Learning Focus:
Recognizing and escalating care for acute musculoskeletal injuries sustained in correctional settings while supporting safe function and continuity of care.
Patient Presentation
A 30-year-old incarcerated person presents to Nursing Sick Call with right knee pain and swelling after a basketball injury.
History of Present Illness
- Twisted right knee while playing basketball two days ago
- Heard/felt a “pop” at the time of injury
- Difficulty bearing weight since; walks with limp
- Pain 8/10 when standing; stiffness and swelling present
- No numbness or tingling
- Ibuprofen 400 mg yesterday provided minimal relief
- No prior knee surgery; recalls mild soreness in the past from sports
Review of Systems
- Positive: knee pain, swelling, stiffness, limited motion
- Negative: fever, chills, numbness, tingling, back pain
- Allergies: No known drug or food allergies
- Medications: Ibuprofen 400 mg PO once yesterday
- Vital Signs: : 98.6°F; P 82; R 16; BP 124/76; SpO₂ 99% RA; BMI 27
Focused Assessment
- Right knee visibly swollen compared to left
- Tenderness along medial joint line
- Limited ROM: unable to fully extend; flexion limited to 90°
- Positive effusion (“ballottement” sign)
- Lachman test: laxity noted
- Valgus stress: pain elicited, no gross instability
- Distal pulses intact; sensation normal
- Ambulates with limp
Prompt:
Which assessment findings are most concerning and require provider notification?
What additional data could you gather to evaluate functional stability and safety?
The nurse synthesizes findings to determine significance:
- Twisting mechanism with a “pop” and effusion suggests ligament or meniscal injury.
- Limited range of motion and instability increase concern for significant internal derangement.
- No redness, warmth, or fever — septic arthritis unlikely.
Prompt:
Which findings support an acute musculoskeletal injury rather than infection?
What factors in a correctional setting might increase risk of re-injury?
Prioritize Hypotheses (Nursing Perspective)
Possible conditions
- Meniscal tear – joint line tenderness and swelling after twisting injury.
- ACL injury – “pop” at time of injury, effusion, and instability.
- MCL sprain – pain with valgus stress.
- Fracture or patellar dislocation – less likely, but must be ruled out by imaging.
Prompt:
How will you summarize this presentation to the provider?
Which findings are essential to report to guide diagnostic decisions?
Generate Solutions (Within Nursing Scope)
Nursing Actions and Communication Steps:
- Notify provider promptly for evaluation and imaging orders.
- Apply RICE protocol (Rest, Ice, Compression, Elevation).
- Provide supportive elastic knee brace (non-metal) if available.
- Restrict activity: no sports; assign light duty only.
- Administer NSAIDs per order and assess effectiveness.
- Reinforce safe ambulation; provide crutches if permitted and available.
- Document all findings, interventions, and patient education.
Correctional-Specific Considerations
- Metal knee immobilizers may not be permitted; use elastic/neoprene braces instead.
- Crutches may require custody approval; advocate for safe mobility accommodations.
- Document all restrictions and recommendations to ensure custody awareness.
- Encourage prompt provider referral for imaging if significant swelling or instability persists.
Prompt:
What challenges might arise when implementing RICE or mobility support in a correctional setting?
How can nurses advocate for safe care when facility equipment is limited?
Nursing Actions Taken
- Applied compression sleeve; instructed patient on rest and elevation.
- Administered ibuprofen 600 mg PO TID per provider order.
- Referred for knee X-ray to rule out fracture.
- Ortho consult requested for possible meniscus or ACL injury.
- Restricted from basketball and assigned light-duty housing.
- Education provided on safe ambulation and early symptom reporting.
Prompt:
What key documentation elements demonstrate appropriate nursing judgment?
What education points ensure safe self-management until follow-up?
Evaluate Outcomes and Reflect
Outcome:
Patient tolerated conservative management well. Knee swelling decreased over several days, though stiffness persisted. Awaiting orthopedic evaluation for possible MRI. Nursing continues to monitor for worsening pain, instability, or swelling.
Prompt:
How will you monitor for deterioration while awaiting specialist follow-up?
What nursing actions support long-term musculoskeletal recovery and function?
Reflection
How did you differentiate between a simple sprain and a more serious ligament injury?
What barriers might delay orthopedic care in corrections, and how can nurses mitigate these?
How does early recognition and restriction prevent chronic disability?
Key Takeaways for Correctional Nursing Practice
- Correctional nurses assess musculoskeletal injuries, identify instability or swelling, and escalate appropriately.
- Sports injuries behind the wall are common; safe return-to-activity guidance is essential.
- RICE management and symptom monitoring can prevent worsening injury.
- Nurses must advocate for timely imaging and specialist referral despite limited on-site resources.
- Documentation, safety planning, and patient education maintain function and prevent reinjury.