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Chapter 20, Section 1 Musculoskeletal Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Objectives 20.1.1 Describe the functions of the following structures: a. b. c. d. e. f. bones cartilage joints muscles synovium tendons 20.1.2 Describe the physiology of human movement. BRADY continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Objectives 20.1.3 Describe how musculoskeletal tissues heal. 20.1.4 List the six types of musculoskeletal injuries. 20.1.5 Compare and contrast sprain and strain. 20.1.6 Describe two classifications of fractures. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Objectives 20.1.7 List the signs and symptoms of sprains and fractures. 20.1.8 Define the following terms: a. dislocation b. fracture c. sprains BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Topics Anatomy and Physiology Physiology of Human Movement Common Musculoskeletal Injuries BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Case Presentation A male teenager is found on the snow below a jump. He is wearing twin tipped skis and a helmet. He complains that his right thigh hurts “very bad”, and you notice that his right forearm is also angulated. His buddies report that he landed “hard.” BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Anatomy and Physiology – the skeleton Joints – the motion Muscles – the power Bones BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Skeleton Provides structure and protection Axial skeleton – skull, vertebrae, and thoracic cage ◦ Transfer weight from upper to lower body ◦ Responsible for upright position skeleton – shoulder, arm, pelvis, legs Appendicular ◦ Responsible for movement BRADY continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Skeleton continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Skeleton Types of Bones ◦ Long: Humerus, radius, ulna, femur, tibia, fibula • Breaks at epiphyseal line (growth plate) can be serious for growing children ◦ Flat: Skull, scapula, ribs, sternum, pelvis ◦ Irregular: Vertebrae, wrist, hands, ankle, feet, patella BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Skeleton BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Joints Joint: Two bones and the connective tissues that surround, support, and stabilize it called the joint capsule. Synovial fluid in the joint capsule lubricates joints. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Joints Range/type of motion depends on type of joint: ◦ ◦ ◦ ◦ ◦ BRADY Ball and socket Hinge Gliding Pivot Suture National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Joints BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Ligaments and Tendons Ligaments connect bone to bone, form part of joint capsule ◦ Restrict the motion of the joint ◦ Tightness/laxity help determine extent of movement Tendons connect muscle to bone Both can be stretched or torn ◦ Stability and function suffer BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Ligaments and Tendons BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Muscles contracts and relaxes – often work in pairs Controlled by nervous system – spinal and peripheral Three types: Tissue ◦ Skeletal (voluntary) ◦ Smooth ◦ Cardiac BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Muscles BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Physiology of Movement Skeletal muscle message is “contract” ◦ Signal provided by nerves ◦ May be voluntary or involuntary ◦ Pairs work in coordination to flex and extend joints BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Healing Process Factors are extent of damage, age, nutrition, overall health Bone healing requires nutrients, oxygen, and immobilization Muscles and ligaments heal slowly Tendons need protection during healing Cartilage does not heal, it is often removed BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ The Healing Process Copyright Nancy Pitstick BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Musculoskeletal Injuries Sprain ◦ Stretching or tearing of a ligament • Tears may need surgery ◦ Joint is displaced beyond its normal alignment continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Musculoskeletal Injuries Strain ◦ Stretched or torn muscle • Overexertion or poor body mechanics • May range from minor to severe ◦ Strain versus Sprain • You strain a muscle or tendon and sprain a ligament. continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Musculoskeletal Injuries Tendon rupture ◦ Active motion of joint may be lost Fracture ◦ ◦ ◦ ◦ BRADY Break in a bone May be open or closed May be displaced or non-displaced May be associated with internal or external bleeding continued National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Musculoskeletal Injuries continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Common Musculoskeletal Injuries Dislocation ◦ Separation or displacement of bones at a joint ◦ Usually the result of forceful trauma Multiple structures and surrounding tissues may be injured in a single event ◦ Soft tissues, nerves, and blood vessels may be involved BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Types of Fractures Butterfly Comminuted Compression Epiphyseal Greenstick Impacted continued BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Types of Fractures Oblique Pathologic Spiral Transverse BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Types of Fractures BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Possible Blood Loss from Fractures Pelvis (1300-1500 ml) Femur (500-1000ml) Humerus (300-500ml) Tibia/Fibula (150-250ml) BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ Case Update You perform a primary assessment. The patient states that he caught “way too much air and crashed.” The patient’s respiratory rate is 16 and his left radial pulse is 100 and strong, but the radial pulse in his injured right arm is absent. You immediately call for assistance, a long spine board, a splint for the femur and transportation to the first aid room. Because of the mechanism of injury, the lack of a right radial pulse, and the fact that ground transport to definitive care will take over 2 hours, you radio for air transport. BRADY National Ski Patrol, Outdoor Emergency Care, 5th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ