CH 13 – Muscle and Bone Injuries
Musculoskeletal system:
1. Muscles (over 600 muscles)
-Most are skeletal muscles: attach to bones
-Muscles are capable of contracting and relaxing. This causes movements.
2.
Connective tissue:
-tendons--MUSCLE TO BONE
-ligament-BONE TO BONE and hold together joints
Injuries to the Bones and Joints
Mechanisms of injury:
 Direct - object strikes the body & causes injury at point of impact
 Indirect - force travels through the body & causes injury to body part away from the point
of impact
 Twisting - one part of the body stays in one position while another part of the body turns.
Types of Injuries: open or closed
Signs & Symptoms:
 Pain and tenderness
 Selling
 Grating
 Deformity or angulation
 Bruising or discoloration of the skin
 Exposed bone ends
 Joint locked into position
 Inability to use affected part
General Care for Bone and Joint Injuries:
 Use appropriate protective equipment (BSI)
 Care for all life-threatening conditions
 Permit the victim to maintain most comfortable position
 Call for more advanced help if:
o Injury involves severe bleeding
o Injury impairs walking to breathing
o Injury involves the head, neck, or back
o You see or suspect multiple injuries
General care for all skeletal injuries is:
 Rest – don’t move if causes pain
 Ice – but not directly on open fracture
 Elevation – but ONLY if adequately immobilized.
Immobilization:
1.
Purposes:
 Lessen pain
 Prevent further damage to soft tissues
 Reduce risk of serious bleeding
 Reduce chance of loss of circulation to injured part
 Prevent closed injuries from becoming open injuries
2.
If EMS has been called, the ground may be a sufficient way to immobilize
3.
If needed, you may apply a splint:
a - split only if you can do it without causing more pain & discomfort to the
victim
b - splint an injury in the position you find it
c - splint the injured area & the joint above and below the injury site
d - check for proper circulation
before & after splinting
Types of splints:
1 - anatomic
2 - soft
3 - rigid
Immobilizing Painful, Swollen Deformed Injuries
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Support the injured part. If possible have someone help you.
Cover any open wounds with a dressing and bandage.
If injury involves an extremity, check for circulation and sensation below the site of
the injury.
 Check for pulse below injury
 Check for feeling, warmth, and color
If using a rigid splint, pad the splint so it is shaped to the injured part
Secure the splint in place
Recheck circulation
Elevate splinted part, if possible
check for ABCs, vital signs, and care for shock
The Skeletal System
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Skeleton (over 200 bones)
Protects vital organs
Joint - two or more bones coming together
Ligaments - hold bones together at joints
Bones - shape depends upon what it does – classified as: long, flat, short, irregular
- weaken with age
- osteoporosis is the gradual, progressive weakening of bone
Types of Musculoskeletal Injuries:
1. Fracture - a break or disruption in bone tissue.
include chipped or cracked bones
Cause - direct & indirect forces; severe twisting can cause a fracture
2. Dislocation - displacement or separation of a bone from its normal position at a joint
 Cause - severe forces.
 May be severe enough to also cause a fracture.
 Shoulders and fingers dislocate more easily than the elbow
 Once a joint is dislocated, will dislocate more easily later
 Displaced bone end often causes a lump, or depression. Joint cannot be moved.
3.
Sprain - stretching or tearing of ligaments and other tissues at a joint
 Cause - bones forced beyond normal range of motion
 May also involve a fracture if severe
 Mild sprains, which only stretch ligaments, heal quickly but must be treated as
more severe sprain may result.
 Generally a sprain is more disabling than a fracture
4. Strains - stretching and tearing of muscle or tendon fibers
 Cause – overexertion or sudden uncoordinated movements
 Commonly involve muscles in: neck, back, front or back of thigh, of back of lower
thigh.
 Must be treated or can re-occur more easily.
Caring for Specific Injuries to Bones & Joints
Upper Arm Injuries:
 most commonly injured area of body.
 Injuries due to falling on outstretched hand
 General care:
o Minimize movement – if held against chest, that is fine. Bind arm to chest
o Make sure blood flow & nerve function have not been impaired -check for
circulation & sensation before and after splinting
Shoulder:
1. May have sprains, but can also have
fractures or dislocations
2. Clavicle or collarbone is more commonly injured in children than adults
a. Must immobilize since clavicle is over major blood vessels and nerves
3. Injuries to scapula (fracture) are not common – requires a great deal of force.
a. if it occurs, also check for broken ribs
Care for shoulder injuries:
 Control external bleeding
 Allow victim to support arm – minimize movement. If there is a space between arm
and body, place a towel or pillow there to help
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Check for circulation and sensation in hands and fingers
Splint the arm in place
Recheck for circulation & sensation
Apply ice to minimize pain & swelling
Minimize shock
Upper Arm: - danger of damage to blood vessels & nerves supplying the arm. Very painful.
Generally: Breaks in upper end for elderly and very young (falls) – breaks in middle for young
adults
Care:
 Control external bleeding
 Immobilize upper arm from shoulder to elbow
 Place arm in sling and bind to chest
 Check for circulation and sensation before and after splinting
 Apply ice
 Treat for shock
Elbow injuries: - permanent damage may result since all nerves & blood vessels to the forearm
and hand go through elbow. Elbows can be sprained, fractured or dislocated.
Care for Elbow Injuries:
 Do NOT force victim to move it – splint in the position you find it
 Control external bleeding
 Check for circulation before and after splinting
 Immobilize arm from shoulder to wrist
 Apply ice
 Treat for shock
Forearm, wrist, & hand injuries:
 Fractures more common in children than adults
 May break radius or ulna, but not always in same place – S-shaped
 Hands are very susceptible to injury
Care:
 Control external bleeding
 Check for circulation and sensation before and after splinting
 Immobilize
 Apply ice
 Treat for shock
Lower Extremity Injuries
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May involve soft tissue and musculoskeletal damage
Thigh & Lower Leg Injuries:
 Femur is largest bone in body
o Fracture usually occurs near hip
o Usually produces a deformity
o One leg may be shorter than the other
Fractures to lower leg :
o may be one or both – if both, usually happens at same time
o since bones are just below skin, are often open fractures
o may have severe angles
Care:
o Control external bleeding
o Immobilize – ground may serve as a splint
o Minimize shock
o Call EMS
o If YOU must move them – splint leg
o Check and re-check circulation & sensation
Minimize shock
Knee Injuries: - very vulnerable to injury
Care:
o Control external bleeding
o Immobilize
o Splint in position you find it
o Apply ice
o Treat for shock
Ankle & Foot Injuries:
o Commonly caused by twisting injuries
Care:
o Control external bleeding
o Immobilize
o Splint
o Apply ice
Traction Splint:
o Used primarily to immobilize fractures of femur
o One end attaches to the hip and the other to ankle
o When traction engaged, there is a steady pull that hold bones in near normal position