Musculoskeletal Assessment

1
Musculoskeletal Assessment

• History
• Previous hx, MOI, acute vs chronic
• Inspection
• Antalgic gait, clothing removal?
• Palpation
• Always start away from injury site
• Special Tests

2
Assessment Decisions

• First aid required
• Splinting
• Type of transportation
• Physician referral
• RTP (limitations?)
• Padding, taping, bracing

3
Immediate Treatment

• Rest
• Ice
• Compression
• Elevation

4
JUST ICE IT!

• Why?
• Decrease pain/promote vasoconstriction to control
  hemorrhage and edema
• Reduces muscle guarding
• Decreases speed of nerve transmission

5
How to ice, ice, baby

• Bestice bag on skin with C and E
• At least 20
• Considerations sub-q fat?, superficial n.?
• First 48-72 hours post-injury
• Never use frozen gel packs
• Monitor for allergic rxn, frostbite

6
Compression

• Decreases swelling by mechanically reducing space
  available
• Should be maintained continuously
• Ace wrap, horseshoe pad, neoprene sleeve
• Always distal to proximal!!!!

7
Elevation

• Name that group!!!
• Eliminates the effects of gravity
• Assists in venous return
• The higher, the better

8
Splinting

• Splint any suspected fx before moving athlete to
  avoid increased tissue damage, hemorrhage, and
  shock
• Splint joints above and below the fx site
• Dress an open fx to avoid contamination

9
Rapid Form Vacuum Immob.

• Styrofoam chips in an airtight cloth sleeve that
  is pliable
• Can mold to shape of any joint
• Good for angulated fx
• Hand-held pump sucks air out of sleeve to give it
  rigidity

10
Air Splint

• Clear plastic splint, inflated with air to
  provide support and pressure
• Do not use if it will alter a fx deformity
• Good for extremity if non-angulated fx
• Provides clear view for x-ray

11
Half-Ring Traction Splint

• Difficult to masterused by EMTs
• Good for femur fx
• Once traction is applied, DO NOT DISCONTINUE!!!

12
Transportation Options

• FWB
• PWB (manual conveyance)
• Wheeled chair
• Stretcher
• Cart
• EMS
• Improper technique can cause further injury!

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Cane Fitting

• Athlete stands with good posture
• Measure from superior aspect of greater
  trochanter of femur to floor

14
Cane or Single Crutch Walking

• Hold cane or single crutch on UNINJURED side

15
Crutch Fitting

• Athlete stands with good posture
• 6 to the side
• 2 to the front
• 1 below the axilla
• Elbow at a 30 degree angle

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Tripod Walking

• Affected foot elevated
• Weight supported by hands, not axilla
• Crutch tip 12-15 inches ahead of feet
• Lean forward, straighten elbows, pull underarm
  crutch piece against side
• Swing through with unaffected limb, crutches
  follow

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Stairs

• Affected leg always moves with the crutches
• Up with the good, down with the bad OR
• Use handrail and both crutches in other hand

18
Documentation

• SOAP note vs.
• Progress note
• Compare current status to initial injury
• Use to monitor progress/sxs discharge from
  rehab change limitations

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Musculoskeletal Injuries

• Skin (largest organ system)
• Muscle/Soft Tissue
• Bone
• Nerve

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SKIN TRAUMA

• Blister?rubbing causes collection of fluid at the
  epidermal layer
• Abrasion?epidermis and dermis are scraped away,
  exposing capillaries
• Incision?skin has been sharply cut
• Laceration?skin has been irregularly torn

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SKIN TRAUMA

• Avulsion?laceration with tissue that is
  completely unattached (flap of skin)
• Puncture?deep penetration by a sharp object
  (infection always a concern)
• Contusion?crush injury that causes bleeding under
  the surface

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Five Signs of Inflammation or Latin 101

• Redness Rubor
• Warmth Calor
• Swelling Tumor
• Pain Dolar
• Loss of Function Functio Laesa

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Terms to Know

• Definition of etiology
• Difference between sign and sx
• Definition of sequela

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SOFT TISSUE TRAUMA

• Contusion?et direct blow sxs ecchymosis,
  edema, dec. function sequelaehematoma, myositis
  ossificans Rx RICE
• Strain?injury to muscle or tendon
• Sprain?injury to ligament

25
SOFT TISSUE TRAUMA

• Dislocation?
• et joint forced beyond anatomical limit
• sxs loss of function, deformity, PT
• sequelae fx
• Rx splint, x-ray, reduce
• Subluxation?dislocation that self-reduces
• treat symptomatically
• usually a lifer unless addressed surgically

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SOFT TISSUE TRAUMA

• Tendinitis? inflammation of tendon-muscle
  attachment
• et overuse, repeated microtraumas
• sxs diffuse tenderness, edema
• Rx RICE
• Tenosynovitis? inflammation of synovial sheath
  surrounding tendon
• et can be acute, usually chronic
• sx crepitus!, edema, thickening of tendon

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SOFT TISSUE ISSUES

• DOMS?usually 24-48 hrs post activity
• Rx ice, stretch
• prevention gradual inc. in initial activity
• Muscle guarding?involuntary muscle contractions
  that occur in response to injury
• body is attempting to splint injured area
• problematic during special tests

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Imaging Soft Tissue

• MR Arthrograms
• Inject dye into joint to visualize disruption
• MRI
• Use magnetic field to view different tissues
• Best for soft tissue pathology

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BONE TRAUMA (acute)

• Periosteal Contusion
• Epiphyseal Injuryin children
• Depressed fxusually in flat bone
• Greenstick fxincomplete fx in children
• Impacted fxshortening of bone
• Longitudinal fxsplits along its length
• Spiral fxrotational force (S-shaped fx)

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BONE TRAUMA (acute)

• Transverse fxacross shaft of bone
• Comminuted fx3 or more fragments
• Contrecoup fxfx at opposite side of the point of
  trauma
• Blowout fxat the wall of the eye orbit
• Avulsion fxbone fragment pulls away from cortex
  but is attached to lig./ten.

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BONE TRAUMA (chronic)

• Stress fxoverload of stress-bearing capabilities
  of bone
• et numerous (surface, training, shoes)
• sx swelling, PT (very localized), pain
• Dx bone scan, x-ray, percussion
• Periostitis (MTSS)
• sx POP of distal medial 1/3 of tibia(classic)
• Wolffs Law

32
Bone Imaging

• Plain film radiography (x-rays)
• Bone Scan
• Injection of radioactive dye
• Fairly generalized information in regards to bone
  healing

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NERVE ISSUES

• Dyesthesiadiminished sensation
• Anesthesiano sensation (numb)
• Hyperesthesiaincreased sensation
• Referred painpain felt at a point other than its
  origin
• Neuritisinflammation of a nerve

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Other Dx Imaging

• Nerve conduction velocity testing
• Ultrasoundmono, monitor spleen size
• ECGcardiac sxs or condition identified at PPE
• Blood testinfection, ect.
• UAlab or dipstick method