Injuries to Muscles

and Bones
Lesson 14

14-1

Musculoskeletal System
Review

Bones
Muscles
Tendons
Ligaments

Primary Functions of
Musculoskeletal System
Provides shape/support for body
Muscles acting on bones allow movement
Bones protect vital internal organs

14-3

Types of Muscles
Skeletal muscles are
voluntary
Smooth muscles are
involuntary
Cardiac muscle is
involuntary
All muscle activity
controlled by nervous
system

Mechanisms of Injury to
Musculoskeletal System
Direct force: force applied directly to body
Indirect force: force transferred from original
body site along an extremity to another point
Twisting forces: part of body forced to move in
unnatural direction

14-5

Factors Involved in Injuries

The greater the force:
the more severe the injury
fracture/joint dislocation more likely

Patients age and health status

14-6

Types of Musculoskeletal Injuries

First Responders not

responsible for determining type
of musculoskeletal injury:
Fractures
Dislocations
Sprains
Muscle injuries

Fractures
The bone may be
completely broken or only
cracked
Closed fracture - skin not
broken
Open fracture - open
wound at site

14-8

Dislocations

Dislocations
One or more bones at joint displaced from
normal position
Ligaments holding bone are torn
Result from strong forces
Sometimes accompanied by bone fractures or
other injuries

14-10

Dislocations continued
Patient cannot use the joint due to
pain/structural damage
Serious bleeding may result
Nearby nerves may be injured
With severe dislocation, joint/limb will look
deformed

14-11

Sprains

Joint injury involving ligament stretching/tearing

Typically occur when joint overextended
Can be mild or severe
Ankles, knees, wrists, fingers most common
Considerable swelling often occurs rapidly

14-12

Muscle Injuries
Strains, contusions, cramps
Usually less serious than fractures/joint injuries
Many causes

14-13

Recognizing Musculoskeletal
Injury
Sometimes injury type is obvious
Often you will recognize musculoskeletal injury
is present
Emergency care is same regardless of injury
type
Usually not life threatening
May be serious and result in pain/disability

14-14

Assessment of Musculoskeletal
Injuries
Perform standard assessment
Ask patient what happened/what he/she felt
If large forces involved, consider potential for
spinal injury
Expose injury site
Amount of pain/swelling not indicator of injury
severity
Immediate medical treatment if no
circulation/possible nerve damage
14-15

Assess for Circulation, Sensation, And

Movement (CSM) Below the Injury Site

Check pulse below injury

Check skin color and temperature.
Touch fingers/toes
Does patient feel touch, tingling sensation, numbness.
Have patient wiggle fingers/toes

Signs and Symptoms

Signs and Symptoms

Abnormal sensation (numbness, tingling)
Inability to move area
Difference in temperature

14-18

Preventing Movement
Movement causes injury, pain, swelling
Bone movement further injures soft tissues
Movement generally increases blood flow - may
increase internal bleeding/ swelling
Manually stabilize or splint injured area

Emergency Care of
Musculoskeletal Injuries

Perform standard patient care

Control any life threats
Allow patient to be in position of comfort
Cover open wounds with sterile dressing
Apply cold pack
Dont replace protruding bones

14-20

Emergency Care of
Musculoskeletal Injuries Continued

Stabilize injured extremity manually

Support above and below injury
If appropriate, splint extremity
Follow local protocol re: oxygen

14-21

Splinting

14-22

Splinting

Movement may worsen musculoskeletal injury

and cause more pain
Splint injured arm or leg if risk of area being
moved (unless help expected quickly)
Always splint an extremity before transporting
victim

14-23

Splinting
Helps prevent further injury
Reduces pain
Minimizes bleeding and swelling

14-24

Types of Splints

Rigid splints
Soft splints
Air splints (inflatable splints)
Pneumatic splints
Anatomic splints

14-25

Rigid Splint
Board
Plastic or metal
Rolled newspaper or
magazine
Thick cardboard

14-26

Soft Splint
Pillow
Folded blanket or
towel
Triangular bandage
folded into sling

14-27

Anatomic Splint
Bandage injured leg
or finger to uninjured
one

14-28

Commercial Splints

Many commercial splints are available

14-29

Securing Splints

Use bandages, strips of cloth, Velcro

Use knots that can be untied
Dont secure with tape

14-30

Guidelines for All Splints

Dress open wounds

Splint only if it doesnt cause more pain
Splint in position found
Immobilize entire area
Pad between splint and skin

14-31

Guidelines for Slings

Use sling to prevent
movement and to elevate
extremity
Splint injury first
If you splint injury in
position found and this
position makes use of
sling difficult do not use
sling
14-32

Guidelines for Slings continued

Do not move arm into
position for sling if it
causes pain
A cold pack can be used
inside sling
Do not cover fingers
inside sling

14-33

Skill:
Applying Arm Sling
and Swathe

14-34

Secure point of bandage at

elbow.

14-35

Position triangular
bandage.

14-36

Bring lower end

of bandage to
opposite side
of neck.

14-37

Tie the ends.

14-38

Tie binder
bandage over
sling and around
chest.

14-39

Shoulder Injuries

Involve clavicle, scapula, or joint structures

Clavicle is most frequently fractured bone
Scapula fractures are rare
Shoulder dislocations are common

14-40

Splinting Shoulder Injuries

Goal is to stabilize area from trunk to upper arm
Use soft splint. Do not move extremity
Assess for circulation, sensation, and movement

14-41

Shoulder Injuries
Pad hollow between
body and arm
Apply sling and binder
to support and
immobilize arm
if this causes pain
use larger soft
splint

14-42

Upper Arm Injuries

Immobilize humerus fractures with rigid splint
Treat fractures near shoulder with soft splint

14-43

Splinting Upper Arm Injuries

Stabilize bone between shoulder and elbow
Assess circulation, sensation, movement in
hand/fingers
Apply rigid splint along outside of arm

14-44

Splinting Upper Arm Injuries

continued
Tie above injury and at elbow
Support wrist with sling and wide swathe
If it causes pain to raise wrist for a sling, use
long rigid splint

14-45

Elbow Injuries
Sprains and dislocations are common
Fractures occur above or below elbow
Patient unable to move joint

14-46

Splinting Elbow Injuries

If elbow bent, apply
rigid splint from upper
arm to wrist
If more support
needed, use sling at
wrist and binder
around chest

14-47

Splinting Elbow
Injuries
If elbow straight, apply
rigid splint from upper
arm to hand
If more support needed,
use binders around
chest and upper arm
and lower arm and
waist
14-48

Skill:
Splinting a
Forearm
14-49

Support arm. Check

circulation.

14-50

Position arm on rigid

splint.

14-51

Secure splint.

14-52

Check circulation.

14-53

Wrist Injuries
Sprains
Fractures

14-54

Splinting Wrist Injuries

Goal is to stabilize from forearm to hand

Soft splint and sling often sufficient
Rigid splint provides more support
Assess circulation, sensation, movement in
hand and fingers

14-55

Wrist Injuries
Apply rigid splint on palm
side of arm from forearm
past fingertips
Tie above and below
wrist
Leave fingers uncovered
Support forearm and
wrist with sling and apply
binder around upper arm
and chest

14-56

Hand Injuries
May be injured by direct blow
Fractures occur when patient punches
something with closed fist

14-57

Splinting Hand Injuries

Goal is immobilization of hand
Use soft or rigid splint

Place roll of gauze in palm

Bandage entire hand
Place rigid splint on palm side of hand. Pad
between hand and splint
Support further with sling and swathe

14-58

Finger Injuries
Fractures and
dislocations
Often splint not
required
Use rigid splint or
anatomic splint

14-59

Splinting Finger Injuries

Use soft splint if finger cannot be straightened
without pain
Dont manipulate finger into normal position
Use rigid splint, secured with tape
Tape finger to adjoining finger with gauze in
between

14-60

Lower Extremity Injuries

Larger forces are typically involved
Forces may also cause spinal injury

Assess patient, without moving extremity

Femur fracture can damage femoral artery

14-61

Hip and Pelvis Injuries

Fractures and dislocations

A hip fracture = fracture of top part of femur
Fractures more common in elderly
Bleeding and pain may be severe
Dislocations occur at any age
Falls
Vehicular crashes
Blows to body

14-62

Hip Injuries
Do not move patient
Immobilize leg and hip
in position found
Pad between legs and
bandage together
(unless this causes
more pain)
Treat for shock but do
not elevate legs

14-63

Upper Leg Injuries

Femur fractures serious

Severe pain/shock may occur
Keep patient from moving
Use rigid splint if lying down with leg supported
by ground
Use folded blankets/coats to immobilize leg in
position found

14-64

Splinting Upper Leg Injuries

Anatomic splint
Rigid splints

14-65

Splinting Upper Leg Injuries

continued
Check circulation and sensation in foot and toes
Put rigid splint on each side of leg
Pad body areas and voids
Inside splint should extend from groin past
foot
Outside splint should extend from armpit past
foot

14-66

Traction Splint for Femur

Fractures
Traction splint maintains continual pull on femur
to keep bone ends in normal position
First Responders usually assist other EMS
personnel

14-67

Knee Injuries
Sprains
Dislocations
Caused by sports injuries, motor vehicle
crashes, falls
Femur, tibia or fibula fractures indistinguishable
from knee injuries

14-68

Splinting Knee Injuries

Splint in position found

Apply soft splint by rolling blanket or placing
pillow around knee
If knee straight, make anatomical splint

Splinting the Knee

If possible, put rigid splint on both sides of leg
Pad body areas and voids
Check circulation and sensation in foot and toes
first and periodically after splinting

14-70

Splinting the Knee

If knee is straight apply two splints along both

sides of knee
If knee is bent, splint in position found
Tie splints with cravats or bandages
14-71

Lower Leg Injuries

Many causes
Either or both bones of lower leg can be
fractured

14-72

Lower Leg Injuries

Rigid splint applied
the same as for knee
injury
Three-sided
cardboard splint
can be used

14-73

Skill:
Splinting the Leg
(Anatomic)

14-74

Check circulation.
Gently slide four to
five strips of
bandages under
both legs.

14-75

Pad between legs.

14-76

Gently slide
uninjured leg next to
injured leg.

14-77

Tie bandages
and
Check circulation

14-78

Ankle Injuries
Commonly a sprain occurring when foot
forcefully twisted to one side
Fractures or dislocations
Often involve torn ligaments and nerve/blood
vessel damage

14-79

Splinting Ankle Injuries

Soft splint usually best
Assess circulation, sensation, movement in toes

14-80

Foot Injuries

Commonly caused by direct blows/falls

Involve almost any bone/ligament of foot
Treat same as ankle injuries
Toe fractures can be very painful

14-81

Splinting Foot Injuries

Usually no splinting required

Use pillow splint as for ankle injury if:
toe is significantly bent
more than one toe involved
foot is very painful

Rib Fractures

Typically caused by blunt trauma to chest

More common in lower ribs and along side
Cause severe pain, discoloration, swelling
Pain often sharper upon breathing in
Patient may breathe shallowly and hold/support
area

14-83

Splinting Rib Injuries

Goal is primarily supportive
Have patient sit/stand in easy breathing position
Support ribs with pillow or soft padding loosely
bandaged over area and under arm
Immobilize arm with sling and swathe
Monitor breathing

14-84