Chapter 15Extremity Injuries

Extremity Injuries

Injuries to the extremities are common because people are involved in active lifestyles that include sports and wilderness activities.

Extremity Injury Assessment• Look for signs and symptoms of fractures

and dislocations.• Examine the extremities using DOTS. • Compare one extremity with the other.• Use the “rule of thirds.”• Consider the cause of injury. • Use CSM (circulation, sensation,

movement).

Types of Extremity Injuries (1 of 2)

• Contusions—occur when tissue is bruised• Strains—occur when the muscles are

stretched or torn • Sprains—involve tearing or stretching of

joints, causing damage to the ligaments and joint capsules

Types of Extremity Injuries (2 of 2)

• Tendinitis—inflammation of a tendon caused by overuse

• Dislocations—occur when bones are displaced from their normal joint alignment, out of their sockets, or out of their normal positions

• Fractures—breaks in bones that may or may not be accompanied by open wounds

Care for Extremity Injuries

• Use RICE procedures.• Apply a splint to stabilize

fractures and dislocations.

RICE Procedures (1 of 7) • Acronym for rest, ice, compression, and

elevation • Recommended immediate treatment for

bone, joint, and muscle injuries • The first 48 to 72 hours after an injury

can do a lot to relieve—and even prevent—aches and pains.

RICE Procedures (2 of 7)

• R = Rest• Do not use or move injured part.• Crutches may be used.

RICE Procedures (3 of 7)

• I = Ice• Apply for 20 to 30 minutes.• Apply as often as possible.• Do not apply directly to skin.• If skin becomes numb, remove.

RICE Procedures (4 of 7)

• C = Compression• Apply elastic

bandage to injury.• Should be worn

continuously for first 18 to 24 hours

• Use horseshoe-shaped pad for ankle injury.

RICE Procedures (5 of 7)

• E = Elevation• Limits circulation to injured area

• Limits internal bleeding; minimizes swelling• Do not elevate a suspected fracture until it has

been stabilized.

RICE Procedures (6 of 7) • R = Rest• I = Ice

• Apply for 20 to 30 minutes.

RICE Procedures (7 of 7)

• C = Compression• Apply a compression

bandage for 3 to 4 hours.

• E = Elevation• Raise the injured area

higher than the heart.

Shoulder Dislocation

• Occurs when shoulder bones come apart• Result of a blow or a particular movement

• Second in frequency only to finger dislocations

Recognizing a Shoulder Dislocation (1 of 2)

• Victim holds upper arm away from body.• Arm cannot be brought across chest.• Extreme pain in the shoulder area• Shoulder appears squared off.

Recognizing a Shoulder Dislocation (2 of 2)

• Injury results in complete loss of function.• History of previous dislocations• Numbness or paralysis in the arm

Care for a Shoulder Dislocation• Do not force, twist, or pull back in place.• Place a folded or rolled blanket or pillow

between upper arm and chest. • Apply an arm sling and swathe.• Apply an ice pack for 20 minutes.• Seek immediate medical care.

Clavicle Fracture• Common• Usually result of falling with arm

and hand outstretched• Most occur in the middle third of

the bone.

Recognizing a Clavicle Fracture (1 of 2)

• Deformity• Fell on outstretched arm• Direct blow to clavicle or shoulder• Severe pain over injured area• Holding injured arm against chest

Recognizing a Clavicle Fracture (2 of 2)

• No movement because of pain• Swelling• Tenderness• “Dropped” or drooped shoulder• Bruising

Care for a Clavicle Fracture

• Treat for shock.• Apply arm sling and swathe. • Apply ice pack:

• 20 minutes, three to four times during 24 hours

• Seek immediate medical care.

Contusions

•Caused by direct blows •Often called shoulder pointers

Recognizing Contusions

• Swelling• Pain at the injury site• Feeling of firmness when

pressure on the shoulder• Tenderness• Black-and-blue discolorations

Care for Contusions

• Apply an ice pack: • 20 minutes, three to four times during first

24 hours• Place arm in sling and swathe.

• One end tucked between arm and body • Ties in back

Tendinitis

• Inflammation of the shoulder• Result of continuous overuse

or unusual use

Recognizing Tendinitis• Constant pain or pain with

motion of the shoulder• Limited motion of shoulder• “Crackling” sound• Tenderness over the area

Care for Tendinitis• Use an ice massage for 10

minutes before and after exercise.• Use a sling and swathe.• Use pain medication.• Seek medical advice.

Humerus Fracture• Shaft of the humerus can be felt

throughout its entire length along inner side of upper arm.

Recognizing a Humerus Fracture• Direct blow to the area• Twist or fall on the outstretched arm• Severe pain and swelling• Deformity• Tender if touched• Inability to move the arm• Holds arm against chest

Care for a Humerus Fracture

• Assess and treat for shock.• Apply an ice pack for 20

minutes.• Stabilize the arm.• Seek immediate medical care.

Elbow Injuries

• Should be considered serious • Treat with extreme care.

Recognizing Elbow Fractures and Dislocations

• Immediate swelling• Severe pain• Possible visible deformity• Restricted, painful motion• Numbness or coldness of the hand

and fingers below the elbow

Care for Elbow Fractures and Dislocations

• Do not move the elbow.• Treat for shock.• Splint the elbow in the position found.• Apply an ice pack for 20 minutes.• Seek immediate medical care.

Tennis Elbow

• Results from sharp, quick twists of the wrist

• Inflammation of the tendons on the outer side of the elbow

Recognizing Tennis Elbow

• Pain increases while using the arm.• Gradual grip weakness• Injured elbow fatigues quicker than

normal.• Very tender on outer protrusion

Care for Tennis Elbow• Apply heat before an activity.• Apply ice pack for 20 minutes

after activity.• Seek medical advice.

Golfer’s Elbow

• Equivalent to tennis elbow• Pain is on the inside of the elbow.

Recognizing Golfer’s Elbow

• Pain increases while using the arm.

• Gradual grip weakness• Injured elbow fatigues

quicker than normal.

Care for Golfer’s Elbow

• Apply heat before an activity.• Apply an ice pack for 20 minutes

after activity.• Seek medical advice.

Radius and Ulna Fractures

• The radius and ulna are the two large bones in the forearm.

• When one bone is broken, the other acts as a splint, and there may be little or no deformity.

• When both are broken, the arm usually appears deformed.

Recognizing Radius and Ulna Fractures

• Pain in the forearm or wrist • Deformity • Severe pain radiating up and down• Inability to move the wrist or painful

when moved

Care for Radius and Ulna Fracture

• Assess and treat for shock if indicated.• Apply an ice pack for 20 minutes.• Apply two rigid splints on both sides of

arm. • Seek medical care.

Wrist Fracture

• Wrist usually breaks when victim falls with arm and hand outstretched.

Recognizing a Wrist Fracture• Snapping or popping sensation • Pain aggravated by movement• Tenderness• Swelling• Unable or unwilling to move wrist• Lumplike deformity

Care for a Wrist Fracture

• Use the RICE procedures.• Stabilize the wrist with a

splint.• Seek medical care.

Hand Injuries—Crushed Hand

• May be fractured by:• Direct blow• Crushing injury

Recognizing a Crushed Hand

• Pain• Swelling• Loss of motion• Open wounds• Broken bones

Care for a Crushed Hand

• Control the bleeding.• Apply an ice pack for 20

minutes.• Seek medical care.

Finger Injuries• The three bones that make up each

finger are the most commonly broken bones.

• The finger has three joints: • Distal interphalangeal• Proximal interphalangeal• Metacarpal phalangeal

Finger Fracture

• Finger bones can move when they are broken.

Recognizing Finger Fractures

• Deformity• Immediate pain• Hurts with or without movement• Numbness• Swelling• Pinpointed tenderness

Testing Finger Fractures

• If possible, straighten fingers and place on a hard surface.

• Tap the tip of the injured finger toward the hand. • Pain lower down in the finger or into the hand

can indicate a fracture.

Care for Finger Fractures• Do not try to realign.• Gently apply an ice pack.• Splint the finger.

• Use “buddy” tape method.• Secure hand, fingers, and arm to rigid splint

in the position of function.• Seek medical care.

Finger Dislocation

• Common• Same causes of fractured fingers

Recognizing Finger Dislocation• Visible deformity • Immediate pain• Swelling• Shortening of the finger• May be unable to bend the finger• Motion not possible

Care for Finger Dislocation• Do not try to realign.• Apply an ice pack for 20 minutes.• Splint the finger.

• Use “buddy” tape method.• Secure hand, fingers, and arm to rigid

splint in the position of function.• Seek medical care.

Sprained Finger

• Upper joints of the fingers have a ligament on each side of the joint.

Recognizing a Sprained Finger

• “Jammed” or compressed• Stepped on• Forced or twisted sideways• Pain and swelling over a joint• Unable to make a fist• Weakness while curling the finger• Weakness or pain when gripping

Care for a Sprained Finger

• Apply an ice pack for 20 minutes.• Reevaluate.• Seek medical care if pain and

weakness exist.• “Buddy” tape the fingers.

Nail Avulsion• Injury in which a nail is partly or

completely torn loose

Recognizing a Nail Avulsion

• Nail may be completely detached or partially held in place by the skin

Care for a Nail Avulsion• Secure damaged nail in place with an

adhesive bandage.• Apply antibiotic ointment.• Secure a partly torn loose nail with an

adhesive bandage. • Do not trim away loose nail.• Consult a physician.

Splinters

• Sharp splinters, usually wooden, can be impaled into the skin or under a fingernail or toenail.

Recognizing Splinters

• Small puncture wound• Sliver may be seen.

Care for Splinters• Use tweezers to remove it. • If splinter is impaled under a nail and

breaks off flesh: • Cut a V-shaped notch in the nail.

• Remove with tweezers.

Blood Under a Nail

• Blood collects under a nail when underlying tissues are bruised.

Recognizing Blood Under a Nail

• Excruciating pain• Pain disappears

only after blood is drained.

Care for Blood Under a Nail

• Immerse finger in ice water or apply ice pack.

• Elevate hand. • Relieve pressure.• Apply dressing.

Ring Strangulation

• Serious damage may result if blood supply is cut• Within 4 or 5 hours

Recognizing Ring Strangulation

• A ring has become tight on a finger.

Care for Ring Strangulation (1 of 2) • Lubricate the finger.• Immerse finger in cold water or apply an

ice pack.• Spray window cleaner onto finger. • Massage finger from tip to hand. • Smoothly wind thread around the finger.

Care for Ring Strangulation (2 of 2)

• Lubricate finger well, and then pass a rubber band under the ring.

• Cut the narrowest part of the ring. • Inflate an ordinary balloon.

• Insert victim’s swollen finger in end.

Hip Joint Injuries

• Hip joint is a stable ball-and-socket joint.

• Requires great force to dislocate

Recognizing Hip Dislocation

• Severe pain at injury• Swelling at injury • Hip is flexed and knee is bent

and rotated inward toward opposite hip.

• Visible injury

Care for Hip Dislocation

• Assess and treat for shock.• Stabilize injury.• Check for ankle pulse.• Seek medical care.

Hip Fracture

• Fracture of the upper end of the femur• Not the pelvis

Recognizing a Hip Fracture

• Severe pain in groin area• Inability to lift injured leg• Leg may appear shortened and be

rotated with the toes pointing abnormally.

Care for a Hip Fracture

• Treat for shock.• Stabilize injured leg.• Monitor ankle pulse.• Seek immediate medical care.

Femur Fractures• Femur injuries can occur in any

part of the femur. • Femur fractures often include

open wounds.• External bleeding may be severe.

Recognizing a Femur Fracture

• Severe pain at injury• Deformity • Swelling • Severe pop or snap

Care for a Femur Fracture• Assess and treat for shock.• Cover wound with sterile

dressing.• Stabilize injured leg.• Monitor ankle pulse.• Seek immediate medical care.

Muscle Contusion• The muscle group on the front of the

thigh is the quadriceps group. • Often gets bruised

Recognizing a Muscle Contusion• Swelling• Pain and tenderness• Tightness or firmness of site • Visible bruise

Care for a Muscle Contusion• Follow the RICE procedures.

• Apply an ice pack.• 20 minutes, three to four times a day

for 48 hours• Stretch the muscle.

Muscle Strain

• Occurs when a muscle is overstretched

• A first aider will be unable to determine its degree.

Recognizing a Muscle Strain

• Pop or pulling sensation while running or jumping

• Tenderness• Stiffness and pain• Swelling• Visible bruise appears days later.

Care for a Muscle Strain• Follow the RICE procedures.

• Apply an ice pack. • 20 minutes, three to four

times a day for 48 hours• Stretch the muscle.

Knee Injuries

• Among the most serious joint injuries

• Medical care is required if the injury is from being hit or twisted.

• A fracture generally occurs as a result of a fall or a direct blow.

Recognizing a Knee Fracture• May look like a dislocation• Deformity• Tenderness• Swelling

Care for a Knee Fracture• No deformity:

• Feel for pulse in the ankle. • If pulse is felt, splint the leg with the knee

straight. • Significant deformity:

• Feel for pulse in the ankle.• If pulse is felt, splint the knee in the position

found. • Seek medical care immediately if pulse is

absent.

Knee Dislocation

• A knee dislocation is a serious injury.• Deformity will be grotesque.

Recognizing a Knee Dislocation

• Excruciating pain• Deformity• Pulse may be absent in the ankle.

Care for a Knee Dislocation

• Stabilize the knee in the position found.

• Seek medical care immediately.

Patella Dislocation• Must be treated immediately • Most commonly occurs in teenagers

and young adults who are engaged in athletic activities.

Recognizing a Patella Dislocation• A blow or twisting causes kneecap to

move outside of the knee joint. • Swelling• Inability to bend or straighten knee• Pain• Deformity

Care for a Patella Dislocation

• Follow the RICE procedures.• Do not try to relocate.• Splint knee in position found.• Seek medical care.

Knee Sprain

• Ligament injury • Can range from mild to

complete tearing

Recognizing a Knee Sprain• Severe pain• Pop or snap at the time of injury• Locking sensation• Inability to walk without limping • Inability to bend or straighten the knee• Swelling• Bruising

Care for a Knee Sprain

• Follow the RICE procedures.• Seek medical care.

Knee Contusion• Caused by:

• A direct blow • Falling on the knee

Recognizing a Knee Contusion

• Pain • Swelling• Tenderness• Black-and-blue discoloration

Care for a Knee Contusion

• Follow the RICE procedures.

Lower Leg InjuriesTibia and Fibula Fractures

• Can occur at any place between the knee joint and the ankle joint

• Deformity may occur when one bone is broken.

• When only one bone is broken, little deformity may be present.

Recognizing Tibia and Fibula Fractures

• Severe pain• Swelling• Deformity• Tenderness

Care for Tibia and Fibula Fractures

• Stabilize the leg.• Apply an ice pack.• Seek medical care.

Recognizing Tibia and Fibula Contusion

• Victim received a direct hit directly on shin.

• Tender when touched• Sharp pain• Black-and-blue mark• Difficulty moving ankle up and down• Numbness or coldness in toes or foot

Care for a Tibia and Fibula Contusion

• Expose the injury.• Apply the RICE procedures.

• Use an ice pack. • 20 minutes, three to four times daily for

48 hours• If numbness or tingling exists, seek

medical care.

Muscle Cramp

• Temporary condition• Usually occurs in the calf and

sometimes in the thigh or hamstring

Recognizing a Muscle Cramp

• During or after intense exercise sessions

• Painful muscle contraction or spasm that disables the victim

Care for Muscle Cramps

• Gently stretch.• Apply pressure.• Apply ice to the muscle. • Pinch the upper lip hard. • Drink lightly salted, cool water. • Drink a commercial sports drink.

Shin Splints

• Pain in the front of the lower leg or shin

Recognizing Shin Splints

• Ache subsides after activity stops. • Ache is a result of an increase in the

workout routine. • Chronic problem that gets worse

Care for Shin Splints• Apply an ice pack before activity.• Apply pressure.• Apply an ice pack for 20 minutes after

activity.• Curtail activity until the shin is pain

free.• Take anti-inflammatory pain

medications.

Ankle and Foot Injuries

• Frequently injured by twisting• Stretches or tears ligaments

• Most ankle injuries are sprains that involve the outside ligaments.

Recognizing Foot and Ankle Injuries (1 of 2)

• Two-part test to determine whether an X-ray is needed:• Press along the bones.

• Pain and tenderness may indicate a broken bone.

• Have the victim try to stand on it. • Ability to take four or more steps is most

likely a sprain.• Inability to walk on it may indicate a break.

Recognizing Foot and Ankle Injuries (2 of 2)

• If injured ankle cannot tolerate hopping on opposite foot, suspect a fracture.

• Swelling• One sided indicates a sprain.• Both sided indicates a fracture.

Care for Foot and Ankle Injuries

• Take shoes off. • Use RICE procedures.

Aftercare of an Ankle Injury (1 of 2)

• Use the RICE treatment for 24 to 48 hours. • Use a contrast bath if swelling persists. • Begin range-of-motion exercises once initial

swelling has decreased. • Begin gentle exercises.

Aftercare of an Ankle Injury (2 of 2)

• Within 7 to 14 days, if pain and swelling have stopped, begin to stretch and strengthen the calf and ankle.

• Brace or tape healed ankle.• Nonsteroidal anti-inflammatory drugs

(NSAIDs)

Toe Injuries

• Include: • Torn-off nails• Hematoma formation under the nails• Dislocations• Fractures

Recognizing Toe Injuries

• Pain and swelling• Deformity

Care for Toe Injuries

• Treat the same as a finger injury.