Muscles: Injuries to the brain, spinal cord or nerves can affect muscle control. When nerves lose control of muscles, it is called paralysis. When a muscle is injured, a nearby muscle often takes over for the injured one.
Bones: Bones weaken with age. Older adults have more brittle bones. Sometimes they break surprisingly easily. This gradual weakening of bones is called osteoporosis.
Joints: All joints have a normal range of movement in which they can move freely, without too much stress or strain. When joints are forced beyond this range, ligaments stretch and tear.
TYPES OF INJURIES: The four basic types of injuries:
What to Look For : Always suspect a severe injury when any of the following signals are present: - There is pain. One of the most common signals in any muscle, bone or joint injury is pain. The injured area may be very painful to touch and move.
- There is signiﬁcant bruising and swelling. The area may be swollen and red or bruised.
- There is signiﬁcant deformity. The area may be twisted or strangely bent. It may have abnormal lumps, ridges and hollows.
- The person is unable to use the affected part normally.
- There are bone fragments sticking out of a wound. - The person feels bones grating or the person felt or heard a snap or pop at the time of injury. - The injured area is cold, numb and tingly. - The cause of the injury suggests that it may be severe.
When to Call 9-1-1:
- There is obvious deformity
- There is moderate or severe swelling and discoloration.
- Bones sound or feel like they are rubbing together.
- A snap or pop was heard or felt at the time of the injury.
- There is a fracture with an open wound at, or bone piercing through, the injury site.
- The injured person cannot move or use the affected part normally.
- The injured area is cold and numb.
- The injury involves the head, neck or spine.
- The injured person has trouble breathing.
- The cause of the injury suggests that the injury may be severe.
- It is not possible to safely or comfortably move the person to a vehicle for transport to a hospital.
What to Do Until Help Arrives:
General care for injuries to muscles, bone and joints includes following the mnemonic RICE:
- Rest: Do not move or straighten the injured area.
- Immobilize: Stabilize the injured area in the position it was found. Splint the injured part only if the person must be moved or transported to receive medical care and it does not cause more pain. Minimizing movement can prevent further injury.
- Cold: Fill a plastic bag with ice and water or wrap ice with a damp cloth and apply ice to the injured area for periods of about 20 minutes. Place a thin barrier between the ice and bare skin.
If 20-minute icing cannot be tolerated, apply ice for periods of 10 minutes. If continued icing is needed, remove the pack for 20 minutes, and then replace it. Cold reduces internal bleeding, pain and swelling. Do not apply heat as there is no evidence that applying heat helps muscle, bone or joint injuries.
- Elevate: Elevate the injured part only if it does not cause more pain. Elevating the injured part may help reduce swelling.
Splinting an Injury:
Anatomic splints. - The person’s body is the splint. For example, you can splint an arm to the chest or an injured leg to the uninjured leg . Soft splints.
- Soft materials, such as a folded blanket, towel, pillow or folded triangular bandage, can be used for the splint . A sling is a speciﬁc kind of soft splint that uses a triangular bandage tied to support an injured arm, wrist or hand. Rigid splints
- Padded boards, folded magazines or newspapers, or padded metal strips that do not have any sharp edges can serve as splints The ground.
- An injured leg stretched out on the ground is supported by the ground.
There are 206 bones in the human body.Cranium and pelvic girdle are two bones fuse together after birth to each form one bone. Bones grow by getting longer at the ends. Cartilage is the soft material connecting ribs to the sterum. Bones have a thin sheet of outer tissue that cover them, this tissue is called the periosteum. Muscles work in opposing pairs. The cords that tie muscle to muscle or bone to muscle is called tendons. Cords that attached bone to bone is called ligaments.
Muscle must contract (shorten) in order for the muscle to move. The soft jelly-like tissue in the middle of certain bones is called marrow.
Muscle, Bone and Joint Injuries Overview The human body is made up of more than 600 muscles and 200 bones. Muscles are firmly attached to bones through tendons, and provide active movement of the skeleton and maintain its posture. A joint is the junction where two or more bones meet, and is supported by ligaments, muscles and a fibrous joint capsule.
Although injuries to a muscles, bones or joints can occur at any age, some types of injuries are more common at certain ages. There are several types of musculoskeletal injury, including fractures, dislocations, sprains, strains, and contusions. It is not always easy to differentiate between them. Usually the only way to diagnose a fracture with certainty is by x-ray. An exact diagnosis is not important when giving first aid.
For the purposes of field treatment, treat fractures, dislocations, severe sprains and strains equally.
Fractures and Dislocations; A fracture is a break in a bone produced by excessive strain or force on the bone. It is usually caused by a blow, a fall, a twisting movement, or even no apparent cause (i.e. spontaneous fracture occurs without any external injury).
Types of fracture: An open fracture (compound) has bleeding and penetration of the skin by the bone. A suspected fracture with bleeding should be treated as an open fracture, even if the bone is not visible. A closed fracture (simple) leaves the skin intact. A stress fracture is a small fracture usually in a weight bearing bone of the lower leg. It is an overuse injury that is caused when muscles fatigue and transfer excess physical stress to a bone. A dislocation is a separation or displacement of bones joined at a joint, with a structural loss of joint stability. It may or may not be accompanied by a fracture (fracture-dislocation).
It is usually caused by an injury such as a hard blow or fall that could occur during sports activities. Treat a dislocation as a fracture, and seek medical attention immediately. A subluxation (partial dislocation) can occur temporarily, and then the bones may return to their original position. It is important to see a doctor for a subluxation because the joint is now unstable and at risk for re-injury.
Signs and Symptoms: Swelling Bruising Deformity, angulation, shortening Pain Numbness Bleeding Inability to use the injured part Exposed bone ends (open fracture) Crepitus (crackling sound with movement) A “snap” or “pop” heard at the time of injury Treatment:
1. Keep the person still. 2. Assess response, breathing, circulation and appearance. 3. Activate EMS (call 9-1-1). 4. Observe for signs of hypovolemic shock due to internal bleeding, or a blue or very pale limb. This would indicate a medical emergency. 5. Cover open wounds with a sterile dressing; apply gentle pressure to control bleeding. 6. Apply an ice pack wrapped in a moist cloth. The cold decreases blood flow to the injured area, limiting bleeding into the soft tissue and joint, and reducing the amount of pain, swelling and bruising. Apply the ice pack up to 20 minutes at a time. 7. Only splint the injury if emergency response is delayed or if you decide to transport the victim yourself (e.g. for a finger injury). 8. Monitor circulation and sensation beyond the injury site. 9. Do not try to move a victim with a suspected fracture unless it is absolutely necessary. 10. Do not try to realign a broken bone or reduce a dislocation yourself. You may damage the joint, muscles, nerves or blood vessels or even fracture a bone. 11. Do not give the victim food or fluids. This may delay any necessary surgery. 12. Do not walk on an injured leg until evaluated and cleared by an appropriate medical professional. Splinting 13. Splints are applied to suspected fractures, dislocations and severe sprains. The objective is to immobilize the joints above and below the injury.
Applying a splint reduces the movement of injured muscles and bones, and allows the person to be transported with less pain and risk of further injury.
It also reduces the risk of shock by decreasing internal bleeding. A splint should not cause increased pain. A splint can be made from a variety of rigid or firm materials, including cardboard, a tree branch, a broom handle, or a tightly rolled blanket or magazine.
An injured limb can also be protected by “buddy taping” it to another part of the body. Under normal circumstances, in both urban and suburban areas the rescuer should simply immobilize the affected area instead of splinting it. Wait for EMS personnel to arrive and splint the injury.
Splinting Procedure: 1. Explain the procedure. 2. Check sensation and skin temperature before and after splinting. 3. If necessary to control bleeding, expose the fracture site by cutting clothing and removing shoes and socks (except for ankle/foot injuries). If you are splinting an upper extremity injury, remove rings, watches or other jewelry. Swelling may make it difficult to remove jewelry at a later time. 4. Cover open wounds with sterile dressings to control bleeding. 5. Select an appropriate splint that is longer than the bone it will support. Measure the splint against the uninjured limb to estimate the correct size. 6. Pad the splint with soft material to relieve local pressure and ensure even contact. 7. Carefully apply the splint. Do not straighten or manipulate the fracture site; suspected strains, sprains and fractures are splinted in the position found. 8. Use tape or binding to secure the splint in place above and below the injury site (e.g. tape, roll gauze, triangular bandages). It should be snug, but not so tight that it restricts blood flow. Avoid placing bindings directly over the fracture site. The splinting methods below are for short-term, emergency use. Only apply a splint to immobilize an injury during transport to seek medical care.
To immobilize a shoulder, gently bind the arm to the chest, with the strap passing beneath the uninjured arm. High ankle shoes can serve as a splint-in-place. Creating a Sling and Swath A person with an arm or shoulder injury may need a sling to support and position the limb after the application of a splint.
A sling can be created out of almost any long pieces of cloth, such as strips from a shirt or blanket. A swath is used to hold the sling in place against the body and reduce the amount of movement. Triangular bandages are a great addition to a first aid kit. They can be used as slings, swaths, bandages, or for padding of gaps during the splinting process.
Create a Sling and Swath
1. Use a triangular bandage or other large piece of cloth cut or folded into a triangle. for the adult victim the base of the triangle should be 4 to 5 feet long. 2. Place the injured arm into the bandage. The elbow is at the point of the triangle and the wrist should be at its base with the fingers exposed. The sling may need to be sized accordingly. 3. Wrap one end of the sling under the injured arm and the other end over the front of the injured arm and around the neck so that the two ends come together. 4. Tie or pin the ends together so that the arm is bent at a right angle. Ensure the knot is near the back of the neck, to the side (not directly on the spine). 5. Tie or pin the sling at the elbow so that the arm does not slip out of the sling. 6. Create a swath by using an additional triangular bandage or other long cloth.
Fold it into a long flat bandage 3 to 4 inches wide. Secure the sling in place by tying the swath over the humerus (upper bone of the arm) and tying the ends under the opposite arm. Ensure the swath is tight enough to restrict the movement of the shoulder but not tight enough to restrict breathing or cause pain. Fractures in Older Adults
Falls are serious for anyone, but they can have especially serious consequences for older persons. Among Americans over age 65, more than one-third fall each year. In 2009 about 2.2 million were treated in hospital emergency departments for fallrelated injuries, and more than 581,000 were hospitalized. More than 18,000 died from fall-related injuries. Approximately 3-5% of older adult falls result in fractures.
Osteoporosis is a disease in which there is a gradual loss of bone density, resulting in extremely fragile bones that break under minimal stress. More than 90% of hip fractures are associated with osteoporosis in people older than age 65.
Women lose bone density more rapidly than men; 80% of hip fractures occur in older women. A fracture may even occur without an associated fall due to weakening of the bones from osteoporosis (pathological fracture).
Half of all women and 25% of men older than 50 will sustain a fracture due to osteoporosis. Certain medications and chronic medical conditions can result in a weakening of bone. Smoking, excessive alcohol consumption, and nutritional deficiencies can also contribute. Lack of weight bearing activities, such as walking, along with prolonged bed rest, will also result in bone loss.
To prevent falls and the progression of osteoporosis, it is important that older adults, once cleared by their physicians, participate in regular physical activity and exercise that can help improve their strength, flexibility and balance. Other factors that can decrease their risk of falls include a medication evaluation, an eye exam, purchasing proper footwear, and improving home safety (removing throw rugs, placing items within easy reach, not using rolling chairs, etc.).
Identify common fractures/dislocations in older persons:
Hip fractures: The leg is often turned outward in an unnatural position, with pain and inability to move the leg. Call 9-1-1.
Hip dislocation: Many older persons have hip replacement surgery. For several weeks after surgery they are at risk for dislocating the new joint if they do not follow specific movement restrictions or if they fall. The leg may be turned inward or outward in an unnatural position, with pain and inability to move the leg. Call 9-1-1. Pelvic fracture: There may be no visible deformity, but there is extreme pain when attempting to walk, roll, or even move the legs. Call 9-1-1.
Compression fracture of the back: The collapse of one or more individual vertebral bones that may occur with no apparent cause. If the fracture is due to osteoporosis, it is usually stable. It may be very painful, or may have no symptoms at all.
Get medical care for evaluation, pain management, and osteoporosis treatment. If unable to move or walk, if pain is severe or caused by injury, call 9-1-1.
Do not move the victim. Fractures can be devastating for an older person. Approximately 20% of people with a hip fracture die within 1 year of their injury. About 25% of adults with hip fracture must stay in a nursing home for at least a year after the injury. After a fall, many older people develop a fear of falling. This causes them to reduce their activities, which leads to loss of mobility and strength, which actually increases the risk for falls.
Fractures in Children Children fall frequently, but the vast majority of children’s falls do not result in a fracture. A child’s bones are softer than an adult’s bones.
When a child does sustain a fracture, it may be a greenstick fracture (one side of the bone is broken, while the other side bends, such as would occur when trying to break a green tree branch). Fractures in children generally heal faster than fractures in adults.
When a child sustains a fracture of a growth plate (the area of growing bone tissue near the ends of long bones in children and adolescents), he or she may require long-term follow-up to ensure that bone growth has not been interrupted. Approximately 85% of growth plate fractures heal without any long-term complications. Sprains, Strains and Contusions.
A contusion is bruising resulting from a direct blow. It is caused when blood vessels are damaged or broken. A sprain is a stretching or tearing of ligaments or other structures in a joint, while a strain is a stretching or tearing of muscle or tendon (a pulled muscle). A sprain or strain occurs when a structure is stretched beyond its normal range of motion.
When the muscles controlling a joint are weak or “caught off guard” at the moment of injury, a joint can be forced beyond its normal range of motion. Common injury sites include the shoulder, elbow, finger, hip and ankle. Ankle injuries cause the most common joint instability problems. Proper footwear can help support a joint and prevent injury. Strengthening exercises can help prevent recurrent sprains.
Sprains and strains can be classified as mild (only slight stretching or tearing), moderate (partial tear), or severe (complete tear). A mild injury will usually heal within two weeks.
An injury with moderate to severe symptoms should be seen by your medical professional. Physical therapy, splinting, casting, or even surgery may be indicated. If a sprain remains swollen and painful for several days, consult a physician. Signs and symptoms of a sprain or strain are similar to those of a fracture.
Closed fractures can often only be detected by x-ray. Acute sprains, strains and contusions should be treated with the R.I.C.E. technique: Rest: Stop activity after an injury. Do not put weight on the injured area. Ice: Apply an ice pack wrapped in a thin moist cloth to the affected area to reduce swelling, bleeding and pain. Apply the ice 20 minutes on, and at least 20 minutes off 3-4 times a day for the first 2-3 days.
The cold decreases blood flow to the injured area, limiting bleeding into the soft tissue and reducing the amount of pain, swelling and bruising. An ice pack can be made by placing ice in a plastic bag and covering with a thin, moist towel or cloth. You may also purchase an instant cold pack, but they are usually not as cold as an actual ice pack.
Another option is using a bag of frozen peas that will conform around the injured area, and can be refrozen and reused (but not eaten). Compress: Stabilize and support the injured area in the position found. Only apply a splint if the patient must be moved, and if it does not increase pain.
Elevate: Raise the injured area above the heart, if it does not increase the pain. This decreases blood flow to the area, reducing swelling and bruising.
Note: Do not apply ice directly onto bare skin, because it can cause frostbite. Do not apply heat to a new injury, because it will increase swelling and bruising. Victims with decreased sensation, diabetes or vascular disease should consult their doctor before applying ice.
Tips: Avoid injury by warming up before exercise. Keep your muscles and joints flexible with regular stretching. A daily stretching program can help prevent injury during physical activity. Although studies have not conclusively shown that stretching immediately prior to activity reduces the risk of injury or improves performance, they have shown that improving overall flexibility does help.
Easy bruising is very common with age due to thinning of the skin and weakening of blood vessels. Often even a minor bump that you don’t even notice can result in a large bruise. Prevent bruises by eliminating household clutter and wearing long sleeved shirts and long pants.
Talk to your doctor about medications, supplements or illness that could be contributing to the bruising. Easy bruising could be a sign of a more serious condition, such as a blood disease or blood clotting problem. Unexplained bruising can be an indication of domestic violence or abuse, especially when the bruising is in an unusual location such as around the eye or face. Ask about the cause of unexplained bruising.
Whiplash Whiplash is a common injury that can occur when the soft tissues of the neck are suddenly jerked or ‘whipped’ beyond their normal range of motion. This can occur when a vehicle is hit from behind or stops suddenly in a crash. It may also occur while playing sports, during a fight, when shaken (shaken baby syndrome), or during roller coaster rides. Pain and stiffness in the neck may develop over the first few days after injury, and may persist for several weeks or even months.
Get medical help for evaluation and treatment. If neck pain is sudden, radiates to shoulders or arms, involves numbness, tingling or weakness of the arms or legs, or any other signs of spinal injury, call 9-1-1. Treat the person in the position found. Stabilize the head and neck together while waiting for EMS responders.
Muscle Cramps A muscle cramp occurs when a muscle is locked into an involuntary contraction or spasm lasting from a few seconds to several minutes. Symptoms can range from muscle twitching to severe pain with a hard bulging muscle. The exact cause is unknown, but it can involve muscle fatigue, overexertion, dehydration, exercising in extreme heat, pregnancy, or inadequate stretching. They may also be associated with certain diseases (e.g. circulatory or nerve problem) or medications.
Treatment: 1. Stop the activity that triggered the cramp. 2. Gently stretch the muscle until the spasm relaxes and the pain subsides. 3. Apply an ice pack wrapped in a moist cloth to the muscle to relax it. Prevent muscle cramps with regular stretching, improving your fitness level, and maintaining hydration.
If muscle cramps persist, consult your physician to determine a medical cause. Ring Removal Removal of a ring may be indicated due to extremity swelling. An application of mild dish soap may help you gently remove the ring.
If not, many EMS personnel carry ring cutters in their first aid boxes. Your local hospital emergency department will also have a ring cutter.