Chapter 15Extremity Injuries

Extremity Injuries

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

Extremity Injury Assessment

• Look for signs and symptoms of fractures and dislocations.

• Examine the extremities using DOTS.• Use the “rule of thirds.”• Consider the cause of injury.• Use CSM (circulation, sensation,

movement).

Types of Extremity Injuries

• Contusions—tissue is bruised• Strains—muscles are stretched or torn• Sprains—tearing or stretching of joints• Tendinitis—inflammation of a tendon

caused by overuse

Types of Extremity Injuries

• Dislocations—bones are displaced from their normal joint alignment, out of their sockets, or out of their normal positions

• Fractures—breaks in bones that may or may not be accompanied by open wounds

RICE Procedure

• 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 relieve—even prevent—aches and pains.

Performing the RICE Procedure

• R = Rest− Do not use or move

injured part.− Crutches may be

used.

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Performing the RICE Procedure

• I = Ice− Apply for 20

minutes every 3 to 4 hours during the first 48 hours.

− Never apply directly to skin.

− When skin becomes numb, remove.

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Performing the RICE Procedure

• 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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Performing the RICE Procedure

• E = Elevation− Limits circulation to

injured area− Do not elevate a

suspected fracture until it has been stabilized.

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Shoulder Dislocation: What to Look For

• Person holds upper arm away from body.• Arm cannot be brought across chest.• Extreme pain• Squared off appearance• Complete loss of function• History of dislocations• Numbness or paralysis © American Academy of Orthopaedic Surgeons.

Shoulder Dislocation:What to Do

• 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.

Clavicle Fracture: What to Look For

• Fall on outstretched arm• Direct blow to clavicle or shoulder• Severe pain over injured area• Holding injured arm against chest• No movement because of pain

Clavicle Fracture: What to Look For

• Swelling• Deformity• Tenderness• Dropped or drooped shoulder• Bruising

Clavicle Fracture: What to Do

• Treat for shock.• Apply arm sling and swathe.• Apply ice pack for 20 minutes, three to

four times during 24 hours.• Seek immediate medical care.

Contusions: What to Look For

• Swelling• Pain at the injury site• Firmness when pressed• Tenderness• Discolorations

Contusions: What to Do

• Apply an ice pack for 20 minutes, three to four times during first 24 hours.

• Place arm in sling and swathe.

Tendinitis: What to Look For

• Constant pain or pain with motion of the shoulder

• Limited motion of shoulder• “Crackling” sound• Tenderness over the area

Tendinitis: What to Do

• Use an ice massage for 10 minutes before and after exercise.

• Use a sling and swathe.• Use pain medication.• Seek medical advice.

Humerus Fracture: What to Look For

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

Humerus Fracture: What to Do

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

Elbow Injuries

• Should be considered serious• Treat with extreme care.

Elbow Fractures and Dislocations: What to Look For

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

fingers below the elbow

Elbow Fractures and Dislocations: What to Do

• 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.

Tennis Elbow: What to Look For

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

normal• Very tender on outer protrusion

Tennis Elbow: What to Do

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

Golfer’s Elbow: What to Look For

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

normal.

Golfer’s Elbow: What to Do

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

activity.• Seek medical advice.

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.− When both are broken, the arm usually

appears deformed.

Radius and Ulna Fractures: What to Look For

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

moved

Radius and Ulna Fractures: What to Do

• Assess and treat for shock if indicated.• Apply an ice pack for 20 minutes.• Stabilize against motion.• Place the arm in a sling and swathe.• Seek medical care.

Wrist Fracture: What to Look For

• Snapping or popping sensation• Pain aggravated by movement• Tenderness, swelling• Inability or unwillingness to move wrist• Lumplike deformity

Wrist Fracture: What to Do

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

Hand Injuries

• May be fractured by:– Direct blow– Crushing injury

Crushed Hand: What to Look For

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

Crushed Hand: What to Do

• Control the bleeding.• Cover wounds with a dressing.• Apply an ice pack for 20 minutes.• Seek medical care.

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

Finger Fractures: What to Look For

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

Finger Fractures: Test

• Straighten fingers and place on a hard surface.

• Tap tip of injured finger toward the hand.– Pain lower down in the finger or into the hand

can indicate a fracture.

Finger Fractures: What to Do

• Do not try to realign.• Gently apply an ice pack.• Splint the finger.• Seek medical care.

Finger Dislocation: What to Look For

• Visible deformity• Immediate pain• Swelling• Shortening of the finger• May be unable to bend the finger

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Finger Dislocation: What to Do

• Do not try to realign.• Apply an ice pack for 20 minutes.• Splint the finger.• Seek medical care.

Sprained Finger: What to Look For

• Finger or thumb has been:− Jammed or compressed− Stepped on− Forced or twisted sideways

• Pain and swelling over a joint• Inability to make a fist• Weakness in finger

Sprained Finger: What to Do

• Apply an ice pack for 20 minutes.• Reevaluate.• Buddy tape the fingers.

Nail Avulsion: What to Look For

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

© American Academy of Orthopaedic Surgeons.

Nail Avulsion: What to Do

• Secure damaged nail in place with adhesive bandage.

• Do not trim away loose nail.• Consult a physician.

Splinters: What to Look For

• Small puncture wound• Sliver may or may not be seen.

Splinters: What to Do

• Use tweezers to remove splinter.− Clean the wound with soap and water.

• If splinter is impaled under a nail and breaks off flesh:− Cut a V-shaped notch in the nail.− Remove splinter with tweezers.

Blood Under a Nail: What to Look For

• Excruciating pain• Pain does not disappear until blood is

drained.

Blood Under a Nail: What to Do

• Immerse finger in ice water or apply ice pack.

• Elevate hand.• Relieve pressure.• Apply dressing.

Ring Strangulation: What to Look For

• A ring has become tight on a finger after an injury or after some other cause of swelling

Ring Strangulation: What to Do

• Try one of the following:– Lubricate the finger.– Immerse in cold water or apply an ice pack.– Spray window cleaner onto finger.– Massage finger from tip to hand.– Wind thread around the finger.

Hip Dislocation: What to Look For

• Severe pain at injury• Swelling at injury• Hip is flexed and knee is bent and rotated

inward toward opposite hip.• Visible injury

Hip Dislocation: What to Do

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

Hip Fracture: What to look For

• Severe pain in groin area• Inability to lift injured leg• Leg may appear shortened and be rotated

with the toes pointing abnormally.

Hip Fracture: What to Do

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

Femur Fracture: What to Look For

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

Femur Fracture: What to Do

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

Muscle Contusion: What to Look For

• The person received a direct hit producing:– Swelling– Pain and tenderness– Tightness or firmness of site– Visible bruise

Muscle Contusion: What to Do

• Follow the RICE procedure.– Apply an ice pack for 20 minutes, three to four

times a day for 48 hours.• Stretch the muscle.

Muscle Strain: What to Look For

• Pop or pulling sensation while running or jumping

• Tenderness• Stiffness and pain• Swelling• Visible bruise appearing days later

Muscle Strain: What to Do

• Follow the RICE procedure.– Apply an ice pack for 20 minutes, three to four

times a day for 48 hours.• Stretch the muscle.

Knee Injuries

• Among the most serious joint injuries• Medical care is required if the injury is

from being hit or twisted.

Knee Fracture: What to Look For

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

Knee Fracture: What to Do

• If a pulse can be felt in the ankle with no deformity, splint leg with knee straight.

• If a pulse can be felt in the ankle with significant deformity, splint knee in position found.

• Seek medical care.

Knee Dislocation: What to Look For

• Excruciating pain• Deformity• Absent pulse in the ankle

Knee Dislocation: What to Do

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

Patella Dislocation: What to Look For

• A blow or twist, causing knee cap to move outside of the knee joint

• Swelling• Inability to bend or straighten knee• Pain• Deformity

Patella Dislocation: What to Do

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

Knee Sprain: What to Look For

• 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

Knee Sprain: What to Do

• Follow the RICE procedure.• Seek medical care.

Knee Contusion: What to Look For

• After a direct blow to the knee cap, the person has:– Pain– Swelling– Tenderness– Black-and-blue discoloration

Knee Contusion: What to Do

• Follow the RICE procedure.

Lower Leg Injuries

• Can occur at any place between the knee joint and the ankle joint

• Marked deformity may occur when both bones are broken.

• When only one bone is broken, little deformity may be present.

Tibia and Fibula Fractures: What to Look For

• A direct blow or twisting force produces:– Severe pain– Swelling– Deformity– Tenderness

Tibia and Fibula Fractures: What to Do

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

Tibia and Fibula Contusion: What to Look For

• Person received a direct hit on shin.• Tenderness when touched• Sharp pain• Discoloration• Difficulty moving ankle up and down• Numbness or coldness in toes or foot

Tibia and Fibula Contusion: What to Do

• Expose the injury.• Apply the RICE procedure.

– Use an ice pack for 20 minutes, three to four times daily for 48 hours.

• If numbness or tingling exists, seek medical care.

Muscle Cramp: What to Look For

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

disables the person

Muscle Cramps: What to Do

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

Shin Splints: What to Look For

• Ache that subsides after activity stops• Ache that is a result of an increase in

workout routine• Chronic condition that gets worse

Shin Splints: What to Do

• 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.

Foot and Ankle Injuries: What to Look For

• Pain and/or a popping or tearing sensation• Swelling and complete loss of function• Tenderness or pain above, below, and to

sides of the injury when pressed

Foot and Ankle Injuries: What to Do

• Take shoes off.• Use RICE

procedure.• If there is question

about severity of injury, splint and seek medical care.

© American Academy of Orthopaedic Surgeons.

Toe Injuries: What to Look For

• Pain and swelling• Deformity

Toe Injuries: What to Do

• Treat the same as a finger injury.