1 Musculoskeletal System Temple College EMS Professions Musculoskeletal

1 Musculoskeletal System Temple College EMS Professions

Musculoskeletal System w w w Bones Muscles Cartilages Tendons Ligaments 2

Skeleton w w w Support against gravity Movement Protection Production of blood cells Storage of calcium, phosphorus 3

Skull w Cranium • • Frontal Parietal Temporal Occipital w Face • • Mandible Maxilla Zygoma Nasal bones 4

Spinal Column w w w Cervical: 7 vertebrae Thoracic: 12 vertebrae Lumbar: 5 vertebrae Sacrum: 5 vertebrae (fused) Coccyx: 4 vertebrae (fused) 5

Thorax 12 pairs of ribs w Sternum w Protects heart, lungs w 6

Pelvis Bony ring w Two innominate bones, each made of 3 fused bones w • Ilium • Ischium • Pubis 7

Lower Extremity w w w w Femur (largest bone in body) Patella (knee cap) Tibia (shin bone) Fibula Tarsals Metatarsals Phalanges 8

Upper Extremity w Shoulder girdle • Scapula • Clavicle w w w Humerus Radius Ulna Carpals Metacarpals Phalanges 9

Muscles Maintain posture, allow movement w 3 types: w • Skeletal (Striated) • Smooth (Involuntary) • Cardiac 10

Skeletal Muscles Voluntary muscles w Attach to bones by tendons that cross joints w Shortening of muscle moves joint w 11

Smooth Muscles Carry out involuntary movements w Located in walls of: w • • GI tract GU tract Respiratory tract Blood vessels 12

Cardiac Muscle Found only in heart w Automaticity w Can initiate own contractions without external stimulation w 13

Joints Joining points of bones w Bone-ends covered with cartilage w Ligaments connect bone-to-bone w Inner surface of joint capsule lined with synovial membrane w • Produces synovial fluid • Lubricates joint 14

15 Extremity Trauma Temple College EMS Professions

Fracture w Break in bone’s continuity 16

Fracture Causes Direct force w Indirect force w Twisting forces (torsion) w Diseases of bones (pathological fractures) w • Osteoporosis • Tumors 17

Open vs. Closed Fractures Closed = skin over fracture site intact w Open = break in skin over fracture site w • 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 Transverse: fracture is at 90 o angle to shaft w Oblique: fracture is at an angle other than 90 o to shaft w Spiral: fracture coils through shaft of bone like a spring w 20

Fracture Types Impacted: bone ends driven into each other w Comminuted: bone broken into > 3 pieces w 21

Fracture Types w 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 Deformity w Tenderness w • Usually point tenderness • Overlies fracture site w Inability to use limb • Reliable sign of significant injury if present • Reverse is not true 23

Fracture Signs Swelling, ecchymosis w Exposed fragments w Crepitus w • Grating of bone ends • May be heard or felt • Do NOT actively seek 24

Dislocation w Displacement of bones from normal positions at joint 25

Dislocation Signs Deformity w Swelling, ecchymosis about joint w Pain/tenderness in joint w Loss of motion usually perceived as “locked” joint w 26

Sprains Partial, temporary dislocations w Result in tearing of ligaments w Bone ends NOT displaced from normal positions w 27

Sprain Signs Tenderness w Swelling, ecchymosis w Inability to use extremity w No deformity w 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 “Muscle pull” w Injury to musculotendenous unit w Pain on active motion w Pain not present on passive motion w 30

Assessment Perform initial (primary) assessment w Locate, treat life-threats w Assess for injuries of head, chest, abdomen, pelvis w Assess distal neurovascular function w 31

Assessment With exception of pelvic, possibly femur fractures, orthopedic injuries are NOT lifethreatening. w Do NOT let spectacular orthopedic injury distract you from ABCs w It’s the unobvious things that kill patients! w 32

Assessment w Evaluation must ALWAYS be done of distal neurovascular function. • • • Pulse Skin color Capillary refill Sensation Movement 33

Management w Splinting • Prevents further movement at injury site • Limits tissue damage, bleeding • Eases pain 34

Management w When in doubt SPLINT w It is difficult to differentiate fractures, dislocations and sprains 35

Principles of Splinting Do NOT move patients before splinting unless patient is in danger w Remove clothes to allow inspection of limb w Note, record distal neurovascular function before, after splinting w 36

Principles of Splinting Cover wounds with dry, sterile compression dressings w Fractures: splint joint above, below fracture w Dislocations: splint bone above, below joint w 37

Principles of Splinting Minimize movement w Support injury until splinting completed w Pad splint to avoid local pressure w 38

Principles of Splinting w Angulated fractures • Realign before splinting • If resistance, pain encountered stop, immobilize as is w Dislocations • Splint as is unless circulation compromised • Attempt to reposition once to restore pulse • If resistance, pain encountered stop, immobilize as is 39