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Chapter 15

Chapter 15. Extremity 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 (1 of 2). Look for signs and symptoms of fractures and dislocations.

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Chapter 15

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  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

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