2. General Information
• Injuries to musculoskeletal system are most
common in wilderness activities
• Bones, ligaments, muscles, tendons, cartilage
• You will often be unsuccessful in your attempt to
assess exactly what’s wrong
• Even so, you need to know how to handle these
emergencies.
3. Assessment and Treatment
of Muscle Injuries
• Muscle injuries are here defined as overstretched
muscles, tendons, or ligaments.
• They can range from a mild annoyance to a debilitation
• Indicated by pain and bruising in area of injury.
4. Assessment and Treatment
of Muscle Injuries
RICE can be helpful:
Rest the injured area and avoid
painful movement.
Immobilize injured area.
Apply Cold to injured area to
reduce swelling and pain.
Elevate injured area above heart
level to reduce swelling.
5. Assessment and Treatment
of Muscle Injuries
• Apply RICE after initial injury evaluation.
• Is the joint usable?
• Look for deformities, swelling, discoloration.
• Have patient evaluate pain when moving joint
• If joint appears usable, have patient test with body
weight.
• Keep injured area at rest for 30 minutes while lowering
temperature.
• Via crushed ice (wrapped), cold water, cold packs
6. Assessment and Treatment
of Muscle Injuries
• Immobilization is best attained with compression
dressing (elastic wrap).
• Wrap snugly, not tightly, from below injury towards
heart.
• After 20-30 min of RICE, remove treatment and let joint
warm for 10 min before use.
7. Assessment and
Treatment of Fractures
In situations where fracture is not obvious, base
assessment on specific guidelines:
1. Carefully remove clothing near area and visually
inspect injury.
2. Ask patient what happened and for their
assessment of the situation.
9. Splinting
• When in doubt, splint!
• Restrict movement to prevent further damage
• Padding should fill spaces within splint
• Splint should be long enough to restrict movement of
joints above and below fracture.
10. Splinting
• Splints should hold injury as close to position of
function as possible
• Spine, neck and pelvis straight; padded lower back
• Legs almost straight; padding behind knees
• Feet at 90 degrees to legs
• Arms flexed across heart
• Hands curved with padded palms
14. Specific Fractures
• Rib fractures can be protected by supporting the
arm on the injured side with sling. Encourage
patient to take deep regular breaths
• Pelvis/Hip fractures can be supported by wrapping
the pelvis. Secure legs to each other and carry
patient out.
16. Complicated Fractures
• Angulated fractures need to be straightened.
• Pull gentle traction on broken bone along the line of
fracture to relax muscles
• Slowly move broken bone back into alignment and
splint.
• Open fractures are indicated by open wounds.
• Irrigate and dress wound appropriately and splint bone.
17. Assessment and Treatment
of Dislocations
• Dislocation means bone ends in a joint are not
aligned.
• Splint joint in most comfortable position
• The sooner a realignment (reduction) is attempted,
the easier it is on the patient.
• Once reduced, splint the injury.
19. Specific Reducible
Dislocations
• Patients can often pull their own shoulder back in place
• Pull injured arm straight forward
• Must be done immediately after injury
• If delayed more than a few minutes, dislocation will spasm so much
that this technique won’t work.
• After reducing shoulder, patient should be placed in sling-
and-swathe.
• Do not swathe if patient may need to use arm in emergency.
21. Specific Reducible
Dislocations
• Kneecap dislocations are also easy to reduce.
• Straighten leg. Sometimes, knee pops back in when
straightened.
• If not, massage thigh and gently push kneecap into
alignment.
22. Guidelines for Preventing
Bone and Joint Injuries
• Paying attention to safety prevents many injuries.
• Adequate and properly fitted footwear decreases
chance of injury.
• Physical conditioning prior to wilderness activities
decreases chance of injury.
23. Guidelines for Evacuation
• With usable injuries, a patient’s level of comfort
will determine need to evacuate.
• Evacuate patients with unusable injuries and first-
time dislocations (except fingers/toes)
• Rapidly evacuate patients with angulated or open
fractures, pelvic or thigh fractures, or fractures that
decrease circulation.
Editor's Notes
2 hours
Reference the following chapters:
Chapter 13, Bone, Joint, and Muscle Injuries
Chapter 14, Extremity Injuries
Chapter 15, Splinting the Extremities
Unusable joints may require a split.
During warmer months, another cooling option is to wrap the joint in wet cotton (shirt, sock, etc) and let evaporation cool the injured area.
A pad should be placed behind the knee within the splint to keep the knee slightly flexed. The patient can be supported further with a stick or staff for balance.
Patients with ankle injuries should have boots laced firmly and walk with stick or staff.
If bone ends stick out of the wound, and if the doctor is more than four to six hours away:
Clean the wound and bone ends without touching them.
Apply gentle traction in line to the fracture and pull the bone ends back under the skin.
Dress the wound.
Splint the fracture. Infection is on the way, but bones survive better if pulled back inside the body.
Realignment may cause pain, but only stop if the pain increases dramatically.
Stimson technique:
Low risk of patient harm
Time consuming
Sometimes fails
