Chapter 15 Extremity Injuries Recognizing a Knee Sprain

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Chapter 15

• Extremity Injuries

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Extremity Injuries

• Injuries to the extremities are common because
  people are involved in active lifestyles that
  include sports and wilderness activities.

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Extremity Injury Assessment

• Look for signs and symptoms of fractures and
  dislocations.
• Examine the extremities using DOTS.
• Compare one extremity with the other.
• Use the rule of thirds.
• Consider the cause of injury.
• Use CSM (circulation, sensation, movement).

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Types of Extremity Injuries (1 of 2)

• Contusionsoccur when tissue is bruised
• Strainsoccur when the muscles are stretched or
  torn
• Sprainsinvolve tearing or stretching of joints,
  causing damage to the ligaments and joint
  capsules

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Types of Extremity Injuries (2 of 2)

• Tendinitisinflammation of a tendon caused by
  overuse
• Dislocationsoccur when bones are displaced from
  their normal joint alignment, out of their
  sockets, or out of their normal positions
• Fracturesbreaks in bones that may or may not be
  accompanied by open wounds

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Care for Extremity Injuries

• Use RICE procedures.
• Apply a splint to stabilize fractures and
  dislocations.

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RICE Procedures (1 of 7)

• Acronym for rest, ice, compression, and elevation
  
• Recommended immediate treatment for bone, joint,
  and muscle injuries
• The first 48 to 72 hours after an injury can do a
  lot to relieveand even preventaches and pains.

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RICE Procedures (2 of 7)

• R Rest
• Do not use or move injured part.
• Crutches may be used.

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RICE Procedures (3 of 7)

• I Ice
• Apply for 20 to 30 minutes.
• Apply as often as possible.
• Do not apply directly to skin.
• If skin becomes numb, remove.

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RICE Procedures (4 of 7)

• C Compression
• Apply elastic bandage to injury.
• Should be worn continuously for first 18 to 24
  hours
• Use horseshoe-shaped pad for ankle injury.

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RICE Procedures (5 of 7)

• E Elevation
• Limits circulation to injured area
• Limits internal bleeding minimizes swelling
• Do not elevate a suspected fracture until it has
  been stabilized.

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RICE Procedures (6 of 7)

• R Rest
• I Ice
• Apply for 20 to 30 minutes.

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RICE Procedures (7 of 7)

• C Compression
• Apply a compression bandage for 3 to 4 hours.
• E Elevation
• Raise the injured area higher than the heart.

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Shoulder Dislocation

• Occurs when shoulder bones come apart
• Result of a blow or a particular movement
• Second in frequency only to finger dislocations

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Recognizing a Shoulder Dislocation (1 of 2)

• Victim holds upper arm away from body.
• Arm cannot be brought across chest.
• Extreme pain in the shoulder area
• Shoulder appears squared off.

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Recognizing a Shoulder Dislocation (2 of 2)

• Injury results in complete loss of function.
• History of previous dislocations
• Numbness or paralysis in the arm

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Care for a Shoulder Dislocation

• Do not force, twist, or pull back in place.
• Place a folded or rolled blanket or pillow
  between upper arm and chest.
• Apply an arm sling and swathe.
• Apply an ice pack for 20 minutes.
• Seek immediate medical care.

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Clavicle Fracture

• Common
• Usually result of falling with arm and hand
  outstretched
• Most occur in the middle third of the bone.

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Recognizing a Clavicle Fracture (1 of 2)

• Deformity
• Fell on outstretched arm
• Direct blow to clavicle or shoulder
• Severe pain over injured area
• Holding injured arm against chest

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Recognizing a Clavicle Fracture (2 of 2)

• No movement because of pain
• Swelling
• Tenderness
• Dropped or drooped shoulder
• Bruising

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Care for a Clavicle Fracture

• Treat for shock.
• Apply arm sling and swathe.
• Apply ice pack
• 20 minutes, three to four times during 24 hours
• Seek immediate medical care.

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Contusions

• Caused by direct blows
• Often called shoulder pointers

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Recognizing Contusions

• Swelling
• Pain at the injury site
• Feeling of firmness when pressure on the shoulder
• Tenderness
• Black-and-blue discolorations

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Care for Contusions

• Apply an ice pack
• 20 minutes, three to four times during first 24
  hours
• Place arm in sling and swathe.
• One end tucked between arm and body
• Ties in back

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Tendinitis

• Inflammation of the shoulder
• Result of continuous overuse or unusual use

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Recognizing Tendinitis

• Constant pain or pain with motion of the shoulder
• Limited motion of shoulder
• Crackling sound
• Tenderness over the area

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Care for Tendinitis

• Use an ice massage for 10 minutes before and
  after exercise.
• Use a sling and swathe.
• Use pain medication.
• Seek medical advice.

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Humerus Fracture

• Shaft of the humerus can be felt throughout its
  entire length along inner side of upper arm.

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Recognizing a Humerus Fracture

• Direct blow to the area
• Twist or fall on the outstretched arm
• Severe pain and swelling
• Deformity
• Tender if touched
• Inability to move the arm
• Holds arm against chest

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Care for a Humerus Fracture

• Assess and treat for shock.
• Apply an ice pack for 20 minutes.
• Stabilize the arm.
• Seek immediate medical care.

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Elbow Injuries

• Should be considered serious
• Treat with extreme care.

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Recognizing Elbow Fractures and Dislocations

• Immediate swelling
• Severe pain
• Possible visible deformity
• Restricted, painful motion
• Numbness or coldness of the hand and fingers
  below the elbow

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Care for Elbow Fractures and Dislocations

• Do not move the elbow.
• Treat for shock.
• Splint the elbow in the position found.
• Apply an ice pack for 20 minutes.
• Seek immediate medical care.

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Tennis Elbow

• Results from sharp, quick twists of the wrist
• Inflammation of the tendons on the outer side of
  the elbow

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Recognizing Tennis Elbow

• Pain increases while using the arm.
• Gradual grip weakness
• Injured elbow fatigues quicker than normal.
• Very tender on outer protrusion

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Care for Tennis Elbow

• Apply heat before an activity.
• Apply ice pack for 20 minutes after activity.
• Seek medical advice.

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Golfers Elbow

• Equivalent to tennis elbow
• Pain is on the inside of the elbow.

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Recognizing Golfers Elbow

• Pain increases while using the arm.
• Gradual grip weakness
• Injured elbow fatigues quicker than normal.

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Care for Golfers Elbow

• Apply heat before an activity.
• Apply an ice pack for 20 minutes after activity.
• Seek medical advice.

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Radius and Ulna Fractures

• The radius and ulna are the two large bones in
  the forearm.
• When one bone is broken, the other acts as a
  splint, and there may be little or no deformity.
• When both are broken, the arm usually appears
  deformed.

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Recognizing Radius and Ulna Fractures

• Pain in the forearm or wrist
• Deformity
• Severe pain radiating up and down
• Inability to move the wrist or painful when moved

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Care for Radius and Ulna Fracture

• Assess and treat for shock if indicated.
• Apply an ice pack for 20 minutes.
• Apply two rigid splints on both sides of arm.
• Seek medical care.

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Wrist Fracture

• Wrist usually breaks when victim falls with arm
  and hand outstretched.

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Recognizing a Wrist Fracture

• Snapping or popping sensation
• Pain aggravated by movement
• Tenderness
• Swelling
• Unable or unwilling to move wrist
• Lumplike deformity

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Care for a Wrist Fracture

• Use the RICE procedures.
• Stabilize the wrist with a splint.
• Seek medical care.

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Hand InjuriesCrushed Hand

• May be fractured by
• Direct blow
• Crushing injury

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Recognizing a Crushed Hand

• Pain
• Swelling
• Loss of motion
• Open wounds
• Broken bones

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Care for a Crushed Hand

• Control the bleeding.
• Apply an ice pack for 20 minutes.
• Seek medical care.

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Finger Injuries

• The three bones that make up each finger are the
  most commonly broken bones.
• The finger has three joints
• Distal interphalangeal
• Proximal interphalangeal
• Metacarpal phalangeal

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Finger Fracture

• Finger bones can move when they are broken.

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Recognizing Finger Fractures

• Deformity
• Immediate pain
• Hurts with or without movement
• Numbness
• Swelling
• Pinpointed tenderness

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Testing Finger Fractures

• If possible, straighten fingers and place on a
  hard surface.
• Tap the tip of the injured finger toward the
  hand.
• Pain lower down in the finger or into the hand
  can indicate a fracture.

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Care for Finger Fractures

• Do not try to realign.
• Gently apply an ice pack.
• Splint the finger.
• Use buddy tape method.
• Secure hand, fingers, and arm to rigid splint in
  the position of function.
• Seek medical care.

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Finger Dislocation

• Common
• Same causes of fractured fingers

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Recognizing Finger Dislocation

• Visible deformity
• Immediate pain
• Swelling
• Shortening of the finger
• May be unable to bend the finger
• Motion not possible

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Care for Finger Dislocation

• Do not try to realign.
• Apply an ice pack for 20 minutes.
• Splint the finger.
• Use buddy tape method.
• Secure hand, fingers, and arm to rigid splint in
  the position of function.
• Seek medical care.

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Sprained Finger

• Upper joints of the fingers have a ligament on
  each side of the joint.

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Recognizing a Sprained Finger

• Jammed or compressed
• Stepped on
• Forced or twisted sideways
• Pain and swelling over a joint
• Unable to make a fist
• Weakness while curling the finger
• Weakness or pain when gripping

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Care for a Sprained Finger

• Apply an ice pack for 20 minutes.
• Reevaluate.
• Seek medical care if pain and weakness exist.
• Buddy tape the fingers.

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Nail Avulsion

• Injury in which a nail is partly or completely
  torn loose

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Recognizing a Nail Avulsion

• Nail may be completely detached or partially held
  in place by the skin

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Care for a Nail Avulsion

• Secure damaged nail in place with an adhesive
  bandage.
• Apply antibiotic ointment.
• Secure a partly torn loose nail with an adhesive
  bandage.
• Do not trim away loose nail.
• Consult a physician.

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Splinters

• Sharp splinters, usually wooden, can be impaled
  into the skin or under a fingernail or toenail.

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Recognizing Splinters

• Small puncture wound
• Sliver may be seen.

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Care for Splinters

• Use tweezers to remove it.
• If splinter is impaled under a nail and breaks
  off flesh
• Cut a V-shaped notch in the nail.
• Remove with tweezers.

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Blood Under a Nail

• Blood collects under a nail when underlying
  tissues are bruised.

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Recognizing Blood Under a Nail

• Excruciating pain
• Pain disappears only after blood is drained.

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Care for Blood Under a Nail

• Immerse finger in ice water or apply ice pack.
• Elevate hand.
• Relieve pressure.
• Apply dressing.

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Ring Strangulation

• Serious damage may result if blood supply is cut
• Within 4 or 5 hours

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Recognizing Ring Strangulation

• A ring has become tight on a finger.

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Care for Ring Strangulation (1 of 2)

• Lubricate the finger.
• Immerse finger in cold water or apply an ice
  pack.
• Spray window cleaner onto finger.
• Massage finger from tip to hand.
• Smoothly wind thread around the finger.

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Care for Ring Strangulation (2 of 2)

• Lubricate finger well, and then pass a rubber
  band under the ring.
• Cut the narrowest part of the ring.
• Inflate an ordinary balloon.
• Insert victims swollen finger in end.

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Hip Joint Injuries

• Hip joint is a stable ball-and-socket joint.
• Requires great force to dislocate

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Recognizing Hip Dislocation

• Severe pain at injury
• Swelling at injury
• Hip is flexed and knee is bent and rotated inward
  toward opposite hip.
• Visible injury

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Care for Hip Dislocation

• Assess and treat for shock.
• Stabilize injury.
• Check for ankle pulse.
• Seek medical care.

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Hip Fracture

• Fracture of the upper end of the femur
• Not the pelvis

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Recognizing a Hip Fracture

• Severe pain in groin area
• Inability to lift injured leg
• Leg may appear shortened and be rotated with the
  toes pointing abnormally.

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Care for a Hip Fracture

• Treat for shock.
• Stabilize injured leg.
• Monitor ankle pulse.
• Seek immediate medical care.

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Femur Fractures

• Femur injuries can occur in any part of the
  femur.
• Femur fractures often include open wounds.
• External bleeding may be severe.

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Recognizing a Femur Fracture

• Severe pain at injury
• Deformity
• Swelling
• Severe pop or snap

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Care for a Femur Fracture

• Assess and treat for shock.
• Cover wound with sterile dressing.
• Stabilize injured leg.
• Monitor ankle pulse.
• Seek immediate medical care.

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Muscle Contusion

• The muscle group on the front of the thigh is the
  quadriceps group.
• Often gets bruised

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Recognizing a Muscle Contusion

• Swelling
• Pain and tenderness
• Tightness or firmness of site
• Visible bruise

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Care for a Muscle Contusion

• Follow the RICE procedures.
• Apply an ice pack.
• 20 minutes, three to four times a day for 48
  hours
• Stretch the muscle.

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Muscle Strain

• Occurs when a muscle is overstretched
• A first aider will be unable to determine its
  degree.

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Recognizing a Muscle Strain

• Pop or pulling sensation while running or jumping
• Tenderness
• Stiffness and pain
• Swelling
• Visible bruise appears days later.

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Care for a Muscle Strain

• Follow the RICE procedures.
• Apply an ice pack.
• 20 minutes, three to four times a day for 48
  hours
• Stretch the muscle.

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Knee Injuries

• Among the most serious joint injuries
• Medical care is required if the injury is from
  being hit or twisted.
• A fracture generally occurs as a result of a fall
  or a direct blow.

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Recognizing a Knee Fracture

• May look like a dislocation
• Deformity
• Tenderness
• Swelling

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Care for a Knee Fracture

• No deformity
• Feel for pulse in the ankle.
• If pulse is felt, splint the leg with the knee
  straight.
• Significant deformity
• Feel for pulse in the ankle.
• If pulse is felt, splint the knee in the position
  found.
• Seek medical care immediately if pulse is absent.

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Knee Dislocation

• A knee dislocation is a serious injury.
• Deformity will be grotesque.

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Recognizing a Knee Dislocation

• Excruciating pain
• Deformity
• Pulse may be absent in the ankle.

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Care for a Knee Dislocation

• Stabilize the knee in the position found.
• Seek medical care immediately.

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Patella Dislocation

• Must be treated immediately
• Most commonly occurs in teenagers and young
  adults who are engaged in athletic activities.

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Recognizing a Patella Dislocation

• A blow or twisting causes kneecap to move outside
  of the knee joint.
• Swelling
• Inability to bend or straighten knee
• Pain
• Deformity

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Care for a Patella Dislocation

• Follow the RICE procedures.
• Do not try to relocate.
• Splint knee in position found.
• Seek medical care.

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Knee Sprain

• Ligament injury
• Can range from mild to complete tearing

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Recognizing a Knee Sprain

• Severe pain
• Pop or snap at the time of injury
• Locking sensation
• Inability to walk without limping
• Inability to bend or straighten the knee
• Swelling
• Bruising

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Care for a Knee Sprain

• Follow the RICE procedures.
• Seek medical care.

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Knee Contusion

• Caused by
• A direct blow
• Falling on the knee

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Recognizing a Knee Contusion

• Pain
• Swelling
• Tenderness
• Black-and-blue discoloration

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Care for a Knee Contusion

• Follow the RICE procedures.

103
Lower Leg InjuriesTibia and Fibula Fractures

• Can occur at any place between the knee joint and
  the ankle joint
• Deformity may occur when one bone is broken.
• When only one bone is broken, little deformity
  may be present.

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Recognizing Tibia and Fibula Fractures

• Severe pain
• Swelling
• Deformity
• Tenderness

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Care for Tibia and Fibula Fractures

• Stabilize the leg.
• Apply an ice pack.
• Seek medical care.

106
Recognizing Tibia and Fibula Contusion

• Victim received a direct hit directly on shin.
• Tender when touched
• Sharp pain
• Black-and-blue mark
• Difficulty moving ankle up and down
• Numbness or coldness in toes or foot

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Care for a Tibia and Fibula Contusion

• Expose the injury.
• Apply the RICE procedures.
• Use an ice pack.
• 20 minutes, three to four times daily for 48
  hours
• If numbness or tingling exists, seek medical care.

108
Muscle Cramp

• Temporary condition
• Usually occurs in the calf and sometimes in the
  thigh or hamstring

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Recognizing a Muscle Cramp

• During or after intense exercise sessions
• Painful muscle contraction or spasm that disables
  the victim

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Care for Muscle Cramps

• Gently stretch.
• Apply pressure.
• Apply ice to the muscle.
• Pinch the upper lip hard.
• Drink lightly salted, cool water.
• Drink a commercial sports drink.

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Shin Splints

• Pain in the front of the lower leg or shin

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Recognizing Shin Splints

• Ache subsides after activity stops.
• Ache is a result of an increase in the workout
  routine.
• Chronic problem that gets worse

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Care for Shin Splints

• Apply an ice pack before activity.
• Apply pressure.
• Apply an ice pack for 20 minutes after activity.
• Curtail activity until the shin is pain free.
• Take anti-inflammatory pain medications.

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Ankle and Foot Injuries

• Frequently injured by twisting
• Stretches or tears ligaments
• Most ankle injuries are sprains that involve the
  outside ligaments.

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Recognizing Foot and Ankle Injuries (1 of 2)

• Two-part test to determine whether an X-ray is
  needed
• Press along the bones.
• Pain and tenderness may indicate a broken bone.
• Have the victim try to stand on it.
• Ability to take four or more steps is most likely
  a sprain.
• Inability to walk on it may indicate a break.

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Recognizing Foot and Ankle Injuries (2 of 2)

• If injured ankle cannot tolerate hopping on
  opposite foot, suspect a fracture.
• Swelling
• One sided indicates a sprain.
• Both sided indicates a fracture.

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Care for Foot and Ankle Injuries

• Take shoes off.
• Use RICE procedures.

118
Aftercare of an Ankle Injury (1 of 2)

• Use the RICE treatment for 24 to 48 hours.
• Use a contrast bath if swelling persists.
• Begin range-of-motion exercises once initial
  swelling has decreased.
• Begin gentle exercises.

119
Aftercare of an Ankle Injury (2 of 2)

• Within 7 to 14 days, if pain and swelling have
  stopped, begin to stretch and strengthen the calf
  and ankle.
• Brace or tape healed ankle.
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

120
Toe Injuries

• Include
• Torn-off nails
• Hematoma formation under the nails
• Dislocations
• Fractures

121
Recognizing Toe Injuries

• Pain and swelling
• Deformity

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Care for Toe Injuries

• Treat the same as a finger injury.