Travel Reference
In-Depth Information
quired amputations. The usual functional deficit is “foot drop,” an inability to flex the foot
upward, which usually requires a brace to support the foot when walking on a flat surface.
On a wilderness trail, disability would be much greater.
Bursitis, Tendinitis, and Shin Splints
Bursitis, tendinitis, and shin splints are caused by inflammation of tendons or the
flattened, cystlike spaces (bursae) that cushion the movement of tendons. These disorders
are characterized by pain and stiffness that has a gradual onset, usually following unaccus-
tomed use of a muscle for an extended time. The pain can be quite severe and frequently is
first noticed the morning after such activities.
Splinting may relieve the immediate discomfort but often prolongs the problem. Moist
heat and a mild analgesic may provide some relief; sometimes cold is more effective. The
pain, which is rarely disabling, may persist for days, weeks, months, or years. Continued
use of the joint through its full range of motion helps to prevent stiffness.
Tenosynovitis
Inflammation and infection of the sheaths that surround tendons and lubricate their
movements may result from unaccustomed overuse or a penetrating injury. In the field,
such infections may develop several days after sustaining a small cut or puncture wound
thatdidnotappearsignificantatthetime,particularlyonthehand,finger,orfoot.Painwith
motion of the involved tendon is the diagnostic finding. When infection is present, painful
swelling,increasedwarmth,andrednessareapparent.Acracklingsensationintheaffected
tissue may be felt with pressure ormovement ofthe tendon. Although sterile inflammatory
episodescausedbyoveruseusuallysubsidewithrest,aninfectedtenosynovitisrequiresthe
attention of a physician, who sometimes must surgically drain the tendon sheath. If infec-
tion is suspected, broad-spectrum antibiotics should be started, and the individual should
be evacuated without delay. Failure to obtain surgical treatment can result in permanent
loss of mobility of the tendon or in extension of the infection to adjacent tendons and body
spaces and even greater loss of function.
Joint Effusion
Swelling,milddiscomfort,increasedwarmth,andrednessmayappearinajointafteranin-
jury—sometimeswithoutanyprecedingtrauma.Thekneeismostcommonlyinvolved,but
other joints, particularly the elbow or wrist, can be involved. The cause may be outside the
joint, as with tennis elbow or a similar condition involving the insertion of the tendons just
below and to the side of the kneecap. Within the joint, effusions often result from deterior-
ation of the cartilage following repeated injury. If inflammation but no infection is present,
the discomfort and swelling may respond to rest, wrapping with an elastic bandage, moist
heat,andamildanalgesic.Aninfectedjoint—manifestedbymoreobviousredness,greater
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