Transcript Chapter 4

Chapter 4- Wound Care
• Anatomical Position
• Directional Terms- 3 Planes Fig 4-1
Sagittal or AP – Right/Left
Transverse or horizontal – Top/Bottom
Frontal or Lateral – Front/Back
• Table 4-1-Read and Understand
Terms in Use
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The neck is __ to the head
The thumb is ___ to the middle finger
The knuckles are ___ to the elbow
The outer ear is ___ to the ear drum
The eyes are on the ___ the head
The ankle is on the ___ part of the body
Terms In Use Cont
• The patella is _________ to the ACL
• The shoulder blade is on the ________ and
_________ aspects of the body
• The heart is ________ to the chest muscles
• The triceps are on the _________ aspect of
the body.
Skin Anatomy
• First layer of defense against injury; most
frequently injured body tissue
• Needed to protect against bleeding and infection
• Two major region
– Epidermis-superficial layer- Multi-Layered -contains
skin pigment, hair, nails and sweat glands
– Dermis-Deep layer- contains hair follicles, blood
vessels, nerve endings
• Resist compression, tension, and shear type
forces
Soft Tissue Injuries
Fig 4-3
• Abrasion = scrape (shear force) (1st)
• Blisters = repeated shear force (1st)
• Skin bruises (contusions) = Compression force
(1st/2nd)
• Incision = clean cut (1st/2nd)
• Laceration = jagged cut (1st/2nd)
• Avulsion = loss of tissue (1st/2nd)
• Puncture = sharp object penetrates skin (1st/2nd)
Care of Soft Tissue Injuries
• Wear Gloves
• Apply direct pressure with a sterile dressing if
possible (Let athlete assist you when possible)
• Clean the wound with saline or soap water
• Apply ointment-Triple Antibiotic and dressings
that extends past the wound
• Secure with pre-wrap and tape (Check for
circulation
• Change dressings daily and look for signs of
infection (redness – red streaks, heat, pus, pain)
• Wash hands when you are finished
Muscles and Tendons
• Muscle Fibers are surrounded by
Endomysium (Inner)
• Small amount of fibers make up fascicles
surrounded by Perimysium (Middle)
• A muscle is made up of a number of
fascicles which are surround by
Epimysium (Outer)
• Muscle Sheath
Muscles and Tendons
• Purpose- movement, maintaining posture,
stabilizing joints, and generating heat as
they contract
• Extensibility = Ability to stretch/increase
in length
• Elasticity = Ability to return to normal
length after lengthening/ shortening
Tendons
• Tendons- assist in movement of body part
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Connect muscle to bone
Collagen or tissue is in parallel pattern
High resistance to unidirectional forces
Patella, Achilles, Biceps
Muscle contractions
• Concentric Contraction
= muscle shortening against resistance
• Eccentric contraction
= muscle lengthening against resistance
• Isometric contraction = no change in
length, no joint movement
• Isotonic contraction = change in length,
joint movement
Muscle stretching
• Figure out muscle and its action(s)
• Stretch in opposite direction
– Stabilize body
– Hold stretch at least 20s
• Three kinds of stretching
– Ballistic (bouncing) Want to avoid this type
– Static –Hold in a position for at least 20 secs
– PNF Stretch, Contract, Stretch
Soft tissue injury classifications
• Contusions
• Severity depends on depth and tissue affected
– 1st degree = little or no ROM restriction; slight
discoloration, pain w/ movement, pt tender
– 2nd degree = moderate ROM restriction; S/S increase
– 3rd degree = severe ROM restriction; S/S increase
• Muscle cramps/spasm
• Myositis/ fasciitis
Soft tissue injury classifications
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Strain = injury to muscle or tendon
Tendonitis (tendon)
Tenosynovitis (synovial sheath over tendon)
Myositis ossificans (muscle to bone)
Cacific tendonitis (tendon to bone)
Bursitis (bursae)
Categories of Strains Table 4.2
• 1st degree: some pain, microtears of collagen,
mild symptoms: pn, point tenderness, swelling,
ROM decreased
• 2nd degree: More tissue destruction, moderate
symptoms, joint laxity/instability, muscle
weakness, increased ROM loss, ecchymosis
(tissue discoloration).
• 3rd degree: Severe tissue destruction, severe
symptoms, complete instability, loss of ROM,
palpable defect (early), ecchymosis
Joints
• Meeting of two bones
• Various types of joints –fibrous, cartilaginous,
and SYNOVIAL
• Synovial- most common; freely moveable; all
joints of the limbs fall into this class
• Features of a synovial joint –Fig 4-6
– Articular Cartilage-protects the ends of your bones
– Joint Cavity- Space between bones which is filled w/
synovial fluid
– Articular Capsule-Surrounds the joint cavity
– Synovial Fluid-Lubricates the joint and articular
cartilage
– Reinforcing Ligaments-ACL, PCL, LCL, MCL
Range of Motions (ROM)
Box 4-1/Fig 4-7
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Flexion/Extension
Dorsiflexion/Plantar Flexion
Abduction/Adduction
Circumduction
Rotation
Supination/Pronation
Inversion/Eversion
Protraction/Retraction
Elevation/Depression
Opposition
Joint Injuries
• Sprain = injury to ligament; mechanism of injurytwisting, direct contact, dynamic overload, 3 degrees (See
table 4.3)
• Subluxation-Partial displacement of the joint surface;
structure damage does occur; check a distal pulse
• Dislocation-displacement of joint; major structure
damage, instable joint, severe pain, loss of ROM; check
distal pulse
Treatment To Closed Tissue
Injuries
• Apply Ice with a compression wrap immediately
for at least 20 minutes; check for a distal pulse
• If no fracture suspected elevate body part
• Repeat the process every 1-2 hours
• NSAIDS if able
• Supply Crutches if necessary
• Continue Ice Application up to 72 hours
• Keep body part wrap with compression
• Refer to physician if necessary
Bones
• Purpose-support, protection, reservoir for
minerals for the bulk of blood cells, aid in
movement w/ muscles
• Bone Classification:
– Long-consist of a shaft and 2 ends; all bones of limbs
fall into this category
– Short-cubelike; bones of wrist and ankle
– Flat-flat, thin and usually a bit curved; ribs and
sternum
– Irregular-don’t fit into any of the above categories;
vertebrae and hip bones
Bone Anatomy
• Structure of Bones:
– Diaphysis-shaft of bone
– Epiphyses-located at the ends of bones; larger
than diaphysis; in adolescents there is a
cartilaginous disc where bone growth occurs,
this fuses with the diaphysis and forms the
epiphyseal line at 18.
Bone Anatomy Cont
– Membranes
• periosteum-outer layer of bone where tendons/lig
attach
• Endosteum- inner layer of bone
– Inside bone- contains bone marrow
Bone injuries
• Fracture = Disruption in continuity of a
bone = break
– Simple = skin remains intact
– Compound = skin integrity compromised
– See types of fractures, pg. 53 & 56
• Stress fractures (repeated low-magnitude
forces)
Fractures
• C/S-direct contact, fall, dynamic overload
• Signs: swelling, bruising, deformity, shortening of the
limb, crepitus, disability
• Types-open (c),closed (s), transverse, epiphyseal,
avulsion
• Five ways of recognizing fracture: Figure 4-12
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Palpation
Percussion
Vibration
Compression (be careful)
Distraction (be careful)
Treatment
• Splint before moving-Follow 1st Aid/Safety Rules
• Types of splints:
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Anatomic
Stiff/rigid
Soft
Vacuum
• Check feeling, warmth, and color before and after
splinting
• Refer for X-rays