ussfpa
1 July 2003, 18:31
Below is an exerpt from an article I wrote on "Sprains", Primarily ANKLE Sprains. Since just reading clinical excerpts can be rather boring and people don't seem to learn as much. I have decided to place blanks for some of the information and let the medics fill the blanks in :D
Please read the article, and in your responses, begin with the information from the blanks, followed with any questions.
NON medics, please ask away.
"Immediately after any sprain type injury, a rapid self-assessment should be accomplished. Ask yourself the following questions; “Does my ankle / wrist / elbow look like my other one? Is it immediately swollen? Are there crunching noises or a grating feeling if I try and move it? Can I still feel my fingers / toes past the injury?” Observations such as obvious deformity, immediate swelling and loss of visual bony landmarks, hearing or feeling crunching and loss of feeling are all signs that a hospital visit should be accomplished. The ability to bear weight should not be the deciding factor for or against a trip to the emergency department or clinic.
Ankle injuries comprise 75% of all sprains. Within that 75%, almost all (90%) involve specifically the 1)______ ankle. The MAJOR stabilizing ligamnets in the ankle are: the 2)__________, the 3)__________ and the 4)____________. Generally, ankle sprains are categorized into three major grades or classes. Class I is a minor, 5)________ ____ of the stabilizing 6)_________ in the ankle. There is minimal swelling, visual landmarks are not lost, some pain experienced, and the ability to bear weight is present. Patients commonly want to “walk it off”. This is considered a 7)stable / unstable (choose) injury and should heal in a couple of weeks.
A class II injury involves more extensive damage to the ligamentous structures. Partial or complete tearing has occurred and immediate swelling will be evident, due to 8)______ entering the space surrounding the joint. Clinical guidelines indicate that 9)_____ should be taken (if available) to confirm 10)_______ of the joint. There is considerable pain associated with this injury and the patient may or may not be able to bear weight. Crunching and grating 11)is / is not (choose) not ordinarily heard or felt on the exam, but it is considerably uncomfortable to have the exam performed. Healing time is significantly longer (12)_____weeks), but the prognosis is good for a complete recovery.
The last, and most serious, ankle sprain is the class III sprain. This injury 13) completely / partially (choose) disrupts multiple sets of 14) tendons / ligaments (choose) and results in 15)________ of the ankle. On x-ray examination, joint spaces are erratic and uneven with associated fractures are commonly seen. The 16)________ will be disrupted. Loss of external visual landmarks, crunching or grating, and significant pain are all to be expected. This sprain is treated like a 17)________ and can often requires 18)________, casting, or a combination of both. Expect a healing time of 4-6 months and significant physical therapy for recovery.
Once recognized, treatment for the various injuries is strikingly similar. Initial immobilization of the injured joint and rapid application of ice to the area is important. Ice in the first 24 hours significantly reduces pain and swelling. After the first day, moist heat is used to promote circulation and resorption of body fluids. Another effective tool is physical therapy and early 19)_____ __ ______ excercises. With a class I or II sprain, providers will often have patients “drawing the alphabet” with their toes. This assists in regaining range of motion and prevents stiffness and stricture during the healing process. Gradually, weight bearing and levels of activity are increased with the assistance of physical therapy and, often, anti-inflammatory medications like 20)_____________"
BONUS!
Describe the attached X-ray
Primum non Nocere
Please read the article, and in your responses, begin with the information from the blanks, followed with any questions.
NON medics, please ask away.
"Immediately after any sprain type injury, a rapid self-assessment should be accomplished. Ask yourself the following questions; “Does my ankle / wrist / elbow look like my other one? Is it immediately swollen? Are there crunching noises or a grating feeling if I try and move it? Can I still feel my fingers / toes past the injury?” Observations such as obvious deformity, immediate swelling and loss of visual bony landmarks, hearing or feeling crunching and loss of feeling are all signs that a hospital visit should be accomplished. The ability to bear weight should not be the deciding factor for or against a trip to the emergency department or clinic.
Ankle injuries comprise 75% of all sprains. Within that 75%, almost all (90%) involve specifically the 1)______ ankle. The MAJOR stabilizing ligamnets in the ankle are: the 2)__________, the 3)__________ and the 4)____________. Generally, ankle sprains are categorized into three major grades or classes. Class I is a minor, 5)________ ____ of the stabilizing 6)_________ in the ankle. There is minimal swelling, visual landmarks are not lost, some pain experienced, and the ability to bear weight is present. Patients commonly want to “walk it off”. This is considered a 7)stable / unstable (choose) injury and should heal in a couple of weeks.
A class II injury involves more extensive damage to the ligamentous structures. Partial or complete tearing has occurred and immediate swelling will be evident, due to 8)______ entering the space surrounding the joint. Clinical guidelines indicate that 9)_____ should be taken (if available) to confirm 10)_______ of the joint. There is considerable pain associated with this injury and the patient may or may not be able to bear weight. Crunching and grating 11)is / is not (choose) not ordinarily heard or felt on the exam, but it is considerably uncomfortable to have the exam performed. Healing time is significantly longer (12)_____weeks), but the prognosis is good for a complete recovery.
The last, and most serious, ankle sprain is the class III sprain. This injury 13) completely / partially (choose) disrupts multiple sets of 14) tendons / ligaments (choose) and results in 15)________ of the ankle. On x-ray examination, joint spaces are erratic and uneven with associated fractures are commonly seen. The 16)________ will be disrupted. Loss of external visual landmarks, crunching or grating, and significant pain are all to be expected. This sprain is treated like a 17)________ and can often requires 18)________, casting, or a combination of both. Expect a healing time of 4-6 months and significant physical therapy for recovery.
Once recognized, treatment for the various injuries is strikingly similar. Initial immobilization of the injured joint and rapid application of ice to the area is important. Ice in the first 24 hours significantly reduces pain and swelling. After the first day, moist heat is used to promote circulation and resorption of body fluids. Another effective tool is physical therapy and early 19)_____ __ ______ excercises. With a class I or II sprain, providers will often have patients “drawing the alphabet” with their toes. This assists in regaining range of motion and prevents stiffness and stricture during the healing process. Gradually, weight bearing and levels of activity are increased with the assistance of physical therapy and, often, anti-inflammatory medications like 20)_____________"
BONUS!
Describe the attached X-ray
Primum non Nocere