Muscle and Bone Injuries Jennifer L. Doherty, MS, ATC, LAT, CIE Academic Program Director, ATEP Florida International University Management of Medical Emergencies

Introduction  Muscle and Bone injuries are often painful but rarely life threatening  When not recognized, muscle and bone injuries may have serious consequences  Some muscle and bone injuries could result in permanent disability

Musculoskeletal System Review  206 bones in the body  Bone consists of hard, dense tissue  Contain blood vessels and nerves  Functions:  Protection  Locomotion

Musculoskeletal System Review  Over 600 muscles in the body  Skeletal muscles attach to bones  Contain blood vessels and nerves  Function to produce movement via contraction/relaxation

Common Signs and Symptoms  Pain  Swelling  Deformity  Discoloration  Loss of function  Audible “pop” or “snap”  Call 911 immediately if the injury….  Involves protruding bone fragments  Impairs breathing  Involves multiple muscle and bone injuries

General Treatment  R est  I ce  C ompression  E levation

General Treatment  Treat serious injuries as if there is a possible fracture  Immobilization

Bone Injuries  Comminuted Fracture  3 or more fragments  MOI:  Hard, direct blow  Fall in awkward position

Bone Injuries  Depressed Fracture  Often occurs in flat bones  MOI:  Falling on hard, immovable surface  Hit with a hard object

Bone Injuries  Greenstick Fracture  Incomplete break  Occurs in immature bone that has not completely ossified

Bone Injuries  Impacted Fracture  Bone is compressed  MOI:  Fall from a height  Immediate splinting and traction are required

Bone Injuries  Longitudinal Fracture  Bone splits along its length  MOI:  Jumping from a height

Bone Injuries  Oblique Fracture  Twisting injury  MOI:  Twisting on end of the bone while the other end is stabilized

Types of Fractures  Serrated Fracture  Two bone fragments have a sawtooth, sharp-edged fracture line  MOI:  Direct blow  Extensive internal damage may result  Severed blood vessels and/or nerves

Types of Fractures  Spiral Fracture  S-shaped separation of bone  MOI:  Foot is firmly planted and the body is rotated in the opposite direction

Bone Injuries  Transverse Fracture  Straight fracture line at a right angle to the bone shaft  MOI:  Direct blow

Bone Injuries  Contrecoup Fracture  Fracture that occurs on the side opposite of the trauma site

Bone Injuries  Stress Fracture  Exact MOI is unknown  Possible MOIs:  Overload caused by muscle contractions  Altered stress distribution in bone due to muscle fatigue  Change in ground reaction forces  Performing rhythmic, repetitive movements

Bone Injuries  Treatment of Bone Injuries  When in doubt, treat the injury as a possible fracture  Splint and support to prevent further injury  Refer

Muscle Injuries  Contusions  Acute muscle injury  MOI:  Direct blow  S/S  Hematoma  Pain  Ecchymosis  First degree  Mild ↓ in ROM  Second degree  Moderate ↓ in ROM  Third degree  Severe ↓ in ROM

Muscle Injuries  Strain  Stretch, rip, or tear in a muscle or tendon  MOI:  Too forceful a contraction  Overstretching

Muscle Injuries  First Degree Strain  S/S  Local pain  Minor loss of strength  Mild edema  Mild ecchymosis  Second Degree Strain  S/S  Impaired muscle function  Moderate loss of strength  Moderate edema  Moderate ecchymosis

Muscle Injuries  Third Degree Strain  S/S  Loss of muscle function  Palpable defect in the muscle  Severe loss of strength  Severe edema  Sever ecchymosis

Muscle Injuries  Muscle Cramp/Spasm  A painful involuntary contraction  MOI:  Lack of salt or other minerals  Muscle fatigue  Trauma

Muscle Injuries  Acute Onset Muscle Soreness  Over-exertional muscle problem  MOI:  Impeded circulation causing ischemia  Lactic acid and K+ build-up  S/S subside immediately after exercise has ceased

Muscle Injuries  Delayed Onset Muscle Soreness (DOMS)  Over-exertional muscle problem  MOI:  Muscle fiber damage  S/S increase in intensity for 2-3 days after exercise  S/S usually subside within 7 days

Muscle Injuries  Treatment  R est  I ce  C ompression  E levation

Joint Injuries  Sprain  Injury to ligamentous or capsular tissue  A tendon may also be involved  MOI:  Overstretching and tearing of ligamentous or capsular tissue

Joint Injuries  First Degree Sprain  S/S  Mild pain/point tenderness  Mild ↓ in function  Little or no edema  Normal ROM

Joint Injuries  Second Degree Sprain  S/S  Moderate pain/point tenderness  Moderate ↓ in function  Moderate edema  Slight-to-moderate joint instability

Joint Injuries  Third Degree Sprain  S/S  Severe pain/point tenderness  Severe ↓ in function  Severe edema  Severe joint instability  May involve a spontaneously reduced subluxation

Joint Injuries  Treatment for Sprains  R est  I ce  C ompression  E levation  Therapeutic rehabilitation  Surgery

Joint Injuries  Dislocation  Result due to forces that cause the joint to go beyond its normal anatomical limits  Two classes:  Subluxations  Luxations

Joint Injuries  Subluxation  Partial dislocation  Incomplete separation between 2 articulating bones

Joint Injuries  Luxation  Complete dislocations  Total separation between 2 articulating bones

Joint Injuries  S/S of Dislocations  Loss of limb function  Deformity  Edema  Point tenderness  May involve damage to the ligamentous and tendinous tissues surrounding the joint

Joint Injuries  Treatment of Dislocations  First time dislocations should be treated as a possible fracture  Splint and support to prevent further injury  Refer