JOINT LESIONS

SPRAINS

A sprain occurs when we move a joint beyond its normal limits, causing a stretching or tearing of the ligaments, even though they remain in touch with the bone joint surfaces.

The symptoms are:

• Pain in the lesion site, which worsens with movements.
• Swelling of the join.
• Loss of strength.

Sometimes it is very difficult to distinguish from a fracture, so in doubt treat as if it were.

Treatment

• Joint immobilisation with splint or bandage (see IMMOBILISATION AND BANDAGES).
• Absolute joint rest.
• Raising of the injured area. The arm in a sling and the leg horizontal.
• In the first 36 to 48 hours cold should be applied locally, with cold bags or pads (see picture 7-46). After that, substitute with heat.
• Ease the pain with 1 to 2 metamizole pills (DRAWER 3, first aid kits A, B, C and RAFTS).
• In case of doubt or complication, ask for MEDICAL ADVICE VIA RADIO .
  
  
  
  
  Picture 7-46: Local cold treatment.

DISLOCATIONS

Dislocations are also caused by flexion or extension beyond normal limits or by a direct bang in the joint, but, unlike the sprain, joint surfaces are split and there is tearing or ligament breakage.

The symptoms are:

• Very severe pain.
• Swelling.
• Strength loss.
• Joint deformity, unlike in sprains. Compare with the opposite side.

Management:

1. Carefully cut the clothes of the injured limb.



2. Check wrist and ankle pulse and finger sensibility. Only when one of these is absent, try to reduce, that is, try to place in its normal position, or also if the patient cannot be attended to by a doctor within six hours.
   
   
   • Reduction of the dislocated shoulder:
     
     Before trying anything, treat the pain with half an ampoule of pethidine hydrochloride subcutaneously (DRAWER 3, first aid kits A and B) and administer a diazepam tablet as a muscle relaxant (DRAWER 4, first aid kits A, B and C).
     
     
     Lay the patient on a comfortable stretcher without a pillow. Wait for 15 minutes before acting. Hold the affected arm and pull smoothly and slowly from the elbow, placing the upper limb in a 45 degree angle with the body (see picture 7-47).
     
     

     
     Picture 7-47.
     
     
     
     Slowly move the arm away from the body while simultaneously pulling smoothly, and rotate the arm slightly outwards (see picture 7-48).
     
     

     
     Picture 7-48.
     
     
     
     Bend the elbow around 90 degrees moving the arm slowly away from the body until placing the palm of the hand under the patient's head (as if sunbathing) (see picture 7-49). Leave in this position for ten to fifteen minutes, encouraging the patient to relax.
     

     
     Picture 7-49.
     
     
     After holding the patient's arm, and pulling smoothly, bring it to its normal position, pushing with the fingers under the armpit (see picture 7-50). If the reduction has been successful, the pain and deformity will disappear.
     
     Immobilise the arm in a splint, (see pictures 7-57 and 7-58).

     
     

     
     Picture 7-50.
     
     If at any time during the manoeuvre there is an increase in pain or loss of sensibility in the limb, do not continue the reduction
     
     
   • Reduction of a dislocated finger in the hand:
     
     Pull the finger firmly for a minute, while pulling the rest of the hand in the opposite direction (see picture 7-51). Slowly place the joint in its normal position. Afterwards, immobilise (see picture 7-76) and treat the pain.
     
     
     
     Picture 7-51: Finger dislocation reduction.


3. Immobilise the joint as if it were a fracture, avoiding all unnecessary manipulation (see IMMOBILISATION AND BANDAGES).



4. Lay the patient down, relaxed and warmed.



5. Place cold pads or cold bags in the affected area (as with sprains).