1. 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

2. 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

3. 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.

4. 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

5. 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)

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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)

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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)

23. 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)

24. 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