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

• 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 InjuriesFig 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– 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

• 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

• 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 injury- twisting, 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

– Palpation– Percussion– Vibration– Compression (be careful)– Distraction (be careful)

Treatment

• Splint before moving-Follow 1st Aid/Safety Rules• Types of splints:

– Anatomic– Stiff/rigid– Soft– Vacuum

• Check feeling, warmth, and color before and after splinting

• Refer for X-rays