BONE JOINT & MUSCLE INJURIES

CHAPTER 7• To assess the victim’s condition quickly & calmly• To steady & support the injured part of the body

• To minimize shock• To call 911 for emergency help if you suspect a serious injury

• To comfort & reassure the victim• To be aware of your own needs

THE SKELETON

• Framework of bones1. Supports muscles, blood vessels & nerves2. Protects organs• 206 bones• Skull= protects brain & supports structures of the face• Jawbone= Mandible• Collarbone= clavicle • Shoulder blade= scapula• Breastbone= sternum• 12 ribs

Shoulder girdle

THE SKELETON

• Humerus= upper arm bone• Ulna• Radius• Femur= thigh bone• Patella= knee cap• Tibia= shin bone• Fibula= splint bone• Wrist bones= carpals• Hand bone= metacarpal• Ankle bones= tarsals• Foot bones= metatarsals• Finger/ toes= phalanx

Forearm

Lower leg bones

THE SKELETON

Skull

Mandible(Hinge- Jt.)

THE SKELETON

Scapula

Sternum

Clavicle

Ribs(12 pairs)

THE SKELETON

Humerus

RadiusUlna

Carpals Metacarpals

Phalanx

THE SKELETON

Femur

Tibia

Patella

Fibula

THE SKELETON

Tarsals

Metatarsals

Phalanx

THE SPINE

• Backbone• 26 vertebrae• Intervertebral discs• Fibrous tissue which helps make the spine flexible • Shock absorption

• Functions:1. Supports head2. Makes upper body flexible3. Supports body’s weight4. Protects spinal cord

SPINAL COLUMN

• Vertebrae form 5 groups:1. Cervical (7)

1. Support head & neck2. Thoracic (12)

1. Anchor for the ribs3. Lumbar (5)

1. Supports body’s weight & gives stability4. Sacrum (5 fused)

1. Supports the pelvis5. Coccyx (4 fused)

1. Forms the end of the spine

THE SKULL• Protects the brain & the top of

the spinal cord• Supports eyes & other facial

structures• Made up of several bones, most

fused at joints called sutures

BONES

• Bone= living tissue containing calcium and phosphorus• Minerals that make bone hard, rigid, & strong

• Able to generate new tissue after injury• Certain diseases can weaken bones• Inherited problems/ Bone disorders (rickets, cancers, infections)

• Age• Adolescence= can shorten/ impair movement• Older= bones can lose density making them brittle (osteoporosis)

PARTS OF A BONE

Each bone is covered by a membrane called the periosteum

Compact bone

Spongy bone (core)

Bone marrow (center cavity

MUSCLES

• Cause various parts of the body to move• Skeletal muscles• Voluntary • Control movement & posture• Attached to bones by strong bands of fibrous tissue= tendons

• Involuntary • Operate internal organs & work constantly• Ex: heart• Controlled by autonomic nervous system

JOINTS

• Where one bone meets another• Immovable joints• Bone joints are fused• Skull (sutures) & pelvis

• Movable joints• Bone ends are joined by fibrous tissue called ligaments• Capsule lining= synovial membrane• Lubricates the joint

Surfaces are flat & slide over each other.Ex: Foot & wrist

Allows bending & straightening in only 1 plane.Ex: Knees & elbows

Allows movement in all directions.Ex: Hip & Shoulder

Bone ends meet at right anglesEx: Base of thumb

One bone rotates within a fixed collar formed by another.Ex: Base of the skull

Movement can occur in most directions Ex: Wrist

FRACTURES

• Break/crack in a bone• Twist/ wrench• Heavy blow• Old/ disease

• Open fracture• Bone is exposed• May suffer bleeding & shock• High risk of infection

• Closed fracture• Skin is not broken• Internal bleeding is a risk

• Stable fracture• Ends of injury remain in place• Not completely broken

• Unstable fracture• Broken bone ends can easily be displaced• May damage blood vessels, nerves &

organs

FRACTURES

• Recognition:• Deformity, swelling, & bruising at fracture site• Pain/ difficulty in moving the area• Course grading (crepitus)• Signs of shock

TREATING A CLOSED FRACTURE• Aims:• Prevent movement at the injury site• To arrange transportation to the hospital• Caution:

• Do not move victim until injured part is secured & supported• Unless immediate danger

• Do not allow victim to eat/ drink anything

1. Advise victim to keep still; support joints above & below injury with your hands until immobilized with sling/ bandages

2. Place padding around injury for extra support; take/send victim to hospital1. Arm injury may be transported by car

3. For further support= secure injured part with unaffected part1. Always tie knots on the uninjured side

4. Treat for shock if necessary; monitor/record vital signs; check circulation (10 minutes) 1. DO NOT raise an injured leg (elevate uninjured leg if necessary)

TREATING AN OPEN FRACTURE

• Aims:• Prevent blood loss, movement & infection• Arrange removal to hospital with comfortable support

• Caution:• Do not move victim until injured part is secured & supported

• Unless immediate danger• Do not allow victim to eat/ drink anything• Do not press directly on a protruding bone end

• SPECIAL CASE: if a bone end is protruding, build up pads of clean, soft, non-fluffy material around the bone until you can bandage over it without pressing on the injury

TREATING AN OPEN FRACTURE

1. Cover the wound with a sterile dressing; apply pressure around the injury to control bleeding

2. Carefully place a sterile dressing/ padding over and around dressing3. Secure dressing & padding with a bandage4. Immobilize injured part as for a closed fracture5. Treat victim for shock; monitor/ record vital signs; check circulation

every 10 minutes

DISLOCATED JOINT• Partially/ completely pulled out of their normal position

• Strong force• Abnormal position• Violent muscle contraction

• Usually affects shoulder, knee, jaw or thumb/fingers• May be associated with torn ligaments• Recognition:

• “sickening” severe pain• Inability to move jt • Swelling/ bruising• Shortening, bending/ deformity

• Aims:• Prevent movement at injury site• Arrange removal to hospital with comfortable support

DISLOCATED JOINT

• Caution: • Do not try to replace a dislocated bone into its socket• Do not move the victim until the injured part is secured & supported• Remove bracelets, rings & watches• Do not allow victim to eat/ drink

1. Advise victim to keep still; help to support injured part in a comfortable position

2. Immobilize 3. Extra support- secure limb to body4. Arrange to take/ send to hospital; monitor/ record vital signs5. Check for circulation (10 minutes)

STRAINS & SPRAINS

• Injury frequently associated with sports (soft tissue)• Occur when tissues are overstretched & partially/ completely torn

(ruptured) by violent/ sudden movements• Strains & sprains should be treated initially by RICE• R- rest• I-ice• C- compression• E- elevation

• Any doubt- treat as a fracture

Strains & Sprains

Muscle & Tendon Injury• Strain, ruptured or bruised• Strain= muscle is overstretched• Example: Gastrocnemius tear

Ligament Injury• Sprain= stretching/ tearing of a

ligament• Sudden/ unexpected wrenching

motion• Example= sprained ATF ligament

in ankle

STRAINS & SPRAINS

• Recognition:• Pain & tenderness• Difficulty in moving the injured part• Swelling & bruising

• Aims:• Reduce swelling & pain• Obtain medical help if necessary

1. Help victim sit/ lie down; support injured part (preferably raised)2. Cool the area (cold compress)3. Apply comfortable support4. If pain is severe/ unable to move injured part take/ send to hospital

STRAINS & SPRAINS

FACIAL INJURY

• Fractures of facial bones are usually due to hard impacts• Main danger= blood, saliva, or swollen tissue may obstruct airway• Always assume there is damage to the skull, brain or neck• Recognition:• Pain • Difficulty speaking, chewing or swallowing• Difficulty breathing• Swelling & deformity • Bruising • Clear fluid/ watery blood from nose or ear

FACIAL INJURY

• Aims:• Keep airway open• Minimize pain & swelling (edema)• Arrange urgent removal to hospital

• Caution: • Never place bandage around lower part of face/ jaw in case victim vomits or

has difficulty breathing• Do not allow victim to eat/ drink• If unconscious but breathing= recovery position• Not breathing= begin CPR

• Be aware of the risk of neck injury

FACIAL INJURY

1. Call 911 for emergency help2. Help the victim sit down & make sure the airway is open & clear3. Ask the victim to spit out any blood/ displaced teeth4. Gently place a cold compress against victim’s face to help reduce

pain & swelling5. Monitor/ record vital signs

COLLAR BONE INJURY

• It is rare for a collar bone to be broken by direct blow• Usually from indirect force transmitted from an impact at the

shoulder or passing along the arm• Young people• Recognition: • Pain & tenderness• Swelling & deformity

• Aims: • Immobilize jt• Arrange transportation to hospital

COLLAR BONE & SHOULDER INJURY

1. Help victim sit down; gently place injured arm across the body & support the elbow

2. Support with an arm sling3. Extra support= secure arm to chest 4. Arrange to take to hospital

Upper arm & elbow injury

RIB INJURY

• Direct force or crush injury• Breathing may be seriously impaired• May injure internal organs• Internal bleeding• Recognition:

• Bruising & swelling• Pain• Shallow breathing• Signs of internal bleeding & shock

• Aims:• Support chest wall• Arrange transportation to hospital

HIP & THIGH INJURIES

• Most serious injury of the femur= fracture• Considerable force• Can pierce major blood vessels• Severe blood loss• Shock

• Recognition: • Pain • Inability to walk (antalgic gait)• Signs of shock• Shortening of the leg & turning outward of the knee & foot

• Aims: • Immobilize limb• Arrange urgent removal to hospital

FRACTURED PELVIS

• Indirect force• May be complicated by injury to tissues & organs• Shock• Recognition:

• Inability to walk/ stand• Pain & tenderness in groin region• Difficulty/ pain with urinating • Signs of shock & internal bleeding

• Aims:• Minimize risk of shock• Arrange urgent removal to hospital