Know how to treat the different typesof ligamentous injuries (sprains, strains, dislocations, subluxations)
Know how to treat the different typesof ligamentous injuries (sprains, strains, dislocations, subluxations): Excerpt from Avoiding Common Pediatric Errors
Author:
Nailah Coleman, MD
What to do - Interpret the data
Overthepasttwodecades,therateofmusculoskeletalsportsinjury,including
softtissueinjury, in childrenhasrisen.This increasehas alsomadeitincreasingly important that pediatricians be able to recognize and treat effectively
soft tissue musculoskeletal injuries, including sprains, strains, subluxations,
and dislocations.
To accurately diagnose a soft tissue musculoskeletal injury, one must
be able to distinguish one injury type from another. Sprains are caused by
the overstretching and partial tearing of a ligament. Excessive stretching of
a muscle, resulting in pain and swelling, is a strain. A subluxation is the
partial separation of a joint with some continued union between the two
bones' articular cartilages. An example of a common subluxation in young
children, often associated with a sudden pull to an outstretched arm, is
the "nursemaid elbow." Complete separation of the articular cartilages of
two bones in a joint is a dislocation, relatively uncommon in children and
associated with major trauma and fractures.
Ingeneral,therearefourphasesofrecoveryforanathletewithsofttissue
injury. The goal of the first phase is to limit additional injury and to control
pain and swelling. The next phase begins the athlete's active rehabilitation
with the gradual improvement in the strength and flexibility of the injured
area. The third phase of rehabilitation progresses from the second, with
the addition of proprioception and endurance training to the strength and
flexibility work. This third phase will continue until the athlete has nearly
regained his normal function. The fourth and last phase of rehabilitation
begins at the athlete's return to his or her sport. Initial phases of rehabilitation should be supported with adequate analgesics, so as to avoid disuse
during recovery. Attention should also be paid to the strength, flexibility, and
fitness of noninjured areas during the athlete's rehabilitation, as well as to
the athlete's general psyche. To avoid separation from his team, the athlete
should be encouraged to attend games and practices with teammates.
The first phase of rehabilitation is commonly referred to as "RICE
therapy": rest, ice, compression, and elevation. The "rest" for an athlete is
the limitation of activity—to avoid any pain during or within 24 hours of the
activity. Ice, placed in a plastic bag and applied directly to the skin for 20
minutes, comprises the next part of RICE therapy and will help not only to
control the painbut to also control theswelling associatedwith the injury. Ice
should be applied three to four times a day for the first 48 hours after injury
and, at a minimum, daily afterwards, while swelling and/or pain persist. The
next part of RICE therapy is compression, which involves the application
of an elastic bandage—above and below the injury—to promote resorption
of injury-related edema. If the compression bandage is applied too tightly,
venous drainage may be impaired, so this should be avoided. For the last
part of RICE therapy, the injured area should be kept elevated as much as
possible, which will also help to decrease swelling.
Pediatric softtissue musculoskeletalinjury usually heals quickly,requiring little additional therapy and minimal immobilization. Often, soft tissue
injuries in children require only the first phase of rehabilitation (i.e., RICE
therapy), after which they can make a fairly rapid (within weeks) return to
play.
Suggested Readings
Hergenroeder AC. Prevention of sports injuries. Pediatrics. 1998;101:1057–1063.
Huurman WW, Ginsburg GM. Musculoskeletal injury in children. Pediatr Rev. 1997;18:429–
440.
Sachs HC. Dislocations. Pediatr Rev. 2000;21:433–434.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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