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1
Musculoskeletal System
Temple College
EMS Professions
Musculoskeletal System
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Bones
Muscles
Cartilages
Tendons
Ligaments
2
Skeleton
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Support against gravity
Movement
Protection
Production of blood cells
Storage of calcium, phosphorus
3
Skull
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Cranium
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Frontal
Parietal
Temporal
Occipital
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Face
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Mandible
Maxilla
Zygoma
Nasal bones
4
Spinal Column
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Cervical: 7 vertebrae
Thoracic: 12 vertebrae
Lumbar: 5 vertebrae
Sacrum: 5 vertebrae (fused)
Coccyx: 4 vertebrae (fused)
5
Thorax
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12 pairs of ribs
Sternum
Protects heart, lungs
6
Pelvis
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Bony ring
Two innominate bones, each made of 3
fused bones
• Ilium
• Ischium
• Pubis
7
Lower Extremity
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Femur (largest bone in body)
Patella (knee cap)
Tibia (shin bone)
Fibula
Tarsals
Metatarsals
Phalanges
8
Upper Extremity
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Shoulder girdle
• Scapula
• Clavicle
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Humerus
Radius
Ulna
Carpals
Metacarpals
Phalanges
9
Muscles
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Maintain posture, allow movement
3 types:
• Skeletal (Striated)
• Smooth (Involuntary)
• Cardiac
10
Skeletal Muscles
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Voluntary muscles
Attach to bones by tendons that cross joints
Shortening of muscle moves joint
11
Smooth Muscles
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Carry out involuntary movements
Located in walls of:
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GI tract
GU tract
Respiratory tract
Blood vessels
12
Cardiac Muscle
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Found only in heart
Automaticity
Can initiate own contractions without
external stimulation
13
Joints
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Joining points of bones
Bone-ends covered with cartilage
Ligaments connect bone-to-bone
Inner surface of joint capsule lined with
synovial membrane
• Produces synovial fluid
• Lubricates joint
14
15
Extremity Trauma
Temple College
EMS Professions
Fracture
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Break in bone’s continuity
16
Fracture Causes
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Direct force
Indirect force
Twisting forces (torsion)
Diseases of bones (pathological fractures)
• Osteoporosis
• Tumors
17
Open vs. Closed Fractures
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Closed = skin over fracture site intact
Open = break in skin over fracture site
• Bone ends do not have to be exposed
• Small opening in skin communicating with
fracture site = open fx
• Open fractures more serious due to external
blood loss, possible infection
18
Fractures
One of the most important things we
do in EMS is prevent closed
fractures from becoming open ones
19
Fracture Types
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Transverse: fracture is at 90o angle to shaft
Oblique: fracture is at an angle other than
90o to shaft
Spiral: fracture coils through shaft of bone
like a spring
20
Fracture Types
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Impacted: bone ends driven into each other
Comminuted: bone broken into > 3 pieces
21
Fracture Types
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Greenstick
• Shaft of bone not completely broken
• Compressed on one side, splintered outward on
other
• What group of patients does this type of
fracture occur in?
22
Fracture Signs
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Deformity
Tenderness
• Usually point tenderness
• Overlies fracture site
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Inability to use limb
• Reliable sign of significant injury if present
• Reverse is not true
23
Fracture Signs
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Swelling, ecchymosis
Exposed fragments
Crepitus
• Grating of bone ends
• May be heard or felt
• Do NOT actively seek
24
Dislocation
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Displacement of bones from normal
positions at joint
25
Dislocation Signs
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Deformity
Swelling, ecchymosis about joint
Pain/tenderness in joint
Loss of motion usually perceived as
“locked” joint
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Sprains
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Partial, temporary dislocations
Result in tearing of ligaments
Bone ends NOT displaced from normal
positions
27
Sprain Signs
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Tenderness
Swelling, ecchymosis
Inability to use extremity
No deformity
28
Sprains
Degree of joint dislocation at time
of injury cannot be determined
during exam
Extensive damage to neural or
vascular structures may have
occurred
29
Strains
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“Muscle pull”
Injury to musculotendenous unit
Pain on active motion
Pain not present on passive motion
30
Assessment
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Perform initial (primary) assessment
Locate, treat life-threats
Assess for injuries of head, chest, abdomen,
pelvis
Assess distal neurovascular function
31
Assessment
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With exception of pelvic, possibly femur
fractures, orthopedic injuries are NOT lifethreatening.
Do NOT let spectacular orthopedic injury
distract you from ABCs
It’s the unobvious things that kill patients!
32
Assessment

Evaluation must ALWAYS be done of
distal neurovascular function.
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Pulse
Skin color
Capillary refill
Sensation
Movement
33
Management
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Splinting
• Prevents further movement at injury site
• Limits tissue damage, bleeding
• Eases pain
34
Management
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When in doubt
SPLINT
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It is difficult to differentiate fractures,
dislocations and sprains
35
Principles of Splinting
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Do NOT move patients before splinting
unless patient is in danger
Remove clothes to allow inspection of limb
Note, record distal neurovascular function
before, after splinting
36
Principles of Splinting
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Cover wounds with dry, sterile compression
dressings
Fractures: splint joint above, below fracture
Dislocations: splint bone above, below joint
37
Principles of Splinting
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Minimize movement
Support injury until splinting completed
Pad splint to avoid local pressure
38
Principles of Splinting
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Angulated fractures
• Realign before splinting
• If resistance, pain encountered stop,
immobilize as is

Dislocations
• Splint as is unless circulation compromised
• Attempt to reposition once to restore pulse
• If resistance, pain encountered stop,
immobilize as is
39