Republic of the Philippines

Bulacan State University

City of Malolos, Bulacan

COLLEGE OF NURSING

NCM 116-A: Care of Clients with Problems in Nutrition and Gastrointestinal,

Metabolism and Endocrine, Perception and Coordination (Acute and Chronic) /
Lecture Course

COMMON
SPORTS
INJURIES
Marlou L. Aganan
Zaira R. Batac
Solaime - ann DG. Bernardo
Zairell Shane B. Corpuz
Angel Jophiel M. Fajardo
Joanna Jean S. Ganelo
Ma. Teresa P. Leoncio
Dennise DC. Lopez
Ria Mae Miller
Raniella F. Radovan
Mariel S. Rapal
Ivy O. Valencia

Final Term Requirement

BNS 3C - Group 3
S.Y. 2022-2023
COMMON
SPORTS
INJURIES
NCM - 116 A
MUSCULOSKELETAL DISORDERS

I
Letter of Gratitude
I would personally like to appreciate all the hard
work and diligent effort of my groupmates that
they put to finish this project. Also, to my family
for their support and encouragement to
continue my study. I would also like to express
my gratitude to our MS Clinical Instructor, Sir
Johp Mendoza for guiding us through this
project and giving us knowledge about the
course. May God bless us all.

First and foremost, I want to convey my gratitude to

my family, who are always there to support and
encourage me. Second, my groupmates, who ensure
that we are always working together to solve the
difficulties we encounter. I also want to express my
gratitude to Sir Johp Mendoza, who has taught and
led us to the completion of our project, and to our
recipients, whom we hope to have received
knowledge that will be useful in their daily lives and
will also benefit others.

I'd like to take this opportunity to thank and

acknowledged my groupmates for their cooperation,
determination, and hard work in creating this coursera,
with special thanks to my partner in creating the
coursera's layout, Ms. Dennise and Ms. Joanna - who is
also our leader - for her patience and organization in
distributing our tasks. To our Med-Surg instructor, Sir
Johp Mendoza, we are pleased and lucky to have you
as our lecturer, we highly appreciate you. I also want
to thank myself for having not enough rest days and
for being able to finish this project. Lastly, to God
Almighty, without His guidance, I would not be able to
motivate and cheer myself to continue this course.

II
Letter of Gratitude
I would like take this opportunity to thank my
fellow colleagues for all of their hard work and
dedication that they put in to accomplish this
project. Also, thank you to my family members
for their support and guidance through up and
downs as I pursue my studies the bachelor of
science in nursing. My friends who are giving
their moral support. I'd also like to thank our MS
Instructor, Sir Johp Mendoza, for guiding us
through this project, giving efforts to provide
learning/ training materials for us to learn and
this is a challenging one due to pandemic. May
God continue to bless everyone of us.

I am so grateful for myself, family and

professors for their encouragements, and
support in my endeavor, especially God
whose so kind to me thank you and I love
you all.

This coursera project will not be completed without these people.

I would like to express my sincere gratitude to those people who
are part of this - to my groupmates/classmates, thank you for
your hard work, and determination to finish this project. I am
beyond grateful because, despite the simultaneous activities,
projects, and exams, we were able to complete this together. To
Sir Johp Mendoza, we could not have completed this project
without you and your guidance. Thank you for all the knowledge
and lessons that you thought we needed and for all the learning
materials that you have provided since we met. Lastly, I want to
thank God Almighty for giving me strength and reasons to
continue to fight every day.
Once again, thank you, and God bless us!

III
Letter of Gratitude
I'd like to thank the entire team for their hard work and
dedication in completing this project. I appreciate my
family and friends' moral support, which helps us stay
motivated. And also, I would like to extend our
recognition to our course instructor sir Johp Mendoza
for his guidance and encouragement. You will always
be an inspiration to the team. Lastly, I would like to
thank the Almighty God for the skills and knowledge
that He gave us which are the foundation of everything
we have as a student.

I would like to grab this opportunity to thank my

groupmates for their cooperation, effort, patience, and
sleepless nights in doing this coursera with the special
thanks to my partner in this project – Ms. Bernardo. To
my nursing buddy – Ms. Nabong for being there since
day 1, To our NCM 116A Instructor, Mr. Joph Mendoza,
for sharing his insights and helping us in the said
subject. To my family & friends, who motivates me to
study and I would also like to thank my self for not
giving up and to be able to finish this project and
Lastly, to our Almighty God for guiding me and helping
me to stay still in my course.

First and foremost, I would like to express my

gratitude to my family and friends for being a
significant source of my motivation to carry on
despite how physically taxing and mentally draining
studying is. To my groupmates who worked hard as
much as I did for this project, I am thankful to all of
you. And to our NCM 116A instructor Sir Johp, I’m
grateful for all the knowledge you’ve imparted to us.

IV
Letter of Gratitude

I would like to express my utmost gratitude to the

following who have helped me in completing our Final
Term Project: To my groupmates, I’ll remember the
camaraderie from the sleepless nights and stressful
moments. We never folded to the pressure, and it
would not have been possible if we did not firmly
stand together. To my ever-supportive parents, who
have given me everything I need. To Sir Johp Mendoza,
who has taught and guided me. To our recipients, we
hope that we have instilled knowledge that can be
used in the long-term.
And last most importantly, the Lord Almighty, for
blessing all of us with wisdom and strength to
complete our project and absorb all the learnings. To
God be the Glory!

I'd like to thank my groupmates for putting up the

effort to be inventive for this project, they are
always willing to assist one another. Each of us did
our best to make our project more engaging and to
educate the audience about our topics. I'd also like
to thank our clinical instructor for giving us this
project to help us expand our knowledge and share
it with others. Finally, I want to express my
gratitude to my parents for their continuous
support and encouragement throughout my
journey.

I would love to express my deepest gratitude to

all of my groupmates for all the efforts and hard
work that made this coursera possible and also
to our respected clinical instructor Mr. Johp
Mendoza, RN,MAN who always pushes us to do
greater and better.

V
 TOPIC OVERVIEW
This course handout will give
you an overview about the
common spots injuries that
athletes experience. Including
the pathophysiology , risk
factors that may contribute to
the injuries, the sign and
symptoms, medical surgical
management and nursing
management.

Through this course handout

you will also gain and improve
your knowledge and skills about
common sport injuries to help
you properly and effectively
manage these situations as a
student nurse that is preparing
to be a nurse in the future.

VI
 TOPIC OVERVIEW
This unit begins with a short overview about
the common sports injuries, it contains
important details about the eight injuires. It
is divided with eight lessons focusing in one
injury every lesson.
Lesson 1: Clavicle Fracture
Lesson 2: Dislocated Shoulder
Lesson 3: Dislocated Elbow
Lesson 4: Wrist Sprain
Lesson 5: Knee Sprain & Knee Strain
Lesson 6: Meniscus Tears of the Knee
Lesson 7: Ankle Sprain & Ankle Strain
Lesson 8: Ankle Fracture
Lesson 9: Metatarsal Stress Fracture

After reading the Coursera, the readers/viewers

were able to reach the following goals:

1. Gain understanding about Common Sports

Injuries.
2. Identify the factors related to the injury.
3. Apply nursing management that can
contribute to the injury.
4. Provide health teaching to patients on how
to manage and avoid experiencing these
kind of injuries.

VII
 Table of Contents
Letter of Gratitude..................................................................................................... ii
Topic Overview........................................................................................................... vi

What is Sport Injuries?

Definition.......................................................................................................................8
Sports that causes sport injuries............................................................................ 9
Common Sports Injuries
Clavicle Fracture................................................................................................ 11
Anatomy Overview...................................................................................................... 11
Injury Definition............................................................................................................ 11
Types of Clavicle Fracture.......................................................................................... 11
Causes............................................................................................................................ 12
Signs & Symptoms....................................................................................................... 12
Diagnostic Test............................................................................................................. 12
Management................................................................................................................. 13
Pathophysiology........................................................................................................... 15
Dislocated Shoulder.......................................................................................... 17
Anatomy Overview........................................................................................................ 16
Injury Definition............................................................................................................. 17
Types of Shoulder Dislocation................................................................................... 17
Causes.............................................................................................................................. 19
Signs & Symptoms....................................................................................................... 18
Diagnostic Test.............................................................................................................. 18
Management.................................................................................................................. 20
Pathophysiology............................................................................................................ 21
Dislocated Elbow............................................................................................... 23
Anatomy Overview....................................................................................................... 23
Injury Definition............................................................................................................. 24
Types of Elbow Dislocation......................................................................................... 24
Causes............................................................................................................................. 24
Signs & Symptoms....................................................................................................... 24
Diagnostic Test.............................................................................................................. 25
Management.................................................................................................................. 26
Pathophysiology............................................................................................................ 27

Wrist Sprain....................................................................................................... 30

Anatomy Overview........................................................................................................ 28
Injury Definition............................................................................................................. 30
Wrist Sprain Grading.................................................................................................... 30
Causes............................................................................................................................. 29
Signs & Symptoms....................................................................................................... 29
Diagnostic Test.............................................................................................................. 31
Management................................................................................................................. 32
Pathophysiology........................................................................................................... 33
 Table of Contents
Knee Sprain & Knee Strain................................................................................ 34
Anatomy Overview.......................................................................................................... 34
Injury Definition............................................................................................................... 35
Knee Sprain Grading...................................................................................................... 36
Causes............................................................................................................................... 37
Signs & Symptoms.......................................................................................................... 37
Diagnostic Test................................................................................................................ 39
Management.................................................................................................................... 39
Pathophysiology.............................................................................................................. 45

Meniscus Tears of the Knee.............................................................................. 46

Anatomy Overview.......................................................................................................... 46
Injury Definition................................................................................................................ 46
Types of Meniscus Tear.................................................................................................. 47
Causes................................................................................................................................ 50
Signs & Symptoms........................................................................................................... 50
Diagnostic Test................................................................................................................. 50
Management..................................................................................................................... 51
Pathophysiology............................................................................................................... 52
Ankle Sprain & Ankle Strain................................................................................ 53
Anatomy Overview........................................................................................................... 53
Injury Definition.............................................................................................................. 54/57
Ankle Sprain Grading...................................................................................................... 54
Causes................................................................................................................................ 54
Signs & Symptoms.......................................................................................................... 55/57
Diagnostic Test................................................................................................................. 55
Management.................................................................................................................... 55/58
Ankle Fracture.................................................................................................... 57
Injury Definition............................................................................................................... 57
Causes............................................................................................................................... 57
Signs & Symptoms......................................................................................................... 57
Diagnostic Test................................................................................................................ 58
Management.................................................................................................................... 58
Pathophysiology.............................................................................................................. 59

Metatarsal Stress Fracture............................................................................... 60

Anatomy Overview........................................................................................................ 60
Injury Definition.............................................................................................................. 61
Causes.............................................................................................................................. 61
Signs & Symptoms......................................................................................................... 62
Diagnostic Test............................................................................................................... 63
Management................................................................................................................... 63
Pathophysiology............................................................................................................. 64
Conclusion.......................................................................................................... 65
Glossary.............................................................................................................. 66
References.......................................................................................................... 71
 What is Sports
Injuries?
Sports injuries are injuires that
occur when engaging in sports or
exercise. Overtraining, lack of
conditioning, and improper form or
technique can all lead to sports
injuires. Warming up properly
reduces the chance of acquiring
sports injuries. Sport injuries can
cause bruises, strains, sprains, tears,
and broken bones. Muscle,
ligaments, tendons, fascia, and
bursae are among the soft tissues
that might be damaged.

COURSERA 3 | 2022 8
 Sports that can cause sports
injuries:
FOOTBALL

RUGBY SPORT

HOCKEY

WRESTLING

GYMNASTICS
SKIING
SQUASH

CYCLING
SKATING

HANDBALL

HORSEBACK RIDING
COURSERA 3 | 2022 9
 Sports that can cause sports
injuries:
BASKETBALL

HIGH JUMP

SOCCER

SWIMMING

TENNIS

RUNNING

DANCING

PHYSICAL
ALL BALL CONTACT
SPORTS SPORTS

COURSERA 3 | 2022 10
 CLAVICLE

Clavicle (collar bone) - part of the pectoral girdle that

attaches medially to the manubrium and laterally to the
scapula.
The clavicle helps maintain the shoulder in the upward,
outward, and backward position from the thorax

CLAVICLE FRACTURE
- Is a common injury that can result from a fall or direct
blow to the shoulder.
- The force is transmitted along the clavicle, which
breaks at its weakest point, the junction of the middle
and outer thirds.
- The lateral fragment is depressed by the weight of the
arm, and it is pulled medially and forward by the strong
adductor muscles of the shoulder joint, especially the
pectoralis major.

Types of Clavicle Fracture

Fracture on Middle third of Fracture on Distal third of

Clavicle Clavicle
COURSERA 3 | 2022 11
 Diagnostic Test
CT - SCAN Complication
Neurovascular injuries
(brachial plexus, injury
subclavian vein or artery
injury from a bony
fragment) pneumothorax

X - RAY and nonunion.

Signs & Symptoms

- Sagging of the shoulder downward and forward
- Inability to lift the arm because of pain
- A grinding sensation when you try to raise the arm
- A deformity or bump over the break
- Bruising, swelling, and/or tenderness over the collarbone

Causes
Common causes of a broken collarbone include: Falls, such as
falling onto your shoulder or onto your outstretched hand. Sports
injuries, such as a direct blow to your shoulder on the field, rink or
court. Vehicle trauma from a car, motorcycle or bike accident.

Always remember
CLAVICLE FRACTURES
- Typically in the middle 1/3 of clavicle
- Usually from FOOSH
- Distinguish from AC separation
Presentation: Look for clavicle prominence, tenderness/edema over
fracture site
- Investigate with AP X-ray at a 45° cephalic tilt
Treatment: Sling, immobilization (longer for adults), periodic ROM,
avoid contact sports for 6 weeks
- Surgical fixation if needed
- Refer if there is neurovascular compromise, open fracture, nonunion
after 12 weeks, fracture involving
- Distal or proximal 1/3 of clavicle (could involve other joints)

COURSERA 3 | 2022 12
 FRACTURE ON MIDDLE THIRD OF
CLAVICLE

Nursing Management
Most of these fractures take 3 to 6 weeks to heal.
- A clavicular strap also called a figure-eight
bandage may be used to pull back, reducing and
immobilizing the fracture.
- Nurses monitor the circulation and nerve function
of the affected arm and compare it with the
unaffected arm to determine variations, which
indicate disturbances in neurovascular status.
- A sling may be used to support the arm and
relieve pain.
- Patients may be permitted to use the arm for light
activities within the range of comfort.

Pharmacological Management
NSAIDs / Analgesics
- e.g. ibuprofen (Advil, Motrin IB), naproxen
sodium (Aleve), or acetaminophen (Tylenol)

Surgical Management
- Surgical intervention is not typical but may
be indicated if the fracture is located in the
third of the clavicle or is severely displaced,
which may result in neurovascular
compromise or pneumothorax.
COURSERA 3 | 2022 13
 FRACTURE ON DISTAL THIRD
OF CLAVICLE
Nursing Management
- Fracture of the distal third of the clavicle,
without displacement and ligament
disruption, is treated with a sling and
restricted motion of the arm.
- Nurse cautions the patient not to elevate
the arm above shoulder level until the
fracture has healed.
- Encourage the patient to exercise the
elbow, wrist and fingers as soon as possible.
- When prescribed shoulder exercises are
performed to obtain full shoulder motion.
- Vigorous activity is limited for
approximately 3months.

Pharmacological Management
- NSAIDs / Analgesics
- e.g. ibuprofen (Advil, Motrin IB), naproxen sodium
(Aleve), or acetaminophen (Tylenol)

Surgical Management
- When a fracture in the distal third is accompanied by a
disruption of the coracoclavicular ligament that connects
the coracoid process of the scapula and the inferior
surface of the clavicle, the bony fragments are frequently
displaced, this type of injury may be treated by open
reduction with internal fixation (ORIF).

COURSERA 3 | 2022 14
 PATHOPHYSIOLOGY

COURSERA 3 | 2022 15
 SHOULDER
- One of the largest and
most complex joints in the
body

- The shoulder joint is

formed where the humerus
fits into the scapula like a
ball and socket.

Important Bones in the Shoulder

Acromion
- Bony projection off the scapula.

Clavicle
- Also known as the “collarbone”.
- Meets the acromion in the acromioclavicular joint.

Coracoid Process
- Hook-like bony projection from the scapula.

Rotator Cuff
- Collection of muscles and tendons that surround the
shoulder, giving it support and allowing a wide range of
motion.

Bursa
- A small sac of fluid that cushions and protects the tendons
of the rotator cuff.

Cuff of Cartilage
- Also called the “labrum” it forms a cup of the ball-like head
of the humerus to fit into.

Humerus
- Gives the shoulder a wide range of motion, but also makes it
vulnerable to injury.

COURSERA 3 | 2022 16
 DISLOCATED SHOULDER
- An injury in which your upper arm bone pops out of
the cup-shaped socket that’s part of your shoulder
blade.

- Can be completely and partially dislocated.

- Common in males aged 20s; a group that is

physically active.
Types of Shoulder Dislocation
Complete Dislocation
- The humerus bone comes off entirely from the
socket.

Partial Dislocation (Subluxation)

- The head of the humerus bone is partially dislocated
from the socket (meaning part of the humerus comes
out of the ball and socket joint and the other part is
still fixated in the joint).
Anterior Dislocation
- The anterior shoulder
dislocation is usually an
indirect force with a
combination of abduction,
extension, and external
rotation. It occurs with the
arm in a position away from
the body with the arm
rotated backwards.
- Anterior dislocation is often associated with a
combination of the tear to the Labrum, more
significant tuberosity fracture, and humeral head
fracture.
COURSERA 3 | 2022 17
 Signs & Symptoms
- Severe shoulder pain

- The motion of the shoulder is not normal

- Muscle contractions

- Swelling

- Bruising

- Abrasion near the joint

- Weakness in hands, fingers, neck

Diagnostic Tests

CT - SCAN MRI

X-RAY

COURSERA 3 | 2022 18
 Posterior Dislocation
- The humerus bone gets separated and retracts
away from the socket joint. Posterior dislocations are
caused by 2% to 4% of all shoulder dislocations.

Inferior Dislocation
- The humerus splits from the socket joint and is
displaced downward.

- Rarest when compared to the other two; 1 in every

200 cases.

- When the arm is pushed violently downward, then

such kind of dislocation occurs.

OTHER CAUSES:

Trauma Fall
Accidents Electric (Sudden
(Traffic Shock Fall)
Accidents)
COURSERA 3 | 2022 19
 Nursing Management
RICE therapy: RICE stands for Rest, Ice,
Compression (not usually necessary), and
Elevation. RICE can improve pain and
swelling of many shoulder injuries.

Collaborative Management
- Physical therapy: An exercise program can
strengthen shoulder muscles and improve
flexibility in the shoulder. Physical therapy is an
effective, nonsurgical treatment for many
shoulder conditions.
- Administer medications as prescribed by the
doctor

Pharmacologic Management
- Pain relievers: Over-the-counter relievers like
acetaminophen (Tylenol), ibuprofen (Motrin) and
naproxen (Aleve) can relieve most shoulder pain.
More severe shoulder pain may require
prescription medications.
- Corticosteroid (cortisone) injection: A doctor
injects cortisone into the shoulder, reducing the
inflammation and pain caused by bursitis or
arthritis. The effects of a cortisone injection can
last several weeks

COURSERA 3 | 2022 20
 Surgical Management
Shoulder surgery: Surgery is generally
performed to help make the shoulder joint more
stable. Shoulder surgery may be arthroscopic
(several small incisions) or open (large incision).

Arthroscopic surgery: A surgeon makes small

incisions in the shoulder and performs surgery
through an endoscope (a flexible tube with a
camera and tools on its end). Arthroscopic
surgery requires less recovery time than open
surgery.

PATHOPHYSIOLOGY

Anterior Dislocation
- Mechanism of injury is usually a blow to an abducted,
externally rotated and extended extremity.
- It may also occur with posterior humerus force or fall
on an outstretched arm.
- On exam, the arm is usually abducted and externally
rotated, and the acromion appears prominent
- There are associated injuries in up 40% of anterior
dislocations including nerve damage, or tears and
fractures associated with the labrum, glenoid fossa,
and/or humeral head.
COURSERA 3 | 2022 21
 Posterior Dislocation
- Usually, the injury is caused by a hit to the
anterior shoulder and axial loading of the
adducted internally rotated arm.
- It may also be a result of violent muscle
contractions (seizures, electrocution).
- On exam, the arm is usually held in
adduction, and internal rotation and patient is
unable to rotate externally.
- Higher risk of associated injuries such as
fractures of surgical neck or tuberosity,
reverse Hill-Sachs lesions (also called a
McLaughlin lesion which is an impaction
fracture of anteromedial aspect of humeral
head), and injuries of the labrum or rotator
cuff.

Inferior Dislocation
- Usually caused by hyperabduction or with
axial loading on the abducted arm.
- On exam, the arm is held above and behind
the head and patient is unable to adduct
arm.
- Often associated with nerve injury, rotator
cuff injury, tears in the internal capsule, and
the highest incidence of axillary nerve and
artery injury of all shoulder injuries.

COURSERA 3 | 2022 22
 ELBOW
- is a hinged joint made up of three
bones, the humerus, ulna, and radius.
The ends of the bones are covered
with cartilage.

Cartilage
- a rubbery consistency that allows
the joints to slide easily against one
another and absorb shock. The bones
are held together with ligaments that
form the joint capsule.

Joint Capsule
- a fluid filled sac that surrounds and
lubricates the joint.
Important ligament of the elbow
medial collateral ligament – on
the inside of the elbow
lateral collateral ligament – on
the outside of the elbow
Together these ligaments provide
the main source of stability for the
elbow, holding the humerus and
the ulna tightly together.
third ligament, the annular
ligament - holds the radial head
tight against the ulna.

There are tendons in your elbow that

attach muscle to bone, Important tendons
of the elbow
- biceps tendon – which is attached
the biceps muscle on the front of
your arm
- triceps tendon – which attaches the
triceps muscle on the back of your
arm

COURSERA 3 | 2022 23
 DISLOCATED ELBOW
- Occurs when any of the three bones in the elbow joint
become separated or knocked out of their normal
positions.
- Dislocation can be very painful, causing the elbow to
become unstable and sometimes unable to move.
- Dislocation damages the ligaments of the elbow and can
also damage the surrounding muscles, nerves and
tendons
A dislocated elbow can be partial or complete:
- Complete – elbow dislocation involves a total separation
and is called a luxation
- Partial – when the elbow joint is partially dislocated it is
called subluxation.

3 Types of Dislocated Elbow

Simple: no major injury to the bone
Complex: severe injuries to the bone and
ligament
Severe: damage to the nerves and blood
vessels around the elbow

Sign & Symptoms

Bruising

Causes Deformed-looking
(bone looks out of place)
arm

Car accidents Weakness in the joint

Sports injuries Loss of ability to move the
Overuse elbow
In some cases, a joint disorder such Pain
as Ehlers-Danlos syndrome causes Swelling
dislocations. Ehlers-Danlos makes
joints unusually loose and flexible.

COURSERA 3 | 2022 24
 Risk Factors
Are over age 65 (because they are more prone to falls)
Overtrain in sports, especially activities involving
throwing
Have inherited joint disorders such as Ehlers-Danlos
syndrome
Diagnostic Test
X-ray
MRI
Ct scans
Musculoskeletal
ultrasound

(musculoskeletal ultrasound)

Pharmacology Management
Acetaminophen
Codeine (Tylenol with codeine, Tylenol #3)

Analgesics and anxiolytics are used to manage

the pain associated with dislocation

Indicated for the treatment of mild to moderate

pain.
Treatments
Manipulation
Medication
Rest
Physical therapy
Surgical Management
Surgery

The surgery performed depends on what area is fractured. Typical

patterns include the following:
- If the radial head (top end of the radius) is fractured, it can be
repaired with small screws with or without plates. If the fracture is
not repairable, the radial head is replaced with a metallic implant.
- If the coronoid (top of the ulna in the front of the joint) is
fractured, it can be repaired with screws or sutures.

COURSERA 3 | 2022 25
 Nursing Management

Activity modification/immobilization with a

splint
Icing or applying heat to the elbow joint
Pain or anti-inflammatory medication
Strengthening exercises/physical therapy
Simple elbow dislocations are treated by
keeping the elbow immobile in a splint or
sling for 1 to 3 weeks, followed by early
motion exercises.
To check for the artery, feel below your
thumb at the base of your wrist. You should
be able to feel your pulse. Press on the tips
of your fingers. They should blanch (turn
white) and then return to a normal pink color
within 3 seconds. If either of these tests is
abnormal, seek medical care immediately.
Three nerves run by the elbow. Each nerve
has portions that help with strength and
feeling. First check for strength by bending
your wrist up as if you were saying "Stop"
(radial nerve function), then spread your
fingers apart (ulnar nerve function), then try
to touch your thumb to your little finger
(median nerve function). If you have trouble
with any of these tests, go to the doctor
immediately.
Check for feeling by touching all over your
hand and arm. If any feeling of numbness
results, see a doctor immediately.

COURSERA 3 | 2022 26
 Pathopysiology
ANTERIOR DISLOCATION
A strong blow to the posterior aspect of a flexed elbow may
result in anterior dislocation of the elbow. This force drives
the olecranon forward in relation to the humerus. Anterior
dislocations and any open fractures are commonly
associated with disruption of the brachial artery and/or
injury to the median nerve. The less often encountered
anterior elbow dislocation requires much more force, and
concern for neurovascular compromise should be greater.

POSTERIOR DISLOCATION
Posterior dislocations account for most elbow dislocations.
Closed posterior dislocations are not commonly associated
with neurovascular injury.
These injuries frequently occur during sporting activities when
a person falls on an extended elbow. In most instances, the
semilunar notch of the ulna is dislocated posteriorly from the
distal humerus. If no fracture is associated with the dislocation,
it is described as simple and the injury is often closed with no
bony protrusion through the skin.

The stability of the elbow joint due to its bony structure means
that significant force is required to disrupt the joint. Therefore,
an associated fracture may be found along with the elbow
dislocation, thus classifying the dislocation as complex.
Neurovascular complications following a simple, closed,
posterior dislocation are rare.

COURSERA 3 | 2022 27
 WRIST

Wrist - a complex joint that connects the hand to the forearm It is

made up of several bones and joints. The wrist bones include the
distal ends of the radius and ulna, eight carpal bones, and the
proximal portions of the five metacarpal bones.

Collateral Ligaments – strong ligaments on either side of the

finger and thumb joints, which prevent sideways movement of the
joint

Volar Plate – a ligament that connects the proximal phalanx to the

middle phalanx on the palm side of the joint. As the joint in the
finger is straightened, this ligament tightens to keep the PIP joint
from bending backward.

Radial and Ulnar Collateral Ligaments – a pair of ligaments

which bind the bones of the wrist and provide stability

Volar Radiocarpal Ligaments – a complex web of ligaments that

support the palm side of the wrist

Dorsal Radiocarpal Ligaments – ligaments that support the back

of the wrist

Ulnocarpal and Radioulnar Ligaments – two sets of ligaments

that provide the main support for the wrist.

COURSERA 3 | 2022 28
 Causes
- Falls
- Lifting heavy weights
- Constantly hitting a heavy bag
- Forcefull bending of the wrist

Signs &
Symptoms
- Pain
- Swelling
- Stifness
- Reduced Flexibility
- Joint Weakness

Risk Factors
Overuse/Repetitive Use of
Wrist
- Repetitive stress, such us
from crutch - walking, playing
a new instrument, exercises
like push - ups

COURSERA 3 | 2022 29
 WRIST SPRAIN
- A wrist sprain happens when the strong
ligaments that support the wrist stretch or tear. This
happens when the wrist is bent or twisted
forcefully, as in a fall onto an outstretched hand.
Wrist sprains are a common type of injury.
- Range from mild to severe, depending on the
severity of ligament injury.

WRIST SPRAIN GRADING

GRADE 1 (MILD)
The ligaments have
been strained but
are not ruptured.

GRADE 2 (MODERATE)
Ligaments are partially
torn. This type of injury
may result in some
function loss.
GRADE 3 (SEVERE)
The ligament is entirely
torn or is pulled off from
its attachment to the
bone. These are major
injuries that require
medical or surgical
treatment.
COURSERA 3 | 2022 30
 Diagnostic Wrist Instability
Test Test
X - ray Scaphoid Wrist Test
Ultrasound (Watson's Test)
MRI

Ballotement Test

Grip Strength
Test Chart

Grip Strength
Test

COURSERA 3 | 2022 31
 Nursing Management
- If a severe sprain is present, prepare the client for
surgical repair or reattachment if indicated
- Instruct the client to rest and repair the muscle or
tendon by avoiding use for about a week and then
gradually increasing activity until healing is
complete.
- Teach appropriate stretching movements to assist
prevent reinjury after recovering.
- Prescription drugs should be administered.

Pharmacological Management
- Non-steroidal anti-inflammatory drugs (NSAIDS).
Over the counter (OTC) NSAIDs may help decrease
pain and swelling at the injured area.
- Ibuprofen (Advil)
- Naproxen sodium (Aleve)

Collaborative Surgical
Management Management
- Tenodesis
- Ligament
- PRICE Theraphy
Reconstruction
- Wrist Splint
- Proximal Row
- Physical Therapy
Carpectomy,
- Return to work/play
Arthrodesis, and
Arthroplasty
COURSERA 3 | 2022 32
 PATHOPHYSIOLOGY

When the patient exerts

weight to the affected joint
and attempts to mobilize it,
the damaged ligament is
unable to stabilize it. Blood
vessels may rupture, resulting
in swelling.

COURSERA 3 | 2022 33
 Knee

Knee – the body's largest and most complex

joints.
Femur - body's longest and strongest bone. It is
an essential component of your capacity to stand
and move. Your femur also provides support for
several muscles, tendons, ligaments, and portions
of your circulatory system.
Tibia - The largest of the two bones is the tibia. It
supports the rest of your weight and is an
integral part of both the knee and ankle joints.
Fibula - located on the lateral side of the leg Its
primary function is to serve as a muscle
attachment rather than as a weight-bearer.
Patella – also known as the “kneecap”; the
patellofemoral groove of the femur is found near
the front of the knee joint. It is connected to the
quadriceps tendon on the superior side and the
patellar ligament on the inferior side.

COURSERA 3 | 2022 34
 The knee has four major ligaments: two that
stabilize the front and back of the joint, and two that
stabilize the side-to-side movement. Knee sprains
are named for the specific ligament that has been
torn or injured:

1. Anterior Cruciate Ligament (ACL) - prevents

the femur from sliding backward on the tibia
(tibia sliding forward on the femur).
2. Posterior Cruciate Ligament (PCL) - prevents
the femur from sliding upward on the tibia (tibia
sliding backward on the femur).
3. Lateral Collateral Ligament (LCL) - prevent the
femur from sliding side to side.
4. Medial Collateral Ligament (MCL) - prevent the
femur from sliding side to side

Knee Sprain

- Ligaments are string-like bands of tissue

that connect your bones and provide joint
stability.
- Knee sprains are major injuries caused by a
stretch or tear of the ligaments in and
around the knee.

COURSERA 3 | 2022 35
 Knee Sprain
Grading

Grade I – It causes only minor stretching or

fraying of the ligament’s Fibers. The patient may
have moderate swelling, discomfort, or bruising
but can still put weight on the affected leg.
Grade I sprain, on average, take the shortest
length of time to heal.
Grade II - A grade II sprain indicates that the
damaged ligament has been partially torn. When
you put weight on the affected leg, the knee may
become unstable and painful.
Grade III - A grade III sprain is the most severe
sprain classification and involves a complete tear
of a ligament. The ligament may detach from the
bone in some instances. Swelling and bruising
may be severe, making weight carrying on the
affected leg difficult or impossible.
COURSERA 3 | 2022 36
 Causes
ACL - When participating in a running or
physical sport such as soccer, basketball,
football, or gymnastics, you are more likely to
sustain an injury as a result of a sudden twist.
PCL - can be injured in a car accident if your
knee hits the dashboard, or in sports if the front
of your knee is impacted while bent. A PCL
sprain can also result from a forceful landing on
your knee.
LCL – you can sprain if you are hit on the inside
of your knee. Because your other leg supports
this area, this form of sprain is less prevalent
than the others.
MCL - is caused mainly by something hitting
your leg from the side, or by a fall that forces
your lower leg to twist outward from your thigh.

Pain
Signs & Symptoms
- Suffering from knee sprains will feel different kind
of experience of pain depending on the severity of
their injury.
- Mild sprains will cause dull and throbbing pain,
whereas severe sprains will cause intense and
persistent pain.

Knee Swelling
- A sprained knee is frequently accompanied by
swelling. The amount of swelling present will vary
depending on how severe the sprain is and how
long it has been since the incident.

Limited Mobility
- The mobility may be limited due to weakness in
the damaged ligament(s) and localized swelling.

COURSERA 3 | 2022 37
 Popping Sound
You may hear an audible popping or snapping sound. This
sound could indicate that one of the four primary knee
ligaments was torn at the time of the incident, indicating a
more severe (Grade III) sprain.

Inability to Hold Weight

The ligament injury, together with the associated knee
inflammation and tenderness, may make it difficult or
impossible for the knee joint to bear weight.

Buckling of the Knee

A buckling sensation in the knee may be noticed when
standing, walking, or running. The direction in which the knee
buckles may indicate determine which ligament is affected.
An LCL injury, for example, may cause the knee to buckle
slightly towards the inside of the leg.

Bruising
Though bruising can occur with any of the four major
ligaments in the knee, it is most likely to develop after an ACL
sprain. Around the front of the kneecap, discoloration will
emerge.

Risk Factors
Improper footwear – Improper footwear
can increase pressure on the knee joint
and/or put the athlete at risk of injury.
Prior Injury - A previous sprained knee
ligament increases the chance of re-injury.
Unexpected Exertion - People who
increase their level of athletic competition
or training too rapidly may increase their
risk of knee sprains.

COURSERA 3 | 2022 38
 Diagnostic Tests Surgical
Drawer Test
Valgus Stress Test
Management
Knee X-ray Arthroscopic surgery
MRI Scan Partial knee replacement
CT Scan surgery
Total kne replacement

Nursing Management
RICE Method - before and after medical
evaluation, the R.I.C.E. method can help to
stabilize the leg and reduce pain.
Rest. Resting the injured knee reduces
the chance of further injury or joint
damage.
Ice. Apply an ice pack wrapped in a towel
or a cool compress to the affected knee in
fifteen-minute intervals, pausing between
each session. Icing the affected joint
helps to minimize any swelling.
Compression. An elasticized bandage
wrapped around the knee can provide
mild compression and assist relieve
localized inflammation. Patients should
avoid wrapping the bandage so tightly
that it causes pain or cuts off circulation.
Elevate the injured knee using a pillow or
other soft object. This will keep blood
from accumulating in the injured site and
causing swelling.
COURSERA 3 | 2022 39
 Assist with the placement of tape, splints, or
casts as needed.
If a severe sprain is present, prepare the client
for surgical repair or reattachment if indicated
Instruct the client to rest and repair the
muscle or tendon by avoiding use for about a
week and then gradually increasing activity
until healing is complete.
Teach appropriate stretching movements to
assist prevent reinjury after recovering.
Prescription drugs should be administered.
Splinting can help prevent reinjury.

Collaborative Management
Physical Therapy - the duration and intensity
of a physical therapy program will be based
upon the factors, including age, medical
history, athletic competition level, and the
severity of the knee injury.
- Weight training - involve resistance bands,
weighted braces, or knee-joint exercise
equipment.
- Stretching for flexibility – measuring range of
motion on a regular basis.
OTC Medications
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Naproxen (Aleve)
Injectable Medication for Knee Pain
- Corticosteroid
- Hyaluronic Acid
COURSERA 3 | 2022 40
 Strain
Strains is when a muscle is stretched too much
and tears. It is also called a pulled muscle and it
can be categorized as acute or chronic and are
graded along a continuum based on post-injury
symptoms and loss of function.

A strain may be caused by:

Injuries — trauma, sports injuries or falls that
overstretch the joints and soft tissue that
surround the knee and wrist cause a strain.
Overuse — building up too quickly in a sport,
such as running, can overwhelm the body and
lead to knee and wrist strain.
Muscle weakness — muscles that can’t
support the knee and wrist can cause a strain.
Reduced flexibility — tight muscles can
restrict joint motion and lead to functional
weaknesses cause a strain

Two types of strains

Acute strains can result from a single
injurious incident; whereas,

Chronic strains result from repetitive

injuries and can result from improper
management of acute strains.

COURSERA 3 | 2022 41
 Three degrees of strains can be
assessed:

First-degree strain
is mild stretching of
the muscle or
tendon with no loss
of range of motion
(ROM). Second-degree
strain involves
Signs and symptoms: moderate stretching
gradual onset of and/or partial tearing
palpation-induced of the muscle or
tenderness and mild tendon.
muscle spasm.
Signs and symptoms:
acute pain during the
precipitating event,
Third-degree
followed by tenderness
strain is severe
at the site with
muscle or tendon
increased pain with
stretching with
passive ROM (PROM),
rupturing and
edema, significant
tearing of the
muscle spasm, and
involved tissue.
ecchymosis.
Signs and symptoms
include immediate
pain described as
tearing, snapping, or
burning, muscle
spasm, ecchymosis,
edema, and loss of
function.
COURSERA 3 | 2022 42
 Knee Strain

Knee Strain is
occurring when a
tendon is torn or
stretched. The
tendons are fibrous
cords that connect
muscles to bones.

Risk Factors

Contact sports: participating in contact sports

such as football, basketball and soccer put you
at a higher risk for knee sprains or strains.

Prior knee strains: prior sprains or strains to

the knee make you more likely to suffer
another knee sprain or strain.

Improper footwear: wearing improper

footwear can put additional pressure on the
knee joint and cause a knee strain.

COURSERA 3 | 2022 43
 Nursing Management
PRICE
Protection from further injury is
accomplished through support of the
affected area (e.g., sling) and/or splinting.
Rest prevents additional injury and
promotes healing.
Intermittent application of cold packs
during the first 24 to 72 hours after injury
produces vasoconstriction, which
decreases bleeding, edema, and
discomfort. Cold packs should not be in
place for longer than 20 minutes at a time,
and care must be taken to avoid skin and
tissue damage from excessive cold
An elastic compression bandage controls
bleeding, reduces edema, and provides
support for the injured tissues
Elevation at or just above the level of the
heart controls the swelling.

Pharmacological Surgical
Management Management

Nonsteroidal Open Reduction

anti-inflammatory Internal Fixation
drugs (ORIF)

COURSERA 3 | 2022 44
 Pathophysiology
When a muscle is torn, it causes
bleeding into the muscle and
surrounding tissue. An inflammatory
exudate forms between the torn ends
of a tendon or muscle when it is torn.
Granulation tissue develops from the
soft tissue and cartilage that
surrounds it. Collagen is formed 4 to
5 days following an injury, eventually
arranging fibers parallel to stress
lines. The new tissue gradually
merges with the surrounding tissues
with the help of vascular fibrous
tissue. The new tendon or muscle
separates from the surrounding
tissue as it reorganizes and
eventually becomes strong enough to
withstand normal muscle strain.
When a muscle is stressed
repeatedly, calcium deposits in the
muscle, restricting mobility and
producing muscle fatigue.

COURSERA 3 | 2022 45
 Meniscus Tears of
the Knee

Knee with a Torn

Normal Knee
Meniscus

Meniscus
- It is a c- shaped piece of tough, rubbery
cartilage that acts as a shock absorber
between the shinbone and thighbone.

- A torn meniscus is one of the most

common knee injuries.

- Meniscus injuries are closely associated

with ligament sprains commonly
occurring in athletes engaging in sports
such as basketball, rugby, football soccer
and hockey.

COURSERA 3 | 2022 46
 Types of
Meniscus Tears
Horizonal Tear
- A horizontal tear most commonly
responds well to surgical meniscus repair.

- It runs along the curved fibers of the

meniscus.

- Rather than removing the damaged

portion of the meniscus, a surgeon may sew
a horizontal tear together.

Radial Tear
- Radial tears of the meniscus are the most
common type of meniscus tear.

- It occurs within the avascular zone of the

meniscus. Avascular means there is no
blood supply. Therefore, without blood
supply, there is little capacity for these tears
to heal.

Vertical Tear
- Vertical tears of the meniscus (sometimes
known as longitudinal tears) are tears that
develop along the circular curve of the
meniscus tissue.

- When these tears get large enough, they

can sometimes displace into the front of the
knee and are then known as bucket-handle
tears.
COURSERA 3 | 2022 47
 Flap Tear
- Flap tears of the meniscus (sometimes
known as a parrot beak tears) also usually
occur in the avascular portion of the
meniscus.

- They can often cause mechanical

symptoms such as catching and locking
since they can flip in and out of position.

Complex Tear
- A complex tear means there is a
combination of tear patterns. For example, a
complex tear often involves both radial and
horizontal tear patterns.

- Complex tears are not usually treated

with surgical repair because of the
complicated nature of the tear.

- However, in some unusual circumstances,

a surgeon can remove some of the torn
meniscus while repairing other portions.

Bucket-Handle Tear
- A bucket-handle tear is a prominent type
of horizontal tear of the meniscus.

- Often cause the knee to become stuck

because the torn portion of the meniscus
blocks normal knee motion.

- Bucket-handle tears often require more

urgent surgical treatment to allow the knee
to start bending again
COURSERA 3 | 2022 48
 Location of the
Tears

Anterior Posterior
Horn Tears Horn Tears

Central Tears Peripheral

Tears

COURSERA 3 | 2022 49
 Causes:
- It can result from any activity that causes you to
forcefully twist or rotate your knee, such as
aggressive pivoting or sudden stops and turns.

- Even kneeling, deep squatting or lifting

something heavy can sometimes lead to a torn
meniscus.

Signs &
Diagnostic Tests
Symptoms: MRI
- Popping sensation
- Swelling or stiffness MvMurray's Test
- Pain, especially
when twisting or
rotating your knee
- Difficulty
straightening your
knee fully
- Feeling as though
your knee is locked in
place when you try to
move it
- Feeling of your knee
giving way

COURSERA 3 | 2022 50
 Nursing Management
Immobilization of the knee (knee
brace or immobilizer to protect the
knee and relieve pain)
Use of crutches (for support)

Collaborative Management
Cryotherapy
Home exercises and physical therapy
(to increase strength in supporting
muscles)

Pharmacologic Management

Anti-inflammatory agents
Analgesics

Surgical Management
Meniscectomy (removed
through arthroscopically)

COURSERA 3 | 2022 51
 Pathophysiology

COURSERA 3 | 2022 52
 Ankle
The ankle is a large joint made up of three
bones:
- Tibia also known as shin bone
- Fibula (thinner bone running
next to the shin bone.
- Talus (foot bone that sits
above the heel bone.

Ligaments
Medial Ligaments
- Anterior Tibiotalar Ligament
- Posterior Tibiotalar Ligament
- Tibionavicular Ligament
- Tibiocalcaneal Ligament
Lateral Ligaments
- Anterior Talofibular Ligament (ATFL)
- Posterior Talofibular Ligament (PTFL)
- Calcaneofibular Ligament (CFL)
Muscles
Anterior Compartment
- Tibialis anterior muscles - facilitates dorsiflexion
of the ankle joint.
Posterior Compartment
- Superficial Posterior Compartment
(Gastrocnemius, soleus muscles) - ankle
plantarflexion
- Deep Posterior Compartment - ankle joint
inversion
Lateral Compartment
- Peroneus Longus, Peroneus Brevis muscles -
ankle joint eversion
COURSERA 3 | 2022 53
 Ankle Sprain
- A sprained ankle is an injury that occurs
when you roll, twist or turn your ankle in an
awkward way. This can stretch or tear the
tough bands of tissue (ligaments) that help
hold your ankle bones together.

Ankle Sprain Grading

Grade I
- minimal swelling, tenderness, and impairement
Grade II
- moderate pain, swelling, impairement and
decreased ROM.
Grade III
- severe pain, swelling, impairement and loss of
motion, bruising and instability.

Causes
- A fall that causes your ankle to twist
- Landing awkwardly on your foot after jumping or
pivoting
- Walking or exercising on an uneven surface
- Another person stepping or landing on your foot
during a sports activity
.
COURSERA 3 | 2022 54
 Sign & Symptoms Diagnostic Tests
- Pain, especially when you
bear weight on the affected
foot
- Tenderness when you touch X - RAY
the ankle MRI
- Swelling
- Bruising
- Restricted range of motion
- Instability in the ankle
- Popping sensation

Nursing Management
Apply first aid remembering the R.I.C.E
Rest- to prevent further damage and keep weight
off of it.
Ice- to reduce swelling and it provides a numbing
sensation to ease pain
Compress- it will help the ankle to keep it immobile
and supported
Elevate- it reduces swelling and pain
- Prepare the client with a severe sprain for surgical
repair or reattachment, if indicated.
- Allow muscles and tendons to rest and repair itself.
- Teach some appropriate stretching exercises.
- Prepare the client for surgical replain in severe
injury.
- Administer prescribed medication.
Pharmacological Management
Analgesics / NSAIDs
- To control pain and inflammation e.g.
ibuprofen (Advil, Motrin IB), naproxen
sodium (Aleve), or acetaminophen
(Tylenol)
55
 Surgical Management
In severe and/or chronic sprains and strains that do not
respond to first-line treatment or rehabilitation, one or more
types of surgery may be required:

Ankle Arthroscopy
- surgery that examines or repairs the tissues inside or
around your ankle using a small camera (arthroscope)
and surgical equipment.
- For diagnosing and correcting problems with the ankle
without requiring deeper cuts in the skin and tissue.
- Less pain and faster recovery

Reconstructive Surgery
- the surgeon uses stitches or other forms of sutures to
repair torn ligaments, muscles, or tendons. To aid in the
reconstruction, the surgeon may transplant tissue from
other regions of the patient's foot and ankle

COURSERA 3 | 2022 56
 Ankle Strain
- Once the tendons or muscles of the ankle
are torn or overstretched

Risk factors of injuring the ankle

- ankle instability , weak muscles may be more
predisposed, activities such as basketball,
jumping sports etc.,

Ankle Fracture
- A partial or total bone break.
- Ankle fractures can range from minor
avulsion injuries to severe shattering-
type breaks of the tibia, fibula, or both.
Causes
- Various modes of trauma (e.g.
twisting, falling, impact, tripping, amd
crush injuries
Signs & Symptoms
- Severe pain
- Bruising
- Tender to touch
- Swelling
- Inability to stand/walk
- Deformity if the joint is dislocated

COURSERA 3 | 2022 57
Diagnostic Nursing Management
- Give cast or walking boots.
Test - Administer pain medications.
- Keep the injured ankle elevated for at least
- X - RAY
2 weeks after surgery.
- BONE SCAN
- Encourage high protein, high calorie diet,
- CT - SCAN
- MRI with vitamins B, C, D and increase calcium
intake. (e.g. Meat, fish, milk, cheese, cottage
cheese, yogurt, nuts, seeds, beans, soy
products, and fortified cereals)
- Exercises to maintain the health of
unaffected muscles for using assistive
devices

Pharmacological Management
Analgesics / NSAIDs
- To control pain and inflammation e.g. ibuprofen
(Advil, Motrin IB), naproxen sodium (Aleve), or
acetaminophen (Tylenol)
Tetanus prophylaxis
- For open fracture

Surgical Management
Open Reduction Internal Fixation (ORIF)
- To stabilize and heal a broken bone.
- To keep the ankle bones steady as they heal,
surgeons might install metal plates, wires, or screws.
Drugs to be avoided before the surgery:
- Herbal supplements and anti-inflammatory drugs
(1-2 weeks prior surgery)
- Viagra or any other erectile dysfunction drugs. (24
hours prior surgery)
COURSERA 3 | 2022 58
 PATHOPHYSIOLOGY

COURSERA 3 | 2022 59
 METATARSAL

The metatarsals refer to the five long bones found in each

foot. They are numbered I to V, from medial to lateral.
Together, the metatarsal and tarsal bones help to form
the main arches of the foot, which are essential for
weight-bearing and walking.

Gross Anatomy & Structure

The metatarsal bones run from the tarsus to the
phalanges, forming two joints: the tarsometatarsal joint &
metatarsophalangeal joint.
Each metatarsal bone consists of the following:
proximal base
shaft (body)
neck
distal head
Arches of the Foot
The metatarsals contribute significantly to the three
arches of the foot. The bones that contribute to each arch
are as follows:
Medial longitudinal arch: talus, calcaneus, navicular,
all three cuneiforms and metatarsals 1-3.
Lateral longitudinal arch: calcaneus, cuboid and
metatarsals 4 & 5.
Transverse arch: bases of all five metatarsals, cuboid
and cuneiforms 1-3.
COURSERA 3 | 2022 60
 Metatarsal Stress
Fracture

Also called "march fractures" or "marcher's foot."

Most commonly occur in the distal second and third
metatarsals.
The metatarsal bones are the long bones in your foot
Also
thatcalled "march
connect fractures"
your ankle orto"marcher's
your toes.foot."
They most commonly occur in the distal second and third
A stress fracture is a break in the bone that happens with
metatarsals. The second and third metatarsals receive the majority
repeated
of injury
stress during or stress.
ambulation and are less mobile compared with the
It progresses
other metatarsals. to malunion or nonunion that can cause
The metatarsal bones
metatarsalgia are the long
or midfoot bones in your foot that connect
arthritis.
your ankle to your toes.
It can also be seen in patients with metabolic bone
A stress fracture is a break in the bone that happens with repeated
disease,
injury rheumatoid arthritis.
or stress.

Causes:
It progresses to malunion or nonunion that can cause metatarsalgia
or midfoot arthritis.
ItStress
is usually an overuse
fractures injury
are that leads
caused to a thinstressing
by overly crack in bone,
theand
foot
can also occur in the metatarsals.
when using it in the same way repeatedly
It can also be seen in patients with metabolic bone disease,
repetitivearthritis.
rheumatoid force, often from overuse — such as repeatedly
jumping up and down or running long distances.
High-impact, weight-bearing activities (such as running,
jumping and dancing) generate stress to the bone,
causing small areas of bone breakdown.

COURSERA 3 | 2022 61
 The following is a list of fractures specific to the
metatarsals of the foot:
- Dancer’s Fractures (Avulsion fracture of the base
of the 5th metatarsal)
- Jones Fractures (5th metaphyseal stress fractures)
- Metatarsal base fractures and Lisfranc injuries
- Metatarsal stress fractures
- Neuropathic metatarsal fractures

Signs & Symptoms:

Gradually worsening pain on top of foot.
Initially, the pain may only be felt with sports.
Eventually, it progresses to pain with daily activities
such as walking. Swelling or bruising may also be
present.
Practicing incorrect training or sport technique.
Having too rapid of a training program or volume of
activity or changing your activity level without a
gradual break-in period.
Changing the surface you exercise on, such as going
from a soft surface (like an indoor track) to outside on
gravel or concrete.
Running on a track or road with a sloped surface.
Doing repetitive activity in certain high-impact sports,
such as:
- Long-distance running (tibia, hip).
- Basketball.
- Tennis.
- Track and field.
- Gymnastics (wrist stress fractures from weight bearing on
hands/wrists, low back).
- Dance (feet, low back).
Having a poor diet that has inadequate caloric intake
for volume of sport.
Having a low vitamin D level.
Experiencing early specialization in sports. Youth who
play one sport year-round without a break are at risk of
stress fracture
COURSERA 3 | 2022 62
 Diagnostic Tests
- MRI
- X- ray
- Radiograph
- Bone densitometry (BMD) - performed
through x-ray or ultrasound
- Bone scan

Nursing Management
- Initial treatment strategies involve rest, ice, non weight
bearing, and avoidance of exercise to prevent fracture
displacement, nonunion, and other complications. Orthopedic
referral will guide definitive care.
- Treatment of a metatarsal stress fracture requires a period of
rest from your activity, usually at least 3-4 weeks. If there is
pain with daily activities, you may need to use crutches or a
walking boot for a short time until you can walk comfortably
without pain. Ice can be helpful in reducing pain.
- Assess for conditions that may require special consideration
during the study or that may be contraindications to the study
- The nurse provides additional comfort measures (e.g., mild
analgesia, ice) as appropriate and explains to the patient that it
is normal to experience clicking or crackling in the joint for 24
to 48 hours after the procedure until the contrast agent or air
is absorbed.

Pharmacologic Surgical
Management Management
- Ibuprofen (Advil), - Metatarsal
- Naproxen (Aleve), osteotomy
-Acetaminophen
(Tylenol), to reduce pain
and swelling

COURSERA 3 | 2022 63
 PATHOPHYSIOLOGY

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 Conclusion
After the completion of the coursera, the
readers/watchers will have better knowledge
about the nine (9) common sports injuries which
include the anatomy and physiology of the
affected body part, cause, diagnostic tests,
different treatments, and its pathophysiology.

For the readers, it is important that they know

what causes these injuries. By knowing how
these injuries occur, athletes or even non-
athletes will be able to prevent these types of
injuries.

For the student nurses, through this cousera,

additional knowledge regarding these injuries
will be acquired, hence, they will be able to
deliver proper and effective nursing
management.

COURSERA 3 | 2022 65
 Glossary
Acetaminophen - Typically given to decrease fever, but it also
increases diaphoresis.

Analgesics- Medications that relieve different types of pain —

from headaches to injuries to arthritis.

Arthrodesis- It is performed to reshape and stabilize the foot.

Arthroplasty- Repair of joint problems through the operating

arthroscope (an instrument that allows the surgeon to operate
within a joint without a large incision) or through open joint
surgery.

Arthroscopy- It is used to drain the joint and remove dead tissue

Arthrogram- is a type of imaging test used to look at a joint,

such as the shoulder, knee, or hip.

Ballottement test- It is also known as the Patella tap test or the

ballottement patella sign.

Bone densitometry- It is also called dual-energy x-ray

absorptiometry, DEXA or DXA, uses a very small dose of
ionizing radiation to produce pictures of the inside of the body
(usually the lower (or lumbar) spine and hips) to measure bone
loss.

Clavicle- called collarbone, curved anterior bone of the shoulder

(pectoral) girdle in vertebrates; it functions as a strut to support
the shoulder.

Clavicle Fracture- is a break in the collarbone, one of the bones

in the shoulder.

Claustrophobia- Fear of confined spaces.

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 Glossary
CT Scan- It provides cross-sectional images of abdominal
organs and structures.

Cryotherapy- The use of extreme cold to freeze and remove

abnormal tissue. Doctors use it to treat many skin conditions
(including warts and skin tags) and some cancers, including
prostate, cervical and liver cancer. This treatment is also called
cryoablation.

Chronic strain- It can result from improper management of

acute strains.

Dancer’s fractures- It is also known as an avulsion fracture, is a

break off the base of the 5thmetatarsal bone, which is the long
bone of the midfoot that attaches to the 5th (little) toe.

Drawer Test- A physical examination doctors use to test the

stability of the knee's anterior cruciate ligament (ACL).

Ecchymosis- Also called bruising. It is a result of trauma and

bleeding into the tissues.

Edema- It is swelling caused by excess fluid trapped in your

body's tissues.

Fibula Fracture- A break to your fibula caused by a forceful

impact that results in injury.

Ibuprofen - is a nonsteroidal anti-inflammatory drug (NSAID). It

works by reducing hormones that cause inflammation and pain
in the body.

Joint – An articulation between two bones in the body and are

broadly classified by the tissue which connects the bones.

COURSERA 3 | 2022 67
 Glossary
Jones Fractures - a fracture of the bone on the pinky toe side of
your foot, the fifth metatarsal bone.

Ligaments – Tough connective tissue band usually connecting

bone to bone

Meniscectomy - surgical removal of a meniscus, especially that

of the knee.

McMurray’s Test - used to detect internal tears in the knee joint.

Meniscus - C-shaped piece of tough, rubbery cartilage that acts

as a shock absorber between your shinbone and thighbone

Metatarsal - long bones in your foot that connect your ankle to

your toes.

Metatarsalgia - is a condition in which the ball of your foot

becomes painful and inflamed.

MRI - medical imaging technique that uses a magnetic field and

computer-generated radio waves to create detailed images of
the organs and tissues in your body

NSAIDs - Non-steroidal anti-inflammatory drugs, medicines

that are widely used to relieve pain, reduce inflammation, and
bring down a high temperature.

Naproxen - is used to relieve pain from various conditions such

as headache, muscle aches, tendonitis, dental pain, and
menstrual cramps.

Radiograph - art and science of using radiation to provide

images of the tissues, organs, bones, and vessels that comprise
the human body.

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 Glossary
Reconstructive Surgery - repairs parts of your body affected by
defects you were born with, defects that have developed
because of disease, or defects caused by an injury.

Range of Motion - refers to how far you can move or stretch a

part of your body, such as a joint or a muscle. The purpose of
range of motion exercises is to prevent the development of
adaptive muscle shortening, contractures, and shortening of the
capsule, ligaments, and tendons.

Scaphoid - one of the carpal bones on the thumb side of the

wrist, just above the radius. The bone is important for both
motion and stability in the wrist joint.

Sprain - stretching or tearing of ligaments; the tough bands of

fibrous tissue that connect two bones together in your joints.

Strain - an act of straining or the condition of being strained.

Sternocleidomastoid muscle - are superficially located neck

muscles that play an important role in tilting your head and
turning your neck, as well as other movements.

Tenodesis - surgical procedure that is typically used to treat

injuries to the biceps' tendon in the shoulder.

Tibia - It supports most of your weight and is an important part

of both the knee joint and ankle joint. The tibia is the larger bone
in your lower leg.

Talus - bone that makes up the lower part of the ankle joint (the
tibia and fibula make up the upper part). The ankle joint allows
your foot to move up and down. The talus also sits above the
heel bone (calcaneus). Together, the talus and calcaneus form
the subtalar joint.

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 Glossary
Valgus Stress Test - used to assess the integrity of the medial
collateral ligament (MCL) of the knee.

Volar Plate - a thick ligament that connects two bones in the

finger. There are other ligaments to each side of the joint as well
(collateral ligaments).

X-ray - mainly used to look at the bones and joints, detect

problems affecting soft tissue, such as internal organs.
Problems that may be detected during an X-ray include bone
fractures and breaks.

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