Work-related MSDs can be prevented. Ergonomics fitting a job to a person helps lessen muscle fatigue, increases productivity and reduces the number and severity of work-related MSDs. Employers are responsible for providing a safe and healthful workplace for their workers. In the workplace, the number and severity of MSDs resulting from physical overexertion, and their associated costs, can be substantially reduced by applying ergonomic principles. Implementing an ergonomic process is effective in reducing the risk of developing MSDs in high-risk industries as diverse as construction, food processing, firefighting, office jobs, healthcare, transportation and warehousing.
The following are important elements of an ergonomic process:.
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Ligaments may also restrict some actions and movements such as hyperextension or hyperflexion that is limited by the ligament ability to prevent this movement to an extent [ 7 ]. A bursa is a small synovial fluid-filled sac contained within white fibrous connective tissue which is lined internally with synovial membrane. The fluid-filled sac can be found in multiple regions in the body mostly around joints [ 2 ]. Other things to keep in mind are to pay special attention to excessive pressure over prominences as they may result in a peripheral nerve compression, compartment syndromes, or crush syndromes.
A thorough history is the first step; always ask about the mechanism of the trauma, it is very essential in the management of musculoskeletal injuries and then past medical history to assess any morbidities, history of medications, any previous injuries, and the last meal the patient had and the timing of it.
Second in line is physical examination. The physical examination in the emergency department for these injuries is based on simple four steps: Inspection discoloration, swelling, or deformity. Assess range of motion both active and passive with consideration to the joint above and below the injured part.
The soft tissue is a term that encompasses all body tissue except the bones. It includes skin, muscles, vessels, ligaments, tendons, and nerves. Their injuries can range from the trivial, such as a scraped knee, to the critical that includes internal bleeding; those which involve the skin and underlying musculature are commonly divided either as closed or open wounds.
Ecchymosis: discoloration under the skin that is caused when blood leaks out into the surrounding soft tissues causing the skin to turn different colors. Strain: stretching or tearing of a muscle resulting from overstretching or overexertion.
Managing Minor Musculoskeletal Injuries and Conditions
Also known as a pulled muscle or torn muscle [ 8 ]. Also known as a torn ligament [ 8 ]. Closed injuries can be managed effectively by applying the R. This involves the application of R rest, I ice, C compression, E elevation, and obtaining a R referral for appropriate medical treatment.
There may be a mild deformity of the injured joint in addition to complete or near complete loss of movement of joint; treatment consists of pain control, supportive strapping or bandaging, and immobilization by splinting so that affected muscle is in relaxed position. If injury is severe, R. R must be followed [ 9 , 10 ]. Also, make sure to cover the following: Reassure the patient. Amputations: partial or full detachment of a limb or other appendage of the body which may be iatrogenic or due to trauma.
The management is usually so minimal requiring cleansing of the wound; small bandages may be applied but tactical situations will usually preclude applying field dressings that are needed for more serious injuries. A large amount of dirt may be ground into the wound; therefore, secondary treatment measures should focus on preventing or stopping infections. Treatment is generally the same as for abrasions.
It is very important to remember protecting yourself from disease by using medical gloves, wash or irrigate the injury with warm saline, remove all foreign bodies, control bleeding by applying local compression and dressing, start intravenous fluids when necessary e. Insure to keep the patient warm, elevate the injured part of the body. If major tendons and muscles are completely cut, immobilize the limb to prevent further damage.
Bleeding should be controlled by direct pressure on the bleeding site; the avulsed part should be managed by applying several pressure dressings or an air splint and followed by regular dressing. Contamination should be avoided; ensure avulsed flap is lying flat and that it is aligned in its normal position.
If the avulsed part is completely pulled off, make every effort to preserve it. Wrap that part in a saline or water-soaked field dressing, pack wrapped part in ice, and whenever possible be careful to avoid direct contact between the tissue and ice.
Transport the avulsed part with the patient but keep it well-protected from further damage and out of view of the patient [ 4 ]. With complete amputations, there is less bleeding than with partial or degloving cases. This is due to elastic nature of blood vessels as they are tended to spaz and retract into the surrounding tissue.
It is very important to notice that replantation is performed only with an injury of isolated finger or extremity and should be performed by a skilled surgical team. If a tourniquet is applied, it must occlude arterial inflow, as occluding only venous system can increase bleeding.
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The physician must be able to make such decision and be aware that this choice is for life and against limb. Place the patient in shock position head down, feet elevated. Make every effort to preserve the amputated part and transfer the patient to the theater as soon as possible after stabilization of the ABCDE. Wrap the amputated part in a sterile dressing, place in ice and send with patient, and prevent direct contact between tissue and ice as possible [ 7 ].
A break in the continuity of bone which may result in partial or complete disruption of the bone. Fractures are further classified as open or closed. The latter has a higher likelihood of contamination. Initiate IV antibiotics usually broad-spectrum type to cover both Gram-positive and Gram-negative bacteria , in addition to tetanus prophylaxis. DO NOT re-place protruding bone or explore the wound nor clamp any vessel at the emergency setting and wait for the orthopedic physician. In general, during clinical examination for suspected fractures, look for the following signs: Discoloration.
Any open wounds over or near a joint should be assumed to extend to the joint till proven otherwise. Serious complications of open fractures are: Soft tissue infection. An appliance made of wood, metal, or plaster used for the fixation and protection of an injured part of the body aiming to: immobilize the injured body part.
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Control hemorrhage. An attempt should be made to straighten a severely deformed limb with gentle traction only if there are no distal pulses, if resistance is felt, stop and splint as it lies. Common complications that can be seen with splinting include abrasions, sores, neurovascular compromise due to tight fitting splints, contact dermatitis, pressure ulcers, and thermal burns.
Splints should be applied by skilled and trained professional, applied splint correctly followed by neurovascular status checkup. Volar short splint which is used for wrist fractures, fractures of the second to fifth metacarpal bones, carpal tunnel syndrome, and soft tissue injuries Figure Finger splints which are used for phalangeal fractures Figure Gutter splint which can be used for phalangeal fractures and metacarpal fractures; these are two types: radial and ulnar Figure Buddy taping of toes used to secure the fractured toe to the adjacent one with adhesive strips; it is necessary to apply a small pad or sheet between toes to prevent maceration Figure Thumb spica splint used for scaphoid fractures, extraarticular fractures of the thumb and ulnar collateral ligament injuries Figure Stirrup splint is a below knee splint wrapping around the ankle to immobilize ankle fractures Figure Posterior leg splint is used for distal leg fractures, ankle fractures, tarsal fractures, and metatarsal fractures Figure Also called luxation, occurs when there is an abnormal separation in the joint where two or more bones meet [ 9 , 10 ].
Sometimes causes tearing or complete ligament separation; a partial dislocation is referred to as subluxation. They are easily recognized and diagnosed; the impact area may be swollen or look bruised with associated redness or discoloration.
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