Musculoskeletal System

1
Musculoskeletal System

• Temple College
• EMS Professions

2
Musculoskeletal System

• Bones
• Muscles
• Cartilages
• Tendons
• Ligaments

3
Skeleton

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

4
Skull

• Cranium
• Frontal
• Parietal
• Temporal
• Occipital

• Face
• Mandible
• Maxilla
• Zygoma
• Nasal bones

5
Spinal Column

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

6
Thorax

• 12 pairs of ribs
• Sternum
• Protects heart, lungs

7
Pelvis

• Bony ring
• Two innominate bones, each made of 3 fused bones
• Ilium
• Ischium
• Pubis

8
Lower Extremity

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

9
Upper Extremity

• Shoulder girdle
• Scapula
• Clavicle
• Humerus
• Radius
• Ulna
• Carpals
• Metacarpals
• Phalanges

10
Muscles

• Maintain posture, allow movement
• 3 types
• Skeletal (Striated)
• Smooth (Involuntary)
• Cardiac

11
Skeletal Muscles

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

12
Smooth Muscles

• Carry out involuntary movements
• Located in walls of
• GI tract
• GU tract
• Respiratory tract
• Blood vessels

13
Cardiac Muscle

• Found only in heart
• Automaticity
• Can initiate own contractions without external
  stimulation

14
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

15
Extremity Trauma

• Temple College
• EMS Professions

16
Fracture

• Break in bones continuity

17
Fracture Causes

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

18
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

19
Fractures
One of the most important things we do in EMS is
prevent closed fractures from becoming open ones
20
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

21
Fracture Types

• Impacted bone ends driven into each other
• Comminuted bone broken into gt 3 pieces

22
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?

23
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

24
Fracture Signs

• Swelling, ecchymosis
• Exposed fragments
• Crepitus
• Grating of bone ends
• May be heard or felt
• Do NOT actively seek

25
Dislocation

• Displacement of bones from normal positions at
  joint

26
Dislocation Signs

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

27
Sprains

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

28
Sprain Signs

• Tenderness
• Swelling, ecchymosis
• Inability to use extremity
• No deformity

29
Sprains
Degree of joint dislocation at time of injury
cannot be determined during exam
Extensive damage to neural or vascular structures
may have occurred
30
Strains

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

31
Assessment

• Perform initial (primary) assessment
• Locate, treat life-threats
• Assess for injuries of head, chest, abdomen,
  pelvis
• Assess distal neurovascular function

32
Assessment

• With exception of pelvic, possibly femur
  fractures, orthopedic injuries are NOT
  life-threatening.
• Do NOT let spectacular orthopedic injury distract
  you from ABCs
• Its the unobvious things that kill patients!

33
Assessment

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

34
Management

• Splinting
• Prevents further movement at injury site
• Limits tissue damage, bleeding
• Eases pain

35
Management

• When in doubt

SPLINT

• It is difficult to differentiate fractures,
  dislocations and sprains

36
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

37
Principles of Splinting

• Cover wounds with dry, sterile compression
  dressings
• Fractures splint joint above, below fracture
• Dislocations splint bone above, below joint

38
Principles of Splinting

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

39
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