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Musculoskeletal System

Temple College
EMS Professions
Musculoskeletal System
 Bones
 Muscles
 Cartilages
 Tendons
 Ligaments

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

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Skull
 Cranium  Face
• Frontal • Mandible
• Parietal • Maxilla
• Temporal • Zygoma
• Occipital • Nasal bones

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Spinal Column
 Cervical: 7 vertebrae
 Thoracic: 12 vertebrae
 Lumbar: 5 vertebrae
 Sacrum: 5 vertebrae (fused)
 Coccyx: 4 vertebrae (fused)

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Thorax
 12 pairs of ribs
 Sternum
 Protects heart, lungs

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

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

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Upper Extremity
 Shoulder girdle
• Scapula
• Clavicle
 Humerus
 Radius
 Ulna
 Carpals
 Metacarpals
 Phalanges
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Muscles
 Maintain posture, allow movement
 3 types:
• Skeletal (Striated)
• Smooth (Involuntary)
• Cardiac

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Skeletal Muscles
 Voluntary muscles
 Attach to bones by tendons that cross joints
 Shortening of muscle moves joint

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Smooth Muscles
 Carry out involuntary movements
 Located in walls of:
• GI tract
• GU tract
• Respiratory tract
• Blood vessels

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Cardiac Muscle
 Found only in heart
 Automaticity
 Can initiate own contractions without
external stimulation

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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

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Extremity Trauma

Temple College
EMS Professions
Fracture
 Break in bone’s continuity

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

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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

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 Fractures

One of the most important things we

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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

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Fracture Types
 Impacted: bone ends driven into each other
 Comminuted: bone broken into > 3 pieces

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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?

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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

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

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Dislocation
 Displacement of bones from normal
positions at joint

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Dislocation Signs
 Deformity
 Swelling, ecchymosis about joint
 Pain/tenderness in joint
 Loss of motion usually perceived as
“locked” joint

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

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Sprain Signs
 Tenderness
 Swelling, ecchymosis
 Inability to use extremity
 No deformity

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 Sprains
Degree of joint dislocation at time
of injury cannot be determined
during exam

Extensive damage to neural or

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Strains
 “Muscle pull”
 Injury to musculotendenous unit
 Pain on active motion
 Pain not present on passive motion

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

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

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

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Management

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

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Management
 When in doubt

SPLINT

 It is difficult to differentiate fractures,

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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

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Principles of Splinting
 Cover wounds with dry, sterile compression
dressings
 Fractures: splint joint above, below fracture
 Dislocations: splint bone above, below joint

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Principles of Splinting
 Minimize movement
 Support injury until splinting completed
 Pad splint to avoid local pressure

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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

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