Treatment of a Soft Tissue Ankle Injury Grade - Essay Example

TREATMENT OF SOFT TISSUE ANKLE INJURY TREATMENT OF SOFT TISSUE ANKLE INJURY Introduction Soft tissues ankle injuries can be defined as injuries which do not constitute fractures of the bones. These injuries only affect the tissues surrounding the ankle. Ankle injuries are a recurrent problem around the world today, especially among athletes and sports participants. There are different treatment approaches which can be utilised in the management of these injuries. The approach utilised in the management of the injury depends on the initial assessment. The effectiveness of these interventions is proportional with the effect of the injury on the individual. Assessment of the injury is the determining factor for the intervention, which is applied in the treatment and management of the ankle injury. Many soft tissue injuries are commonly treated through simple interventions without surgery. Surgery is not indicated except to correct the most severe injuries. Soft injuries involve different range of tissue injuries from ankle tissue sprains to muscular and tendon injuries. The treatment of these injuries commonly involves interventions aimed at restoring full range of functionality to these tissues. The fundamental symptoms of these injuries include swelling, pain and stiffness, which commonly result in limited mobility. Epidemiology of the condition has indicated that these common issues can easily result in chronic disabilities. Management of Soft Tissue Injuries Soft tissue injuries commonly refer to trauma in various muscles, tendons, and ligaments located in a range of structures. These injuries commonly result from strains, sprains or excessive use of a body part, common to athletes, whose activities create soft-tissue risk factors for injuries in the legs specifically. The basic symptoms of these injuries include extreme pain, swelling and inflammation stressing affected tissues to the detriment of normal function. The PRICE principle is the intervention that is applied immediately following the injury. This principle is an acronym referring to the management procedures applied for soft tissue injury. The intervention usually begins immediately following the injury before hospitalisation and diagnosis of the severity of the sustained injury. Protection: This is performed to ensure the individual does not sustain further damage upon the injured area. Often, this involves a cast or brace that restricts whatever motion or position is most likely to exacerbate the injury while supporting the healing process. Rest: The individual is advised to refrain from engaging in activities which cause pain to the injured area. Ice: After sustaining an injury, ice is a necessity for the reduction of swelling and pain within the first 72 hours following injury. Icing of the injured part is advised after 4 hours, and for 15 minutes per session. Compression: This is the process of applying some pressure upon the injured part. This can be performed through the utilisation of elastic wrap, bandage or compression tape. Essentially, this controls bleeding and minimises swelling. This should be undertaken immediately following injury for the best benefits. Elevation: This refers to the elevation of the injured limb above the heart; often combined with ice and compression. This also minimises tissue bleeding and swelling. The PRICE principle is a basic management process suitable if the trauma is comparatively minor. This principle serves as the first aid administered to injured individuals within the first 24 hours of soft tissue injury. While some injuries might be effectively treated through this process, consultation of a professional is essential in analysing serious debilitations. This intervention serves a basic function of reducing pain and swelling before a proper diagnosis can be performed. Diagnosis is essential in seeking to ensure the injured person is able to return to normal activities, following implementation of a suitable treatment plan. Diagnosis Management of soft tissue injuries is dependent on an accurate diagnosis. This is performed on the site where the injury occurs, and proper first aid administered following the PRICE principle. Following the administration of PRICE, the individual is assessed with respect to the progression of healing; or lack thereof - to determine future courses of action. This is needed to decide which areas should receive further attention. Initial diagnosis is commonly undertaken in seeking to establish the necessity for advanced diagnostic analysis. Structural damage can be established from the initial diagnosis and referrals made based on the evaluation. Radiology is a basic tool utilised in the assessment of soft-tissue injuries. Ankle injuries could be limited to the tissues surrounding the ankle or there may be fractures in the bone itself. Specialised diagnosis undertaken within a hospital setting is essential in distinguishing fractures, as opposed to soft tissue damage. This further diagnosis in necessitated by the increased pain and continued inflammation of the injured part of the body. The treatment for these injuries is different, hence, the need to distinguish these traumas. Pain and swelling are common symptoms for both fractures and soft-tissue injuries. Imaging technology is often necessary to distinguish type one, two, and three injuries – to be described later. This is commonly performed following the initial diagnosis, based on observations and analysis of the symptoms displayed by the patient. Ottawa Ankle Rules The Ottawa Ankle Rules refer to a medical set of guidelines utilised in the assessment of foot and ankle injuries. The guidelines are employed in radiography, through exclusion of fractures. The rules are effectively utilised by medical professionals when determining whether to use X-rays in the diagnosis of suspected fractures, among patients experiencing foot or ankle pains. Before the introduction of the rules most individuals experiencing such pains were scanned. This resulted in slow treatment of the existing condition because of the time consumed in performing the imaging; which also carries a radiation risk from prolonged exposure. These rules provide guidelines on when to conduct imaging upon an injured patient. The guidelines provide definitions of injury situations in which X-ray-imaging is appropriate. These include situations when a patient experiences pain within the malleolar zone of the ankle. The inability of a patient to bear body weight when walking, immediately after sustaining an injury or for four steps following administration of other management interventions, within an emergency department of a medical facility is another element which necessitates radiological imaging. These rules have been established to be highly accurate in the diagnosis of an ankle injury and subsequent elimination of unnecessary x-rays. The increased application of the guidelines prevents false negatives in terms of fracture diagnoses. Classification of Injuries The diagnosis of the injuries through the utilisation of accurate approaches like the Ottawa Ankle Rules is essential in elucidating the importance of the sustained injury. Following the exclusion of fracture, through diagnosis using the Ottawa rules, the next stage is to determine the extent of the injury sustained to the soft tissue. The exclusion of fracture directly implies damage upon the soft tissues. For treatment, the extent of the damage must be described accurately. The traditional approach for classification of ankle sprains involved the description based on damage sustained upon the lateral ligaments of the ankle joint. The damages to the lateral ligaments of the ankle joint constitute about 85% of the soft tissue ankle injuries. This traditional classification defines three grades of injury pathology. Grade 1 – These are described as injuries which cause stretching of the soft tissues without macroscopic tears upon the tissues. This class of injuries is characterised by minimal swelling of the affected part, without any functional loss being sustained by the patient. Individuals who sustain these injuries can perform their functions normally. Grade 2 – This class of injuries can be identified through presence of partial microscopic tearing of the soft tissues. The patient commonly experiences moderate swelling and pain in the affected structures. Motion is limited as the patient experiences instability during movement. Grade 3 – This class of injury of characterised by complete rupturing of one or more of the ligaments contained within the ankle joint. Excessive swelling and severe pains are experienced by patients suffering from this class of soft tissue injury. Considerable functional loss is present with the patient experiencing severe instability during movement. The classification of these injuries is commonly undertaken following historical medical information and clinical examination of the injury. The anterior drawer test and tallar tilt test are the commonly utilised stress methods for testing the injuries sustained by individuals . These tests have been effectively utilised in testing for injuries upon the ligaments of the ankle joint. These methods have been extensively utilised in the evaluation of acute ankle injuries sustained by individuals while performing their daily responsibilities. The reliability of these methods however is questionable with imaging being preferred in the evaluation of fractures. Interventions Grade I and II ankle sprains are commonly managed through the utilisation of the PRICE approach. The immediate application of this approach is intended to ensure the patient returns to full functionality within the shortest duration possible. The fundamental reason behind the application of PRICE in the management of soft tissue injury is reduction of inflammation during the initial stages of the injury. This approach has been accepted as the standard management process for all acute soft tissue injuries before, proper diagnosis and the subsequent implementation of a treatment plan. Cases involving grade I and II injuries are commonly followed by early mobilisation of the patient. In seeking to implement the early mobilisation of the patient various approaches and interventions are applied for this patient. Non-steroidal anti-inflammatory and protected weight bearing are the fundamental approaches, which are commonly utilised in the management of these injuries. Both of these approaches can be defined as functional treatments which seek to ensure the patient returns to normal functions immediately . Functional treatment is an essential intervention for all acute ankle injuries, as many have adverse functional effect upon the affected individual. The functional treatment commonly involves the utilisation of rigid or semi-rigid bracing or bandages in order to facilitate early mobilisation of the patient. The ultimate outcome of the interventions is enabling the patient to regain mobility, strength and coordination of locomotive functions. Tubi-grip This can be defined as an elastic bandage which can be effectively utilised in the provision of required support for patients suffering from soft tissue injuries. The elasticity characteristics of the material bandage enables sprains, strains and weak joints to be properly supported, consequently enabling the individual to undertake basic functions. The tubi-grip provides an effective support, which is essential in reducing swelling resulting from performing various activities, while injured. The product can be effective in controlling persistent swelling of injured ankles. The application of tubi-grip also provides protection to the dressings applied upon the injured part, preventing them from falling by keeping them in place. This elastic bandage presents numerous advantages over other kinds of bandages. The advantages include the following The bandage is extremely easy to apply as an individual only requires putting it on. It effectively reduces costs as it is reusable and washable. It easily stays in place because it does not require pins to hold it in place. Back Slab cast This can be defined as a cast of the plaster of Paris, which is utilised in provision of protection to injured body parts. This intervention involves moulding of a protective element form gypsum material, commonly called plaster of Paris. This material is easy to mould, hence the increased utilisation in providing protection for injured body parts. The back slab is an artificial cast, which is commonly utilised in providing protection for injured parts to enable the patient to return to basic functionality within the shortest time possible. This slab is similar to the plaster of Paris; however, it does not cover the entire limb. A bandage is usually applied upon the back slab cast to ensure it completely covers the limb. The slab consists of an underlying layer of a woollen bandage covered by a slab of the old-fashioned plaster of Paris. The advantages of utilising the back slab cast include the following It provides a firm support for injured joints. The cut-away which is removed from the complete cast, enable swelling to occur and does not constrict the injured part. Air-cast or Walking Boot Air-casts and walking boots are similar items which can be effectively utilised in the management of soft tissue injuries sustained by various individuals. These items resemble other shoes but are commonly manufactured from durable semi-rigid shell in order to provide essential protection to injured body parts. The sole of the shoe absorbs shock from the foot, significantly reducing the pressure exerted upon the injured ankle. This consequently enables the injured individual to perform basic functions without experiencing any excruciating pain. These items are utilised in enabling a patient to engage in normal functions in the process of seeking to achieve complete recovery. These items are commonly manufactured from lightweight material, which is hardened on the outside to enable absorption of the shock, which might cause increased pain upon the patient. They provide the essential protection from further damage enabling quick recovery by patients who utilise them. The major advantages of these items in the management of soft tissue injuries include the following They allow significantly high level of mobility, consequently enabling quick recovery. The quick healing significantly reduces rehabilitation time for injured individuals They are extremely light and effective compared to the plaster of Paris. Conclusion Soft tissue injuries are a common problem among athletes and the general public alike, and could be easily incurred while undertaking daily tasks. Ankle injuries sustained during various activities require quick assessment and the application of first aid in order to minimise the effects of these injuries. A common approach utilised in the management of the injuries is the PRICE principle, which should be administered immediately following an injury. This principle is significant in reducing the adverse effects including swelling and excruciating pain experienced by the injured individual. Further diagnosis of these injuries is essential in seeking to eliminate the possibility of a fracture within the ankle joint. To reduce error rates, ongoing research is recommended into radiography and related technologies. This diagnosis is effectively performed through different imaging techniques, and the necessity of radiography is determined through the application of Ottawa Ankle Rules. Some issues with the Ottawa Ankle rules might pertain to extreme situations; such as a comatose patient unable to walk in any event, but with a soft-tissue injury to the ankle, and possible fracture. It is not possible to interview or test this patients ability to walk. While the Ottawa rules are intended to reduce the need for radiographic scans in the interest of efficiency, it is important not to neglect changes whenever they appear for ongoing technological improvement. This also applies to the cast methods described above. The Tubi-grip is useful for wounds, but less so for any serious fracture; with the rigid support it provides being minimal. This should allow healing in the case of soft-tissue, but is less advisable for Grade III injuries with severe ligament damage. The back slab method could provide more rigid support, and is useful with respect to fractures, yet could be modified to allow limited swelling in the event of Grade II or III injuries. It represents a useful, form-fitting option with potential for both soft-tissue and fractures. But any form of solid cast nonetheless entails limitations in terms of the range of mobility and dexterity. For convalescence, this method seems entirely appropriate – but the patient cannot move as fast or as expertly with any form of cast. This is not necessarily a counter-indication, as a recently injured patient should relax for an extended period. But in the case of long-term bone breaks/fractures the hindrance on mobility will become increasingly inconvenient. The third possibility represents the most sophisticated option. The air-casts can provide rigidity while weighing less. Additional research should examine air casts with expandable structures to also permit swelling. This option provides support and protection in the case of fractures or Grade III tissue ruptures, yet if made to be adjustable, and with a lighter weight it would be less cumbersome than a solid cast or back slab, so for long-term convalescence the patient could go about normal business with marginally less difficulty. This option could be counter-indicated for minor injuries, such as Grade I tissue damage; not that it wouldnt be effective, but simply that it would entail too much expense and complication for light sprains. Classification of the injuries can be undertaken following proper diagnosis and the applicable intervention implemented in order to enable the patient regain mobility. Grade I and II injuries commonly involve early mobilisation of patients and this requires the application of different protective elements to ensure the patient moves without difficulty and pain. Grade I probably should not require any form of cast. The process of management of soft tissue ankle injuries begins with first aid, diagnosis and implementation of treatment plan in seeking to handle the condition effectively. Management of these injuries requires effective diagnostic measures in seeking to effectively exclude the possibility of fractures for individuals who have experienced sprains and strains on their ankles. The accuracy of the process involved in undertaking diagnostic evaluation remains essential in determining the treatment intervention which shall be utilised. References Bleakley, C.M. et al., 2010. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. British Medical Journal, 340. Dowling, S. et al., 2009. Accuracy of Ottawa Ankle Rules to Exclude Fractures of the Ankle and Midfoot in Children: A Meta‐analysis. Academic Emergency Medicine, 16(4), pp.277–287. Flegel, M.J., 2004. Sport first aid: A coach’s guide to preventing and responding to injuries, Hong Kong: Human Kinetics. Fong, D.T.P. et al., 2009. Understanding acute ankle ligamentous sprain injury in sports. BMC Sports Science, Medicine and Rehabilitation, 1(1), p.14. 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