Chapter 15

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. R = Rest I = Ice C = Compression E = Elevation RICE Procedure (2 of 2)

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

36. Care for Golfer’s 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 Injuries—Crushed 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