Primary Care for Sports and Fitness A Lifespan Approach Brian J. Toy, PhD, ATC Interim Dean, College of Nursing and Health Professions Associate Professor of Athletic Training, Department of Exercise, Health, and Sport Sciences University of Southern Maine Phyllis F. Healy, PhD, BC-FNP, CNL, RN Associate Professor of Nursing, School of Nursing University of Southern Maine Primary Care for Sports and Fitness A Lifespan Approach F. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.com Copyright © 2009 by F.
Davis Company All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopy- ing, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne Patzek DaCunha, RN, MSN Developmental Editor: Laura Bonazzoli Content Development Manager: Darlene Pedersen, RN, MSN Project Editor: Kristin L.
Kern Manager of Art and Design: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication.The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug.
Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Toy, Brian J. Primary care for sports and fitness : a lifespan approach / by Brian J. Includes bibliographical references.
Athletic Injuries—Nurses' Instruction. Physical Fitness—Nurses' Instruction. Primary Health Care—Nurses' Instruction.1'027--dc22 2008041770 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. Davis Company for users registered with the Copyright Clear- ance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923.
For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1492-5/09 0 + $. This book is dedicated to – My mom, who watches over our family from afar; – My dad, who watches over us from above; – My siblings, who are all accomplished professionals in their chosen careers; – My daughter, Christine, our princess and Daddy’s little girl; – My son, Aiden, our funny little man; – My wife, Jacqueline, whose enduring love, support, and understanding allow me to pursue projects like this.Toy Lovingly dedicated to – My parents, Vivian (Joe-“Chief”) and Cora Foster, smiling from above when once again they realize I do not know what to do when my father is named Vivian! – My daughter, Megan, and her husband, Ron Raye. Life is so much sweeter because of you both! Phyllis F.
Healy v Acknowledgments A project of this magnitude cannot be completed without the support of many, many people. In particular, we extend thanks to our contributing authors for helping us produce a quality product. Thanks to Joanne DaCunha and Kristin Kern at F. Davis for keeping us on task these past few years and to Laura Bonazzoli who, in the manuscript’s early stages, provided excellent insight into the book-writing process.
We are grateful to Tracey Fox-Bartels for editing and assuring that the infor- mation presented is appropriate for student, and practicing, primary health care providers (and thanks for modeling, Tracey!). Special thanks to Jean Marie Toy, artist extraordinaire, for producing the Patient Teaching Handout figures. We are also indebted to the authors of the numerous F. Davis holdings from which we repro- duced figures.
Thanks to all who reviewed the manuscript. The insight provided was invaluable. To our mentors, past and present, we hope the production of this text pleases you. To our colleagues at the University of Southern Maine, thanks for provid- ing a dynamic place for us to work.
To our students, particularly those enrolled in USM’s Nurse Practitioner program, this was written with you in mind. We hope you find it useful.Toy, PhD, ATC Phyllis F. Healy, PhD, BC-FNP, CNL, RN University of Southern Maine vii Contributors Tracey Fox-Bartels, MSN, FNP, RN Karen A. Croteau, EdD, FACSM Martin’s Point Health Care Associate Professor of Health Fitness, Portland, ME Department of Exercise, Health, and Sport Sciences Thomas W.
Buford, MS, CSCS University of Southern Maine Doctoral Research Assistant, Exercise and Biochemical Nutrition Lab William F. Simpson, PhD, CES, Adjunct Professor, Department of FACSM Health, Human Performance, and Associate Professor and Director, Recreation Exercise Physiology Laboratory Baylor University University of Wisconsin-Superior Tina L. Claiborne, PhD, ATC, CSCS Assistant Professor and Director of Athletic Training Education Dept. of Exercise Science/Physical Education Adrian College ix Reviewers Charlotte Covington, MSN, APRN Mary Knudtson, DNSc, NP Family Nurse Practitioner Professor of Family Medicine Associate Professor Director of FNP Program Vanderbilt University School of Nursing University of California Irvine Nashville, Tennessee Irvine, California Sharon Ewing, PhD, FNP, MSN, RN, CS Kathleen Nash, PhD, RN, FNP Clinical Assistant Professor Assistant Professor College of Nursing University of Texas Medical Branch University of Arizona School of Nursing Tucson, Arizona Galveston, Texas Linda J.
Keilman, MSN, APRN, BC Karen Koozer Olson, PhD, FNP Assistant Professor Professor of Nursing Gerontological Nurse Practitioner Outreach Programs Coordinator Michigan State University College of Texas A&M University Nursing Corpus Christi, Texas East Lansing, Michigan xi Preface P rimary health care providers are increasingly faced with the responsibility of offering to patients expert advice spanning an array of subject matter related to sports and fitness. Indeed, musculoskeletal injuries are among the most commonly encountered problems in the primary care setting. Recognizing this, in 1998 we proposed that the then Department of Nursing at the University of Southern Maine offer a graduate level course titled Sports Medicine: Orthopedic Evaluation and Treat- ment for the Primary Health Care Professional. The basic premise of this proposal was to offer Nurse Practitioner students, and those practicing in the field, an opportu- nity to gain more in-depth knowledge in the area of orthopedics than what is typically included in a traditional Nurse Practitioner curriculum.
Seeing merit to this proposal, the Department’s Graduate Curriculum Committee approved the course offering as a program elective. Over the next few years, course content was modified based on student and faculty feedback and on the ever-changing demands placed on those working in the primary care setting. Thus, though it is impossible for any text to cover all aspects of a subject, the content included in this book is a by-product of 10 years’ worth of learning the issues that providers most often encounter in the primary care setting. We hope you find this information helpful.Toy, PhD, ATC Phyllis F.
Healy, PhD, BC-FNP, CNL, RN University of Southern Maine April 2008 xiii Contents Part I:The Basics, 1 10. Conditions Involving the Hip, 1. Foundations of Musculoskeletal Pelvis, and Sacral and Lumbar Injury, 3 Spines, 267 Tina L. Claiborne, PhD, ATC, and Brian J.Toy, PhD, ATC, Brian J.Toy, PhD, ATC 2.
The Pre-Participation 11. Conditions Involving the Examination, 25 Brian J.Toy, PhD, ATC Cervical Spine, Shoulder 3. Physical Fitness, 53 Complex, and Arm, 311 Brian J.Toy, PhD, ATC Karen A. Croteau, EdD, FACSM; Edited by Brian J.Toy, PhD, ATC 12.
Conditions Involving the Elbow, 4. Nutrition for the Primary Health Forearm, Wrist, and Hand, 361 Brian J.Toy, PhD, ATC Care Provider, 85 William F. Simpson, PhD, FACSM, Part III: Conditions Involving Brian J.Toy, PhD, ATC,Thomas W. Buford, MS, CSCS, and Tracey Fox-Bartels, MSN, Other Systems, 411 FNP, RN, 13.
Conditions Involving the Head 5. The Inflammation Process, 113 and Face, 413 Brian J.Toy, PhD, ATC Brian J.Toy, PhD, ATC 6. Conditions Involving Brian J.Toy, PhD, ATC, and Phyllis F. Healy, the Thorax, Abdomen, PhD, BC-FNP, CNL, RN and Genitalia, 443 Part II: Orthopedic Brian J.Toy, PhD, ATC Conditions, 161 15.
Conditions Involving the Skin, 467 7. Introduction to Orthopedic Brian J.Toy, PhD, ATC, and Phyllis F. Healy, Evaluation, 163 PhD, BC-FNP, CNL, RN Brian J.Toy, PhD, ATC 8. Conditions Involving the Foot, Glossary, 483 Ankle, and Leg, 179 Index, 495 Brian J.Toy, PhD, ATC 9.
Conditions Involving the Knee and Thigh, 227 Brian J.Toy, PhD, ATC xv 1 THE BASICS Foundations of Musculoskeletal Injury 1 Brian J. Toy, PhD, ATC Musculoskeletal Definitions Muscle Spasm Sprain Hard Tissue Dislocation Soft Tissue Bursitis Classification and Mechanisms Neuropathies of Musculoskeletal Injury Compartment Syndrome Acute Injury Bone Conditions Chronic Injury Fractures Soft Tissue Conditions Conditions of the Apophysis Muscle Soreness Conditions of the Epiphysis Tendinopathies Avascular Necrosis Muscle Contusion and Myositis Arthritis Ossificans Gender Differences and Strain Musculoskeletal Injury 3 4 P A R T 1 The Basics B efore working with people who are interested in participating in sports and fit- ness activities, primary health care providers must become familiar with body tissues used for exercise. Indeed, understanding what these structures do, recognizing how they are most commonly injured, and knowing what the most common musculoskele- tal injuries are, are particularly important when patients report to the primary care setting with a sports-related injury. Musculoskeletal Definitions In general, musculoskeletal tissue is divided into two broad classifications: soft and hard.
Whereas bone comprises all of the hard tissue within the body, soft tissue includes all things not bone, such as ligaments and tendons. It is these hard and soft tissues that become injured when the musculoskeletal system is traumatized. In many instances, this means that the joint associated with these tissues is also injured. When working in the primary health care setting, it is important that the health and integrity of hard and soft tissue be assessed during both the pre-participation examination (discussed in Chapter 2) and the orthopedic evaluation process (described in Part II).
Hard Tissue Bone is comprised of osseous tissue and comes in the following shapes: long, short, flat, and irregular. Sesamoid bones, those which are embedded within a tendon, such as the patella (discussed in Chapter 9), also exist. When the major bones of the body are con- sidered, most long bones are located in the extremities, otherwise known as the appendic- ular skeleton. Exceptions include the short bones of the wrist (carpals) and foot (tarsals) and the flat bones of the pelvis (innominate) and shoulder (scapula).
The axial skeleton consists of irregularly shaped bones of the vertebral column and the flat bones of the skull. Regardless of type, when two bones come together, a joint is formed, and the place where this union occurs is referred to as the joint line. Though joints can be immovable, otherwise known as synarthrodial (e., sutures of the skull), or slightly moveable, also referred to as amphiarthrodial (e., pubic symphysis), it is the diarthrodial, or synovial, joints that usually become injured in response to musculoskeletal trauma. The structure and types of diarthrodial joints are discussed later in this chapter.
Major portions of a long bone include the diaphysis, metaphyses, and epiphyses (Fig. Whereas compact bone comprises the diaphysis and metaphyses, both compact and spongy bone make up the epiphyses. The diaphysis, or shaft, is relatively long and straight and maintains the bone’s marrow. This marrow is located in the endosteum-lined medullary cavity, which runs lengthwise within the diaphysis.
The metaphyses connect the diaphysis to the proximal and distal epiphyses, which house the bone’s secondary ossification centers.