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Musculoskeletal System

Temple College

EMS Professions

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Musculoskeletal System

Bones Muscles Cartilages Tendons Ligaments

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Skeleton

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

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Skull

Cranium• Frontal• Parietal• Temporal• Occipital

Face• Mandible• Maxilla• Zygoma• Nasal bones

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Spinal Column

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

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Thorax

12 pairs of ribs Sternum Protects heart, lungs

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Pelvis

Bony ring Two innominate bones, each made of 3

fused bones• Ilium• Ischium• Pubis

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Lower Extremity

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

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Upper Extremity Shoulder girdle

• Scapula• Clavicle

Humerus Radius Ulna Carpals Metacarpals Phalanges

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Muscles

Maintain posture, allow movement 3 types:

• Skeletal (Striated)• Smooth (Involuntary)• Cardiac

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Skeletal Muscles

Voluntary muscles Attach to bones by tendons that cross joints Shortening of muscle moves joint

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Smooth Muscles

Carry out involuntary movements Located in walls of:

• GI tract• GU tract• Respiratory tract• Blood vessels

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Cardiac Muscle

Found only in heart Automaticity Can initiate own contractions without

external stimulation

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Joints

Joining points of bones Bone-ends covered with cartilage Ligaments connect bone-to-bone Inner surface of joint capsule lined with

synovial membrane• Produces synovial fluid• Lubricates joint

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Extremity Trauma

Temple College

EMS Professions

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Fracture

Break in bone’s continuity

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Fracture Causes

Direct force Indirect force Twisting forces (torsion) Diseases of bones (pathological fractures)

• Osteoporosis• Tumors

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Open vs. Closed Fractures

Closed = skin over fracture site intact Open = break in skin over fracture site

• 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

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Fractures

One of the most important things we do in EMS is prevent closed

fractures from becoming open ones

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Fracture Types

Transverse: fracture is at 90o angle to shaft Oblique: fracture is at an angle other than

90o to shaft Spiral: fracture coils through shaft of bone

like a spring

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Fracture Types

Impacted: bone ends driven into each other Comminuted: bone broken into > 3 pieces

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Fracture Types

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?

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Fracture Signs

Deformity Tenderness

• Usually point tenderness• Overlies fracture site

Inability to use limb• Reliable sign of significant injury if present• Reverse is not true

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Fracture Signs

Swelling, ecchymosis Exposed fragments Crepitus

• Grating of bone ends• May be heard or felt• Do NOT actively seek

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Dislocation

Displacement of bones from normal positions at joint

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Dislocation Signs

Deformity Swelling, ecchymosis about joint Pain/tenderness in joint Loss of motion usually perceived as

“locked” joint

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Sprains

Partial, temporary dislocations Result in tearing of ligaments Bone ends NOT displaced from normal

positions

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Sprain Signs

Tenderness Swelling, ecchymosis Inability to use extremity No deformity

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Sprains

Degree of joint dislocation at time of injury cannot be determined

during exam

Extensive damage to neural or vascular structures may have

occurred

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Strains

“Muscle pull” Injury to musculotendenous unit Pain on active motion Pain not present on passive motion

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Assessment

Perform initial (primary) assessment Locate, treat life-threats Assess for injuries of head, chest, abdomen,

pelvis Assess distal neurovascular function

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Assessment

With exception of pelvic, possibly femur fractures, orthopedic injuries are NOT life-threatening.

Do NOT let spectacular orthopedic injury distract you from ABCs

It’s the unobvious things that kill patients!

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Assessment

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

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Management

Splinting• Prevents further movement at injury site

• Limits tissue damage, bleeding

• Eases pain

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Management

It is difficult to differentiate fractures, dislocations and sprains

When in doubt

SPLINT

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Principles of Splinting

Do NOT move patients before splinting unless patient is in danger

Remove clothes to allow inspection of limb Note, record distal neurovascular function

before, after splinting

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Principles of Splinting

Cover wounds with dry, sterile compression dressings

Fractures: splint joint above, below fracture Dislocations: splint bone above, below joint

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Principles of Splinting

Minimize movement Support injury until splinting completed Pad splint to avoid local pressure

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Principles of Splinting

Angulated fractures• Realign before splinting• If resistance, pain encountered stop, immobilize as is

Dislocations• Splint as is unless circulation compromised• Attempt to reposition once to restore pulse• If resistance, pain encountered stop, immobilize as is