Musculoskeletal System –

Trauma
Eugene Pitt
Objective:

TO DISCUSS ABOUT
SOFT TISSUE
TRAUMA
Definition – Soft Tissue
Refers to tissues that connect, support, or
surround other structures and organs of the
body.

The four fundamental tissues that are affected

are the epithelial, muscular, nervous and
connective tissues.
Definition – Soft Tissue
Soft tissue includes tendons, ligaments, fascia,
fibrous tissues, fat, and synovial membranes
(which are connective tissue), and muscles,
nerves and blood vessels (which are not
connective tissue).
Definition – Soft Tissue
Many activities can lead to soft-tissue damage
of muscles, ligaments, and tendons.

The result can be pain, swelling, bruising, and

damage. Soft-tissue injuries are classified as the
following:
◦ CONTUSIONS (BRUISES)
◦ SPRAINS
◦ STRAINS
Definition – Contusion
CONTUSION (Bruise)
◦ An injury to the soft tissue often produced by
a blunt force such as a kick, fall, or blow.

◦ The result will be pain, swelling, and

discoloration.
Definition – Contusion
Treatment – Contusion
REST – ICE – COMPRESSION – ELEVATION
RICE

Immediately after the strain apply ICE to

decrease pain, swelling and inflammation.
Applying elastic bandage to COMPRESS and
ELEVATE the strained area. Encourage the
patient to REST.
Definition – Strain
STRAIN

◦ A soft tissue injury that occurs when a muscle

or tendon is excessively stretch.

◦ Falls, Excessive Exercise, and Lifting Heavy

Items (without using proper body mechanics)
can be a cause of strain

◦ It can be categorized by Mild, Moderate, and

Severe.
Definition – Strain
Mild Strain
◦ Causes minimal inflammation; swelling and
tenderness are present.

Moderate Strain
◦ Involves partial tearing of the muscle or
tendon fiber.
◦ Pain and inability to move the affected body
part result.
Definition – Strain
Severe Strain
◦ When muscle or tendon is ruptured, with
separation of muscle from muscle, tendon is
ruptured, or tendon from bone.

◦ Severe pain and disability result from this

injury.
Definition – Strain
Treatment – Strain
REST – ICE – COMPRESSION – ELEVATION
RICE

Immediately after the strain apply ICE to

decrease pain, swelling and inflammation.
Applying elastic bandage to COMPRESS and
ELEVATE the strained area. Encourage the
patient to REST.
Definition – Sprain
SPRAIN
◦ Is excessive stretching of one or more
ligaments that usually result from twisting
movements during a sports activity.

◦ Like strain, sprain can also be categorized by

Mild, Moderate, and Severe.
Definition – Sprain
◦ Mild Sprain
 Involves tearing of just a few ligament fibers
and causes tenderness.

◦ Moderate Sprain
 More fibers are torn but the stability of the
joint is not affected.
 Uncomfortable, especially with activity.
Definition – Sprain
◦ Severe Sprain
 Causes instability for the joint and usually
requires surgical intervention for tissue
repair or grafting.
Definition – Sprain
Treatment – Sprain
REST – ICE – COMPRESSION – ELEVATION
RICE

Immediately after the strain apply ICE to

decrease pain, swelling and inflammation.
Applying elastic bandage to COMPRESS and
ELEVATE the strained area. Encourage the
patient to REST.
Objective:

TO DISCUSS ABOUT
FRACTURE
Definition - Fracture
A fracture is a partial or complete break in the
bone. When a fracture occurs, it is classified as
either open or closed:
◦ Open fracture (Compound Fracture)
◦ Closed fracture (Simple Fracture)
Definition - Fracture
◦ Open fracture (Compound Fracture)
 The bone exits and is visible through the
skin, or a deep wound that exposes the bone
through the skin.

◦ Closed fracture (Simple Fracture)

 The bone is broken, but the skin is intact.
Definition - Fracture
Fractures have a variety of names:

◦ Greenstick (Incomplete fracture)

 The broken bone is not completely separated.

◦ Transverse
 The break is in a straight line across the bone.

◦ Spiral
 The break spirals around the bone; common
in a twisting injury.
Definition - Fracture
Compression
◦ The bone is crushed, causing the broken bone
to be wider or flatter in appearance.

Oblique
◦ Diagonal break across the bone.
Greenstick Fracture
Objective:

TO DISCUSS ABOUT THE

CAUSES OF
FRACTURE
Causes – Fracture
Fractures occur when there is more force
applied to the bone than the bone can absorb.

Bones are weakest when they are twisted.

Breaks in bones can occur from falls, trauma, or

as a result of a direct blow or kick to the body.
Objective:

TO DISCUSS ABOUT
SYMPTOMS OF
FRACTURE
Symptoms – Fracture
The following are the most common symptoms
of a fracture. However, each individual may
experience symptoms differently. Symptoms
may include:
◦ Pain in the injured area
◦ Swelling in the injured area
◦ Obvious deformity in the injured area
◦ Difficulty using or moving the injured area in
a normal manner
◦ Warmth, bruising, or redness in the injured
area
Objective:

TO DISCUSS ABOUT THE

DIAGNOSTIC
EXAMINATION FOR
FRACTURE
Diagnostic Examination – Fracture
X – RAY
◦ A diagnostic test which uses invisible
electromagnetic energy beams to produce
images of internal tissues, bones, and organs
onto film.
Diagnostic Examination – Fracture
Magnetic Resonance Imaging (MRI)
◦ A diagnostic procedure that uses a
combination of large magnets,
radiofrequencies, and a computer to produce
detailed images of organs and structures
within the body.
Diagnostic Examination – Fracture
Computed Tomography Scan (CT or CAT scan)

◦ A diagnostic imaging procedure that uses a

combination of x-rays and computer
technology to produce cross-sectional images
(often called slices), both horizontally and
vertically, of the body.
Diagnostic Examination – Fracture
◦ A CT scan shows detailed images of any part
of the body, including the bones, muscles,
fats, and organs.

◦ CT scans are more detailed than general

X – RAYS.
Objective:

TO DISCUSS ABOUT THE

TREATMENT FOR
FRACTURE
Treatment – Fracture
Specific treatment for a fracture will be
determined by your physician based on:
◦ Age, Overall Health, and Medical History
◦ The extent of the condition
◦ The tolerance of the patient for specific
medications, procedures, or therapies
◦ Expectations for the course of the condition
◦ The opinion or preference of the patient
Treatment – Fracture
The goal of treatment is to:
◦ Control the pain
◦ Promote healing
◦ Prevent complications
◦ Restore normal use of the fractured area.
Treatment – Fracture
Splint / Cast
◦ Immobilizes the injured area to promote bone
alignment and healing to protect the injured
area from motion or use

Medication
◦ To control pain
Treatment – Fracture
Traction

◦ The application of a force to stretch certain

parts of the body in a specific direction.
◦ Traction consists or pulleys, strings, weights,
and a metal frame attached over or on the bed.
◦ The purpose of traction is to stretch the
muscles and tendons around the broken bone
to allow the bone ends to align and heal.
Treatment – Fracture
Surgery
◦ May be used to put certain types of broken
bones back into place.
 Internal Fixation Devices
 Metal rods or pins located inside the bone
 External Fixation Devices
 Metal rods or pins located outside of the
body
 It hold the bone fragments in place to allow
alignment and healing.
Objective:

RELATE MUSCULO-
SKELETAL SYSTEM
WITH SMOKING
Smoking – Skeletal System
Tobacco and nicotine increase the risk of bone
fractures and interfere with the healing process,
according to research.

Nicotine can slow fracture healing, estrogen

effectiveness, and can counter the antioxidant
properties of vitamins C and E.
Smoking – Skeletal System
Some of the orthopedic problems caused by
smoking include:

◦ More severe disc degeneration

◦ Weakened spinal ligaments

◦ Reduced production of bone cells

◦ Faster bone loss in postmenopausal women

Smoking – Skeletal System
◦ Fractures take longer to heal

◦ Rotator cuff surgery is less successful

◦ Longer healing time for surgical incisions

◦ More post-surgery complications

◦ Delayed spinal fusion

Objective:

TO DISCUSS ABOUT
DISLOCATIONS
Dislocations – Ligaments
Ligaments

◦ Flexible bands of fibrous tissue that connect

various bones and cartilage.

◦ It bind the bones in a joint together.

◦ Stress on joint ligaments can lead to

dislocation of the joint.
Dislocations – Ligaments
◦ The hip and shoulder joints, for example, are
called "ball and socket" joints.

◦ Extreme force on the ligaments in these joints

can cause the head of the bone (ball) to
partially or completely come out of the socket.
Definition – Dislocations
Dislocation occurs when extreme force is put on
a ligament, allowing the ends of two connected
bones to separate.
Definition – Dislocations
Definition – Dislocations
Symptoms – Dislocation
The following are the most common symptoms
of a dislocation:
◦ Pain in the injured area
◦ Swelling in the injured area
◦ Difficulty using or moving the injured area in
a normal manner
◦ Deformity of the dislocated area
Diagnostic Examination -
Dislocation
The physician makes the diagnosis with a
physical examination.
◦ During the examination, the physician obtains
a complete medical history of the child and
asks how the injury occurred.

Diagnosticprocedures may help to evaluate the

problem. Diagnostic procedures may include:
Diagnostic Examination -
Dislocation
X – RAY
◦ A diagnostic test which uses invisible
electromagnetic energy beams to produce
images of internal tissues, bones, and organs
onto film.
Diagnostic Examination -
Dislocation
Magnetic Resonance Imaging (MRI)
◦ A diagnostic procedure that uses a
combination of large magnets,
radiofrequencies, and a computer to produce
detailed images of organs and structures
within the body.
Diagnostic Examination -
Dislocation
All dislocations require immediate medical
attention since fractures can also occur with
dislocations.
Treatment – Dislocation
Splint / Cast
◦ Immobilizes the injured area to promote bone
alignment and healing to protect the injured
area from motion or use

Medication
◦ To control pain
Treatment – Dislocation
Traction

◦ The application of a force to stretch certain

parts of the body in a specific direction.
◦ Traction consists or pulleys, strings, weights,
and a metal frame attached over or on the bed.
◦ The purpose of traction is to stretch the
muscles and tendons around the broken bone
to allow the bone ends to align and heal.
Treatment – Dislocation
Surgery
◦ May be used to put certain types of broken
bones back into place.
 Internal Fixation Devices
 Metal rods or pins located inside the bone
 External Fixation Devices
 Metal rods or pins located outside of the
body
 It hold the bone fragments in place to allow
alignment and healing.
Treatment – Dislocation
Additional recommendations may include:
◦ Activity restrictions (while the dislocation
heals)
◦ Crutches/wheelchair (to enable your child to
move around during healing)
◦ Physical therapy (to stretch and strengthen the
injured muscles, ligaments, and tendons)
Splint
Objective:

TO DISCUSS ABOUT
MUSCLE
DYSFUNCTION
Classification – Muscle Dysfunction
Muscle Strain (Meregang; Menyaring)
Muscle Cramps (Kejang)
Muscle Strain – Definition
Muscle Dysfunction
Muscle strain or muscle pull or even a muscle
tear implies damage to a muscle or its attaching
tendons.

Muscle damage can be in the form of tearing

(partial or complete) of the muscle fibers and the
tendons attached to the muscle.
Muscle Strain – Definition
Muscle Dysfunction
The tearing of the muscle can also damage small
blood vessels, causing local bleeding (bruising)
and pain (caused by irritation of the nerve
endings in the area).
Muscle Cramps – Definition
Muscle Dysfunction
A muscle cramp is an involuntarily and forcibly
contracted muscle that does not relax.
Almost everyone experiences a muscle cramp at
some time in their life.
Numerous medicines can cause muscle cramps.
Most muscle cramps can be stopped if the
muscle can be stretched.
Muscle cramps can often be prevented.
Muscle Cramps – Definition
Muscle Dysfunction
A cramped muscle may feel very hard to the
touch and may even look visibly distorted
beneath the skin.

The intense pain may last for only a few seconds

or up to 15 minutes and there may be repeated
bouts of cramp over a short period of time.
Muscle Cramps – Definition
Muscle Dysfunction
The most commonly affected muscle groups are:

◦ Back of lower leg/calf muscles

 Known as the gastrocnemius.

◦ Front of thigh muscles

 Known as quadriceps.

◦ Inner thigh muscles

 Commonly referred to as hamstrings.
Muscle Cramps – Treatment
Muscle Dysfunction
1st – The first action to take is to stop doing
whatever activity triggered the cramp - unless
you were asleep in bed when your muscles went
into spasm!

2nd – Then, gently stretch and massage the

cramping muscle, holding it in the stretched
position until the cramp stops. If the muscles are
tight or tense, apply HEAT.

3rd – If they are sore or tender, apply COLD.

Muscle Cramps – Prevention
Muscle Dysfunction
Try to work to a better level of overall fitness.

Keep your body adequately hydrated by

drinking plenty of fluids, especially in hot
weather. Children, in particular, need to drink
fluids often to replenish essential body fluids
lost during play.
Muscle Cramps – Prevention
Muscle Dysfunction
◦ Drink water at regular intervals throughout the
day, even before you get thirsty.

◦ Always drink more than your thirst requires.

◦ Drink fruit juice or a recommended sports

beverage if you are sweating for more than an
hour, or working in conditions of intense heat.
Muscle Strain – Definition
Muscle Dysfunction
Swelling,bruising or redness, or open cuts as a
consequence of the injury
Pain at rest
Pain when the specific muscle or the joint in
relation to that muscle is used

Weakness of the muscle or tendons (A sprain, in

contrast, is an injury to a joint and its ligaments.)
Muscle Strain – Definition
Muscle Dysfunction
Inability to use the muscle at all
Muscle Strain – Definition
Muscle Dysfunction
Muscle Strain – Definition
Muscle Dysfunction
Muscle Strain – Diagnostic Exam
Muscle Dysfunction

Physical Examination
◦ On exam, it is important to establish whether
the muscle is partially or completely torn
(which can involve much longer healing,
possible surgery, and a more complicated
recovery).
Muscle Strain – Treatment
Muscle Dysfunction
REST – ICE – COMPRESSION – ELEVATION
RICE

Immediately after the strain apply ICE to decrease

pain, swelling and inflammation. Applying elastic
bandage to COMPRESS and ELEVATE the
strained area. Encourage the patient to REST.
Muscle Strain – Treatment
Muscle Dysfunction
Anti-inflammatory agents such as aspirin and
ibuprofen to reduce the pain and to improve
your ability to move around.
Muscle Strain – Treatment
Muscle Dysfunction
Treatment is similar to the treatment at home.

The doctor, however, also can determine the

extent of muscle and tendon injury and if
crutches or a brace is necessary for healing.

The doctor can also determine if you need to

restrict your activity, take days off work, and if
rehabilitation exercises are required to help you
recover.
Muscle Strain – Prevention
Muscle Dysfunction
Avoid injury by daily stretching.

Stretch every time before you exercise.

Establisha warm-up routine prior to engaging in

strenuous exercise.

Startan exercise program in consultation with

your doctor.
Objective:

TO DISCUSS ABOUT
MUSCLE
WASTING
Muscle Wasting – Definition
Muscle Dysfunction
Muscle atrophy is the wasting or loss of muscle
tissue

◦ Disuse Atrophy

 Occurs from a lack of physical exercise.

 In most people, muscle atrophy is caused by

not using the muscles enough.
Muscle Wasting – Definition
Muscle Dysfunction
 People with sedentary jobs, medical
conditions that limit their movement, or
decreased activity levels can lose muscle
tone and develop atrophy.

 Bedridden people can have significant

muscle wasting.
 Astronauts who are away from the Earth's
gravity can develop decreased muscle tone
and lose calcium from their bones after just a
few days of weightlessness.
Muscle Wasting – Definition
Muscle Dysfunction
◦ Neurogenic Atrophy

 The most severe type of muscle atrophy

 It occurs when there is an injury to, or

disease of a nerve.

 This type of muscle atrophy tends to occur

more suddenly than disuse atrophy.
Muscle Wasting – Definition
Muscle Dysfunction
 Example:

 Amyotrophic Lateral Sclerosis (ALS or

Lou Gehrig's disease)

 Guillain-Barre Syndrome

 Polio (Poliomyelitis)
Muscle Wasting – Definition
Muscle Dysfunction
Muscle Wasting – Definition
Muscle Dysfunction
Muscle Wasting – Diagnostic Exam
Muscle Dysfunction
CT scans

Electromyography

MRI scans

Muscle Biopsy

X-rays
Muscle Wasting – Treatment
Muscle Dysfunction
An exercise program (under the direction of a
therapist or doctor) is recommended.
◦ This may include exercises in water to reduce
the muscle workload, and other types of
rehabilitation.

People who cannot actively move one or more

joints can do exercises using braces or splints.
 NURSING DIAGNOSIS
&
NURSING INTERVENTION
Nursing Diagnosis I (Nx 1)

Impaired physical mobility related to loss

of integrity of bone structure, movement
of bone fragment, soft tissue injury, and
prescribed movement restrictions as
evidence by limited joint range of motion,
inability to purposefully move, and
inability to bear weight. (Nx 1)
 Patient Goals of Nx 1
Experiences uncomplicated bone healing
and return of skeletal function
Uses assistive devices as necessary to
increase physical mobility
Experiences no complications of
immobility
 Outcomes (NOC) of Nx 1
Bone Healing:
Intact peripheral circulation
Return of skeletal function
Mobility:
Balance…
Coordination…
Joint movement…
Moves with ease…
Interventions (NIC) and Rationale of
Nx 1
Splinting
Support the affected body part

R: Avoid fracture displacement and soft

tissue injury
Move the injured extremity as little as
possible
R: avoid additional injury
Monitor for bleeding at injury site

R: Plan appropriate interventions

Interventions (NIC) and Rationale of
Nx 1
Tractions/Immobilization Care
Position in proper body alignment
R: Enhance traction and skeletal function
Maintain traction at all times

R: prevent misalignment of bone fragments

Monitor circulation, movement, and sensation of
affected extremity
R: detect complications of peripheral vascular
function
Interventions (NIC) and Rationale of
Nx 1
Provide trapeze for movement in bed
R: reduce complications of immobility
Monitor skin and body prominences for
signs of skin breakdown
R: anticipate decubitus
Administer appropriate skin skin care at
friction point
R: prevent skin breakdown
Interventions (NIC) and Rationale of
Nx 1
Cast Care: Wet
Expose drying cast to air
R: promote even drying
Support cast with pillows during the
drying period
R: prevent denting and flattening of the
cast
Interventions (NIC) and Rationale of
Nx 1
Apply plastic to cast if close to groin
R: Prevent soiling of cast
Mark the circumference of any drainage
R: As a gauge for future assessment
Interventions (NIC) and Rationale of
Nx 1
Cast Care: Maintenance
Instructpatient not to scratch skin under the cast
with any objects
R: prevent skin injury and infection
Position cast on pillow

R: lesson strain on other body parts

Pad rough cast edge and traction connections

R: prevent skin irritation and breakdown of cast