Musculoskeletal Injuries Chapter 20, Section 1 Musculoskeletal Injuries

Objectives 20.1.1 Describe the functions of the following structures: bones cartilage joints muscles synovium tendons 20.1.2 Describe the physiology of human movement. continued

Objectives 20.1.3 Describe how musculoskeletal tissues heal. 20.1.4 List the six types of musculoskeletal injuries. 20.1.5 Compare and contrast sprain and strain. 20.1.6 Describe two classifications of fractures. continued

Objectives 20.1.7 List the signs and symptoms of sprains and fractures. 20.1.8 Define the following terms: dislocation fracture sprains

Topics Anatomy and Physiology Physiology of Human Movement Common Musculoskeletal Injuries

Case Presentation A male teenager is found on the snow below a jump. He is wearing twin tipped skis and a helmet. He complains that his right thigh hurts “very bad”, and you notice that his right forearm is also angulated. His buddies report that he landed “hard.”

Anatomy and Physiology Bones – the skeleton Joints – the motion Muscles – the power

The Skeleton Provides structure and protection Axial skeleton – skull, vertebrae, and thoracic cage Transfer weight from upper to lower body Responsible for upright position Appendicular skeleton – shoulder, arm, pelvis, legs Responsible for movement continued

The Skeleton continued (a) The appendicular skeleton. (b) The axial skeleton. continued

The Skeleton Types of Bones Long: Humerus, radius, ulna, femur, tibia, fibula Breaks at epiphyseal line (growth plate) can be serious for growing children Flat: Skull, scapula, ribs, sternum, pelvis Irregular: Vertebrae, wrist, hands, ankle, feet, patella

The Skeleton Three major types of bones according to shape.

Joints Joint: Two bones and the connective tissues that surround, support, and stabilize it called the joint capsule. Synovial fluid in the joint capsule lubricates joints.

Joints Range/type of motion depends on type of joint: Ball and socket Hinge Gliding Pivot Suture

Joints • Types of freely movable joints. • An example of a suture joint.

Ligaments and Tendons Ligaments connect bone to bone, form part of joint capsule Restrict the motion of the joint Tightness/laxity help determine extent of movement Tendons connect muscle to bone Both can be stretched or torn Stability and function suffer

Ligaments and Tendons • The anatomy of the knee. Ligaments connect bone to bone and are an essential part of the skeletal system. • Flexion and extension are the two main movements of the elbow.

Muscles Tissue contracts and relaxes – often work in pairs Controlled by nervous system – spinal and peripheral Three types: Skeletal (voluntary) Smooth Cardiac

Muscles The three types of muscle.

Physiology of Movement Skeletal muscle message is “contract” Signal provided by nerves May be voluntary or involuntary Pairs work in coordination to flex and extend joints

The Healing Process Factors are extent of damage, age, nutrition, overall health Bone healing requires nutrients, oxygen, and immobilization Muscles and ligaments heal slowly Tendons need protection during healing Cartilage does not heal, it is often removed

The Healing Process Copyright Nancy Pitstick An X-ray of a lower leg showing surgical hardware and a surrounding cast. Copyright Nancy Pitstick

Common Musculoskeletal Injuries Sprain Stretching or tearing of a ligament Tears may need surgery Joint is displaced beyond its normal alignment continued

Common Musculoskeletal Injuries Strain Stretched or torn muscle Overexertion or poor body mechanics May range from minor to severe Strain versus Sprain You strain a muscle or tendon and sprain a ligament. continued

Common Musculoskeletal Injuries Tendon rupture Active motion of joint may be lost Fracture Break in a bone May be open or closed May be displaced or non-displaced May be associated with internal or external bleeding continued

Common Musculoskeletal Injuries Two zones of injury. One is at femur fracture site, and the other is at the tibial fracture site. continued

Common Musculoskeletal Injuries Dislocation Separation or displacement of bones at a joint Usually the result of forceful trauma Multiple structures and surrounding tissues may be injured in a single event Soft tissues, nerves, and blood vessels may be involved

Types of Fractures Butterfly Comminuted Compression Epiphyseal Greenstick Impacted continued

Types of Fractures Oblique Pathologic Spiral Transverse

Types of Fractures Types of fractures.

Possible Blood Loss from Fractures Pelvis (1300-1500 ml) Femur (500-1000ml) Humerus (300-500ml) Tibia/Fibula (150-250ml)

Case Update You perform a primary assessment. The patient states that he caught “way too much air and crashed.” The patient’s respiratory rate is 16 and his left radial pulse is 100 and strong, but the radial pulse in his injured right arm is absent. You immediately call for assistance, a long spine board, a splint for the femur and transportation to the first aid room. Because of the mechanism of injury, the lack of a right radial pulse, and the fact that ground transport to definitive care will take over 2 hours, you radio for air transport. Discussion Points: Take the students to part 2 of this chapter for discussion.