Chapter 28: Musculoskeletal System Flashcards
Extremities
the portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet (lower extremities)
Bones
hard but flexible living structures that provide support for the body and protection to vital organs
Joints
places where bones articulate, or meet
Axial skeleton
comprised of the skull, spine, ribs, and sternum
Appendicular skeleton
composed of the extremities
Long bones
found in the arms and legs
Short bones
found in the hands and feet
Irregular bones
vertebrae in the spinal column
Periosteum
strong, white, fibrous material that covers bones; blood vessels and nerves pass through this membrane as they enter and leave the bone
muscles
tissues or fibers that cause mvmt of body parts and organs
cartilage
tough tissue that covers the joint ends of bones and helps to form certain body parts such as the ear
tendons
tissues that connect muscle to bone
ligaments
tissues that connect bone to bone
3 mechanisms of musculoskeletal injuries
direct force, indirect force, and twisting force
direct force
person being struck by an automobile, causing crushed tissues and fractures
indirect force
when a person falls and lands on their feet, direct force causes injury to feet and ankles, whereas indirect force causes injury to knees, femur, pelvis, and spinal column
twisting/rotational force
can cause stretching or tearing of muscles and ligaments , as well as broken bones, such as when a ski digs into the snow while the skier’s body rotates
Fracture symptoms
painful, swollen, or deformed extremity
traction splint
a splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb; used primarily on femoral shaft fractures
4 types of musculoskeletal injury
- fracture
- dislocation
- sprain
- strain
Fracture
any break in a bone; can be classified as open or closed
Greenstick fracture
an incomplete fracture
Comminuted fracture
a fracture in which the bone is broken in several places
Angulated fracture
fracture in which the broken bone segments are at an angle to each other
Dislocation
the disruption or “coming apart” of a joint; the soft tissue of the joint capsule and ligaments must be stretched beyond the normal range of motion and torn
Sprain
the stretching and tearing of ligaments; most commonly associated with joint injuries
Strain
muscle injury resulting from overstitching or overexertion of the muscle
Closed extremity injury
an injury to an extremity with no associated opening in the skin
Open extremity injury
an extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to the bone
Compartment syndrome
injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast
Compartment syndrome progression
- a fracture or crush injury causes bleeding and swelling within the extremity
- pressure and swelling caused by the bleeding within the muscle compartment becomes so great that the body can no longer perfuse the tissues against the pressure
- cellular damage occurs and causes additional swelling
- blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved
Musculoskeletal injury signs and symptoms
- pain and tenderness
- deformity or angulation
- grating or crepitus
- swelling
- bruising
- exposed bone ends
- joints locked into position
- nerve and blood-vessel compromise
Crepitus
a grating sensation or sound made when fractured bone ends rub together
The 6 Ps
- method of assessing compromise to an extremity when a musculoskeletal injury is suspected
- pain or tenderness
- paresthesia, or the sensation of “pins and needles”
- pulses diminished or absent in the injured extremity
- paralysis or the inability to move
- pressure
Realignment of the deformed extremity
- if the extremity is not realigned, the splint may be ineffective, causing increased pain and possible further injury (including an open fracture) during transportation
- if the extremity is not realigned, the chance of nerves, arteries, and veins being compromised increases. When distal circulation is compromised or shit dow, tissues beyond the injury become starved for O2 and die
- pain is increased for only a moment during realignment under traction. Pain is reduced by effective splinting
General guidelines for realigning an extremity:
- one EMT grasps the distal extremity while a partner places one hand above and one hand below the injury site
- The partner supports the site while the first EMT creates gentle manual traction in the direction of the long axis of the extremity. If you fell resistance or if it appears that bone ends will come through the skin, stop realignment and splint the extremity in the position found
- If no resistance is felt, maintain gentle traction until the extremity is properly aligned and splinted
manual traction
the process of applying tension to straighten and realign a fractured limb before splinting, Also called tension
General rules that apply to all types of immobilization
- care for life-threatening problems first
- expose the injury site
- assess the injury site
- assess distal CSM
- align long-bone injuries to the anatomic position
- do not push protruding bones back into place
- immobilize both the injury site and adjacent joints
- choose a method of splinting
- splint before moving the pt to a stretcher or other location if possible
- pad the voids
To splint long-bone or joint injuries:
- Take standard precautions, and if possible, expose the area to be splinted
- Manually stabilize the injury site. This can be done either by you or by a helper
- Assess circulation, sensation, and motor function (CSM). Check for pulses and see if the pt can feel your touch distal to the injury. Ask the pt to wiggle his fingers or toes to assess mvmt. Do not ask the pt to grasp, press, or pull an extremity you believe may be fractured. This will cause unnecessary pain and may aggravate the injury
- Realign the injury if deformed or if the distal extremity is cyanotic or pulseless. Be sure to attempt to realign an injured joint only if the distal extremity is pulseless or cyanotic
- Measure or adjust the splint, and move it into position under or alongside the limb. Maintain manual stabilization or traction during positioning and until the splinting procedure is complete
- Apply and secure the splint to immobilize adjacent joints and the injury site
- Reassess CSM distal to the injury
Application of a traction splint
- Take standard precautions and, if possible, expose the area to be splinted
- Manually stabilize the leg and apply manual traction
- Assess CSM distal to the injury
- Adjust the splint to the proper length, and position it at or under the injured leg
- Apply the proximal securing device (ischial strap)
- Apply the distal securing device (ankle hitch)
- Apply mechanical traction
- Position and secure support straps
- Reevaluate the proximal and distal securing devices, and reassess CSM distal to the injury
- Secure the pt’s torso and the traction splint to a long spine board to immobilize the hip and to prevent mvmt of the splint
