Extremity Injuries

1
Chapter 15

• Extremity Injuries

2
Extremity Injuries

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

3
Extremity Injury Assessment (1 of 2)

• Look for signs and symptoms of fractures and
  dislocations.
• Examine the extremities, using the mnemonic
  D-O-T-S.
• Compare one extremity with the other to determine
  size and shape differences.
• Use the rule of thirds for extremity injuries.

4
Extremity Injury Assessment (2 of 2)

• Consider the cause of injury (COI) when
  evaluating the possibility of a fracture and its
  location.
• Use the mnemonic CSM as a reminder to check for
  Circulation, Sensation, and Movement of fingers
  or toes.

5
Types of Injuries

• Types of injuries to the extremities range from
  simple contusions to complex open fractures.
• Contusions
• Strains
• Sprains
• Tendinitis
• Dislocations
• Fractures

6
Care for Extremity Injuries

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

7
RICE Procedure (1 of 2)

• R Rest.
• Injuries heal faster if rested.
• I Ice.
• Ice should be applied to the inured area as soon
  as possible after the injury.
• C Compression.
• Compressing the injured area squeezes fluid out
  of the injury site.
• E Elevation.
• Gravity slows the return of blood to the heart
  from the lower parts of the body.

8
RICE Procedure (2 of 2)

• R Rest
• I Ice
• C Compression
• E Elevation

9
Shoulder Injuries

• Three bones come together at the shoulder
• Scapula
• Clavicle
• Humerus
• The shoulder is the most freely movable joint in
  the body.

10
Shoulder Dislocation

• A dislocation of the shoulder occurs when the
  bones of the shoulder comes apart.
• Shoulder dislocation is second in frequency only
  to finger dislocations.

11
Recognizing Shoulder Dislocation (1 of 2)

• Victim holds the upper arm away from the body,
  supported by the uninjured arm
• Dislocated arm cannot be brought across the chest
  wall to touch the opposite shoulder
• Extreme pain in the shoulder area
• In a dislocation, the shoulder looks squared off,
  rather than rounded.

12
Recognizing Shoulder Dislocation (2 of 2)

• Victim may describe a history of previous
  dislocations.
• Numbness or paralysis in the arm from pressure,
  pinching blood vessels or nerves

13
Care for a Shoulder Dislocation

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

14
Clavicle Fracture

• Fractures of the clavicle are common and usually
  are the result of falling with the arm and hand
  outstretched.
• 80 of clavicle fractures occur in the middle
  third of the bone.

15
Recognizing a Clavicle Fracture (1 of 2)

• Usually the fracture is easy to detect because
  the clavicle lies immediately under the skin.
• The victim
• Fell on an outstretched arm
• Received a direct blow to the clavicle or shoulder

16
Recognizing a Clavicle Fracture (2 of 2)

• AND if the victim has
• Severe pain over the injured area
• Not moved the arm because of pain
• Swelling
• Visible deformity
• Tenderness
• Dropped or drooped shoulder
• Bruising

17
Care for a Clavicle Fracture

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

18
Contusions

• Direct blows cause contusions around the
  shoulder.
• Often called shoulder pointers
• Contusions of this type may cause severe
  discomfort

19
Recognizing Contusions

• Swelling
• Pain at the injury site
• Feeling of firmness when pressure is exerted on
  the shoulder
• Tenderness
• Discoloration under the skin

20
Care for Contusions

• Apply an ice pack to the area for 20 minutes,
  three to four times during the first 24 hours.
• Place the arm in a sling and swathe.

21
Tendinitis

• General cause of tendinitis in the shoulder is
  continuous overuse or unusual use.
• Examples include many of the throwing sports,
  such as baseball, and in swimming.

22
Recognizing Tendinitis

• Constant pain or pain with motion of the shoulder
• Limited motion of the shoulder
• Crackling sound when the joint is moved
• Tenderness over the area

23
Care for Tendinitis

• Use an ice massage for 10 minutes before and
  after exercise.
• Use a sling and swath to rest the shoulder.
• Use pain medication such as ibuprofen.
• Seek medical advice if needed.

24
Humerus Fracture

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

25
Recognizing a Humerus Fracture (1 of 2)

• The victim received
• Direct blow to the area
• Twist or fall on the outstretched arm
• AND any one or combination of these occurred
• Severe pain
• Swelling

26
Recognizing a Humerus Fracture (2 of 2)

• Visible deformity
• Tender if touched
• May be unable to move the arm
• Will hold the arm against the chest for comfort

27
Care for a Humerus Fracture

• Treat for shock.
• Apply an ice pack for 20 minutes.
• Stabilize the arm by applying one rigid splint on
  the part of the arm away from the body.
• Apply an arm sling and swathe.
• Seek immediate medical care.

28
Elbow Injuries

• All elbow fractures and dislocations should be
  considered serious and treated with extreme care.
• Inappropriate care can result in injury to the
  nearby nerves and blood vessels.

29
Recognizing Elbow Fractures and Dislocations

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

30
Care for Elbow Fractures and Dislocations

• Do not move the elbow.
• Treat for shock.
• Splint the elbow in the position found in order
  to prevent nerve and blood vessel damage.
• Apply an ice pack for 20 minutes.
• Seek immediate medical care.

31
Tennis Elbow

• Results from sharp, quick twists of the wrist
  (not just from playing tennis)
• An inflammation of the tendons on the outer side
  of the elbow
• Can be very painful whenever the wrist and elbow
  are used

32
Recognizing Tennis Elbow

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

33
Care for Tennis Elbow

• Apply heat before an activity the victim might
  wear a brace on the sore elbow.
• Apply ice for 20 minutes after completion of the
  activity.
• Seek medical advice for appropriate
  rehabilitation program.

34
Golfers Elbow

• The equivalent of the more common tennis elbow
  but with pain on the inside of the elbow
• It is tendinitis affecting the tendons attached
  to the bony protrusion, on the inside of the
  elbow.

35
Recognizing Golfers Elbow

• Pain increases while using the arm.
• Causes gradual grip weakness
• The injured elbow fatigues quicker than normal.

36
Care for Golfers Elbow

• Apply heat before an activity the victim might
  wear a brace on the tender elbow.
• Apply an ice pack for 20 minutes after completion
  of the activity.
• Seek medical advice for appropriate
  rehabilitation program.

37
Radius and Ulna Fractures

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

38
Recognizing Radius and Ulna Fractures (1 of 2)

• The victim has pain in the forearm or wrist from
• A direct blow
• Falling on an outstretched hand
• AND has
• A visible deformity
• Severe pain radiating up and down from the injury
  site

39
Recognizing Radius and Ulna Fractures (2 of 2)

• An inability to move the wrist or it is painful
  while moving the wrist.
• OR
• The wrist is painful on the thumb side and pain
  continues into next day

40
Care for Radius and Ulna Fracture

• Treat for shock.
• Apply an ice pack to the area for 20 minutes.
• Apply two rigid splints on both sides of the arm
  from the tip of the elbow to the fingers.
• Place the arm in a sling and swathe with the hand
  in a thumb-up position.
• Seek medical care.

41
Wrist Fracture

• The wrist is usually broken when the victim falls
  with the arm and hand outstretched.

42
Recognizing a Wrist Fracture

• Injury to the wrist associated with a snapping or
  popping sensation within the wrist
• Pain in the wrist that is aggravated by movement
• Tenderness
• Swelling
• Unable or unwilling to move the wrist
• Lump-like deformity on the back of the wrist

43
Care for a Wrist Fracture

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

44
Hand InjuriesCrushed Hand

• The hand may be fractured by a direct blow or by
  a crushing injury.
• Recognizing a crushed hand
• Pain
• Swelling
• Loss of motion
• Open wounds
• Broken bones

45
Care for a Crushed Hand

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

46
Finger Injuries

• The three bones that make up each finger are the
  most commonly broken bones in the body.
• The three joints can also be injured.
• A so-called finger sprain may be a complicated
  fracture or dislocation.

47
Finger Fracture

• Contrary to popular belief, broken bones
  especially the fingers can move when they are
  broken.

48
Recognizing Finger Fractures (1 of 2)

• The finger or thumb has
• A visible deformity
• Immediate pain and hurts with or without movement
• Numbness
• Swelling
• Pinpointed tenderness

49
Recognizing Finger Fractures (2 of 2)

• Test for a finger fracture
• If possible, straighten the fingers and place
  them 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.

50
Care for Finger Fractures

• Do not try to realign the finger.
• Gently apply an ice pack.
• Splint the finger by one of two methods
• Buddy taping the fractured finger to another for
  support
• Keeping the hand and fingers in the position of
  function with extra padding in the palm

51
Finger Dislocation

• Finger dislocations are common.
• Same causes of fractured fingers can also cause a
  dislocated finger.

52
Recognizing Finger Dislocation

• The finger or thumb has
• A visible deformity
• Immediate pain
• Swelling
• Shortening of the finger
• May be unable to bend the finger in the injured
  area

53
Care for Finger Dislocation

• Do not try to realign the dislocation.
• Apply an ice pack.
• Splint the finger by one of two methods
• Buddy taping the fractured finger to another for
  support
• Keeping the hand and fingers in the position of
  function with extra padding in the palm
• Seek medical care.

54
Sprained Finger

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

55
Recognizing a Sprained Finger

• The finger or thumb has been
• Jammed or compressed
• Stepped on
• Forced or twisted sideways
• AND the victim
• Has pain and swelling
• Is unable to make a fist
• Has weakness while curling the finger or gripping

56
Care for a Sprained Finger

• Apply an ice pack for 20 minutes.
• Reevaluate after the ice-pack application and
  seek medical care if pain and weakness exist.
• Tape fingers with buddy taping.

57
Nail Avulsion

• When a nail is partly or completely torn loose
• Recognizing a nail avulsion
• Nail may be completely detached or partially held
  in place by the skin

58
Care for a Nail Avulsion

• Secure the damaged nail in place with an adhesive
  bandage.
• If part of all of the nail has been completely
  torn away, apply antibiotic ointment.
• Do not trim away the loose nail.
• Consult a physician for further advice.

59
Splinters

• Sharp splinters can be impaled into the skin or
  under a fingernail or toenail.
• Recognizing splinters
• Small puncture wound
• Sliver may be seen or in other cases, not seen
  nor can it be felt

60
Care for Splinters

• If embedded in the skin, use tweezers to remove
  it.
• In some cases, you may need to tease it out with
  sterile needle.
• Clean the wound with soap and water.
• If the splinter is impaled under a fingernail or
  toenail and breaks off flush, cut a V-shaped
  notch in the nail to gain access to the splinter.

61
Blood Under a Nail

• Blood collects under a nail when underlying
  tissues are bruised.
• Recognizing blood under a nail
• Excruciating pain exists because of the blood
  pressure against the nail
• Pain does not disappear until the collection of
  blood is drained

62
Care for Blood Under a Nail

• Apply an ice pack with the hand elevated.
• Relive the pressure using a knife or a red-hot
  metal paperclip or needle.
• Apply a dressing.

63
Ring Strangulation

• Can be a serious problem if it cuts of the blood
  supply long enough
• Recognizing ring strangulation
• The ring has become tight on the finger after an
  injury or swelling.

64
Care for Ring Strangulation (1 of 2)

• Try one of the following methods to remove a
  ring
• Lubricate the finger with soap and water or some
  other slippery substance.
• Immerse the finger in cold water or apply an ice
  pack to reduce swelling.
• Liberally spray window cleaner onto the finger,
  then try to slide the ring off.

65
Care for Ring Strangulation (2 of 2)

• Massage the finger from the tip toward the hand
  to move the swelling
• Lubricate the finger again and try removing the
  ring
• Cut the narrowest part of the ring with a ring
  saw, jewelers saw, or fine hacksaw blade, taking
  care to protect the exposed parts of the finger.

66
Hip-Joint Injuries

• Hip Dislocation
• Hip Fracture

67
Hip Dislocation

• A hip can be dislocated by a fall, a blow to the
  thigh, or direct force to the foot or knee.
• Often a hip is dislocated when the knee strikes
  the dashboard during a motor vehicle crash.
• It is difficult to differentiate a hip
  dislocation from a hip fracture.

68
Recognizing Hip Dislocation

• Severe pain at the injury site
• Swelling at the injury site
• Hip is flexed and the knee bent and rotated
  inward toward the opposite hip
• Injury usually quite visible

69
Care for Hip Dislocation

• Treat for shock.
• Stabilize the injury.
• Check for an ankle pulse.
• Seek medical care.
• This injury is best transported by EMS.

70
Hip Fracture

• Fracture of the upper end of the femur, not the
  pelvis
• Elderly people, especially women, are susceptible
  to this type of injury because of brittle bones.

71
Recognizing a Hip Fracture

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

72
Care for a Hip Fracture

• Treat for shock.
• Stabilize the injured leg against movement.
• Monitor the ankle pulse.
• Seek immediate medical care.
• This injury is best transported by EMS.

73
Thigh Injuries

• Femur fracture
• Muscle contusion
• Muscle strain

74
Femur Fractures

• Because the femur is the largest bone in the
  body, considerable force is required to break it.
• Femur fractures often include open wounds and
  external bleeding may be severe.

75
Recognizing a Femur Fracture

• Severe pain at the injury site
• Deformity may occur
• Swelling comes from severe damage to blood
  vessels
• Victim may report having heard or felt a severe
  pop or snap at the time of injury.

76
Care for a Femur Fracture

• Treat for shock.
• Cover a wound with a sterile dressing.
• Stabilize the injured leg against movement.
• Monitor the ankle pulse.
• Seek immediate medical care.
• This injury is best transported by EMS.

77
Muscle Contusion

• The muscle group on the front of the thigh is the
  quadriceps group and often gets bruised.
• Depending upon the force of impact and muscles
  involved, the contusion may be of varying degrees
  of severity.

78
Recognizing a Muscle Contusion

• Victim received a direct hit producing
• Swelling
• Pain and tenderness
• Tightness or firmness of site when pressed
• Visible bruise that may appear hours later

79
Care for a Muscle Contusion

• Follow the RICE procedures.
• Stretch the muscle by bending the knee toward the
  victims chest.

80
Muscle Strain

• When a muscle is overstretched, it can result in
  a tear, called a strain.
• Different degrees of strains occur, but first
  aiders will be unable to determine their degree.

81
Recognizing a Muscle Strain

• While running or jumping, the victim
• Feels a pop or pulling sensation
• And later has
• Tenderness
• Stiffness and pain during movement
• Swelling
• A visible bruise appearing days later

82
Care for a Muscle Strain

• Follow the RICE procedures.
• Stretch the muscle but do not force stretching.

83
Knee Injuries

• Among the most serious joint injuries
• Their severity is difficult to determine, thus
  medical care is necessary if the injury is from
  being hit or twisted and not from overuse.

84
Knee Fracture

• Generally occurs as a result of a fall or a
  direct blow
• May occur at the end of the femur, at the end of
  the tibia, or in the knee cap

85
Recognizing a Knee Fracture

• Determining if a fracture exists is difficult.
• Some fractured knees may look like a
  discoloration.
• Other signs include
• Deformity
• Tenderness
• Swelling

86
Care for a Knee Fracture

• If a pulse can be felt in the ankle with no
  deformity, splint the leg with the knee straight.
• If a pulse can be felt in the ankle with
  significant deformity, splint the knee in the
  position found.
• Seek medical care.

87
Knee Dislocation

• A knee dislocation is a serious injury.
• Recognizing a knee dislocation
• Excruciating pain
• Deformity
• Pulse may be absent in the ankle
• Do not confuse a knee dislocation with a patella
  dislocation

88
Care for a Knee Dislocation

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

89
Patella Dislocation

• A dislocated patella can be a very painful injury
  and must be treated immediately.
• Some people have repeated kneecap dislocations.
• A dislocated patella most commonly occurs in
  teenagers and young adults who are engaged in
  athletic activities.

90
Recognizing a Patella Dislocation

• Possible swelling
• An inability to bend or straighten the knee
• Pain
• Deformity

91
Care for a Patella Dislocation

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

92
Knee Sprain

• Ligament injuries occur most often in sports.
• The knee is very prone to ligament injury,
  ranging from mild sprains to complete tearing.

93
Recognizing a Knee Sprain

• At the time of injury the victim has
• Severe pain
• The feeling of a pop or snap
• A locking sensation
• The victim may not be able to walk without
  limping, or bend the knee
• Later, there may be swelling in the knee and
  bruising.

94
Care for a Knee Sprain

• Follow the RICE procedures.
• Seek medical care.

95
Knee Contusion

• Contusions of the knee are caused by a direct
  blow or by falling on the knee.
• Recognizing a knee contusion
• Pain
• Swelling
• Tenderness
• Bruise marks
• Care for a knee contusion
• Follow the RICE procedures.

96
Lower-Leg Injuries

• Tibia and fibula fractures
• Tibia and fibula contusion
• Muscle cramps
• Shin splints
• Ankle and foot injuries
• Toe injuries

97
Tibia and Fibula Fractures

• Tibia and fibula injuries can occur at any place
  between the knee joint and the ankle joint.
• Injuries to the blood vessels, caused by extreme
  deformity, are common with injuries of the tibia
  and fibula, and the pain is usually severe.

98
Recognizing Tibia and Fibula Fractures

• Severe pain
• Swelling
• Visible deformity
• Tenderness when touched

99
Care for Tibia and Fibula Fractures

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

100
Recognizing Tibia and Fibula Contusion

• Victim received a hit directly on the shin.
• Tender when touched
• Sharp pain
• Later has
• Discoloration
• Difficulty moving ankle up and down
• Numbness or coldness in toes or foot

101
Care for a Tibia and Fibula Contusion

• Expose the injury.
• Apply the RICE procedures.
• If numbness or tingling exists, seek medical care.

102
Muscle Cramp

• Muscle spasm or cramping usually occurs in the
  calf and sometimes in the thigh or hamstring.
• It is a temporary condition of little consequence.

103
Recognizing a Muscle Cramp

• Happens during or after intense exercise sessions
• Painful, muscle contraction or spasm which
  disables the victim

104
Care for Muscle Cramps

• Try one or more of the following
• Have the victim gently stretch the affected
  muscle.
• Relax the muscle by applying pressure to it.
• Apply ice to the cramped muscle.
• Pinch the upper lip hard to reduce calf-muscle
  cramping.
• Have the victim drink lightly salted, cool water.

105
Shin Splints

• Describes pain in the front of the lower leg
• Caused by repetitive stress in the leg such as
  running or walking

106
Recognizing Shin Splints

• The shin aches during activity, but
• Ache subsides significantly after activity stops
• Ache is a result of an increase in the workout
  routine
• Usually a chronic problem that gets worse

107
Care for Shin Splints

• Apply an ice pack before an activity.
• Apply pressure with a 3-inch elastic bandage over
  the sorest point.
• Apply an ice pack for 20 minutes after the
  activity.
• Curtail activity until the shin is pain free.
• Pain medications that are anti-inflammatory drugs
  may be taken.

108
Ankle and Foot Injuries

• The ankle and foot frequently are injured, mainly
  by twisting.
• In some cases, the damage requires surgical
  correction.
• Most ankle injuries are sprains about 85 of
  sprains involve the outside ligaments.

109
Recognizing Foot and Ankle Injuries

• Press along the bones to check for pain and
  tenderness.
• Ask the victim, Have you tried standing on it?
• If the victim hops on the good foot and the
  injured ankle cannot tolerate the jarring,
  suspect a fracture.
• Ankle sprains tend to swell on only one side of
  the foot swelling on both sides usually
  accompanies fractures.

110
Care for Foot and Ankle Injuries

• Controversy exists about whether to remove a shoe
  from an injured foot.
• Shoe may act as a splint and retard swelling
  however, taking the shoe off allows for better
  examination and care.
• Use RICE procedures to reduce swelling.