chapter 32

Muscle Functions

• Protection: Muscles serve to protect underlying structures by forming a protective layer around them.

• Thermoregulation: As muscles contract, they generate heat, which plays a crucial role in thermoregulation.

• Movement: Muscles are integral for movement and functioning of the body.

• Types of Muscle:

  • Skeletal Muscle: Striated muscle that is under voluntary control.

  • Cardiac Muscle: Found in the heart, responsible for pumping blood.

  • Smooth Muscle: Involuntary muscle found in the walls of organs.

Connective Tissues

• Ligaments: Structures that connect bone to bone.

• Tendons: Structures that connect muscle to bone.

• Cartilage: Found at the ends of long bones to reduce friction; also provides cushioning at joints.

• Joints: Locations where two or more bones meet, allowing for movement.

Functions of the Skeletal System

1. Framework: Provides structure and support for the body, maintaining upright posture.

2. Protection: Shields vital organs and underlying structures from damage.

3. Movement: Serves as the attachment point for skeletal muscles, facilitating movement.

4. Calcium Regulation: Helps to regulate calcium levels in the blood, which is critical for various bodily functions.

5. Blood Cell Production: The bone marrow is responsible for producing different types of blood cells, including red blood cells.

Clavicle and Shoulder Girdle

• Common Injuries:

  • Clavicle Fracture: Often a result of direct impact; the most commonly broken bone.

  • AC Joint Separation: More commonly injured joint between the acromion and clavicle.

• Sling and Swath: Used to secure the arm after an injury.

  • Sling: Supports the arm.

  • Swath: Prevents excessive motion of the arm, holding it stable.

• PMSC:

  • P: Pulse

  • M: Motor function

  • S: Sensory function

  • Each assessment helps in evaluating potential nerve or circulation damage.

Scapula and Shoulder Joint

• Shoulder Joint: Also known as the glenohumeral joint; a ball-and-socket joint.

• Common Injuries:

  • Dislocations: Anterior (common) or posterior dislocation, with a jarring fall leading to instability.

  • Subluxation: Partial dislocation where the joint returns to place on its own.

• Management of Shoulder Injuries:

  • Manual Stabilization: Essential to prevent further injury.

  • Sling and Swath for dislocated or subluxed shoulder.

Humerus and Elbow Injuries

• Dislocated Elbow: Always associated with a fracture, requires immobilization in current position.

• Management:

  • Sling: To support the arm.

  • Splint: For affected areas of the arm.

• Position of Function: Maintains the arm in a functional position, providing comfort and stability.

Radius and Ulna Injuries

• Common Fractures: Can occur individually or together; often require splinting.

• Specific Injuries:

  • Colles Fracture: A fracture of the distal radius resulting in characteristic wrist deformity.

  • Nurse Maid's Elbow: A common injury in children from pulling on their arm, leading to dislocation of the radial head.

Lower Extremity Injuries

• Pelvic Injuries:

  • Open Book Fracture: Significant injury requiring careful management to prevent further damage.

  • Pelvic Binder: Used to stabilize the pelvis, especially if fractures or sharp bone fragments are present.

• Femur Fractures:

  • Indication for Traction Splint: These splints are used for a closed mid-shaft femur fracture to realign the bone.

  • Positioning: Ensure joint above and below the injury is immobilized.

Fracture Classifications

• Open vs. Closed:

  • Open: Bone protrudes through the skin.

  • Closed: Bone is intact beneath the skin.

• Displaced vs. Nondisplaced:

  • Displaced: Bone ends are misaligned.

  • Nondisplaced: Bone crack does not cause noticeable deformity.

• Complete vs. Incomplete:

  • Complete: Bone completely fractured.

  • Incomplete: Bone partially fractured.

Common Fracture Types

• Comminuted: Bone breaks into multiple fragments.

• Epiphyseal: Occurs at growth plate; significant in children and may affect growth.

• Greenstick: Incomplete fracture common in children due to softer bones.

• Pathologic: Fracture due to underlying disease, like osteoporosis.

• Spiral Fracture: Occurs due to a twisting force.

Sternal and Other Muscle Functions

• RICES Protocol: Used for soft tissue injuries; rest, ice, compression, elevation, and splinting are key.

• Compartment Syndrome: Monitor for pressure and blood flow issues that can compromise the limb due to swelling post-injury.

• Six P's of Assessment: Pain, pallor, paresthesia, paralysis, pulselessness, and pressure are key indicators to check during assessments on injuries.

Muscle Functions

• Protection: Muscles serve as a protective layer for underlying structures, such as organs and bones. This includes not only physical protection during injury but also forming a barrier against pathogens.

• Thermoregulation: When muscles contract, they generate heat through metabolic processes, which is essential for maintaining the body’s core temperature in various conditions, thereby playing a vital role in homeostasis.

• Movement: Muscles are integral to all movements of the body, working in coordination with the skeletal system to facilitate actions from gross motor skills, like running, to fine motor skills, such as typing.

Types of Muscle:

• Skeletal Muscle: This is striated muscle that connects to bones via tendons and is under voluntary control. It is responsible for locomotion and voluntary movements and can adapt to training, increasing in size and strength.

• Cardiac Muscle: This specialized muscle found only in the heart is responsible for pumping blood throughout the body. It is involuntary and features intercalated discs that facilitate synchronized contractions.

• Smooth Muscle: Involuntary muscle found in the walls of organs such as the intestines and blood vessels; it is not striated and regulates involuntary movements like digestion and vasoconstriction.

Connective Tissues

• Ligaments: Tough connective tissue structures that connect bone to bone, providing stability to joints.

• Tendons: Connective tissues that attach muscles to bones, enabling movement when muscles contract.

• Cartilage: A resilient and flexible connective tissue found at the ends of long bones, it reduces friction in joints and absorbs shock, providing cushioning.

• Joints: Locations where two or more bones meet, allowing for various types of movement from freedom of movement in ball-and-socket joints to stability in hinge joints.

Functions of the Skeletal System

• Framework: The skeleton provides structure and support for the body, maintaining an upright posture and allowing for growth.

• Protection: It encases and safeguards vital organs (like the heart, lungs, and brain) from mechanical injury.

• Movement: The skeleton serves as the attachment point for skeletal muscles, facilitating various movements through levers.

• Calcium Regulation: Plays a critical role in maintaining calcium levels in the blood, necessary for muscle contractions, nerve transmission, and blood clotting functions.

• Blood Cell Production: The bone marrow within the skeletal system produces essential blood cells, including red and white blood cells, contributing to immune function and oxygen transport.

Clavicle and Shoulder Girdle

• Common Injuries:

  • Clavicle Fracture: Often the result of direct impact (like a fall), the clavicle is the most commonly fractured bone in the body. Immediate treatment often involves immobilization and possible surgical intervention.

  • AC Joint Separation: This injury occurs between the acromion and clavicle, typically due to a fall or a direct blow to the shoulder.

• Sling and Swath: Used to secure the arm following an injury.

  • Sling: Supports the arm next to the body to minimize movement.

  • Swath: Prevents excessive motion of the arm, keeping it immobilized to reduce pain and promote healing.

• PMSC:

  • P: Pulse (checks circulation).

  • M: Motor function (assesses nerve function and muscle activity).

  • S: Sensory function (evaluates nerve conduction and sensation). Each assessment helps in evaluating potential nerve or circulation damage, crucial for effective treatment.

Scapula and Shoulder Joint

• Shoulder Joint: Also known as the glenohumeral joint, it is a ball-and-socket joint that allows for a wide range of motion but is prone to dislocations.

• Common Injuries:

  • Dislocations: Anterior dislocations are common, often resulting from falls or trauma, which can lead to instability and require prompt reduction.

  • Subluxation: A partial dislocation where the joint returns to place on its own, often resulting in pain and reduced mobility.

• Management of Shoulder Injuries:

  • Manual Stabilization: Essential to prevent further injury during transportation.

  • Sling and Swath: This method is particularly important following dislocated or subluxed shoulders to ensure proper healing.

Humerus and Elbow Injuries

• Dislocated Elbow: This severe injury is typically associated with fractures and requires immobilization in the position of injury to prevent further damage.

  • Management:

    • Sling: Provides support to the injured arm.

    • Splint: Stabilizes the affected areas to prevent movement.

    • Position of Function: Arranging the arm in a functional position aids in comfort and stability during healing.

Radius and Ulna Injuries

• Common Fractures: These can happen either to the radius or ulna individually, or both may fracture simultaneously, often necessitating splinting to keep the bone in alignment.

• Specific Injuries:

  • Colles Fracture: A fracture of the distal radius commonly associated with a fall on an outstretched hand, leading to a distinctive wrist deformity.

  • Nurse Maid's Elbow: Common in children and occurs when a caregiver pulls on an arm, causing dislocation of the radial head and typically requires gentle reduction.

Lower Extremity Injuries

• Pelvic Injuries:

  • Open Book Fracture: A significant injury resulting from blunt trauma, requiring careful management to avoid potential severe complications.

  • Pelvic Binder: A device used to stabilize the pelvis during transport, particularly in cases involving fractures or sharp bone fragments.

• Femur Fractures:

  • Indication for Traction Splint: These are important in handling closed mid-shaft femur fractures, aimed at realigning the fractured bone for effective healing.

  • Positioning: Proper immobilization of joints above and below an injury site ensures stability and pain relief.

Fracture Classifications

• Open vs. Closed:

  • Open: The bone protrudes through the skin, significantly increasing the risk for infection.

  • Closed: The bone remains intact beneath the skin, lowering complication risks.

• Displaced vs. Nondisplaced:

  • Displaced: Fracture results in bone ends being misaligned, complicating healing and requiring external manipulation or surgery.

  • Nondisplaced: The bone crack does not move out of its normal alignment, often healable without surgery.

• Complete vs. Incomplete:

  • Complete: The bone is completely fractured into separate pieces.

  • Incomplete: The bone may crack but remains largely intact.

Common Fracture Types

• Comminuted: The bone shatters into multiple fragments, complicating the healing process significantly.

• Epiphyseal: Fractures occurring at the growth plate; critical in children as they may affect future growth and development.

• Greenstick: An incomplete fracture common in children due to their softer bones, where the bone bends and partially fractures.

• Pathologic: Fractures that occur due to underlying diseases like osteoporosis, indicating a need for careful health evaluation.

• Spiral Fracture: Typically results from a twisting force and is often associated with sports injuries or accidents.

Sternal and Other Muscle Functions

• RICES Protocol: A standard method used for managing soft tissue injuries, consisting of Rest, Ice, Compression, Elevation, and Splinting. Each of these elements is crucial to minimizing damage and promoting recovery.

• Compartment Syndrome: A serious condition that involves increased pressure within a muscle compartment, compromising circulation and potentially damaging nerves and muscles. Monitoring for symptoms ensures timely intervention.

• Six P's of Assessment: Includes Pain, Pallor, Paresthesia, Paralysis, Pulselessness, and Pressure. These indicators are vital during assessments of limb injuries to determine the severity and necessary treatment.