Skeletal trauma - First Aid

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First aid

First aid

Skeletal trauma

Contusions Sprains Dislocations
  • Bruises
    • Symptoms and signs
  • Distortions
  • Dislocations

Bruises

Contusion is a lesion caused by the effect of direct trauma on our body which, however, is not such as to cause an interruption of the skin surface, that is, to cause an injury.

The damage caused, depending on the intensity of the applied force, consists in the lesion of the subcutaneous and deeper tissues, such as the fat layer (fat), the muscle groups and the muscles, the tendons, the joints, the bones and the blood vessels.

The latter, if small in size (capillaries or small caliber vessels), can cause a minor and irregularly diffused bleeding, called bruising. On the other hand, in the case of larger blood vessels, the bleeding resulting from a contusion is greater and, flowing into a single area, determines a real collection of blood, called a hematoma.

Visiting the bruised person, it is noted that the part affected by the trauma may initially appear red, more or less raised due to the presence of an underlying hematoma, with bruises that may become darker and more evident in the following days.

In fact, there is a gradual reabsorption of the blood extravasation, the swelling decreases and the variation in the color of the skin is characteristic which, from bluish, becomes first brownish, then green and finally yellow more and more light, until disappearing with restoration of normal color of the skin.

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Symptoms and signs

Symptomatology varies according to the strength of the trauma and the affected body area, consisting of immediate pain that can run out more or less quickly or persist and even accentuate with the passing of the hours, due to the deep lesions and the hematoma caused, which, forced by the surrounding tissues, it assumes increasing tension and consequently causes pain due to the compression exerted in the neighboring tissues.

If muscle, tendon or joint structures are affected, the disorders will be more important and may be accompanied by a more or less evident limitation of functionality.

The muscle, especially if at the time of the trauma it was contracted and therefore with less capacity to absorb and distribute the force applied at the point of impact, can suffer damage of various magnitudes, from the simple breaking of a few muscle fibers to the breaking of more or less extensive parts with the formation of hematomas located deep, painful contraction attempts and more or less complete impossibility of making movements with bruised muscles.

A tendon can be frequently affected when its course is superficial, as happens to the tendons of the hand (the extensor tendons of the fingers are located on the back of the hand), of the knee (patellar or quadriceps tendon, located above the patella), of the foot (structured like the hand), the Achilles tendon, placed above the heel. In these cases the hematoma will be limited due to the modest presence of blood vessels in the structure of the tendon and, if present, will be caused by the involvement of the surrounding tissues. The pain will be more pronounced due to the involvement of the sheath surrounding the tendon: in fact, the latter being rich in blood vessels and equipped with sensory nerve branches, the slightest movement caused to the tendon bruised by the contraction of the muscle triggers an immediate pain consequent to its tension and swellings that occurred in the sheath itself following the trauma.

The bruised joint can suffer damage both at the level of the ligaments, and therefore with characteristics superimposable to those described for the tendons, and at a deeper level, affecting the joint capsule, i.e. the fibrous tissue that encloses the joint by sleeve. In the latter case an appreciable swelling can be created from the outside, which is caused by a "spill" of liquid inside the joint itself; this, if produced by a simple inflammation following the trauma, will be made up only of serum (in these cases of hydrarthrosis); if, on the other hand, it is supported by lesion of vessels of the synovial membrane that covers the inside of the capsule, it is made up of blood (and then we talk about the formation of a haemarthrosis). The resulting pain is caused in the movement of the joint and by the tension of any liquid that has collected inside it and which also mechanically limits its movement (the joint in which the liquid is contained is a kind of "bag" not dilated a lot), both by the involvement of ligaments and insertions of nearby muscles.

Finally, trauma affecting a bone can be particularly painful, often in the places where it is less protected from fat and muscles, as happens for example for the fingers, elbows, head and face, ribs, tibia and malleoli ankles. The fibrous membrane that tenaciously wraps the bone (the periosteum) is in fact rich in sensitive vessels and nerve endings, so that, even in the absence of an evident hematoma, the pain is acute and persistent after some time, in particular on palpation interested party.

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