2013 baa - musculoskeletal system

7/30/2019 2013 BAA - Musculoskeletal System

1/16

Module9 MusculoskeletalSystem

1/16

1 TheSkeleton Madeupof206bones Providesprotectionforvitalorgans+isframeworkforthebody Skeletonprovidessupport:

o Supportagainstgravityo Movemento Protectiono Productionsofbloodcellso Storageofcalcium+phosphorus

Musculoskeletal systemcomposedof:o Boneso Muscleso Cartilageso Tendonso Ligaments

1.1 AxialSkeleton(80bones)Forms

central

(longitudinal)

axis

of

body

Skull(28bones)o Cranium(8Bones)o Face(14Bones)o Earbones(6Bones)

Hyoidbone(1bone) Vertebralcolumn(26bones) Thoraciccage(25bones)1.2 Appendicularskeleton(126bones) Pectoralgirdle(4bones)

o Clavicle(2bones)o Scapula(2bones)

Upperlimbs(60bones) Pelvicgirdle(2bones) Lowerlimbs(60bones)

1.3 TheSkull Madeupof22bones

o 8of22bonesarecraniumboneso Craniumbonesisboxlikecavitycontainsandprotectsthebraino 14otherbonesfromfaceo Facialbonesgiveitsshapeandprovideprotectionforeyes

Amongbonesformingcraniumo Frontalo Occipitalo Parietal(2bones)o Temporal(2bones)

Amongbonesformingfaceo Maxillary(2bones)o Mandible(2bones)o Zygomatic(2bones)o Nasalbones(2bones)

InferiorNasalConchae(2bones)


2/16


2/16

Other:LacrimalBones(2bones)PalatineBones(2bones)ZygomaticBones(2bones) AllbonesfusedorfixedtooneanotherEXCEPTmandible

o Mandibleattachedtoskulloneachsidebyhingejointtoallowformovement Infancy:craniumNOTfullyformed

o Donotfusetogetheruntilage+15montho Latefusionreasonwhyinfantshavetwosoftareasontheirheadso Softspotscalledanteriorandposteriorfontanelle

1.4 Spinalcolumn Spinalcolumncentralsupportingstructureofbody Composedof33bones

o Cervical(7vertebrae) Cervicalspinal:C1C7 SkullrestonC1

o Thoracic(12vertebrae) Thoracicspine:T1T12 Onepairofribsattachedtoeachvertebrae

o Lumbar(5vertebrae) Lumbarspine:L1L5 Akadorsalspine

o Sacrum(5vertebraefused) Sacralspinal:S1S5 Fusedtogetherformonebonecalledsacrum Sacrumjoinedtoiliacbonesofpelvis

withstrongligamentsatsacroiliacjointstoformpelviso Coccyx(4vertebraefused)

Lastfourvertebraefusedformcoccyx/tailbone1.5 TheThorax Thorax/ribcagemadeupof12pairsofribsandsternum(breastbone) Contains+protectslungs,heart,greatvessels,trachea(windpipe),oesophagus(gullet/foodpipe) Thorax/chestcavitytwomainparts

o 12pairsofribs Trueribs,falseribs,floatingribs

o Sternum


3/16


3/16

1.6 Pelvis Bonyring Twoinnominatebones Eachbonemadeof3fusedbones

o Ilium(hip)o

Ischium

(bum

bone)

o Pubis1.7 Lowerextremities Threemainpartsoflowerextremities

o Thigho Lego Foot

Threejointsconnectmainpartsoflego Hip

Betweenhipandthigho Knee

Between

thigh

and

leg

o Ankle Betweenlegandfoot

Bonesofthelowerextremitieso Femur(Largestboneinthebody thigh)o Patella(kneecap)o Tibia(shinbone)o Fibulao Tarsalso Metacarpalso Phalanges

1.8 Upperextremities Extendsfromshouldergirdletofingertipscomposedof:

o Shouldergirdle Scapula(2) Clavicle(2)

o Humeruso Radiuso Ulnao Carpalso Metacarpalso Phalanges

1.9 TypesofBones Theyarehardandstrongstructures Bonesclassifiedaccordingtoshape

o Longbone Longbonesofthearmsandlegs

o Shortbone Smallbonesofwristandankle

o Flatbone Shoulderbladeandscalp,sternum

o Irregularbone Vertebrae

o Sesamoidbone Patella


4/16


4/16

Classificationbasedonstructure:o Compactbone(hardanddense,outerbone)o Spongybone(marrow)

Classificationbasedonstructure:

Importantpartsofbonesbestillustratesbyfemur

Heado

Rounded

end

made

of

compact

bone

allows

for

rotation

Necko Belowthehead

Shafto Longcylindricalportionofbonewithcompactbone(outerlayer)+spongymarrow(innerlayer)

Condyleso Bumps/prominencesusuallyforarticulationwithanotherbone

Tuberositieso Prominencesonbone

Epiphysealplateo Plateofcartilageresponsibleforgrowthinlengthofbone(foundinchildren)


5/16


5/16

1.10 Joints Jointformedwhentwobonescomeintocontact Jointconsistsofendsofbonesandsurroundingconnectingandsupportingtissue Mostjointsinbodynamedbycombiningnamesoftwobonesthatformjoint Jointclassifications

oBall

and

socket

o Condyloid+saddlejointso Gliding/Planeo Hingeo Pivot


6/16


6/16

1.10.1 Ballandsocket Mostfreelymoveablejoint Possiblemovements:

o Flexiono Extensiono Adductiono Rotationo Circumduction

Hipandshoulderjoints1.10.2 Condyloid+saddlejoints Movementtakesplacearoundtwoaxis Permittingmovements:

o Flexiono Extensiono Adductiono Abductiono Circumductiono Circumduction(Combinationofabovemovements)

Wrist

1.10.3 Gliding/Plane Articularsurfacesglideovereachother Possiblemovements:

o Glidemovement Sternoclavicularjoint,jointsbetweencarpalsbonesandbetweentarsalbones,jointbetweenvertebrae


7/16


7/16

1.10.4 Hinge Permitsmovementinoneplaneonly Possiblemovements:

o Flexiono Extension

Knee,

Elbow,

ankle

1.10.5 Pivot Rotarymovement(allowsmovementaroundoneaxisonly) Possiblemovements:

o Rotarymovement Classicexample:superior+inferiorradioulnajoints1.11 Tendons Tendonsareconnectivetissue Attachesmuscletobone Composedofwhitefibroustissuearrangedinverydensemanner+ofgreatstrength1.12 Ligaments Similarstructuretotendons Butattachbonetobone Ligamentsstrongbandsoffibroustissueservetobindtogetherbonesenteringinjoints

o TheyareeitherCordlikeorflattenedbandso Thoughmostjointssurroundedbyfibrouscapsule/capsularligament

1.13 Cartilage Cartilagealsotypeofconnectivetissue Formsthesmoothsurfaceovertheendsofthebones Cartilageprovidescushioningatjoints1.14 Muscles Muscleiscontractiletissue

o Hasabilitytoactivelyshortenandlengthen Mostmusclesattachedtobonebymeansoftendons 3typesofmuscles(maintainpostureandallowformovement)

o Skeletalmuscles(Striated)o Smooth(Involuntary)o Cardiac

1.14.1 SkeletalMuscle Skeletalmuscleattachestotheboneoftheskeleton Formmajormusclemassofthebody CalledVoluntarymuscle

o Underdirectvoluntarycontrolofbraino Canbestimulatedtocontractandrelaxatwill

AlsocalledStriatedmuscle Whenviewedundermicroscopehascharacteristicsofstripes(striations) Specificnervespassdirectlyfrombraintospinalcord

o Theyconnectwithothernervesandpasstoeachskeletalmuscleo Facia Coversallskeletalmuscles

Faciaencasesthemuscletissue AteitherendofmuscleFaciaextendsbeyondmuscletoattachtobone


8/16


8/16

1.14.2 SmoothMuscle Involuntarymuscle

o Carriesoutmuchofautonomicworkofbody Foundinwallsofmosttubularstructures

o Gastrointestinal tracto Urinarysystemo Bloodvesselso Bronchioflungs

1.14.3 CardiacMuscle Speciallyadaptedinvoluntarymuscle

o Veryrichsupplybloodsupplyandownelectricalsystem Heartislargemusclecomposedoftwopumps

o Unequalforce Onelowerpressure Onehigherpressure

Heartfunctionscontinuouslyfrombirthtodeath

Cardiac

muscle

can

tolerate

interruption

of

blood

supply

ONLY

FOR

A

FEW

SECONDS

o Requirescontinuoussupplyofoxygen+glucosefornormalfunction Cardiacmuscleplacedinseparatecategory

o Becauseofspecialstructureandfunction

2 MusculoskeletalInjuries2.1 ClassificationInjuriesresultedfromtraumaticforceinclude:

Strains Sprains Fractures Jointdislocations2.2 Complications Haemorrhage Instability Lossoftissue Simplelaceration Contamination(speciallyopenfractures) Interruptionofbloodsupply Nervedamage

Long

term

disability

Canresultfromo Directtrauma

Bluntforceappliedtoanextremityo Indirecttrauma

Verticalfallthatcausesfracturedistantfromsiteofimpacto Pathologicconditions

Tumours FormsofArthritis Malignancy


9/16


9/16

2.2.1 Strains Injurytomuscleoritstendon Causedbyoverexertionoroverextension Commonlyoccurinbackandarms Maybeaccompaniedbysignificantlossinfunction

Severe

strains

may

cause

avulsion

of

bone

from

attachment

site

2.2.2 Sprains Moreeventsandsportsinjuries Partialtearingofligament Causedbysuddentwistingorstretchingofjointbeyondnormalrangeofmotion Twocommonareasforsprains

o Ankles+knees Sprainsaregradedbyseverity

o Firstdegreespraino Seconddegreespraino Thirddegreesprain

2.2.3 Jointdislocations Occurwhennormalarticulatingendsoftwoormorebonesaredisplace

o Luxationcompletedislocationo Subluxationincompletedislocation

Suspectjointdislocationwhenjointisdeformed/doesnotmovewithnormalrangeofmotion Alldislocationscanresultingreatdamageandinstability2.2.4 Arthritis Inflammationofthejoint Characterizedbypain,swelling,stiffnessandredness Ajointdisease(involvingone/manyjoint)canoccurfrommanycauses Variesinseverityfrommildachetostiffnesstoseverepainandlaterjointdeformity Osteoarthritis(degenerativearthritis)mostcommon Painassociatedwiththisconditionusuallymanagedwithantiinflammatoryagents2.2.5 Fractures Breakinthecontinuityofbone/cartilage Maybecomplete/incomplete dependingonlineoffracturethroughbone Maybeclassifiedasopen/closeddependingonintegrityofskinnearfracture2.2.5.1 Classificationoffractures

o Openo Closedo Comminuted(crushinginjury)o Greenstick(bonesbend)o Spiralo Oblique(angle/slantlinefracture)o Transverse(straightlinefracture)o Stress(manyhairlinefractures)o Pathologicalo Epiphyseal(atthegrowthplate)


10/16


10/16

2.2.6 ExtremitytraumaCommonsignsandsymptoms

Painonpalpitationormovement Swelling,deformity

Crepitus

Decreasedrangeofmotion Falsemovement(unnaturalmovementofextremity) Decreased/absentsensoryperception Decreased/absentcirculationdistaltoinjury2.2.7 Assessment Conductinitialassessmentdetermineifanylifethreateningconditions

o Emergencycareforlifethreateningconditionsfirst(severebleeding) Neveroverlookmusculoskeletaltrauma Neverallowanoncriticalmusculoskeletalinjurytodistractfromprioritiesofcare2.2.8 SIXPsofmusculoskeletalinjuries Pain Painonpalpation(tenderness)

Painonmovement

Pallor Pale,coldandclammyskin+poorcapillaryrefill Paraesthesia Pinsandneedlessensation Pulse Diminished/absent Paralysis Inabilitytomove Pressure Compartmentsyndrome(pressurebuildupunderneaththeskin) Evaluatinganextremitiesneurovascularstatusby:

o Assessingdistalpulseo Functiono Sensation(beforeandaftermovement/splinting)

Compareinjuredextremitywithoppositeuninjuredextremity Ifextremitytraumasuspectedimmobilizedinjurybysplinting


11/16


11/16

3 Principlesofsplinting Thegoalofsplintingisimmobilizationoftheinjuredbodypart Immobilization bysplinting:

o Helpsalleviatepain(decreaselevelofpain)o Decreasedtissueinjury

Bleedingandcontaminationinopenwoundo Simplifiesandfacilitatespt.transport

Splintjointsabove+belowandboneendso Immobilizeopenandclosefracturesinsamemannero Coverfracturestoreducecontaminationo Assessandreassess(aftersplinting)

distalpulse capillaryrefill neurologicalsensation motorfunctionbeforeandaftersplinting

o Stabilizeextremitygently Inlinetractiontonormalpositionofalignment GeneralrulealignONLYONCE

o Immobilizelongboneextremityinstraightpositionthatcanbeeasilysplinted Immobilizeddislocationinpositionofcomfort

o Ensuregoodvascularsupply Immobilizejointsfound

o JointinjuriesonlyalignedifNOdistalpulse Applyicetoreduceswellingandpain Applycompressiontoreduceswelling Elevateextremity(ifpossible)3.1 Splints Threemaintypes

o Rigidsplintso Softorformablesplintso Tractionsplints

3.1.1 Rigidsplints Padbeforeuse Canonlychangeitsshapeminimally(andonlywithsomesplints) Bodyneedstobepositionedtofitthesplint

o Boardsplintso Cardboardsplintso Samsplint

3.1.2 Softorformablesplints Canbemouldedintovariousshapestoaccommodatetheinjuredbodypart

o Pillowso Blanketso Slingsandswathes

3.1.3 Tractionsplints Speciallydesignedformidshaftfemurfracture DONOTapplyormaintainsufficienttractiontoreduceafemoralfracture DOESprovideenoughtractiontostabilizeandalignit


12/16


12/16

3.2 Shoulderinjuries Commoninolderadultsbecauseofweakerbonestructure

o Frequentlyresultfromfallonoutstretchedarm3.2.1 Anteriorfractureanddislocation

Pt.

often

positioned

with

affected

arm

or

shoulder

close

to

chest

Lateralaspectofshoulderappearsflatinsteadofround Deepdepressionbetweenheadofhumerusandtheacromionlaterally(hollowshoulder)3.2.2 Posteriorfractureanddislocation Pt.maybepositionedwitharmabovehead3.2.3 Managementofshoulderinjuries(fractureanddislocation) Assessandreassess(aftersplinting)

o Neurovascularstatuso Neurologicalsensationo Distalpulseo Capillaryrefill

Applicationofice Applicationofslingandswathe Splintmayneedtobeimprovisedtoholdinjury3.3 Humerusinjuries Commoninolderadultsandchildren

o Oftendifficulttostabilize3.3.1 Associatedcomplication Radialnervedamage

o Maybepresentifmiddleordistalportionofhumeralshaftfractured Axillarynervedamage

o Maybepresentifhumeralneckfracture Internalhaemorrhaging

o Intothejoint Compartmentsyndrome(pressurebuildupunderneaththeskin)3.3.2 ManagementofHumerusinjuries Assessandreassess(aftersplinting)


Applyice Alignifthereisvascularcompromise Applicationofrigidsplitandslingandswathe ORsplinttheextremitywitharmextended3.4 Radius,Ulna/Wristinjuries Commoninadultandinchildren Usuallyresultfromfallonoutstretchedarm Wristinjuriesmayinvolve:

o Distalradiuso Ulnao Oranyoftheeightcarpalbones

Commoninjury:CollesFracture(wristfracture)


13/16


13/16

3.4.1 ManagementofHumerusinjuries Assessandreassess(aftersplinting)


Applyice Splintinpositionfountwithrigidorformablesplints/slingandswathe Elevation3.5 Hand(metacarpal)injuries Frequentlyresultsfrom:

o Contactsportso Violence(fighting)o Crushinginindustrialcontext

Commoninjuryo Boxersfractureo

Result

from

direct

trauma

to

closed

fist

fracturing

fifth

metacarpal

bone

Injuriesmaybeassociatedwithhaematomasandopenwounds3.5.1 ManagementofHumerusinjuries Assessandreassess(aftersplinting)


Applyice Splintinpositioninnormalpositionofalignment/normalpositionoffunction Elevation3.6 Lowerextremityinjuries Comparetoupperextremityinjurieslowerextremityinjuriesare:

o Associatedwithgreaterwoundingforceo Moresignificantbloodlosso Moredifficulttomanageinpt.withmultipleinjurieso Maybelifethreatening:

Femurfracture Pelvicfracture

Cancausehypovolemicshock3.6.1 Femurfracture Usuallyresultfrommajortrauma(MVA/pedestrianaccidents) Fairlycommoninchildabuse Fracturesusuallyevidentfrompowerfulthighmusclesproducingoverridingofbonefragments Pt.generallyhasshortenedleg+externallyrotatedandmidthighswellingfromhaemorrhaging Bleedingmaybelifethreatening3.6.1.1ManagementofFemurfracture Highconcentrationoxygenadministration Treatmentforshock Assessandreassess(aftersplinting)



14/16


14/16

Applicationoftractionsplintmidshaftfemurfracture Regularmonitoringofvitalsigns Rapidtransportisessential3.6.2 Pelvicfracture Bluntforcetraumaorpenetratinginjurytopelvismayresultin:

o Fractureo Severehaemorrhagingo Associatedinjurytourinarybladderandurethra

Deformitymaybedifficulttosee Suspectinjurytopelvisbasedon:

o MOI(Mechanismofinjury)o Presenceoftendernessonpalpationoftheiliaccrest(hipbone)

3.6.2.1ManagementofPelvicfracture Highconcentrationoxygenadministration Treatmentforshock

Full

body

immobilization

(long

spin

board

and

spider

straps)

o Adequatelypaddedforcomfort Regularmonitoringofvitalsigns Rapidtransportisessential3.6.3 Hipinjury Commoninolderadultsbecauseofafall

o Alsoinyoungeradultfromtrauma Ifhipfracturedatfemoralheadandneck

o Affectedlegusuallyshorterandexternallyrotated(rotatesoutwards) Dislocationofhipusuallyevidencedbyshortenedandrotatedleg3.6.3.1ManagementofHipinjury Assessandreassess(aftersplinting)


Fullbodyimmobilization (longspinboardandspiderstraps)o Adequatelypaddedforcomfort

Slightflexofthekneeorpaddingbeneaththekneemayimprovecomfort Regularmonitoringofvitalsigns Rapidtransportisessential3.7 Kneeandpatellainjuries Fracturestokneeanddislocationsofpatellacommonlyresultfrom:

o MVAo Pedestrianaccidentso Contactsportso Fallsonflexedknee

Relationshipofpoplitealarterytokneejointmayleadtovascularinjuryo Particularlywithposteriordislocation

3.8 TibiaandFibiainjuries Mayresultfromdirectorindirecttraumaortwistinginjury Isassociatedwithknee,poplitealvascularinjuryshouldbesuspected


15/16


15/16

3.8.1 Managementoftibiaandfibiainjuries Assessandreassess(aftersplinting)


Applicationofice Splintwithrigidorformablesplint Elevate3.9 Footandankleinjuries Fracturesanddislocationoffootandanklemayresultfrom:

o Crushinjuryo Fallfromheighto Violentrotaryforce

Pt.usuallycomplainsofpointtendernessandishesitanttobearweightonextremity3.9.1 Managementoffootandankleinjuries Assessandreassess(aftersplinting)


Applicationofice Splintwithrigidorformablesplint(e.g.pillow, blanket/airsplint) Elevate3.10 OpenFractures Consideranysofttissuewoundaroundsuspectedfracturetobeevidenceofopenfracture Fracturesmaybeopenintwoways:

o Fromwithin(bonefragmentspiercethroughskin)o Fromwithout(gunshot)

Openfracturesmayhavemadecontactwithskinsomedistanceawayfromfracture Openfracturesconsideredatruesurgicalemergencybecauseofthepotentialforinfection3.11 Limbthreateninginjuries Kneedislocation Fractureordislocationofpoplitealandankle Subcondylarfractureofelbow

o Theseinjuryrequirerapidtransportforphysicianevaluation3.12 Managementoffracturesanddislocations Elbowshowneverbemanipulatedinprehospitalsetting Asarule,fractureanddislocationshouldbeimmobilizedinpositionofinjury

o Andpt.transportedtoemergencydepartmentdoerealignment(reduction) Iftransportdelayed/prolongedandcirculationisimpaired ONEattempttorepositionagrosslydeformedfractured/dislocatedjointshouldbemade3.12.1 Method Handleinjurycarefully Applygentle,firmtractionindirectionoflongaxisofextremity Ifnotobviousresistancesplintextremitywithoutrepositioning


16/16


16 / 16

3.12.2 Realignment ONLYONEattemptatrealignmentshouldbemadeinprehospitalsetting ONLYifseverneurovascularcompromise(extremelyweak/absentdistalpulse) Manipulationshouldbeperformedassoonaspossible(ONLYifindicated) Shouldbeavoidedinpresenceofotherseverinjuries IfNOcontractindicationsconsideruseofEntonoxforrealignmentprocedure Assess+documentandreassess+document(aftersplinting)


2013 baa - musculoskeletal system

Documents