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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.
© Jones & Bartlett Learning.
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.
© Jones & Bartlett Learning.
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.
© Jones & Bartlett Learning.
Performing the RICE Procedure
• E = Elevation− Limits circulation to
injured area− Do not elevate a
suspected fracture until it has been stabilized.
© Jones & Bartlett Learning.
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
© Jones & Bartlett Learning.
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.