Mucoloskeletal Flashcards
How do musculoskeletal injuries usually occur
From application of significant direct or transmitted force
What are 5 common causes of musculoskeletal injuries
- Penetrating trauma
- Sports injuries
- Falls
- MVC’s
- Assault
What is an indicator of significant musculoskeletal trauma, as well as underlying organ injury and internal/ external hemorrhage
Multi-system trauma
Are injuries to upper extremities life threatening
No usually although painful and debilitating
What is required for injury to lower extremities
Usually greater force of impact
- more often leading to possible internal hemorrhage and life/limb threat
What 5 parts are included in musculoskeletal system
Bones Cartilage Ligaments Muscles Tendons
What are some modern preventions of injury
- seatbelts and airbags
- sports equipment
- safety equipment (boots,vests,harnesses, WSIB regulations)
- canes, walkers, wheelchairs
Blood vessels and major nerves run ______ with the bone proximal to distally
Parallel
What makes up a joint
Arrangement of ligaments, cartilage, synovial fluid ( keeps joint together and allows range of motion)
How is muscle connected to bone
By tendons
- direct skeletal movement through fibres and fasciculi along with muscle bodies
Musculoskeletal system is complex arrangement of what tissues
Connective Skeletal Vascular Nervous Muscular
What are the classification of musculoskeletal injuries
Muscular
Joint
Bone
What is included in muscle injuries
Contusion, compartment syndrome, penetrating injury, muscle fatigue/cramps/spasm/strain
What is included in joint injuries
Sprain, subluxation, dislocation
What is included in bone injuries
Fractured
-closed, open, hairline, impacted, transverse, oblique, comminuted, spiral fatigue, greenstick,epiphyseal
Muscle injuries may result from (3)
Blunt/ penetrating trauma
Overexertion
Oxygen depletion
When can muscle injury contribute to shock or hypovolemia
in cases with large hematomas or penetrating trauma that causes vessel damage
What does bone require constantly
Oxygenated circulation as it is living tissue
What is a contusion
- Bruise
- Damage to muscle cells and blood vessels that supply them
What causes a contusion to be painful
Small vessels leak blood into interstitial space causing pain, erythema, and ecchymosis
What is cause of edema(swelling) from contusions
Due to body’s inflammatory response and engorged capillary beds
- swelling may make 1 lumbar larger than the other
What is a Hematoma
When a contusion is more severe and blood pools beneath tissue layers
- large enough hematoma or significant muscular edema may cause hypovolemia
Where can you get contusions
Anywhere on body
What is compartment syndrome
Internal hemorrhage and swelling (from other injuries)
What happens in compartment syndrome when there is increased pooling of blood
Pressure builds up in fascial compartment where injury is
- obstructs blood flow, nerve impulses and venous return
- may lead to stop in arterial circulation
What is a signs of compartment syndrome
Pt seems to be in more discomfort than external signs indicate
- decreased distal circulation is a late sign
What are symptoms of compartment syndrome
Initially May be increased pain with movement, feeling of muscle tension, loss of distal sensation
What is a penetrating injury
Injury to deep underlying muscle masses and tendons
- can affect muscle function
What is a sign that penetrating injury has damaged muscle/ tendon
Muscle/ tendon Can no longer fight opposing muscles to keep neutral alignment
What interventions are required with damaged muscle or tendon from penetrating injury
Surgical intervention
What can penetrating injury lead to
- Infection (from open wound or object that is penetrating)
- ischemia = lack of oxygenated blood flowing to an area ( from decreased blood flow)
When do you remove penetrating objects
Never!
Unless it interferes with ABCs (including CPR)
What is 1st degree burn concidered
Superficial
What is 2nd degree burn concidered
Partial thickness, blistering
What is 3rd degree burn concidered
Full thickness, partially or fully charred
What is 4th degree burn concidered
Complete thickness, likely into muscle and bone
What are the major concerns with burns
- Infection
- Hypovolemia
- Hypothermia
- Pain
Rule of 9s adult head
Front 4.5%
Back 4.5%
Rule of 9s adult trunk
Front 18%
Back 18%
Total 36 %
Rule of 9s adult arms
Front 4.5 %
Back 4.5%
Total bilat 18%
Rule of 9s adult legs
Front 9%
Back 9%
Total 36%
Rule of 9s adult perineum
1 %
Rule of 9s pediatric head
Front 9%
Back 9%
Total 18%
Rule of 9s pediatric trunk
Front 18%
Back 18%
Rule of 9s pediatric arms
Front 4.5%
Back 4.5 %
X 2 arms = 18%
Rule of 9s pediatric trunk
Front 18%
Back 18%
Rule of 9s pediatric legs
Front 6.7
Back 6.7
X 2 arms 13.4 = 26.8%
Rule of palms
Size of pts palm accounts for 1% of their BSA burned
What is fatigued muscle
Muscles ability to respond to stimulation is lost or reduced through overactivity
What happens in fatigued muscle when it reaches limits of performance / ability
Decreased ability of muscle fibers to contract
What is depleted and roduced in muscle fatigue
Oxygen depleted
Lactic acid is produced
What are symptoms of muscle fatigue
Decreased strength to muscle
Painful when used
How to treat muscle fatigue
Requires restored oxygenation and proper rest
What is a muscle cramp
Muscle pain from overactivity, lack of oxygen, and accumulation of waste product
- circulatory system fails to remove waste product
What causes muscle cramp
Muscle fatigue from strenuous exercise or if muscle was in unusual position
How to treat muscle cramp
Obstructed circulation needs to be restored
- change limbs position or massage the muscle
What is muscle cramps often associated with
Muscle spasms
What is a muscle spasm
Intermittent or continuous contraction of a muscle
What is clonic and tonic
Clonic = intermittent Tonic = continual
What can be a sign of muscle spasm
How to treat muscle spasm
Rest, rehydration, restoration of circulation
What is rigor mortis
Entire body in muscle spasm following death
- usually sets in 1-3 hours after death
- subsides 6- 8 hours after death (depending on temp)
- caused by loss of ATP from body muscles after death
What is muscle strain
Injury from overstretching of muscle fibres from excessive forces, leading to tears in the fibres
How is muscle strain caused
During extreme muscle stress (heavy lifting, sprinting) or from muscle fatigue due to reduced # of muscle fibers working, leading to increased likelihood of muscle overload
Symptoms of muscle strain
- pain with any use of muscle involved
- pain on palpation of area
Causes limited use of affected area
Signs of muscle strain
Usually no outward signs
What are sprains
Tearing of a joint capsules CT - usually a ligament
What are signs / symptoms of sprain
Acute pain and inflammation/swelling
- ecchymotic discoloration sets in gradually
Can have complete joint failure as ligament tears affect joint function
What is a grade 1 sprain
Minor, incomplete tear.
Ligament is painful and swelling is minimal.
Joint is stable
What is grade 2 sprain
Significant, incomplete tear
Swelling and pain are moderate- severe
Joint is intact but stable
What is grade 3 sprain
Complete tear of ligament
May appear the same as fracture due to pain severity and spasm
Joint unstable
What is subluxation
Partial displacement of a bone end from its position in a joint capsule
What causes subluxation
Joint stress and stretching of ligaments
- hyperextensio , hyperflexion, lateral rotation beyond normal ranges, or extreme axial force
Symptoms of subluxation
More significantly reduces joint t integrity than a sprain
- increasing pain and swelling rapidly
- limited range of motion and unstable joi t
What is dislocation
Complete displacement of a bone end from its position in joint capsule
Signs of dislocation
Noticeable deformity as joint gets stuck in an abnormal position once it is out of the socket
What are symptoms of dislocation
Painful, swollen, immobile
- may damage or compress blood vessels and nerves
How does dislocations typically occur and what can it lead to
Occurs when the joint moves forcefully beyond it’s normal range of motion
- may lead to ligament damage , socket damage, or associated cartilage damage
What is a fracture
Disruption in the continuity of the bone structure
What can cause a fracture
Direct force (bat to femur) Or transmitted force (fall from ladder, landing on feet- impact transmitted from foot to ankle to tibia/fibula to femur)
What structures within bone are disrupted during bone fracture
Collagen, astrocytes, salt crystals, blood vessels, nerves and medulla canal
What damage can bone ends cause to vessels
Vascular damage - increased cap refill, diminished distal pulses, cool limb temperature, discoloration/ pallor, and paresthesia (pins and needles)
What damage can bone ends cause to nerves
Nerve damage - distal paresthesia, anesthesia (complete), paresis (weakness), or paralysis
What damage can bone ends cause to muscles and tendons
Muscle / tendon damage - inability to move or decreased ROM; could result in compartment syndrome
What is a closed fracture
A broken bone in which the bone ends or forces that caused the break dont penetrate the skin
What is open fracture
A broken bone where bone ends or forces that caused break penetrate the surrounding skin
What is a risk with open fractures
Infection as now open wound
When can open fracture occur with limited force
If bone is close to the surface (like shin)
What is another name for open fracture
Compound
What is a hairline fracture
Small crack in bone that doesnt disrupt its total structure.
- painful but maintains position and stays stable
What is impacted fracture
Break in bone where bone is compressed on itself
- usually compression / crush injuries
- maintains position
What is common between hairline and impacted fractures
Both can become worse with added stress
What is a transverse fracture
A break that runs perpendicular to the bones orientation
What is oblique fracture
A break in bone running ant angle but at 90°
What is comminuted fracture
Fracture where bone is broken into several pieces
What is spiral fracture
A curving break in bone; may be caused by rotational forces
- possibly from a limb caught in machinery or a child’s arm being grabbed and twisted by adult
What is fatigue fracture
Break in bone associated with prolonged or repeated stress
- often in metatarsal from extensive walking with inappropriate shoes or running a marathon
How can fractures lead to fat embolism and what is the risk
- injury releases fat into damaged vessels of circulatory system (enters venous system and travels to heart)
- emboli moves to lungs
- usually caused by crush injuries and manipulation of a fracture
Pediatric considerations for fractures
Pediatric bones have more cartilage and dont fracture the same as adults
- still growing from epiphyseal plate
What is greenstick fracture
Partial fracture of child’s bone
- disrupts only one side of long bone
- causes angulation and resists alignment
- the injured side grows more as it heals (usually best to break completely to heal evenly)
What is epiphyseal fracture
- disruption in the epiphyseal plate of a child’s bone
- if growth plate disrupted, the disruption may lead to reduction or stop in bone growth (usually at proximal tibia)
Geriatric considerations for fractures
- bone mass and collagen structures begin decreasing progressively after 40yo
- bones are less flexible, more brittle and more easily fractured
- healing slows down, loss of muscle and coordination makes skeletal injuries more likely
- fractures happen more easily with less force
What is osteoporosis
Weakening of bone tissue due to loss of essential minerals (especially calcium)
- accelerated degeneration of bone tissue
- usually affects women more than men( after menopause)
- increased occurrence of fractures, spinal curvatures, structure degeneration
What are pathological fractures
- result from disease pathologies that affect bone development
- can be from tumors of the bone, periosteum, articular cartilage; diseases that increase osteoclast activity and osteoporosis
- radiation treatment (kills bone cells, localized bone degeneration, weakened bones and fractures)
- do not heal well if at all
What are osteoclasts
Large multinucleated cell responsible for the dissolution and absorption of bone
What is diaphysis
Shaft or central part of long bone
What is epiphyseal
Rounded end of long bone (joint )
Where is largest diameter in long bone
Around midshaft due to placement of skeletal muscle
What is best way to understand injury
When concider both muscular and skeletal systems together
- helps to look for possible nervous and vascular injuries
Limited tissue surrounding joint increases risk of
Dislocation, subluxation, sprain, fracture
- swelling/ deformity compromise the nerve and vasculature
Where is nerve and vascular injury less likely
In long bone fracture
Where do blood vessels enter long bones and what is the possible consequence of displacement occurs
Blood vessels enter bone at epiphysis
- if displacement occurs, distal compromise may occur causing tissue death
What happens to muscles in long bone fractures
Pain causes surrounding muscle to contract and spasm
- causes bone ends to cross fracture site, interferes with muscles and causes crepitus
What can be damaged to cause bone repair cycle
Trauma fractures a bone
- tear to periosteum, blood vessels, soft tissue and endosteum
What is first step of bone repair
Blood fills injury and forms RBC and collagen clot
What is second stage of bone repair cycle
Osteocytes from bone ends multiply and reduce osteoblasts, which put salt crystals in collagen clot - begins to connect bone ends
What is a Callus
Thickened area that forms at site of a fracture as part of the repair process
What strengthens the callus
Salt crystals and collagen
What do osteoclast and osteoblasts do
- Osteoclasts dissolve salt crystals in areas of low stress
- osteoblasts lay down new collagen and salts in areas of high stress
Result of bone repair cycle If bone is well aligned at fracture
It may not result in permanent damage
Result of bone repair cycle if bone is displaced
Injury site may never heal properly
- may cause disability, deformity or persistent issues
How can inflammatory and generative issues present
Joint pain, tenderness and fatigue
What can be side effects of inflammatory or degenerative issues
Difficulty walking, moving, performing normal daily functions without assistance
What is Bursitis
Acute or chronic inflammation of the small synovial sacs that reduce friction and cushion the ligaments/ tendons/ joints
What causes burtitis
Repeated trauma, gout and infection
Symptoms of burtitis and common areas affected
- localized pain, swelling, and tenderness at joint
- usually olecranon (elbow), above patella (knee), and shoulder
What is tendinitis
Inflammation of a tendon and/ or its protective sheath
Presents similarly to burtitis
What causes tendinitis and common areas affected
- Repeated trauma to a muscle group
- Usually affects major tendons or upper and lower extremities
What is osteoarthritis
Inflammation of a joint resulting from wearing down of the articular cartilage
- most common type of CT disorder (general wear and tear of articular cartilage)
What are predisposing factors of osteoarthritis
Trauma, obesity, aging
What a symptoms of osteoarthritis
Results in bony overgrowth
- causing pain, stiffness, decreased movement, joint enlargement (especially fingers)
What is rheumatoid arthritis
Chronic disease that causes deterioration of peripheral joint CT
What are symptoms/ effects of rheumatoid arthritis
Inflammation of the synovial joints
- causing immobility, pain (especially with movement), fatigue
Who is rheumatoid arthritis more common for
2 - 3 x more comment in women
What is gout
Inflammation of joints and CT due to buildup of uric acid crystals
Symptoms of gout
Peripheral joint pain, swelling and possible deformity
Who does your most frequently affect
Males who have a higher concentration of uric acid in the blood (meta oils end product that is not easily dissolved)
Are musculoskeletal injuries usually life threatening
No
- usually well assessed and managed at the scene
Can we diagnose musculoskeletal injuries
Not conclusively without imaging
When does serious injury occur
When the energy is transmitted down the bone to the Internal organs
- always concider MOI to evaluate potential for internal injuries
What is pattern of assessment for pt with musculoskeletal injuries
Same as any pt
- scene assessment
- primary assessment
- focused history
- focused secondary assessment
What should you add to musculoskeletal assessment if there is trauma and altered LOC
Include a rapid trauma assessment and detailed secondary assessment
Environmental issues that may arise in assessment to always keep in mind
If MOI on roadway, make sure you are protected from oncoming traffic
- if injury from assault make sure assailant not on scene
- contact appropriate resources when needed
Primary assessment of musculoskeletal injuries
- AVPU and ABC’s ( same as always)
- ID risk or c-spine/ spinal injuries
- do not tunnel vision on injury no matter how “bad” it looks ( dont want to miss other issues that could be going on)
Musculoskeletal injuries are classified in 4 different ways
- Life and limb threatening
- Life threatening injuries with minor musculoskeletal injuries
- Non-life threatening injuries but serious limb-threatening musculoskeletal injuries
- Non-life threatening injuries and only isolated minor musculoskeletal injuries
If pt is 4th classification what is needed
Only focused secondary assessment is needed
What assessment should you add to pt with more severe injuries
A detailed secondary as pt may have one distracting injury that does not allow them to give an accurate account of their injuries
When do you do Rapid trauma assessment
Any pt with sign/symptoms/mechanism of serious injury
How to preform rapid trauma assessment
From head to toe - hands on assessment for any pt who is altered LOC or may have a distracting injury
What do you do if there is crepitus, instability or pain in the pelvis
- only palpate once
- dont want to manipulate pelvis if it could be fractured to avoid causing life-threatening hemorrhage
Why is blood loss /swelling possibly difficult to see in femurs
Due to muscle mass
What to check on upper and lower extremities in rapid trauma assessment
Stability, sensation, colouration, temperature, circulation
How to check on upper and lower extremities in rapid trauma assessment
If pt contious - have them show grip strength, joint movement, ROM bilaterally - check plantar flexion (pushing down on gas pedal) And dorsiflexion (pulling toes towards nose)
What accompanies physical assessment
Detailed history
What does detailed history and secondary assessment provide
Further info about initial findings in primary assessment
When should secondary assessment be preformed
On scene if pt stable
En route if pt unstable
Why remove or cut any restrictive clothing, jewelry or shoes
Want it removed before more inflammation sets in and it’s harder to remove
Tips for dealing with musculoskeletal I jury in assessment
-Have partner /bystander stabilize injured extremity to avoid movement
- expose all Injury sites and compare to uninjured side
- OPQRST
- Full 5 Ps
Ask pt if heard a snap, crack or pop before or after fall
What are 5 p’s
Pain Pallor Pulse Paralysis Paresthesia (Sometimes pressure )
What is first priority in management of any case
Manage all ABC issues and spinal precautions before worrying about extremity splinting
- with exception of pelvis
Goal of management of musculoskeletal
- goal is to prevent further injury
- protect against infection by covering open injuries
- avoid overt manipulation to avoid nerve and vessel damage
Tip for managing musculoskeletal injuries
- splint injuries I position found unless circulation is compromised
- manipulate into neutral alignment (1 attempt only)
- explain all actions to pt, warn about pain when you manipulate
- do not reduce a dislocation
Tips about realignment of injury
- stop attempt if meet any resistance or intense pain
- do not attempt alignment of I juries within 7cm of a joint (concidered joint injury if within 7cm )
- if unable to secure to joint above and below use body for stability
- place limb in position of function or neutral when possible
Immobilization is aimed to prevent: (3)
- Movement of broken bone ends
- Dislodging of bone from a joint
- Reduce further stress on muscles, ligaments, or tendons
Why do you secure splinting device above and below the injury
Holds joints in place to prevent transmission of movement through long bone
Why do we wrap splint from distal to proximal
- makes sure pressure pushed blood to moved into systemic circulation and not distal limb
- assists venous dressing
How tight do you wrap dressing
Tight enough to ensure its secured but you need to be able to at least get a finger under it
What is RICE
Rest
Immobilize
Cold
Elevate
Change to RICE for muscular and joint injuries
Alternate heat and ice after 48hrs
What is rigid splint
Firm and durable supports
- cardboard, plastic, Metal, synthetic or wood
What helps with discomfort of rigid splint
Require added padding to reduce discomfort when applied
Side note about rigid splint
- speed splint is brand typically used in prehospital setting in ontario
- other brands available but usually not purchased by EMS
What is formable splints
Malleable splint- able to be shaped to fit extremity
What are formable splints used for
Hand, wrist (use pt good arm or your arm if similar size to shape)
Also: flail segment in chest
What is brand of formable splint usually used by EMS and what is it made from
SAM splint
- made of foam and mesh or can be “ladder” splints made of soft metal wire
What are soft splint
Usually called air or pillow splints - use padding to support injury
- allow for ankle / foot to be wrapped comfortably in position found with triangle bandages to secure it
- not to be used above knee or elbow
How to use soft splint
Position limb in aligned position without extreme manipulation and provides pressure to injury - reduce internal/ external hemorrhage
- change in temp can change pressure in air splint
What is traction splint
Uses the force against the truck and the tension against the ankle to pull bone ends apart from rubbing
- use cravats after traction is applied to hold extremities together
What is traction splint used for
- primarily closed femur fractures
- tibia/ fibula fractures
- sometimes hip fractures
- bilateral femur fractures
What is traction splint used for
- primarily closed femur fractures
- tibia/ fibula fractures
- sometimes hip fractures
- bilateral femur fractures
How much traction do you apply to traction splint
One femur = 10% body weight (max 15lbs)
Bilat femurs = 20% body weight (max 30lbs)
Tib/ Fib= 5- 7 lbs
Contraindications for traction splint
Dont use in femur fractures with knee, tibia or foot injury
What are types of pelvis fractures
Involve iliac Crest or pelvic ring
What is a usual iliac Crest fracture
Often isolated and stable
- cared for by simple immobilization
What are usual pelvic ring fractures
Often serious, unstable and life threatening due to ring structure = 2 fracture sites
Possible risk with pelvic ring fracture
- pelvis is active in blood cell production and adjacent to major blood vessels feeding lower extremities
- > risk of interfering with lower extremity circulation
- > risk of circulatory compromise (vessel can empty into pelvic and retriperitoneal cavities)
- > risk of hip dislocation
How to car for pelvic fracture
- cravats or pillow/ blanket padding
- securing pt to scoop stretcher or spinal board
- managing hemodynamic compromise
- rapid transport
Is pelvis fracture always load and go
Yes even if pt is deemed stable
Cause of femur fractures
- Traumatic = usually extreme discomfort
- non-traumatic = degenerative
- > degenerative (older age, hx of degenerative issues) may have minimal pain and no significant MOI ( older pts can be on alot of pain meds)
Proximal fractures (neck and intertrochanteric) of femur
- May appear as hip fx
- or associated with hip/ pelvic trauma (more common in elderly)
- feoot will likely be externally rotated and shortened
What are mid-shaft fractures in femur
Caused by higher levels of force and result in greater blood loss
What are distal femur fractures (condylar and epicondylar)
Extensive injury and usually involves blood vessels before they enter the knee/lower leg
Management of femur fx
Manage obvious femur fractures with traction splint (if fx not compound)
- one femur = stay and play (if stable)
- bilat femur = load and go (stable or not)
Tibia fx
- Most common leg bone fx
- often = compound fx
- if fx alone may stay inline but not strong enough to bear weight
Fibula fx
- may accompany tibia fx or be related to ankle/knee I jury
- if only fibula fx, leg may stay inline and be stable with just discomfort when bearing weight
Management of tib/fib fx
- if distal circulation is present, use speed splint to immobilize
- if distal circulation is absent, consider safer splint
- 5 p’s
- RICE
Cause of clavicle fx
- most frequently fx bone in body
- usually from transmitted force (fall on outstretched arm force goes up arm to clavicle)
Main concern with clavicle fx
Very close to upper lungs and vasculature of upper body
- risk of pneumothorax or hemorrhage
Usual presentation of clavicle fx
Pain to clavicle and shoulder, with shoulder rotated forward
How to manage clavicle fx
Use a sling and swathe with cold pack to immobilize clavicle
- can also use traction splint (in a figure 8 with traction being twisted and pulled back - use pen or tongue depressor to turn traction)
What is difficulty with humerus fx
Due to position of humerus into shoulder, and proximity to axillary artery, traction to humerus is difficult to accomplish without compromising circulation
How to manage humerus fx
- use body as splint
- sling and swathe with cold pack
- can wrap a triangle around pt wrist and use countertraction to anchor arm to body
- if pt conscious, have them hold arm in comfortable position
- can use speed splint ( best for mid-shaft or distal humerus injuries)
Most common radius fx
Distal end as it meets wrist
- called a Colle’s fx (silver fork fx)
- wrist angulates upwards and circulation may be compromised makes hand ashen colour
Radius and ulna fx together
Usually not life or limb threatening
In only 1 fractured may only have minor angulation
Management of radius/ ulna fx
- use speed splint or SAM splint to immobilize forearm (secure above and below fx just like all long bone fx)
- pt may be more comfortable with sling and swathe applied after splint
- leave at least fingernail beds exposed for distal pulse check
- if possible leave gap for radial pulse check
Two ways hip may dislocate
Anterior= foot turned outward and head of femur palpable in inguinal area Posterior= flexed knee and internally rotated limb; head of femur buried in muscle mass of buttock (not often palpable)
Management of hip dislocation
- treat same as pelvic fx (padding and careful movement)
- not load and go unless circulation compromised or other serious injuries
- compare circulation in both legs
- compare length and position of both legs for evidence of deformity
What is new spinal restriction standard for elderly pt who falls
A collar must be placed for any pt over 65 who had a fall
- hip dislocations are more common in elderly pts as well
What may be included in knee fx
Femur, tibia, patellar dislocation, Frank dislocation of the knee
Patella dislocation
Most common
Anterior = angled up
Posterior = angled down
Why are knee injuries serious to pt
Could affect quality of life and limit pt mobility in future
- knee is a large joint that bears alot of weight
- could result in popliteal artery damage compromising distal circulation
Management of knee fx / dislocation
- immobilize in position found
- use “A” frame technique (one ridged splint on medial side and one on lateral side )
Why should you avoid reducing knee dislocation unless part of your base hospital standards
Multiple ligaments, vessels, nerves, synovial fluid sacs that may become injured
Ankle / foot fx
- usually obvious deformity because of smaller diameter of ankle
- typically painful but not usually gross deformity as bones very small not much angulation other than toes
- sprains are common in ankle but more swelling than overt deformity
Types of ankle / foot dislocation
Anterior = dorsiflexion (upward pointing) Posterior = lengthen plantar reflex (downward pointing) Lateral = foot turned outward (most common)
Management of ankle / foot fx / dislocation
- use pillow splint for gross deformity / foot angulation
- use speed splint for injuries without significant angulation
RICE 5 P’s
Shoulder fx often involve
Proximal humerus, lateral scapula and distal clavicle
Directions of shoulder dislocation
Anterior= displaced forward - pt often holding arm against body and pulling across midline Posterior= elbow and forearm held away from body due to internal rotation of shoulder Inferior= humoral head is down, pts arm may be locked above head or hanging down immobile
Management of shoulder fx / dislocation
- sling and swathe when possible
- secure arm against pt body with bulky dressing between arm and body
- cold pack and 5 Ps
- do not reduce
What increases chances of shoulder dislocation
Prior dislocations
What is risk with elbow fx
High occurrence of nerve / vascular involvement (especially children)
- brachial artery
- medial, ulnar, and radial nerves
Causes of elbow fx
Often from falling on outstretched hand
- in children, common with someone grabbing and pulling arm fordefully
Management of elbow fx
Use speed splint or sling/swathe to immobilize injury against body
Wrist/ hand/ fingers fx or dislocation
- commonly from direct trauma
- noticeable deformity is common
- pt may be distressed as use hands for daily life
Management of wrist/ hand / fingers fx or dislocation
- use SAM splint to immobilize wrist/ hand
- ensure distal circulation
- monitor cap refill
- if finger fx use good finger beside or tongue depressor as rigid splint
Non- pharmaceutical pain management of musculoskeletal injuries
- Splinting / immobilization
- Hot packs - to improve circulation
- Cold packs - to reduce inflammation
- Patient position
- Pt coaching / breathing
- Oxygen therapy (if needed)
