Musculoskeletal System Injuries

(3 hours: Basic and Intermediate levels)
Purpose: This course is designed to review the anatomy and physiology, and the pathophysiology of the major bones, joints, and muscles of the body. Specific symptomatology and management of injuries will be taught. With the sport season approaching, special consideration will be given to reviewing athletic musculoskeletal injuries.

  1. Introduction (5 minutes)

  2. Review of anatomy and physiology of the musculoskeletal system (20 minutes)
    1. Review definitions of terminology (bone, muscle, joint, tendon, ligament, cartilage, etc.) and structure of bone and muscle.
    2. Brief mention of axialary skeleton (skull, spinal cord and thorax).
    3. Review upper extremity appendicular skeletal system.
    4. Review lower extremity appendicular skeletal system.
    5. Review of type of muscles and their functions (smooth or involuntary, cardiac, and particularly skeletal muscle.

  1. Mechanisms of musculoskeletal injury. (10 minutes)

  2. Types of musculoskeletal injury with signs and symptoms. (30 minutes)
    1. Fractures
    2. Dislocations
    3. Sprains
    4. Strains
    5. Traumatic amputations

  1. General principles of assessment and management (10 minutes)
    1. Primary survey
    2. Secondary survey and neurovascular evaluation
    3. Possibility of development of shock and necessity of ALS fluid replacement

  1. Review of splinting injured extremities (30 minutes)
    1. Purpose of splinting
    2. General principles of splinting
    3. Types of splints
      1. rigid
      2. air
      3. sling and swathe
      4. pillow
      5. vacuum
      6. traction splint - both Hare and Sager
      7. long spinal board
      8. MAST as a splint

    1. Some specific musculoskeletal injuries (20 minutes)
      1. Upper extremity
        1. shoulder dislocation
        2. fractured clavicle
        3. fractures of distal humerous (elbow)
        4. fractured wrist (Colles fractures)
      2. Lower extremity
        1. fracture of pelvis
        2. dislocation of hip
        3. femoral shaft
        4. dislocation of knee
        5. tibial shaft
        6. ankle injury

    1. Special considerations for the athletic setting (25 minutes)

    2. Practical splinting exercises (25 minutes)
      Using conventional splinting materials as well as concentrating on creativity in using available materials for splinting a deformed extremity "in place."

    3. Discussion and questions (5 minutes)

    References:
    Caroline, Nancy J., Emergency Care in the Streets, 4th edition. pp. 361-386.
    Hafen, Brent Q and Keith J. Karen, Prehospital and Emergency Care, 3rd Edition, pp. 193-224.
    Grant, Harvey D., Robert H. Murray, Jr. and J. David Bergeron, Emergency Care, 6th Edition, pp. 268-321.
    Alvero, Ernesto, "Life on a Limb: Management of Upper Extremity Fractures," JEMS, August 1994, pp. 30-42.
    WMEMS Prehospital Protocols, p. 31

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