1. Chapter 20: Musculoskeletal Injuries

2. Objectives: Describe the functions of the following structures:
bones
cartilage
joints
Describe the physiology of human movement
describe how musculoskeletal tissues heal
list the six types of musculoskeletal injuries
compare and contrast sprain and strain
list the signs and symptoms of sprains and fractures
define: dislocation, fracture, & sprain
muscles
synovium
tendons

3. Musculoskeletal system - allows body to perform organized movement and stand/walk upright

4. Anatomy & Physiology

5. The Skeleton 3 skeletal functions:
Provide a rigid framework to protect the internal organs
Maintain body’s form
Produce blood cells
Skeleton consists of bones, connective tissue, and cartilage
Divided into 2 major parts:
Axial: skull, vertebrae, and thoracic cage (80 bones)
Appendicular: bones of the shoulders, arms, pelvis, and legs (126 bones)

6. Bones 3 TYPES: 1. Long – produce blood, stem, and immune cells
upper extremities: humerus, radius, ulna
lower extremities: femur, tibia, fibula
Flat – protect organs
skull, scapula, upper extremities, ribs, sternum, pelvic bones
Irregular – 2 or more functions (ex. Wrist)

7. PARTS OF BONES...AND HOW THEY CONNECT
periosteum = the thin outer covering of a bone
cortex = hard outer layer of a bone (contains bone marrow where blood cells are made)
cartilage = tough, elastic, fibrous, connective tissue found in various parts of the body (incl. joints, outer ear, end of nose)
articular cartilage = cartilage that is affixed to the end of a bone within a joint
·epiphiseal line = fractures along this line can affect growth/development

8. Joints Joints: site where 2 or more bones make contact
Joint capsule: a sheet of fibrous connective tissue enclosing a synovial joint
Synovium: the inner lay of the joint capsule whose cells make a viscous fluid that lubricates joints
Types of joints:
Ball and socket: movement in multiple planes
Hinge: movement in one plane; flexion and extension
Gliding
Pivot
Suture (fixed)
The joint capsule contains synovial fluid (made by the synovium), which helps the bones move freely within the joint capsule
Freely movable: include the hip, knee, elbow, and shoulder joints
Slightly movable: joints between vertebrae
Minimal movement: joints that permit little movement due to thickened fibrous ligaments
Ball and socket: allow for extension, flexion, abduction, and adduction (shoulder and hip)
Hinge: only allow extension and flexion (elbow, knee, and finger)
Gliding: allow bones to slide over one another (wrist, ankle)
Pivot: allow one bone to rotate on another (joint at base of thumb)
Suture: permit little to no motion (joints in the skull that close)

9. Ligaments & Tendons
Ligaments: thick bands of tissue that connect two bones together (restrict motion of bones)
By holding bones together they provide structure and stabilize the skeleton
Tendons: straplike continuations of a muscle that connect a muscle to a bone
Transmits the force of contracting muscle to the bone
ligaments
Restrict joint movement to the normal range of motion
Provide structure and stabilization
The extent to which a joint can move is determined by the degree of tightness/laxity of the ligaments and capsule
Knee: 2 ligaments; femur to tibia medially and laterally
Shoulder: only a few restrictive ligaments → able to move in several directions
tendons
Damage to tendons through overstretching/tearing
Damage to tendon can affect muscle

11. Muscle
A unique type of tissue that, when stimulated, has the ability to contract
Combination of contraction and relaxation allows for the body to move
Divided into complementary pairings
3 types of muscle:
Skeletal muscle (voluntary muscle): under direct voluntary control of the brain
Smooth muscle (involuntary muscle): performs most actions that are not controlled by conscious thought
Cardiac muscle: unique type of involuntary muscle that is found only in the heart
Complementary pairings: bicep and tricep; contraction of bicep allows us to flex elbow, contraction of triceps allows us to extend the elbow
Skeletal: arterial blood delivers oxygen and nutrients to muscles and veins carry away waste
Smooth: Found in the walls of the GI tract, blood vessels, bronchi
Contraction of smooth muscles controls blood and oxygen flow

12. Physiology of Movement

13. Physiology of Movement
skeletal muscles receive a signal from brain to contract (either voluntary or involuntary), either flexing or extending a joint (which, since attached to bones move bones)
muscles often paired, one relaxes while the other contracts
when repeated, this process results in sustained body movement

14. Healing Process
bones and other tissues are able to generate new tissue
ability to heal depends on extent of damage, age, overall health)
Bone: break causes bleeding hematoma forms and organizes into a callus → eventually forms bone as calcium is deposited
o Immobilization (the process of holding an object in place as for a fracture by a cast or internal orthopedic hardware) is necessary for healing
Healing Speeds:
Muscles: healing slow (SLOWER TO HEAL THAN BONE) and generally involves fibrous scar tissue
Ligament and tendon: slow healing
always heal w/ some scar tissue
Cartilage does not heal b/c little blood supply (if injured, usually removed)-why if you pierce the cartilaginous parts of your ear it doesn’t heal

15. Common Musculoskeletal Injuries

16. Involves the stretching or tearing of a ligament
Injury
Definition
Cause
Sprains
Involves the stretching or tearing of a ligament
Occurs when a joint is displaced beyond its normal range of motion
Strains
Stretched or torn muscle - “pulled muscle”
Often caused by overexertion or poor body mechanics
Ruptured Tendons
Damage to either muscle tissue or a tendon
Caused by sudden and forceful contraction of a muscle; likelihood increased by poor body mechanics
Fractures
Break in a bone
Closed or open
Displaced or nondisplaced
Incomplete or complete
Most are caused by trauma, but may also result from bone disease
Dislocations
Separation or displacement of the bones of a joint
Usually caused by forceful trauma
zone of injury: area close to or surrounding an injury of an extremity
Mild sprains heal quickly; more serious sprains require surgery
May occur with other MS injuries
Wrist, knee, ankle
Common strains include hamstring and biceps
Fractures
Closed: overlying skin surface is not disrupted
Open: overlying skin has been opened
Nondisplaced: ends of the bone remain in alignment
Displaced: Causes affected extremity to appear crooked or bent
Complete: bone surfaces are completely separated
Incomplete: fracture line does not penetrate the entire bone
o subluxation: a joint that partially dislocates and returns to normal
can also be completely dislocated and locked

17. Not Pictured: Compression, Epiphyseal, Pathologic, Butterfly
Transverse: straight across the bone
Oblique: runs through the bone at an angle
Spiral: Twisting force causes a spiral-shaped injury in a long bone
Greenstick: bone bends like a stick from a young tree branch; most common in children
Comminuted: fracture that has 3 or more fragments
Butterfly: trauma to one side of a bone causes a triangular, wing-shaped piece to break off the other side
Compression: fracture when the bone becomes shortened into itself (results when axial load is put on bone --> occurs in vertebrae)
Epiphyseal: fracture of bone’s growth place near the end of bone
Pathologic: fracture in an area of diseased or damaged bone; seen in cancerous or old bone

18. Assessment
DANIELLE
-scene size up
patient assessment: ABCDS

19. Signs & Symptoms of Common MS Injuries
Sprains
Point tenderness over the injured ligaments
Swelling and bruising within the zone of injury
Joint instability (abnormal motion of the affected joints)
Decreased motion due to pain, swelling, and/or ligament instability
Difficulty bearing weight on the injured joint (in the lower extremities)
Ruptured tendons
A noticeable “gap” under the skin where the tendon has ruptured
Minimal pain due to minimal nerve involvement
Little bruising or swelling
Lack of joint movement
Fractures
Pain at the fracture site that worsens upon movement of the affected bone
Tenderness to palpation
Swelling due to internal bleeding from the fracture site
Ecchymosis
Decreased motion due to pain, and lack of bone continuity
Deformity due to bone misalignment
Bone crepitus
signs and symptoms
o guarding
o swelling/bruising
o point tenderness
o ruptured tendons: gap under skin where tendon should be
o fracture: bone crepitus (crackling sound/feeling à due to bone rubbing one bone)

20. Signs & Symptoms continued
Dislocations
Pain
Swelling
Deformity
Reduced joint motion
Joint “locking” or “freezing”

21. DCAP-BTLS D- deformities C - contusions A - abrasion/avulsions
P - punctures/penetrations
B - burns/bleeding/bruises
T - tenderness
L - lacerations
S - swelling
avulsion = chunk of tissue partially or completely torn

22. Treatment Splinting: decreases movement decreases pain
improves anatomical alignment
prevents further damage
facilitates transport
Types of splints used at the Bowl:
Soft splints: sling and swathe splints
Blanket Roll/Pillow splint
Rigid/semi-rigid splints:
Cardboard splints
Quick splints
Traction splints

23. ANY QUESTIONS?
Middlebury Snow Bowl