Chapter 4- Wound Care Anatomical Position Directional Terms- 3 Planes Fig 4-1 Sagittal or AP – Right/Left Transverse or horizontal – Top/Bottom Frontal or Lateral – Front/Back Table 4-1-Read and Understand

Terms in Use The neck is __ to the head The thumb is ___ to the middle finger The knuckles are ___ to the elbow The outer ear is ___ to the ear drum The eyes are on the ___ the head The ankle is on the ___ part of the body

Terms In Use Cont The patella is _________ to the ACL The shoulder blade is on the ________ and _________ aspects of the body The heart is ________ to the chest muscles The triceps are on the _________ aspect of the body.

Skin Anatomy First layer of defense against injury; most frequently injured body tissue Needed to protect against bleeding and infection Two major region Epidermis-superficial layer- Multi-Layered -contains skin pigment, hair, nails and sweat glands Dermis-Deep layer- contains hair follicles, blood vessels, nerve endings Resist compression, tension, and shear type forces

Soft Tissue Injuries Fig 4-3 Abrasion = scrape (shear force) (1st) Blisters = repeated shear force (1st) Skin bruises (contusions) = Compression force (1st/2nd) Incision = clean cut (1st/2nd) Laceration = jagged cut (1st/2nd) Avulsion = loss of tissue (1st/2nd) Puncture = sharp object penetrates skin (1st/2nd)

Care of Soft Tissue Injuries Wear Gloves Apply direct pressure with a sterile dressing if possible (Let athlete assist you when possible) Clean the wound with saline or soap water Apply ointment-Triple Antibiotic and dressings that extends past the wound Secure with pre-wrap and tape (Check for circulation Change dressings daily and look for signs of infection (redness – red streaks, heat, pus, pain) Wash hands when you are finished

Muscles and Tendons Muscle Fibers are surrounded by Endomysium (Inner) Small amount of fibers make up fascicles surrounded by Perimysium (Middle) A muscle is made up of a number of fascicles which are surround by Epimysium (Outer) Muscle Sheath

Muscles and Tendons Purpose- movement, maintaining posture, stabilizing joints, and generating heat as they contract Extensibility = Ability to stretch/increase in length Elasticity = Ability to return to normal length after lengthening/ shortening

Tendons Tendons- assist in movement of body part Connect muscle to bone Collagen or tissue is in parallel pattern High resistance to unidirectional forces Patella, Achilles, Biceps

Muscle contractions Concentric Contraction Eccentric contraction = muscle shortening against resistance Eccentric contraction = muscle lengthening against resistance Isometric contraction = no change in length, no joint movement Isotonic contraction = change in length, joint movement

Muscle stretching Figure out muscle and its action(s) Stretch in opposite direction Stabilize body Hold stretch at least 20s Three kinds of stretching Ballistic (bouncing) Want to avoid this type Static –Hold in a position for at least 20 secs PNF Stretch, Contract, Stretch

Soft tissue injury classifications Contusions Severity depends on depth and tissue affected 1st degree = little or no ROM restriction; slight discoloration, pain w/ movement, pt tender 2nd degree = moderate ROM restriction; S/S increase 3rd degree = severe ROM restriction; S/S increase Muscle cramps/spasm Myositis/ fasciitis

Soft tissue injury classifications Strain = injury to muscle or tendon Tendonitis (tendon) Tenosynovitis (synovial sheath over tendon) Myositis ossificans (muscle to bone) Cacific tendonitis (tendon to bone) Bursitis (bursae)

Categories of Strains Table 4.2 1st degree: some pain, microtears of collagen, mild symptoms: pn, point tenderness, swelling, ROM decreased 2nd degree: More tissue destruction, moderate symptoms, joint laxity/instability, muscle weakness, increased ROM loss, ecchymosis (tissue discoloration). 3rd degree: Severe tissue destruction, severe symptoms, complete instability, loss of ROM, palpable defect (early), ecchymosis

Joints Meeting of two bones Various types of joints –fibrous, cartilaginous, and SYNOVIAL Synovial- most common; freely moveable; all joints of the limbs fall into this class Features of a synovial joint –Fig 4-6 Articular Cartilage-protects the ends of your bones Joint Cavity- Space between bones which is filled w/ synovial fluid Articular Capsule-Surrounds the joint cavity Synovial Fluid-Lubricates the joint and articular cartilage Reinforcing Ligaments-ACL, PCL, LCL, MCL

Range of Motions (ROM) Box 4-1/Fig 4-7 Flexion/Extension Dorsiflexion/Plantar Flexion Abduction/Adduction Circumduction Rotation Supination/Pronation Inversion/Eversion Protraction/Retraction Elevation/Depression Opposition

Joint Injuries Sprain = injury to ligament; mechanism of injury- twisting, direct contact, dynamic overload, 3 degrees (See table 4.3) Subluxation-Partial displacement of the joint surface; structure damage does occur; check a distal pulse Dislocation-displacement of joint; major structure damage, instable joint, severe pain, loss of ROM; check distal pulse

Treatment To Closed Tissue Injuries Apply Ice with a compression wrap immediately for at least 20 minutes; check for a distal pulse If no fracture suspected elevate body part Repeat the process every 1-2 hours NSAIDS if able Supply Crutches if necessary Continue Ice Application up to 72 hours Keep body part wrap with compression Refer to physician if necessary

Bones Purpose-support, protection, reservoir for minerals for the bulk of blood cells, aid in movement w/ muscles Bone Classification: Long-consist of a shaft and 2 ends; all bones of limbs fall into this category Short-cubelike; bones of wrist and ankle Flat-flat, thin and usually a bit curved; ribs and sternum Irregular-don’t fit into any of the above categories; vertebrae and hip bones

Bone Anatomy Structure of Bones: Diaphysis-shaft of bone Epiphyses-located at the ends of bones; larger than diaphysis; in adolescents there is a cartilaginous disc where bone growth occurs, this fuses with the diaphysis and forms the epiphyseal line at 18.

Bone Anatomy Cont Membranes Inside bone- contains bone marrow periosteum-outer layer of bone where tendons/lig attach Endosteum- inner layer of bone Inside bone- contains bone marrow

Bone injuries Fracture = Disruption in continuity of a bone = break Simple = skin remains intact Compound = skin integrity compromised See types of fractures, pg. 53 & 56 Stress fractures (repeated low-magnitude forces)

Fractures C/S-direct contact, fall, dynamic overload Signs: swelling, bruising, deformity, shortening of the limb, crepitus, disability Types-open (c),closed (s), transverse, epiphyseal, avulsion Five ways of recognizing fracture: Figure 4-12 Palpation Percussion Vibration Compression (be careful) Distraction (be careful)

Treatment Splint before moving-Follow 1st Aid/Safety Rules Types of splints: Anatomic Stiff/rigid Soft Vacuum Check feeling, warmth, and color before and after splinting Refer for X-rays