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Chapter 4- Wound Care • Anatomical Position • Directional Terms- 3 Planes Fig 4-1 Sagittal or AP – Right/Left Transverse or horizontal – Top/Bottom Frontal or Lateral – Front/Back • Table 4-1-Read and Understand Terms in Use • • • • • • The neck is __ to the head The thumb is ___ to the middle finger The knuckles are ___ to the elbow The outer ear is ___ to the ear drum The eyes are on the ___ the head The ankle is on the ___ part of the body Terms In Use Cont • The patella is _________ to the ACL • The shoulder blade is on the ________ and _________ aspects of the body • The heart is ________ to the chest muscles • The triceps are on the _________ aspect of the body. Skin Anatomy • First layer of defense against injury; most frequently injured body tissue • Needed to protect against bleeding and infection • Two major region – Epidermis-superficial layer- Multi-Layered -contains skin pigment, hair, nails and sweat glands – Dermis-Deep layer- contains hair follicles, blood vessels, nerve endings • Resist compression, tension, and shear type forces Soft Tissue Injuries Fig 4-3 • Abrasion = scrape (shear force) (1st) • Blisters = repeated shear force (1st) • Skin bruises (contusions) = Compression force (1st/2nd) • Incision = clean cut (1st/2nd) • Laceration = jagged cut (1st/2nd) • Avulsion = loss of tissue (1st/2nd) • Puncture = sharp object penetrates skin (1st/2nd) Care of Soft Tissue Injuries • Wear Gloves • Apply direct pressure with a sterile dressing if possible (Let athlete assist you when possible) • Clean the wound with saline or soap water • Apply ointment-Triple Antibiotic and dressings that extends past the wound • Secure with pre-wrap and tape (Check for circulation • Change dressings daily and look for signs of infection (redness – red streaks, heat, pus, pain) • Wash hands when you are finished Muscles and Tendons • Muscle Fibers are surrounded by Endomysium (Inner) • Small amount of fibers make up fascicles surrounded by Perimysium (Middle) • A muscle is made up of a number of fascicles which are surround by Epimysium (Outer) • Muscle Sheath Muscles and Tendons • Purpose- movement, maintaining posture, stabilizing joints, and generating heat as they contract • Extensibility = Ability to stretch/increase in length • Elasticity = Ability to return to normal length after lengthening/ shortening Tendons • Tendons- assist in movement of body part – – – – Connect muscle to bone Collagen or tissue is in parallel pattern High resistance to unidirectional forces Patella, Achilles, Biceps Muscle contractions • Concentric Contraction = muscle shortening against resistance • Eccentric contraction = muscle lengthening against resistance • Isometric contraction = no change in length, no joint movement • Isotonic contraction = change in length, joint movement Muscle stretching • Figure out muscle and its action(s) • Stretch in opposite direction – Stabilize body – Hold stretch at least 20s • Three kinds of stretching – Ballistic (bouncing) Want to avoid this type – Static –Hold in a position for at least 20 secs – PNF Stretch, Contract, Stretch Soft tissue injury classifications • Contusions • Severity depends on depth and tissue affected – 1st degree = little or no ROM restriction; slight discoloration, pain w/ movement, pt tender – 2nd degree = moderate ROM restriction; S/S increase – 3rd degree = severe ROM restriction; S/S increase • Muscle cramps/spasm • Myositis/ fasciitis Soft tissue injury classifications • • • • • • Strain = injury to muscle or tendon Tendonitis (tendon) Tenosynovitis (synovial sheath over tendon) Myositis ossificans (muscle to bone) Cacific tendonitis (tendon to bone) Bursitis (bursae) Categories of Strains Table 4.2 • 1st degree: some pain, microtears of collagen, mild symptoms: pn, point tenderness, swelling, ROM decreased • 2nd degree: More tissue destruction, moderate symptoms, joint laxity/instability, muscle weakness, increased ROM loss, ecchymosis (tissue discoloration). • 3rd degree: Severe tissue destruction, severe symptoms, complete instability, loss of ROM, palpable defect (early), ecchymosis Joints • Meeting of two bones • Various types of joints –fibrous, cartilaginous, and SYNOVIAL • Synovial- most common; freely moveable; all joints of the limbs fall into this class • Features of a synovial joint –Fig 4-6 – Articular Cartilage-protects the ends of your bones – Joint Cavity- Space between bones which is filled w/ synovial fluid – Articular Capsule-Surrounds the joint cavity – Synovial Fluid-Lubricates the joint and articular cartilage – Reinforcing Ligaments-ACL, PCL, LCL, MCL Range of Motions (ROM) Box 4-1/Fig 4-7 • • • • • • • • • • Flexion/Extension Dorsiflexion/Plantar Flexion Abduction/Adduction Circumduction Rotation Supination/Pronation Inversion/Eversion Protraction/Retraction Elevation/Depression Opposition Joint Injuries • Sprain = injury to ligament; mechanism of injurytwisting, direct contact, dynamic overload, 3 degrees (See table 4.3) • Subluxation-Partial displacement of the joint surface; structure damage does occur; check a distal pulse • Dislocation-displacement of joint; major structure damage, instable joint, severe pain, loss of ROM; check distal pulse Treatment To Closed Tissue Injuries • Apply Ice with a compression wrap immediately for at least 20 minutes; check for a distal pulse • If no fracture suspected elevate body part • Repeat the process every 1-2 hours • NSAIDS if able • Supply Crutches if necessary • Continue Ice Application up to 72 hours • Keep body part wrap with compression • Refer to physician if necessary Bones • Purpose-support, protection, reservoir for minerals for the bulk of blood cells, aid in movement w/ muscles • Bone Classification: – Long-consist of a shaft and 2 ends; all bones of limbs fall into this category – Short-cubelike; bones of wrist and ankle – Flat-flat, thin and usually a bit curved; ribs and sternum – Irregular-don’t fit into any of the above categories; vertebrae and hip bones Bone Anatomy • Structure of Bones: – Diaphysis-shaft of bone – Epiphyses-located at the ends of bones; larger than diaphysis; in adolescents there is a cartilaginous disc where bone growth occurs, this fuses with the diaphysis and forms the epiphyseal line at 18. Bone Anatomy Cont – Membranes • periosteum-outer layer of bone where tendons/lig attach • Endosteum- inner layer of bone – Inside bone- contains bone marrow Bone injuries • Fracture = Disruption in continuity of a bone = break – Simple = skin remains intact – Compound = skin integrity compromised – See types of fractures, pg. 53 & 56 • Stress fractures (repeated low-magnitude forces) Fractures • C/S-direct contact, fall, dynamic overload • Signs: swelling, bruising, deformity, shortening of the limb, crepitus, disability • Types-open (c),closed (s), transverse, epiphyseal, avulsion • Five ways of recognizing fracture: Figure 4-12 – – – – – Palpation Percussion Vibration Compression (be careful) Distraction (be careful) Treatment • Splint before moving-Follow 1st Aid/Safety Rules • Types of splints: – – – – Anatomic Stiff/rigid Soft Vacuum • Check feeling, warmth, and color before and after splinting • Refer for X-rays