Immediate phase - circulation evaluation

• OBJECTIVES

• IMMEDIATE PHASE

• circulation evaluation
• wound evaluation
• neurological evaluation
• PRICE/RICE regime
• managing pain
• managing circulation
• maintaining quads tone
• EARLY PHASE - IN BED
• EARLY PHASE - MOBILE
• INTERMEDIATE PHASE
• LATE PHASE
• GLOSSARY OF EXERCISES

After an injury or knee surgery, it is helpful to know a little bit about assessing blood circulation in the lower limb. These features suggest poor blood flow to the limb:

• Injured lower leg is quite a lot paler than the good leg.
• It is colder to the touch.
• The pulse, which is usually felt on the top of the foot, in the region between the big and second toe, but about an inch away from them, is less than the other leg.

If a bandage is too tight the circulation away from the limb can be obstructed and the toes might become swollen and darker in colour. Loosening the dressing should improve blood flow.

A serious problem of circulation after knee injury, and sometimes after surgery, is 'compartment syndrome'. The calf muscles and vessels are contained within fibrous compartments, and any bleeding within a compartment may cause an increase in pressure there, causing pressure damage to the blood supply and the nerves. Compartment syndrome is rare but is a clinical emergency - the calf will be tense, pain will be severe and constant, the limb pale and the patient will experience pins and needles.