sprains include the thumb, ankle and wrist.
Strains

Muscles are anchored to joints with connective tissue called tendons. Injury to these
tendons or the muscles themselves is called a strain. Common sites for strains include the
calf, groin and hamstring.
Symptoms of sprains and strains

The symptoms of a sprain or strain may include:
 pain
 swelling
 stiffness
 reduced efficiency of function.
First aid for sprains or strains

Suggestions for immediate treatment of acute sprains or strains include:
 Stop your activity
 Rest the injured area
 Use icepacks every two hours, applied for 15 minutes and separated from the skin
by wet towelling
 Compress or bandage the injured site firmly, extending the wrapping from below to
above
 Elevate (raise) the injured area above heart height whenever practical
 Avoid exercise, heat, alcohol and massage, which can exacerbate swelling
 If symptoms get worse in the first 24 hours, see your doctor for further medical
investigation.
Treatment for sprains and strains

Most soft tissue injuries take a few weeks to heal, depending on the severity of the sprain
or strain, and the general health of the person. It is important to get the correct treatment as
soon after the injury as possible to help rapid recovery. See your doctor if you don’t have
full function of the area, or if the pain and swelling don’t subside after a couple of days.

Treatment may include:
 exercises, under the guidance of your doctor or other health professional, to
promote healing, strength and flexibility
 manual techniques, such as mobilisation and massage
 electrotherapy
 pain-relieving medication (talk to your doctor or pharmacist before taking any
medications, as they can sometimes disrupt the healing of soft tissue injuries)
 gradually introducing activities to back-to-normal levels.
A short period of immobilisation may help with the healing process for grade II type
injuries.

Severe injuries, where the tissue has completely ruptured, may need surgery to put the torn
pieces back together. Surgically repaired grade III injuries will require significant treatment
to regain strength and function. Whether you have surgery, or immobilisation and physical
therapy, as the treatment for a grade III injury, medium to long-term success is similar for
either treatment.

Your treating therapist, together with a sports physician, may seek the opinion of an
orthopaedic surgeon if you have a significant soft tissue injury (grade III). In some cases, it
may be more suitable to immobilise rather than have surgery. This decision should be made
by you and your treating team.






FRACTURE











Medical Therapy
The general aim of early fracture management is to control hemorrhage, provide pain relief,
prevent ischemia-reperfusion injury, and remove potential sources of contamination
(foreign body and nonviable tissues). Once these are accomplished, the fracture should be
reduced and the reduction should be maintained, which will optimize the conditions for
fracture union and minimize potential complications.
The goal in managing fractures is to ensure that the involved limb segment, when healed,
has returned to its maximal possible function. This is accomplished by obtaining and
subsequently maintaining a reduction of the fracture with an immobilization technique that
allows the fracture to heal and, at the same time, provides the patient with functional
aftercare. Either nonoperative or surgical means may be used.
Nonoperative (closed) therapy consists of casting and traction (skin and skeletal traction).
Casting
Closed reduction should be performed initially for any fracture that is displaced, shortened,
or angulated. This is achieved by applying traction to the long axis of the injured limb and
then reversing the mechanism of injury/fracture, followed by subsequent immobilization
through casting or splinting. Splints and casts can be made from fiberglass or plaster of
Paris. Barriers to accomplishing reduction include soft-tissue interposition at the fracture
site and hematoma formation that create tension in the soft tissues.
Closed reduction is contraindicated under the following conditions
[30]
:
 Undisplaced fractures
 If displacement exists but is not relevant to functional outcome (eg, humeral shaft
fracture where the shoulder and elbow motion can compensate for residual
angulation)
 If reduction is impossible (severely comminuted fracture)
 If the reduction, when achieved, cannot be maintained
 If the fracture has been produced by traction forces (eg, displaced patellar fracture)
Traction
For hundreds of years, traction has been used for the management of fractures and
dislocations that are not able to be treated by casting. With the advancement of orthopedic
implant technology and operative techniques, traction is rarely used for definitive
fracture/dislocation management. Two types of traction exist: skin traction and skeletal
traction.
In skin traction, traction tapes are attached to the skin of the limb segment that is below the
fracture or a foam boot is securely fitted to the patient's foot. When applying skin traction,
or Buck traction, usually 10% of the patient's body weight (up to a maximum of 10 lb) is
recommended.
[39]
At weights greater than 10 lb, superficial skin layers are disrupted and
irritated. Because most of the forces created by skin traction are lost and dissipated in the
soft-tissue structures, skin traction is rarely used as definitive therapy in adults; rather, it is
commonly used as a temporary measure until definitive therapy is achieved.
In skeletal traction, a pin (eg, Steinmann pin) is placed through a bone distal to the fracture.
Weights are applied to this pin, and the patient is placed in an apparatus to facilitate
traction and nursing care. Skeletal traction is most commonly used in femur fractures: A
pin is placed in the distal femur (see image below) or proximal tibia 1-2 cm posterior to the
tibial tuberosity. Once the pin is placed, a Thomas splint is used to achieve balanced
suspension.






















DISLOCATION

















What is a Dislocation?
A dislocation occurs when the bones that are usually be connected at a joint separate. You
can dislocate a variety of different joints in your body, including your knee, hip, ankle, or
shoulder.
Since a dislocation means your bone is no longer where it should be, you should treat it as
an emergency and seek medical attention as soon as possible. An untreated dislocation
could cause damage to your ligaments, nerves, or blood vessels.
Part 2 of 8: Causes
What Causes Dislocations?
Dislocations typically result when a joint experiences an unexpected or unbalanced impact.
This might happen if you fall or experience a harsh hit to the affected area. Once a joint has
been dislocated, it is more at risk for dislocations in the future.

Treating Dislocations
Your doctor’s choice of treatment will depend on the joint that you may have dislocated. It
may also depend on how severe your dislocation is. According to Johns Hopkins
University, initial treatment for any dislocation involves R.I.C.E.—Rest, Ice, Compression,
and Elevation. In some cases, the dislocated joint might go back into place naturally after
this treatment (Johns Hopkins).
If the joint does not return to normal naturally, your doctor may use one of the following
treatments:
 manipulation or repositioning
 immobilization
 medication
 rehabilitation

Medication
Most of your pain should go away once the joint is returned to its proper place. However,
your doctor may prescribe a pain reliever or a muscle relaxant if you are still feeling pain.
Surgery
You will need surgery only if the dislocation has damaged your nerves or blood vessels, or
if the doctor is unable to return your bones to the joint. Surgery may also be necessary for
those who often dislocate the same joints, such as their shoulders.
Rehabilitation
Rehabilitation begins after the joint has been properly repositioned or manipulated into the
correct position and the sling or splint has been removed (if you needed one). Your doctor
will work with you to devise a rehabilitation plan that best works for you. The goal of
rehabilitation is to gradually increase the joint’s strength and rebuild its range of motion.
Remember, it’s important to go slowly, so you don’t reinjure yourself before the recovery
is complete.
Preventing Dislocations and Accidental Injury
Dislocations can be prevented if people practice safe behavior. Methods for preventing
dislocations vary depending on the age you are focusing on. However, general tips to
prevent dislocations include:
 Use handrails when going up and down staircases.
 Keep a first aid kit in the area.
 Use nonskid mats in wet areas, such as bathrooms.
 Move electrical cords off of the floors.
To prevent children from possible dislocations, consider practicing the following:
 Teach children safe behaviors
 Watch and supervise children as needed.
 Ensure that your home is childproof and safe.
 Put gates on stairways to prevent falls.
If you are an adult and want to protect yourself from dislocations, you should:
 Wear protective gear or clothing when doing physical activities, such as sports.
 Remove throw rugs from your floor, or replace them with nonskid rugs.
 Avoid standing on unstable items, such as chairs.














BLISTER




A blister is caused by friction between the
skin and the inside of a shoe or clothing.
Heat builds up causing a swelling under
the skin which may or may not have blood
in it.
Treatment
Prevention is by far the best cure in this case. Most small ones should be left alone and will
usually heal on their own, however if you do get one on a long run or walk then there are a
few things you can do to ease the pain.
The first sign of a blister will be redness over the skin, possibly at the
back of the heel, the instep or toes. This is known as a hot spot and is the early warning
sign of a one forming. Applying a second skin dressing, plaster or tape to the affected area
can provide an additional protective layer helping to prevent it forming.
Ensure feet are dry and change your socks regularly. Wet socks will cause friction much
faster than dry socks. An effective but short term measure is cover the foot and affected
area in petroleum jelly. This should provide some relief from pain as it protects the skin
and lubricates but as the heat from the foot melts the petroleum jelly it will run away and
be ineffective.
Most will drain and heal naturally on their own. For larger blisters it may be necessary to
pop them. This should be done with caution, following these guidelines.
Make a small hole at the edge with a sterilized pin or needle. A pin can
be sterilized by passing it through a flame. Do not drain a blood filled blister. The skin is
protecting the wound from infection. Clean with a sterilising wipe.
Drain the fluid but leave as much of the skin as possible covering the wound. This is an
important protective layer for the underlying skin and will help to prevent infection. Cover
with a second skin or specialist plaster taking the time to apply it correctly. For additional
security apply tape over top.
Blister prevention
Preventing it in the first place should be an easy task if you look after
your feet and follow are few simple tips.
Shoes - Take care of your footwear. Ensure that shoes fit correctly. Poorly fitting shoes that
are either too tight or too big will increase rubbing or friction on the foot and toes. Running
shoes should last 6 months or 500 miles. Introduce new shoes gradually and change them
before they become too worn out. Look after your walking boots or shoes. Do not leave
them on radiators or near heaters. This may cause the leather to shrink and seams protrude.
Taping - Protect the potential hot spots by applying a second skin or taping. Use the
highest quality zinc oxide tape which will stay stuck to the foot for longer especially when
the feet get wet. A blister plaster is designed specifically to act as a second skin. Make sure
they are warm and the foot dry before applying, but once they are on properly they should
stay in place for 24 hours and be very effective.
Feet - Keep feet as dry as possible. Wet shoes, boots and socks will cause blisters far
quicker than dry ones. Wherever possible change your socks regularly and use foot powder
to help keep them dry.
Socks - Some people advocate wearing socks with a double layer. The second layer stops
the first one from rubbing against the skin. Others prefer a single layer loop stitched sock as
less heat is generated. The important thing is to find what works best for you.
Blood blisters
These appear dark or red in color. This is due to damage occurring to blood
vessels which bleed into the skin tissues. It tends to occur more from a sudden impact or
pinching of the skin, rather than a repetitive friction.
It should be treated in the same way as a normal blister, although be aware that due to the
deeper damage, the skin underneath would be raw and usually very sore and more prone to
infection


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What is RICE?
The term RICE stands for Rest, Ice, Compression, and Elevation.
RICE is used as the first treatment for many muscle strains, ligament sprains, or other
bruises and injuries. RICE is used immediately after an injury happens and for the first 24
to 48 hours after the injury. Rest, ice, compression, and elevation can help reduce the
swelling and pain and help you heal faster.
What does the rest mean?
After a muscle, bone, or joint injury you need to take some time off from your activities to
allow your body to heal. For example, if you sprained your ankle, you need to not walk
around or put weight on your ankle. You should rest the injured body part until it no longer
hurts to use it or put pressure on it. You should rest the injured body part for at least 1 to 2
days. If the injury is serious, you may need to see a healthcare provider. In these cases, you
may need crutches, a splint, or cast and need to rest the injury for an even longer period of
time.
How should I use ice?
Ice helps control swelling and inflammation around the injured area. Ice should be put on
an injury as soon as possible. Putting ice on early usually helps the injury heal faster.
Never put ice directly on the skin. Wrap a bag of ice in a towel or a piece of clothing. If ice
is not available, use a bag of frozen vegetables such as peas or corn. The idea is to put
something cold over the injured area. Even a cold water bottle is fine.
Leave the ice on for 15 to 20 minutes at a time then remove it for 15 to 20 minutes so the
area can warm up to room temperature. You may repeat this on and off process for as long
as you want. Ice should be used as often as possible during the first 1 to 2 days after an
injury.
How do I use compression?
Compression helps limit swelling to the injured area. It also provides some additional
support to the injured area. You may use an elastic bandage, trainer’s tape, or even a piece
of clothing to tie around the injured area. Be sure not to tie it too tightly. Putting it on too
tight can cut off the blood supply to the area.
What about elevation?
Elevation is another way to help decrease swelling by using gravity. If you can, keep the
injured part above the level of your heart. This helps blood go back to the heart. If you
can’t raise the injured body part above the level of your heart, at least keep it parallel to the
ground.