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Main » 2013 » October » 14 » Sprains and Joint Pain by John Laurusonis, MD
6:33 AM Sprains and Joint Pain by John Laurusonis, MD |
Sprains and Joint Pain by John Laurusonis, MD
SPRAINS, STRAIN, FRACTURE,
AND DISLOCATIONS
Traumatic injuries cause damage to tissues. The
incidental rupturing of ancillary and primary blood vessels supplying these
tissues internally bleed at the site of trauma. The blood supplies normally
bring nutrients, oxygen, and remove waste materials and metabolic by-products
from tissues. With damage, the delicate piping systems of blood vessels rupture
at smaller capillary, aterioli, venule, and even in larger blood vessels
yielding profuse bleeding. This bleeding is what causes the swelling at the site
of the injury. The injury is enclosed within the skin creating increased
fluid/blood pressure inside the body. When the traumatic site fills and expands
with bleeding, it tamponades the traumatic site. This occurs by increasing he
site�s inner body pressure at or above the person�s normal blood pressure. This
pressure is what finally stops the bleeding naturally.
The heart pumps
blood out to the tissues in the arteries. About 99% of all blood pumped out of
the heart is returned by the venous return system. Being an enclosed plumbing
system, the arterial pressure via the capillary bed drives the blood back to the
heart by the pressure in the enclosed venous system. The generally low negative
right-sided heart, allows natural decreased pressures to direct blood from the
venous systems back into the heart. This allows the blood to be re-circulated
and be pumped again and again by the heart.
LYMPHATICS: In addition to
the heart, artery, and venous systems, there is a passive lymphatic pip system
form the tissue sites back to the heart. This lymphatic system acts as a
cleaning sewage system allowing extra fluid not removed by the veins to drain
from the capillary beds and trauma site, via the venous system, and finally to
the heart. Lymphatic vessels have one-way valves and pumps. These passive pumps
called lymph nodes are located behind joints or at sites of pressure from
physical movement. They are much like a hose with a bulb and a valve attached to
another hose. When the bulb is squeezed, the system pumps fluid in one direction
only-towards the heart. When a joint is flexed and extended, the bulb is
naturally compressed and it pumps moving fluids from the distal extremity
towards the heart. This naturally removes blood, fluid, and potential infections
fluid from the site or injury. This reduces the on-site pressure after bleeding
is stopped to allow new circulation and healing.
THE DEFINITION OF
ELEVATION: The definition of elevation of a traumatic point is applied by
measuring from the floor directly vertical to the heart Isabel Marant. Then measure
from the floor directly vertical to the site of injury. This means that the
point of injury should be elevated approximately 12-16 inches higher that the
position of the heart at any time and from any position, i.e. sitting in the
chair with your foot on an ottoman if the foot is the site of injury IS NOT
ELEVATION. The distance to the floor from the foot must be less than the heart
to the floor. However, laying flat on a couch with your foot up high on the back
of the couch at the head level IS elevation of a traumatic site decreasing pain
and removing the fluids.
Therapy:
ELEVATION: All traumatic
injuries should be elevated 12-16 inches immediately from the time of injury to
decrease bleeding and capillary pressure. This is most critical the first 3-5
days after the injury. If you do not have elevation, this is the cause of the
thumping and pounding of your heart in the new injury site causing swelling post
by haiyan111.
ICE decreases circulation at an injury site. Ice should be
placed gently against the wound of 5-20 minutes per hour as tolerated for at
least the first 5-7 days and depending on the injury 10-12 after the injury. Ice
in an ice bag or blue ice pack should have at least 1-2 layer of a thick towel.
You don�t want to burn or freeze health superficial tissues and cause other
substantial secondary damage.
HEAT is good only after 7-12 days. This
time allows the ripped blood vessels to heal by increasing the circulation.
Early heat to a new acute injury will definitively increase bleeding, swelling,
and pain and will lengthen the recovery time. Heat should only be on low, not
hot, with gentle warming. I.e. a heating pad on low heat with at least 1-2 layer
of a thick terrycloth towel Etoile
Isabel Marant Dicker Suede Ankle Boots Brown.
MOVEMENT of joints
closer toward the heart occasionally with elevation, pumps traumatic fluids away
from the injury. After several days, movement and pumping of lymphatics reverses
swelling at the site and promotes healing and circulation.
ACE: An
external ace bandage gently and lightly applied may compress a new injury,
stopping or slowing the bleeding and controlling the injury. Light compression
with an ace bandage stops the bleeding by compressing the wound and should NEVER
be place on tight.
IMMOBILIZATION: A fracture, tendinous
strain/pull-partial or complete rip must be initially immobilized with a splint.
Splints decrease movement so further bleeding or damage doesn�t occur. The most
distal site beyond the injury, i.e. the finger and toes, should always be
exposed (splinting permitted) to check to see that there is good distal
capillary refill.
DISTAL CAPILLARY REFILL: Squeezing a finger or a toe
between the thumb and index finger for 2-3 seconds and getting a whitish
blanching under the nail tests for distal capillary refill. Suddenly removing
then
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