Injury to the shoulder girdle, as well as the upper extremities, is a phenomenon that is faced not only by professional athletes, as most people usually assume. Dislocations, fractures, ruptures of ligaments and muscles, penetrating, through and blind wounds can be obtained at work, during car accidents, during a fall, an unsuccessful jump into water, or lifting heavy objects at home. According to the World Health Organization, approximately 80% of all injuries with which people end up in surgery and traumatology are musculoskeletal injuries, and half of them relate to the upper extremities and shoulder girdle. That is why understanding and being able to differentiate different types of injuries, as well as mastering first aid and bandaging techniques is important for every person.
Types of injuries to the upper shoulder girdle and limbs
Content:
- Types of injuries to the upper shoulder girdle and limbs
- Characteristics of specific shoulder and forearm injuries
- General rules for first aid
- Algorithms and techniques for applying bandages
Injuries to the arms, shoulders and forearms can vary.
But, in general, this term refers to a violation of the normal condition and integrity of bones, soft tissues and skin, which causes pain and significantly limits the mobility of the limbs and torso as a whole.
When examining the victim at the scene of the incident, it is necessary, first of all, to determine the main visible deformations and damage.
If the victim is conscious, he must be interviewed to clarify the nature and location of the pain. In addition, the damaged areas are palpated, but this must be done very carefully and without sudden movements, since any damage may be accompanied by injuries to internal organs. The main division of injuries to the upper shoulder girdle implies the presence of two large groups of injuries - open and closed.
Open injuries are injuries associated with a violation of the integrity of the skin at the site of injury, therefore, upon visual inspection, internal ruptures, fractures and other wounds can be seen.
Closed injuries are more dangerous - they are hidden under the skin and subcutaneous fat, which in this case remain intact. To identify such injuries, a simple examination is not enough, which significantly complicates the provision of adequate first aid. This classification is the most general, and each type of injury should be considered separately. Common injuries are:
- bruises;
- dislocation;
- sprains and ligament tears;
- cracks and fractures of bones.
Why do you need an arm support bandage?
No person is protected from accidents. Each of us hopes for the work of doctors, but before the ambulance arrives, the victim requires first aid. An effective remedy for a hand injury is to apply a scarf bandage. A modified analogue of such a product is considered a medical bandage.
The use of an orthopedic product is advisable for injuries of the upper limb:
- Fractures, sprains, bruises and dislocations.
- During the rehabilitation period after operations and injuries.
In case of serious injuries and pathologies, a Deso-type fixing bandage of the shoulder joint is used. The orthosis is a tight-fitting shoulder, part of the back, chest and a corsage encircling the waist.
Characteristics of specific shoulder and forearm injuries
A bruise is a soft tissue injury that does not break the integrity of the skin. The cause is usually a sudden mechanical impact, such as a fall or blow. A painful sensation appears at the site of the bruise, which may result in limited mobility. After a few hours, bruising and tissue swelling may appear at the site of the injury. Over time, the color of the bruise changes from purple to yellow-greenish. Such injuries can be independent or accompany more dangerous injuries, such as fractures.
Positional compression of the upper limbs is a process of pressing soft tissues, due to which blood circulation in them is disrupted, the sensitivity of the limb and its mobility worsen.
A person feels numbness in the arm or shoulder, and the skin at the site of compression becomes pale, cold, and bluish. There is also a weakening of the pulse. The danger of such lesions is that tissue necrosis may develop due to them in the future.
Violations of the integrity of the ligaments can occur as a result of sudden movements of the joint that exceed its mobility. In this case, the ligaments almost do not stretch - ruptures or micro-tears occur in places of greatest tension. The victim feels pain in the joint, there is swelling in the affected area, and limited mobility. Not only muscles and ligaments are damaged, but also the vascular system - blood and lymphatic vessels.
Dislocation is a functional disorder of the normal state of the articular apparatus. The articulating parts of the bones that form the joint, as a result of mechanical action, cease to interact normally and change their location. The pathology is accompanied by severe pain, decreased mobility, and severe swelling.
Upper extremity fractures represent approximately 50% of all fractures. They can occur as a result of a sharp blow, a fall, or a car accident. This condition is dangerous for humans, since the bone loses its strength and integrity and ceases to function as a “frame” for a limb or joint. Incorrectly fused bones significantly complicate the life of their owner.
How to properly bandage the shoulder joint
The psychological state of the patient is important for the correct procedure. The person needs to be seated, calmed down, and told about the basic principles of the upcoming bandaging. This will help him relax, and the doctor will quickly fix the injured shoulder. Before bandaging, a roller supporting the arm is placed in the armpit, and a sterile dressing material is applied to the wound. Immobilization of the shoulder joint is carried out according to the following algorithm:
- during the first rotation, the bandage is applied loosely, and during subsequent rotations its tension should be tighter, with a tight fit to the body;
- The bandage will be tight and secure if you move the bandage by a third of its width with each turn. The basic principle of spica bandaging is based on the uniform weave of the dressing material covering the wound surface;
- During the application process, the surface of the bandage is constantly leveled by hand to ensure a tight fit and to avoid the formation of folds and bends. The area of the shoulder joint is uneven, so when fixing it, cutting the dressing material is allowed. After application is completed, the remaining part of the bandage is located under the last layers. It is secured with a safety pin or straps obtained by cutting the bandage.
The main requirements for a spica bandage are comfort, tight fit of the bandage layers and the absence of excessive compression. It should not reduce the range of motion of healthy joints and cause discomfort even when worn for a long time. It should only be applied by a qualified physician. Bandaging too tightly will compress blood vessels, nerves and muscles. This will cause the development of necrosis. And weak fixation will significantly slow down tissue regeneration or provoke a relapse of the pathology, for example, with dislocation of the abdominal end of the clavicle.
Signs of improper application include decreased sensitivity of the upper limb, swelling of the free part of the arm, and pain in the shoulder joint.
General rules for first aid
Considering that lesions of this type can be completely different - from contusions and bruises to severe bone fractures, of course, the first aid algorithm for victims differs in each specific case, depending on the type of wound or injury.
However, general requirements for assistance are mandatory for all types of lesions. It is necessary to carry out an external examination of the victim, assess the severity of his injuries, as far as possible visually. If a person is bleeding and there is no pulse or breathing, resuscitation measures must first be taken.
Stopping bleeding is the first thing you should pay attention to. For this purpose, a tourniquet or pressure bandages can be applied to the limbs, or the method of finger squeezing the damaged vessel can be used. You should remember the rules of asepsis - before starting any manipulations, hands and all materials used must be disinfected.
In the absence of breathing and pulse, it is necessary to carry out resuscitation measures - cardiac massage, artificial respiration.
In case of dislocations, ligament ruptures and bone fractures, the main thing is to ensure complete immobilization of the damaged area. For this purpose, tight bandages or splints are applied to the injured limb or joint.
If we are talking about a minor bruise, help with it will include disinfecting the injured area, applying a cold compress, and, if necessary, administering painkillers.
Severe bruises and crushing of tissue, as well as positional compression, require immobilization of the damaged area, and when tissue is compressed, blood circulation must be restored.
Changing dressings
Changing the dressing The quality of the dressing is one of the factors that significantly influences the entire course of wound healing. Taking into account the contact route of transmission of wound infection, when dressing, the principle of continuous asepsis and a non-touch technique are always used, in which the wound or dressing is not allowed to be touched without gloves. In order to reduce the risk of transmission of infection, dressing of infected wounds should be done by two people. In this case, all materials that come into contact with the wound or serve asepticity of the process must be sterile. The practical implementation of changing the dressing includes mandatory preliminary protective measures in accordance with hygiene instructions and patient preparation. When changing dressings in patients with HIV, AIDS, viral hepatitis, in patients with multidrug-resistant or anaerobic microflora in the wound, the person doing the dressing must take special measures to protect himself from infection: latex gloves, safety glasses and a mask covering the nose and mouth are required. The patient is informed about the upcoming dressing and the nature of the wound treatment. Before changing the dressing, you must give an anesthetic 30 minutes before changing the dressing. Stages of dressing
- Removing a previously applied dressing is done using non-sterile gloves with the obligatory wet separation of the dried textile dressing from the wound, followed by replacing the gloves with sterile ones;
- Inspection of the wound - a visual examination is carried out for the purpose of a comprehensive clinical assessment of the condition of the wound and the course of the wound process, possible complications are identified;
- Cleaning of the wound and surrounding tissues - removal of residual exudate, antiseptic treatment of the skin surrounding the wound, if necessary, instrumental removal of dry crusts, necrosis, fibrinous plaque, foreign bodies within non-viable tissues, final treatment of the wound with antiseptics;
- Application of a new dressing is carried out in sterile gloves, ensuring the most complete contact of the dressing corresponding to the current local status without excessive mechanical impact on the wound and the mandatory use of a sterile instrument;
- Fixation of the bandage is done using fixing plasters (for small wounds) or bandaging according to the rules of desmurgy with uniform distribution of pressure on the wound area. Hydrocoll and Hydrosorb comfort are self-fixing dressings;
- After dressing, the used materials are prepared according to the hygienic regime for final disposal or reuse;
- Finally, hygienic hand disinfection is carried out (Sterillium).
Frequency of dressing changes The frequency of dressing changes depends on the condition of the wound and the special properties of the dressing itself. The wound should be given as much rest as possible. However, the bandage should be removed immediately if: the patient complains of pain, a fever develops, the bandage becomes dirty or has exhausted its absorbency, or its fixation is broken. In an aseptic wound that heals by primary intention, the bandage can be left in place until the sutures are removed. In the first phase of the wound process with heavy exudation, one should focus on the degree of absorption of the wound discharge by the bandage. This may require 1-2 or more dressing changes per day. With normal development of granulation tissue in the wound, the frequency of dressings decreases. With epithelialization, the physiological secretion of the wound decreases, and therefore the intervals between dressings can be further increased. Thus, in the 2nd and 3rd phases of the wound healing process, when using hydroactive dressings “Hydrocoll” and “Hydrosorb”, the intervals for dressings can increase to 7 days.