Sprains, Strains Dislocations and

Subluxation
A. Pusey Murray (Mrs)
RN, Cert Psych Nursing & Nursing
Admin, BSc (Hons), MPH, Dip.
Ed.
 Objectives
• At the end of this session students will be able
to:
• Define the terms sprain, strain, dislocation
and subluxation.
• Outline the etiology of sprain, strain and
dislocations.
• State the pathophysiology of sprain, strain
and dislocations.
 Objectives cont’d
• List the clinical manifestations of sprain, strain
and dislocations.
• Discuss the nursing management of sprain,
strain and dislocations.
• Discuss the musculoskeletal care modalities.
 Definition
• A sprain is a complete or in complete tear in
the supporting ligaments surrounding a joint.
Common locations include the ankle, knee,
wrist, thumb, shoulder, neck and lower back.
• A strain is an overstretching injury to the
muscle or tendon. Commonly affected areas
are the groin, hamstring, calf, shoulder and
back muscles and the Achilles tendon.
 Definitions cont’d
• Dislocation is the displacement of a bone from
its normal articulation with a joint. Common
locations include the shoulder, elbow, wrist,
digits, hip, knee, ankle and vertebrae.
 Definitions cont’d
• Subluxation is a partial or incomplete
displacement of the joint surface. The clinical
manifestations are similar to dislocation but
are less severe. Treatment of subluxation is
similar to that of dislocation, but subluxation
requires less healing time.
 Etiology

• Sprains commonly result from a wrenching or

twisting motion that disrupts the stabilizing
action of ligaments.
• Strains typically result from excessively
vigorous movement in understretched or
overstretched muscles and tendons.
 Etiology
• A dislocation may be congenital (congenital
hip displacement) or may result from trauma
(eg. abnormal twisting) or disease of
surrounding joint tissue (eg Paget Disease)
Pathophysiology of Sprains and Strains

• The affected ligament is unable to stabilize the

joint where the client is applying weight and
attempting to mobilize the affected joint.
Blood vessels may be ruptured and edema
produced.
 Pathophysiology of Dislocation
• Traumatic dislocation may cause severe stress
to associated joint structures, interrupting
blood supply and causing nerve damage. If
untreated, this may lead to avascular necrosis
or nerve palsy in the affected area.
 Clinical Manifestations
• Sprains
 Pain and discomfort, especially in joint
movement.
 Edema, possibly ecchymoses
 Decreased joint function and motion.
 Feeling of joint looseness with severe pain
 Clinical manifestations cont’d
• Strains
 Pain. In acute strain, pain may be sudden,
severe and incapacitating. With chronic strain,
pain may be manifested as a gradual onset of
soreness and tenderness.
 Edema
 Ecchymoses developing after several days of
injury.
 Clinical Manifestations - Dislocations
• Pain
• Visible disruption of joint contour
• Edema
• Ecchymoses
• Impaired joint mobility
• Change in extremity length
• In severe dislocation, circulatory or sensory
changes of the affected limb or joint.
 Nursing Management - Sprain
• Administer prescribed medications.
• Elevate or mobilize the affected joint and
apply ice packs immediately.
• Assist with splint, tape or cast application, as
necessary.
• Prepare the client with a severe sprain for
surgical repair or reattachment, if necessary.
 Nursing Management - Strain
• Instruct the client to allow the muscle or
tendon to rest and repair itself by avoiding use
for approximately 1 week and then by
progressing activity gradually until healing is
complete.
• Teach appropriate stretching exercises to be
performed after healing to help prevent
reinjury.
 Client and Family Teaching
• Teach patient and ensure safe use of
treatment modalities such as slings, walkers
and crutches.
• Instruct client to notify health care provider if
any of the following changes occur:
• Increased pain not relieved by prescribed
medications
• Skin cold to touch
• Increased swelling of the affected extremity.
 Client and Family Teaching cont’d
• Any tingling, numbness or abnormal sensation
in affected extremity.
• Any diminished capillary refill.
• Instruct patient to perform ADL within
therapeutic limits of the musculoskeletal
disorder.
Musculoskeletal Treatment
Modalities
 Cast
• A rigid, external immobilizing device.
Uses
- Immobilize a reduced fracture
- Correct a deformity
- Apply uniform pressure to soft tissues
- Support to stabilize a joint
 Teaching Needs of the Patient with a
Cast
• Prior to cast application
- Explanation of condition necessitating the cast
- Purpose and goals of the cast
- Expectations during the casting process- for
example heat from hardening plaster
 Teaching Needs of the Patient with a
Cast
• Cast care: keep dry, do not cover with plastic
• Positioning: elevation of extremity, use of
slings
• Observe for pulse and polar(coldness)
• Activity and mobility
• Exercises
• Do not scratch or stick anything under the cast
 Teaching Needs of the Patient with a
Cast
• Signs and symptoms to report: persistent pain
or swelling, changes in sensation, movement,
skin colour or temperature, signs of infection
or pressure areas.
• Cast Removal
• Potential Complications: compartment
syndrome, pressure ulcer, delayed union or
non union of fracture(s)
References