Chapter 28: Musculoskeletal System

Question 1

Extremities

Answer 1

the portions of the skeleton that include the clavicles, scapulae, arms, wrists, and hands (upper extremities) and the pelvis, thighs, legs, ankles, and feet (lower extremities)

Question 2

Bones

Answer 2

hard but flexible living structures that provide support for the body and protection to vital organs

Question 3

Joints

Answer 3

places where bones articulate, or meet

Question 4

Axial skeleton

Answer 4

comprised of the skull, spine, ribs, and sternum

Question 5

Appendicular skeleton

Answer 5

composed of the extremities

Question 6

Long bones

Answer 6

found in the arms and legs

Question 7

Short bones

Answer 7

found in the hands and feet

Question 8

Irregular bones

Answer 8

vertebrae in the spinal column

Question 9

Periosteum

Answer 9

strong, white, fibrous material that covers bones; blood vessels and nerves pass through this membrane as they enter and leave the bone

Question 10

muscles

Answer 10

tissues or fibers that cause mvmt of body parts and organs

Question 11

cartilage

Answer 11

tough tissue that covers the joint ends of bones and helps to form certain body parts such as the ear

Question 12

tendons

Answer 12

tissues that connect muscle to bone

Question 13

ligaments

Answer 13

tissues that connect bone to bone

Question 14

3 mechanisms of musculoskeletal injuries

Answer 14

direct force, indirect force, and twisting force

Question 15

direct force

Answer 15

person being struck by an automobile, causing crushed tissues and fractures

Question 16

indirect force

Answer 16

when a person falls and lands on their feet, direct force causes injury to feet and ankles, whereas indirect force causes injury to knees, femur, pelvis, and spinal column

Question 17

twisting/rotational force

Answer 17

can cause stretching or tearing of muscles and ligaments , as well as broken bones, such as when a ski digs into the snow while the skier’s body rotates

Question 18

Fracture symptoms

Answer 18

painful, swollen, or deformed extremity

Question 19

traction splint

Answer 19

a splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb; used primarily on femoral shaft fractures

Question 20

4 types of musculoskeletal injury

Answer 20

1. fracture
2. dislocation
3. sprain
4. strain

Question 21

Fracture

Answer 21

any break in a bone; can be classified as open or closed

Question 22

Greenstick fracture

Answer 22

an incomplete fracture

Question 23

Comminuted fracture

Answer 23

a fracture in which the bone is broken in several places

Question 24

Angulated fracture

Answer 24

fracture in which the broken bone segments are at an angle to each other

Question 25

Dislocation

Answer 25

the disruption or "coming apart" of a joint; the soft tissue of the joint capsule and ligaments must be stretched beyond the normal range of motion and torn

Question 26

Sprain

Answer 26

the stretching and tearing of ligaments; most commonly associated with joint injuries

Question 27

Strain

Answer 27

muscle injury resulting from overstitching or overexertion of the muscle

Question 28

Closed extremity injury

Answer 28

an injury to an extremity with no associated opening in the skin

Question 29

Open extremity injury

Answer 29

an extremity injury in which the skin has been broken or torn through from the inside by an injured bone or from the outside by something that has caused a penetrating wound with associated injury to the bone

Question 30

Compartment syndrome

Answer 30

injury caused when tissues such as blood vessels and nerves are constricted within a space as from swelling or from a tight dressing or cast

Question 31

Compartment syndrome progression

Answer 31

1. a fracture or crush injury causes bleeding and swelling within the extremity 2. pressure and swelling caused by the bleeding within the muscle compartment becomes so great that the body can no longer perfuse the tissues against the pressure 3. cellular damage occurs and causes additional swelling 4. blood flow to the area is lost. The limb itself may be lost if the pressure is not relieved

Question 32

Musculoskeletal injury signs and symptoms

Answer 32

- pain and tenderness - deformity or angulation - grating or crepitus - swelling - bruising - exposed bone ends - joints locked into position - nerve and blood-vessel compromise

Question 33

Crepitus

Answer 33

a grating sensation or sound made when fractured bone ends rub together

Question 34

The 6 Ps

Answer 34

- method of assessing compromise to an extremity when a musculoskeletal injury is suspected - pain or tenderness - paresthesia, or the sensation of "pins and needles" - pulses diminished or absent in the injured extremity - paralysis or the inability to move - pressure

Question 35

Realignment of the deformed extremity

Answer 35

- if the extremity is not realigned, the splint may be ineffective, causing increased pain and possible further injury (including an open fracture) during transportation - if the extremity is not realigned, the chance of nerves, arteries, and veins being compromised increases. When distal circulation is compromised or shit dow, tissues beyond the injury become starved for O2 and die - pain is increased for only a moment during realignment under traction. Pain is reduced by effective splinting

Question 36

General guidelines for realigning an extremity:

Answer 36

1. one EMT grasps the distal extremity while a partner places one hand above and one hand below the injury site 2. The partner supports the site while the first EMT creates gentle manual traction in the direction of the long axis of the extremity. If you fell resistance or if it appears that bone ends will come through the skin, stop realignment and splint the extremity in the position found 3. If no resistance is felt, maintain gentle traction until the extremity is properly aligned and splinted

Question 37

manual traction

Answer 37

the process of applying tension to straighten and realign a fractured limb before splinting, Also called tension

Question 38

General rules that apply to all types of immobilization

Answer 38

- care for life-threatening problems first - expose the injury site - assess the injury site - assess distal CSM - align long-bone injuries to the anatomic position - do not push protruding bones back into place - immobilize both the injury site and adjacent joints - choose a method of splinting - splint before moving the pt to a stretcher or other location if possible - pad the voids

Question 39

To splint long-bone or joint injuries:

Answer 39

1. Take standard precautions, and if possible, expose the area to be splinted 2. Manually stabilize the injury site. This can be done either by you or by a helper 3. Assess circulation, sensation, and motor function (CSM). Check for pulses and see if the pt can feel your touch distal to the injury. Ask the pt to wiggle his fingers or toes to assess mvmt. Do not ask the pt to grasp, press, or pull an extremity you believe may be fractured. This will cause unnecessary pain and may aggravate the injury 4. Realign the injury if deformed or if the distal extremity is cyanotic or pulseless. Be sure to attempt to realign an injured joint only if the distal extremity is pulseless or cyanotic 5. Measure or adjust the splint, and move it into position under or alongside the limb. Maintain manual stabilization or traction during positioning and until the splinting procedure is complete 6. Apply and secure the splint to immobilize adjacent joints and the injury site 7. Reassess CSM distal to the injury

Question 40

Application of a traction splint

Answer 40

1. Take standard precautions and, if possible, expose the area to be splinted 2. Manually stabilize the leg and apply manual traction 3. Assess CSM distal to the injury 4. Adjust the splint to the proper length, and position it at or under the injured leg 5. Apply the proximal securing device (ischial strap) 6. Apply the distal securing device (ankle hitch) 7. Apply mechanical traction 8. Position and secure support straps 9. Reevaluate the proximal and distal securing devices, and reassess CSM distal to the injury 10. Secure the pt's torso and the traction splint to a long spine board to immobilize the hip and to prevent mvmt of the splint