Injuries to Muscles

and Bones

14-1
Musculoskeletal System
Review

• Bones
• Muscles
• Tendons
• Ligaments
 Primary Functions of
Musculoskeletal System

• Provides shape/support for body

• Muscles acting on bones allow movement
• Bones protect vital internal organs

14-3
Types of Muscles
• Skeletal muscles are
voluntary
• Smooth muscles are
involuntary
• Cardiac muscle is
involuntary
• All muscle activity
controlled by nervous
system
 Mechanisms of Injury to
Musculoskeletal System

• DIRECT FORCE: force applied directly to body

• INDIRECT FORCE: force transferred from
original body site along an extremity to another
point
• TWISTING FORCES: part of body forced to
move in unnatural direction

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 Factors Involved in Injuries

• The greater the force:

– the more severe the injury
– fracture/joint dislocation more likely
• Patient’s age and health status

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Types of Musculoskeletal
Injuries

• First Responders not

responsible for determining type
of musculoskeletal injury:
– Fractures
– Dislocations
– Sprains
– Muscle injuries
 Fractures
• The bone may be
completely broken or only
cracked
• Closed fracture - skin not
broken
• Open fracture - open
wound at site

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Dislocations
 Dislocations

• One or more bones at joint displaced from

normal position
• Ligaments holding bone are torn
• Result from strong forces
• Sometimes accompanied by bone fractures or
other injuries

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 Dislocations continued
• Patient cannot use the joint due to
pain/structural damage
• Serious bleeding may result
• Nearby nerves may be injured
• With severe dislocation, joint/limb will look
deformed

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 Sprains

• Joint injury involving ligament stretching/tearing

• Typically occur when joint overextended
• Can be mild or severe
• Ankles, knees, wrists, fingers most common
• Considerable swelling often occurs rapidly

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 Muscle Injuries

• Strains, contusions, cramps

• Usually less serious than fractures/joint injuries
• Many causes

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 Recognizing Musculoskeletal
Injury

• Sometimes injury type is obvious

• Often you will recognize musculoskeletal injury
is present
• Emergency care is same regardless of injury
type
• Usually not life threatening
• May be serious and result in pain/disability

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Assessment of Musculoskeletal
Injuries
• Perform standard assessment
• Ask patient what happened/what he/she felt
• If large forces involved, consider potential for
spinal injury
• Expose injury site
• Amount of pain/swelling not indicator of injury
severity
• Immediate medical treatment if no
circulation/possible nerve damage

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Assess for Circulation, Sensation, And
Movement (CSM) Below the Injury Site
• Check pulse below injury
• Check skin color and temperature.
• Touch fingers/toes
• Does patient feel touch, tingling sensation, numbness.
• Have patient wiggle fingers/toes
Signs and Symptoms
 Signs and Symptoms

• Abnormal sensation (numbness, tingling)

• Inability to move area
• Difference in temperature

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 Preventing Movement
• Movement causes injury, pain, swelling
• Bone movement further injures soft tissues
• Movement generally increases blood flow - may
increase internal bleeding/ swelling
• Manually stabilize or splint injured area
 Emergency Care of
Musculoskeletal Injuries
• Perform standard patient care
• Control any life threats
• Allow patient to be in position of comfort
• Cover open wounds with sterile dressing
• Apply cold pack
• Don’t replace protruding bones

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 Emergency Care of
Musculoskeletal Injuries Continued

• Stabilize injured extremity manually

• Support above and below injury
• If appropriate, splint extremity
• Follow local protocol re: oxygen

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Splinting

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 Splinting

• Movement may worsen musculoskeletal injury

and cause more pain
• Splint injured arm or leg if risk of area being
moved (unless help expected quickly)
• Always splint an extremity before transporting
victim

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 Splinting
• Helps prevent further injury
• Reduces pain
• Minimizes bleeding and swelling

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 Types of Splints
• Rigid splints
• Soft splints
• Air splints (inflatable splints)
• Pneumatic splints
• Anatomic splints

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 Rigid Splint
• Board
• Plastic or metal
• Rolled newspaper or
magazine
• Thick cardboard

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 Soft Splint
• Pillow
• Folded blanket or
towel
• Triangular bandage
folded into sling

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 Anatomic Splint
• Bandage injured leg
or finger to uninjured
one

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 Commercial Splints

Many commercial splints are available

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 Securing Splints

• Use bandages, strips of cloth, Velcro®

• Use knots that can be untied
• Don’t secure with tape

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 Guidelines for All Splints
• Dress open wounds
• Splint only if it doesn’t cause more pain
• Splint in position found
• Immobilize entire area
• Pad between splint and skin

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Guidelines for Slings
• Use sling to prevent
movement and to elevate
extremity
• Splint injury first
• If you splint injury in
position found and this
position makes use of
sling difficult – do not use
sling

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Guidelines for Slings continued
• Do not move arm into
position for sling if it
causes pain
• A cold pack can be used
inside sling
• Do not cover fingers
inside sling

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Skill:
Applying Arm Sling
and Swathe

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Secure point of bandage at
elbow.

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 Position triangular
bandage.

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 Bring lower end
of bandage to
opposite side
of neck.

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Tie the ends.

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 Tie binder
bandage over
sling and around
chest.

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 Shoulder Injuries
• Involve clavicle, scapula, or joint structures
• Clavicle is most frequently fractured bone
• Scapula fractures are rare
• Shoulder dislocations are common

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 Splinting Shoulder Injuries
• Goal is to stabilize area from trunk to upper arm
• Use soft splint. Do not move extremity
• Assess for circulation, sensation, and movement

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 Shoulder Injuries
• Pad hollow between
body and arm
• Apply sling and binder
to support and
immobilize arm
– if this causes pain
use larger soft
splint

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 Upper Arm Injuries
• Immobilize humerus fractures with rigid splint
• Treat fractures near shoulder with soft splint

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 Splinting Upper Arm Injuries
• Stabilize bone between shoulder and elbow
• Assess circulation, sensation, movement in
hand/fingers
• Apply rigid splint along outside of arm

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 Splinting Upper Arm Injuries
continued
• Tie above injury and at elbow
• Support wrist with sling and wide swathe
• If it causes pain to raise wrist for a sling, use
long rigid splint

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 Elbow Injuries
• Sprains and dislocations are common
• Fractures occur above or below elbow
• Patient unable to move joint

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Splinting Elbow Injuries
• If elbow bent, apply
rigid splint from upper
arm to wrist
• If more support
needed, use sling at
wrist and binder
around chest

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 Splinting Elbow
Injuries

• If elbow straight, apply

rigid splint from upper
arm to hand
• If more support needed,
use binders around
chest and upper arm
and lower arm and
waist

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Skill:
Splinting a
Forearm

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 Support arm. Check
circulation.

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 Position arm on rigid
splint.

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Secure splint.

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Check circulation.

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 Wrist Injuries
• Sprains
• Fractures

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 Splinting Wrist Injuries
• Goal is to stabilize from forearm to hand
• Soft splint and sling often sufficient
• Rigid splint provides more support
• Assess circulation, sensation, movement in hand
and fingers

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 Wrist Injuries
• Apply rigid splint on palm
side of arm from forearm
past fingertips
• Tie above and below
wrist
• Leave fingers uncovered
• Support forearm and
wrist with sling and apply
binder around upper arm
and chest

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 Hand Injuries
• May be injured by direct blow
• Fractures occur when patient punches
something with closed fist

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 Splinting Hand Injuries
• Goal is immobilization of hand
– Use soft or rigid splint
• Place roll of gauze in palm
• Bandage entire hand
• Place rigid splint on palm side of hand. Pad
between hand and splint
• Support further with sling and swathe

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 Finger Injuries
• Fractures and
dislocations
• Often splint not
required
• Use rigid splint or
anatomic splint

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 Splinting Finger Injuries
• Use soft splint if finger cannot be straightened
without pain
• Don’t manipulate finger into normal position
• Use rigid splint, secured with tape
• Tape finger to adjoining finger with gauze in
between

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 Lower Extremity Injuries
• Larger forces are typically involved
– Forces may also cause spinal injury
• Assess patient, without moving extremity
• Femur fracture can damage femoral artery

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 Hip and Pelvis Injuries
• Fractures and dislocations
• A hip fracture = fracture of top part of femur
• Fractures more common in elderly
• Bleeding and pain may be severe
• Dislocations occur at any age
– Falls
– Vehicular crashes
– Blows to body

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Hip Injuries
• Do not move patient
• Immobilize leg and hip
in position found
• Pad between legs and
bandage together
(unless this causes
more pain)
• Treat for shock but do
not elevate legs

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 Upper Leg Injuries
• Femur fractures serious
• Severe pain/shock may occur
• Keep patient from moving
• Use rigid splint if lying down with leg supported
by ground
• Use folded blankets/coats to immobilize leg in
position found

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 Splinting Upper Leg Injuries
• Anatomic splint
• Rigid splints

14-65
 Splinting Upper Leg Injuries
continued
• Check circulation and sensation in foot and toes
• Put rigid splint on each side of leg
– Pad body areas and voids
– Inside splint should extend from groin past
foot
– Outside splint should extend from armpit past
foot

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 Traction Splint for Femur
Fractures
• Traction splint maintains continual pull on femur
to keep bone ends in normal position
• First Responders usually assist other EMS
personnel

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 Knee Injuries
• Sprains
• Dislocations
• Caused by sports injuries, motor vehicle
crashes, falls
• Femur, tibia or fibula fractures indistinguishable
from knee injuries

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 Splinting Knee Injuries

• Splint in position found

• Apply soft splint by rolling blanket or placing
pillow around knee
• If knee straight, make anatomical splint
 Splinting the Knee
• If possible, put rigid splint on both sides of leg
• Pad body areas and voids
• Check circulation and sensation in foot and toes
first and periodically after splinting

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 Splinting the Knee

• If knee is straight apply two splints along both

sides of knee
• If knee is bent, splint in position found
• Tie splints with cravats or bandages

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 Lower Leg Injuries
• Many causes
• Either or both bones of lower leg can be
fractured

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 Lower Leg Injuries
• Rigid splint applied
the same as for knee
injury
– Three-sided
cardboard splint
can be used

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Skill:
Splinting the Leg
(Anatomic)

14-74
 Check circulation.
Gently slide four to
five strips of
bandages under
both legs.

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 Pad between legs.

14-76
 Gently slide
uninjured leg next to
injured leg.

14-77
 Tie bandages
and
Check circulation

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 Ankle Injuries
• Commonly a sprain occurring when foot
forcefully twisted to one side
• Fractures or dislocations
• Often involve torn ligaments and nerve/blood
vessel damage

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 Splinting Ankle Injuries
• Soft splint usually best
• Assess circulation, sensation, movement in toes

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 Foot Injuries
• Commonly caused by direct blows/falls
• Involve almost any bone/ligament of foot
• Treat same as ankle injuries
• Toe fractures can be very painful

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 Splinting Foot Injuries

• Usually no splinting required

• Use pillow splint as for ankle injury if:
– toe is significantly bent
– more than one toe involved
– foot is very painful
 Rib Fractures
• Typically caused by blunt trauma to chest
• More common in lower ribs and along side
• Cause severe pain, discoloration, swelling
• Pain often sharper upon breathing in
• Patient may breathe shallowly and hold/support
area

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 Splinting Rib Injuries
• Goal is primarily supportive
• Have patient sit/stand in easy breathing position
• Support ribs with pillow or soft padding loosely
bandaged over area and under arm
• Immobilize arm with sling and swathe
• Monitor breathing

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PENCEGAHAN DAN
PENATALAKSANAAN
CEDERA OLAHRAGA

14-85
• Cedera Olahraga adalah segala bentuk ruda
paksa/trauma sebagai akibat berolahraga.

• Cedera olahraga terjadi karena

ketidakmampuan jaringan (otot, persendian,
tendon, kulit) dan organ tubuh lainnya dalam
menerima beban latihan pada saat berolahraga .

14-86
Individu
Laki-laki / perempuan
Umur
Karakter
Pemanasan

Sarana
Karakteristik olahraga
Lingkungan
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 KLASIFIKASI
1. Berdasarkan waktu terjadi:
• Akut : terjadi secara tiba-tiba dan terjadi dalam beberapa jam yang lalu.
Tanda & Gejala:
sakit , nyeri tekan, kemerahan,
kulit hangat, bengkak & inflamasi
• Kronis : Berkembang secara lambat. Gejala hilang–timbul dan
menyebabkan nyeri tumpul dan sakit. Biasanya karena overuse
atau cedera akut yang tidak sembuh sempurna.

2. Berdasarkan berat ringan cedera

3. Berdasarkan jaringan yang terkena: lunak, keras
4. Berdasarkan lokasi cedera

14-88
 BIOMEKANIK
Traction (traksi)
Compression (kompresi)
Bending (pembengkokan)
Shear Stress (tekanan memotong)
Torsion (putaran)
Overload (beban berlebih) dan Overuse (beban
berulang)

14-89
Sprain Strain Dislokasi

Muscle
Fraktur Contusio
cramp

Open
wound

14-90
Cedera Otot, Tendon dan Ligamen

• 1. STRAIN
a. Cedera pada otot:
• - muscle sorenes
• - hematoma: intramuskular, intermuskular
• - ruptur: partial, total
• - kram
b. Cedera pada tendon
• 2. SPRAIN
• Cedera ligamen: derajat I,II,III

14-91
 FISIK
INFLAMASI KIMIAWI
INFEKSI
TRAUMA
14-92
 INFLAMASI

Calor Rubor Tumor Dolor Fungsiolesa

14-93
 Penatalaksanaan Cedera
Olahraga
1. Terapi dingin:
• - Terapi terbaik untuk cedera akut
• - Es adalah vasokonstriktor sehingga dapat mengurangi perdarahan internal
dan bengkak
• - Dapat juga membantu cedera overuse atau nyeri kronis setiap selesai
berlatih

2. Terapi panas:
• - Digunakan pada cedera kronis atau cedera tanpa bengkak
• - Meningkatkan elastisitas jaringan ikat sendi, memperbaiki sirkulasi darah
• - Jangan dilakukan setelah berlatih
- Contoh: nyeri, kaku, nyeri sendi.

14-94
 SOFT TISSUE

R I C E
EST CE OMPRESIION LEVATION

14-95
14-96
 Injury Acute: Avoid the HARM
Factors
• Heat ® Bleeding
• Alcohol ® Swelling
• Running ® Can make the injury worse
• Massage ® in the 1 st 48-72 hours, Increases swelling &
bleeding

14-97
 Tanda Serius Cedera Olahraga
• Nyeri sendi: khususnya lutut, siku, pergelangan tangan
dan kaki
• Nyeri tekan
• Bengkak
• ROM menurun
• Perbandingan kelemahan
• Rasa tumpul dan rasa geli

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DISLOKASI

14-99
 DEFINISI
• Dislokasi adalah suatu keadaan keluarnya
(bercerainya) kepala sendi dari mangkuknya.

• Dislokasi merupakan suatu kedaruratan yang

membutuhkan pertolongan segera.

14-100
Klasifikasi

A. Dislokasi Kongenital
B. Dislokasi Patologik :
Akibat penyakit di jaringan sekitar sendi,
misalnya tumor, infeksi.
C. Dislokasi Traumatik :
Merupakan kedaruratan ortopedi. Terjadi
karena trauma yang kuat sehingga dapat
mengeluarkan tulang dari jaringan
disekeililingnya.

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14-102
14-103
• Dislokasi Regio Bahu
(Shoulder Dislocation)
• sendi sternoklavikular
• sendi akromioklavikular
• sendi glenohumoral
-Dislokasi regio bahu (sendi glenohumoral)
merupakan 50 % kasus dari semua dislokasi. 80 %
dari dislokasi regio bahu ini adalah tipe dislokasi
bahu anterior
-Stabilitas sendi bahu tergantung dari otot - otot dan kapsul
tendon yang mengitari sendi bahu. Sedangkan hubungan
antara kepala humerus dengan cekungan glenoid terlalu
dangkal

14-104
• Dislokasi bahu anterior

– Sering pada usia dewasa muda

– Dislokasi terjadi karena kekuatan yang menyebabkan gerakan
rotasi ekstern (puntiran keluar) dan ekstensi sendi bahu.
Posisi lengan atas dalam posisi abduksi.

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14-106
• Gejala klinik
– Pasien merasakan sendinya keluar dan tidak mampu
menggerakkan lengannya
– Lengan yang cedera ditopang oleh tangan sebelah
lain
– Pundak terasa sakit sekali
– Bentuk pundak asimetris, posisi badan pendeita
miring ke arah sisi yang sakit
– Bentuk deltoid pada sisi yang cedera tampak
mendatar
– Pada palpasi daerah subacromius jelas teraba
cekungan

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14-108
• Pemeriksaan penunjang
– Dengan pembuatan X – ray foto, umumnya dengan proyeksi AP
sudah dapat terdiagnosis adanya dislokasi sendi bahu

14-109
• Penatalaksanaan
Keadaan ini memerlukan reposisi
segera. Ada beberapa indikasi untuk
melakukan reposisi, yaitu :
• tidak adanya fraktur
• tidak adanya defisit neurologi

14-110
Pre reduction examination
– Nervus axillary : 8% terjadi kelumpuhan
• Sensoris: dibawah m. Deltoideus
– Nervus Radialis: extensi tangan
– Artery brachialis: denyut nadi radialis

14-111
Terdapat 3 cara untuk mereposisi dislokasi bahu
anterior

Cara Stimson
 Cara ini mudah dan tidak memerlukan
anestesia.
 Penderita tidur tengkurang di atas meja,
lengan yang cedera dibiarkan tergelantung
ke bawah.
 Lengan diberi beban seberat 5 – 7 ½ kg.
 Pada saat otot bahu dalam keadaan
relaksasi, diharapkan terjadi reposisi akibat
berat lengan yang tergantung di samping
tempat tidur tersebut.
 Hal ini dilakukan selama 20 – 25 menit.

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14-113
– Cara Hippocrates
• Penderita tidur terlentang di atas meja, lengan
penderita pada sisi yang sakit ditarik ke distal,
posisi lengan sedikit abduksi.
• Sementara itu kaki penolong ditekankan ke
aksila untuk mengungkit kaput humerus ke arah
lateral dan posterior.
• Setelah reposisi, bahu dipertahankan dalam
posisi endorotasi dengan penyangga ke dada
selama paling sedikit 3 minggu.

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14-115
 Cara Kocher
Penderita ditidurkan di atas meja. Penolong
melakukan gerakan yang dapat dibagi dalam 4
tahap.
 Tahap pertama, dalam posisi siku fleksi penolong menarik
lengan atas ke arah distal
 Tahap kedua, dilakukan gerakan eksorotasi dari sendi
bahu
 Tahap ketiga, melakukan gerakan adduksi dan fleksi pada
sendi bahu
 Tahap ke empat, melakukan gerakan endorotasi sendi
bahu.

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14-117
• Komplikasi
– Cedera plexus brachialis dan n. Axillaris yang
menyebabkan kumpulnya m. deltoid sehingga bahu
tidak dapat diangkat abduksi
– Robeknya muskulus tendineus cuff (cuff rotator)
– Patah tulang humerus
– Rekurrens dislokasi bahu anterior

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 Dislokasi Regio Panggul
(Hip Dislocation)

Mekanisme terjadinya dislokasi yaitu saat

kaput yang terletak di belakang asetabulum,
kemudian segera berpindah ke dorsum illium.
Biasanya juga mengalami cedera serius
misalnya trauma benturan depan mobil akibat
tabrakan mobil frontal.

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14-121
Dislokasi panggul posterior
• Dislokasi panggul posterior biasa
disebabkan oleh trauma. Ini terjadi pada
axis longitudinal pada femur saat femur
dalam keadaan fleksi 90o dan sedikit
adduksi.

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• Gejala klinis
– Pemeriksaan pada penderita dislokasi panggul
posterior akan menunjukkan tanda yang abnormal.

– Paha (pada bagian yang mengalami dislokasi)

diposisikan sedikit fleksi, internal rotasi dan adduksi.

– Ini merupakan posisi menyilang karena kaput femur

terkunci pada bagian posterior asetabulum.

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14-124
• Pemeriksaan penunjang
Dengan pembuatan X – ray foto, umumnya dengan
proyeksi AP.

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 Penatalaksanaan
The Bigelow Maneuver :
 Tempatkan penderita di lantai (telentang). Amati
(dislokasi) secara cermat dan suruh seorang
asisten mendorongnya ke anterosuperior pada
SIAS.
 Fleksikan lutut penderita dan panggulnya, dan
rotasikan tungkainya pada posisi netral.
 Tarik tungkainya ke atas secara terus-menerus
dengan lembut.
 Saat masih dilakukan traksi (penarikan) sesuai arah
femur, rendahkan tungkainya ke lantai.
 Reduksi biasanya jelas dirasakan tetapi perlu
didukung dengan sinar-X.
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14-127
14-128
• Komplikasi
Komplikasi yang mungkin terjadi dislokasi
panggul posterior, yaitu :
– Lesi n. Ischiadicus
– Nekrosis avaskuler
– Artrosis degeneratif

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