Chapter 6.docx

Bone and Joint Injuries Chapter 6 Bone and joint injuries Injuries to bones, joints and muscles are common and, although they are usually not life-threatening, they can be painful and debilitating. Appropriate first aid for these injuries can reduce the pain and prevent further injury. Fractures A b...

Bone and Joint Injuries Chapter 6 Bone and joint injuries Injuries to bones, joints and muscles are common and, although they are usually not life-threatening, they can be painful and debilitating. Appropriate first aid for these injuries can reduce the pain and prevent further injury. Fractures A break or crack in a bone is called a fracture. A fracture is either closed or open: A closed fracture is where the skin over the fracture is not broken An open fracture is where the skin over the fracture is broken-this could cause serious infection, even if the wound is very small Closed Fracture Open Fracture A fracture can be caused by a direct force (e.g. a punch or kick), an indirect force (e.g. a fall), or by a twisting force. Certain bone diseases, such as osteoporosis, make bones very brittle and they can break without much force. One or more of the following signs and symptoms will be present when a bone is fractured: Pain and tenderness-worse when the injury is touched or moved Loss of function-the casualty cannot use the injured part A wound-the bone ends may be sticking out Deformity-any unnatural shape or unnatural position of a bone or joint Unnatural movement Shock-this increases with the severity of the injury Crepitus-a grating sensation or sound that can often be felt or heard when the broken ends of bone rub together Swelling and bruising-fluid accumulates in the tissues around the fracture Dislocations & Sprains Ligaments connect bones to other bones to form joints, while tendons connect muscles to bones. Ligaments limit the range of movement, support the joint in motion or prevent certain movements altogether. Joints may be injured when the bones and surrounding tissues are forced to move beyond their normal range. When that happens: The bones may break, resulting in a fracture The ligaments may stretch or tear, resulting in a sprain The bone ends may move out of proper position resulting in a dislocation Sprains A sprain is an injury to a ligament and can range from a stretched to a completely torn ligament. Be cautious and give first aid as if the injury is serious to avoid further damage and pain. Sprains of the wrist, ankle, knee and shoulder are most common. The signs and symptoms of sprains may include: Pain that may be severe and increase with movement of the joint Loss of function Swelling and discolouration Dislocations A dislocation is when the bones of a joint are not in proper contact. A force stretches and tears the joint capsule, causing the dislocation. Once this occurs, the bones can put pressure on blood vessels and nerves, causing circulation and sensation impairments below the injury. The most commonly dislocated joints are shoulder, elbow, thumb, fingers, jaw, and knee. The signs and symptoms of a dislocation are similar to those of a fracture, and may include: Deformity or abnormal appearance, a dislocated shoulder may make the arm look longer Pain and tenderness aggravated by movement Loss of normal function; the joint may be "locked" in one position Swelling of the joint General first aid for injuries to bones and joints The aim of first aid for bone and joint injuries is to prevent further tissue damage and to reduce pain. Perform a scene survey and a primary survey. Steady and support any obvious fractures or dislocations found in the primary survey (during the rapid body survey). Do a secondary survey to the extent needed, gently expose the injured area. You may have to cut clothing to do this without moving the injured part. Examine the entire injured area to determine the extent of the injury. Check the circulation below the injury. If circulation is impaired, medical help is needed urgently. Steady and support the injured part and maintain support until medical help takes over, or the injury is immobilized. Protect protruding bones. Do not push the bone ends back in. Do not attempt to apply traction to a limb (pull on it) or manipulate it in any way. If medical help is on the way and will arrive soon, steady and support the injury with your hands until they arrive. If medical help will be delayed, or if the casualty needs to be transported, immobilize the injury. Consider the following when making your decision: Are there other risks to the casualty? Are there risks to yourself or others? If medical help can get to the scene, how long will it take? Do you have the materials needed to properly immobilize the injury? How long will it take to immobilize the injury compared to how long it will take for medical help to arrive? Apply cold to the injury, as appropriate. Give ongoing casualty care until medical help arrives. Monitor circulation below the injury site. Use RICE for injuries to bones, joints and muscles Most injuries to bones, joints and muscles benefit from RICE, which stands for: R- Rest I - Immobilize C-Cold E- Elevate Use RICE while waiting for medical help to arrive or while transporting a casualty to medical help. Even the most minor injuries will benefit from RICE. Rest means stopping the activity that caused the injury and staying off it until a doctor tells the casualty it is OK to continue. For a minor injury, gentle use of the injured part is okay provided the casualty can easily tolerate the pain. Immobilize means suspecting a fracture whenever there is an injury to an arm or a leg and taking steps to prevent movement of the injured limb. Immobilization may mean using a sling for a shoulder joint injury or a splint to immobilize the joint above and the joint below the injury. Cold means applying cold to the injury as soon as you can once the injury has been immobilized. The cold narrows the blood vessels, reducing pain, swelling and bruising. Use a commercial cold pack, an improvised ice pack or a cold compress for more about using cold. Apply cold over the entire injured area-15 minutes on, 15 minutes off. Elevate means raising the injured part if possible. Only elevate if it will not cause more pain or harm to the casualty. Elevation helps to reduce swelling and makes it easier for fluids to drain away from the injury. This in turn, helps reduce swelling (don't elevate a "locked" joint). Head and spinal injuries Head injuries include skull fractures, concussion and compression. Such injuries are frequently complicated by unconsciousness. Fractures at the base of the skull often involve injury to the cervical spine. For this reason, when you suspect a head injury, you should also suspect a neck injury. Injuries associated with the spine/pelvis include fractures, spinal cord damage, and severe bleeding. The bladder is the organ most frequently damaged with pelvic injuries. A head/spinal injury should be suspected whenever the incident involves a car accident or a fall, from a height of 6 feet or more. It should also be suspected if signs and symptoms include: Fluid from the ears Headache Bruising on the head Casualty complains of pain in the head and neck Casualty tells you they cannot move or feel Always suspect head/spinal injury if the casualty is unconscious and the history is unknown. Head injuries The following signs and symptoms indicate a possible fracture of the skull or facial bones, concussion or compression: Deformed skull Swollen, bruised or bleeding scalp Straw-coloured fluid or blood coming from the nose or ear(s) Bruising around the eyes (black eye) or behind the ears Nausea, vomiting, especially in children Confused, dazed, possibly combative Semi-conscious or unconscious Stopped breathing or irregular respiration Very slow pulse rate Pupils are of unequal size Pain at the injury site Weakened or paralyzed arms and/or legs Pain when swallowing or moving the jaw Wounds in the mouth Knocked-out teeth Shock Convulsions An unconscious casualty with a head injury may vomit. Be ready to turn the casualty to the side (as a unit if possible) and clear the airway quickly. Skull fracture Fractures of the skull may be the result of direct force or an indirect force that is transmitted through the bones. Fractures may occur in the cranium, at the base of the skull, or in the face. Facial fractures include the nose, the bones around the eyes, the upper jaw and the lower jaw. Fractures of the jaw are often complicated by wounds inside the mouth. First aid for head injury First aid for fractures of the skull depends on the fracture site and the signs. Whenever there is a skull fracture, a spinal injury should be suspected-give first aid as if there was a neck injury. The head and neck should be immobilized accordingly. Perform a scene survey. Assess the mechanism of injury. If you suspect that there may be a head injury tell the casualty not to move and get medical help. Steady and support the head with your hands as soon as possible. Perform a primary survey. If blood or fluid is coming from the ear canal, secure a sterile dressing lightly over the ear, making sure fluids can drain. Protect areas of depression, lumps, bumps, or scalp wounds where an underlying skull fracture is suspected. Avoid pressure on the fracture site. Warn the casualty not to blow their nose if there is blood or fluid coming from it. Do not restrict blood flow. Wipe away any trickling blood to prevent it from entering the mouth, causing breathing difficulties. Give ongoing casualty care until medical help takes over. First aid for fractures of the facial bones and jaw Perform a scene survey. If you suspect a head injury, tell the casualty not to move and get medical help. Steady and support the head with your hands as soon as possible. Perform a primary survey. Check the airway and make sure there is nothing in the mouth. Remove any knocked-out teeth or loose dentures and maintain drainage for blood and saliva. If there is a suspected head or spinal injury, steady and support the casualty in the position found until medical help takes over. If there is no suspected head or spinal injury: Place the conscious casualty in a sitting position with head well forward to allow any fluids to drain freely If the casualty cannot sit comfortably, place them in the recovery position Place the unconscious breathing casualty in the recovery position. Get medical help and give ongoing casualty care. If transporting the casualty on a stretcher, ensure good drainage from the mouth and nose so that breathing will not be impaired. Concussion and compression Concussion is a temporary disturbance of brain function usually caused by a blow to the head or neck. The casualty may become unconscious but usually for only a few moments. The casualty usually recovers quickly, but there is a chance of serious brain injury. Use both the mechanism of injury and the signs and symptoms below to assess for concussion or compression. Partial or complete loss of consciousness, usually of short duration Shallow breathing Nausea and vomiting when regaining consciousness Casualty says they are (or were) "seeing stars" Loss of memory of events immediately preceding and following the injury Severe overall headache (not local scalp pain) Compression is a condition of excess pressure on some part of the brain. It may be caused by a build-up of fluids inside the skull, or by a depressed skull fracture where the broken bones are putting pressure on the brain. It is very important to monitor a casualty's vital signs and look for other symptoms after a blow to the head. The signs and symptoms of compression are progressive-they usually get worse as time goes on, as more and more pressure is put on the brain. Loss of consciousness Decreasing level of consciousness Nausea and vomiting Unequal size of pupils One or both pupils don't respond to light Helmets Helmets are designed to protect the wearer from fractures. They are not actually designed to protect against concussion or compression injury. If you see damage to the helmet you should suspect a.. concussion or compression 1nJury. Ongoing casualty care for head injury When a casualty has received a blow to the head or neck that causes decreased consciousness or unconsciousness, immediately suspect a neck injury. Tell the casualty not to move, steady and support the head. Send for medical help and give ongoing casualty care. A casualty with a concussion may appear to recover quickly, but there is always the threat of serious injury. Tell the casualty to get medical help right away for a full evaluation of the injury. If the casualty is unconscious and you must leave them alone, place them in the recovery position, carefully supporting the head and neck during any movement. If the casualty is face-up, monitor breathing continuously. A casualty who shows signs of compression needs to seek medical help immediately. Spinal injuries Injury to the spine threatens the spinal cord that runs through it and the nerves that branch out from the cord. Damage to the spinal cord or nerves can result in complete and permanent loss of feeling and paralysis below the point of injury. In every emergency situation, assess the possibility of a spinal injury. If it exists at all, give first aid for a spinal injury and get medical help as soon as possible. Use the history of the scene, especially the mechanism of injury, to decide if there is a chance of a spinal injury. If the history of the scene suggests a spinal injury, give first aid for a spinal injury even if the signs and symptoms below are not present. Swelling and/or bruising at the site of the injury Numbness, tingling or a loss of feeling in the arms and legs on one or both sides of the body Not able to move arms and/or legs on one or both sides of the body Pain at the injury site Signs of shock Stabilizing a head or spinal injury The aim of first aid for spinal injuries is to prevent further injury, by preventing movement of the injured area. When moving the casualty is necessary, support them in a way that minimizes movement of the head and spine. As soon as you suspect a head or spinal injury, tell the casualty not to move. Steady and support the casualty's head and neck as soon as you can-show a bystander how to do this: Keep elbows on the ground to keep arms steady. Firmly hold the head with fingers along the line of the Jaw. Show a second bystander how to steady and support the feet. The head and feet should be continuously supported until either the casualty is fully immobilized or medical help takes over. Perform a primary survey. If the casualty is unresponsive, check for breathing before opening the airway. Do a secondary survey to the extent needed. If medical help will arrive at the scene, steady and support the casualty in the position found and give ongoing casualty care. Continue to steady and support the head and feet until help arrives. Pelvic injury Signs and symptoms of pelvic injury include: Signs of shock (casualty could be bleeding internally) Casualty cannot stand or walk Urge to urinate Casualty cannot urinate or there is blood in the urine Sharp pain in the groin and small of the back Increased pain when moving Immobilizing a fractured pelvis Give first aid as you would for a spinal injury. Steady and support the casualty in the position found while waiting for medical help. Stabilize the pelvic area with heavy padding such as blankets on either side. Chest injury Signs and symptoms include: Pain at injury site when casualty moves, coughs or breathes deeply Shallow breathing Casualty guards injury Deformity and discolouration May be a wound May cough up frothy blood May show signs of shock First aid for chest injury First aid for injured ribs or breastbone aims to reduce the chance of further injury, to minimize pain and to make breathing easier. A fracture is very painful and causes shallow breathing. Start Emergency Scene Management. Expose the injured area and look for a wound. If there is a wound, put a dressing on the wound and get medical help quickly. If injuries permit, place the casualty in a semi-sitting position, leaning slightly toward the injured side-this should help breathing. Hand support over the injured area may make breathing easier. Support the arm on the injured side in a St. John tubular sling to restrict movement. Give ongoing casualty care, monitor breathing often. Get medical help. Flail chest A flail chest occurs when several ribs in the same area are broken in more than one place. The flail segment moves opposite to the rest of the chest while breathing, which causes pain for the casualty. Signs and symptoms of a flail chest include: Paradoxical chest movement-this is the sign that will tell you whether there is a flail chest Breathing is very painful, and the casualty may support the injured area Bruising at the injury site First aid for a flail chest Steady and support the head and neck. Perform a primary survey. If the casualty complains of difficulty breathing and pain in the chest, expose and examine the injury. Support the injured area with your hand-this may make breathing easier. Give first aid for ineffective breathing if needed. Secure the arm to the chest wall with a broad bandage to prevent movement of the arm. Give ongoing casualty care until medical help takes over. Pneumothorax A serious complication of a chest injury that requires immediate medical help The pleural space is the space between the lungs and the chest wall that is filled by the lungs. The lungs expand into this space as the chest cavity changes volume because of the action of the diaphragm and rib cage. But if air gets into the space, the lung on that side won't expand into it, and it will collapse. A pneumothorax occurs when air gets into the pleural space. It is life-threatening because the lungs can collapse and cause the person severe breathing difficulties Splinting materials A splint is any material used to prevent fractured bones from moving unnecessarily. A good splint is: Rigid enough to support the injured limb Well-padded for support and comfort Long enough, which means: For a fracture between 2 joints, it extends beyond the joints above and below the fracture For an injured joint, it's long enough for the limb to be secured so the joint can't move Commercial splints There are many commercial splints available. You may have access to one of these if the incident happened at a workplace, sporting event, etc. It is important to be familiar with the splints before use. Always follow the manufacturer's directions. Improvised splints A splint can be improvised from any material, as long as it works to immobilize the injury. The casualty's own body can be used as a splint; one leg can be splinted to the other for example. This is called an "anatomical" splint. Other materials needed for splinting To put the splint on, you will need materials for padding and bandages. Padding does two things: It fills in the natural hollows between the body and the splint, ensuring the injured limb is properly supported It makes the splint more comfortable Always pad between a splint and the injured limb, and between two body parts to be bandaged together. When using bandages: Make sure they are wide enough to provide firm support without discomfort Pass them under the natural hollows of the body-go under the knee, the small of the back, the hollow behind the ankles Tie them tightly enough to prevent movement, but not so tight they cut off circulation. Check circulation every 15 minutes below any bandages you've tied First aid for specific bone & joint injuries Collarbone/shoulder blade fracture Signs and symptoms include: Pain at injury site Swelling and deformity Loss of function of the arm on the side of the injury Casualty holds and protects the arm if they can, and may tilt the head to the injured side Possible complications Circulation to the arm below the injury may be impaired or cut off First aid for a fractured collarbone or shoulder blade Check circulation below the injury. If circulation is impaired, get medical help quickly. Immobilize the arm in the position of most comfort. A St. John tubular sling may work. Secure the arm to the chest with a broad bandage to prevent movement of the arm. Pad under the elbow, if necessary, to keep the arm in the most comfortable position. Tie the bandage on the uninjured side-don't tie it so tightly that the arm is pulled out of position. Pad under the knots for comfort. Check circulation below the injury. If circulation is impaired, and it was not before, loosen the sling and bandage. Immobilizing a dislocated joint Immobilize the limb in the position of most comfort-usually the position found. To immobilize a dislocated shoulder, if the arm will bend: Use a St. John tubular sling to transfer the weight of the arm to the other side Use broad bandages to prevent movement Pad under the elbow for support If the arm will not bend: Support the weight of the arm with a bandage around the neck Bandage the arm to the body to prevent movement Pad under the elbow, if necessary, to keep the arm in the most comfortable position The casualty may want to hold the injured arm The success of the method you use depends on whether it stops the injured limb from moving-which causes pain and could cause further injury. Once the injury is immobilized, apply cold to help reduce pain and swelling providing the casualty can tolerate the added weight. Monitor circulation below the injury often-check the skin colour and temperature, use a nail bed test and check for a pulse. Compare the injured side with the uninjured side. If circulation becomes impaired after immobilizing the injury, loosen the bandages. If circulation remains impaired, get medical help quickly. Immobilizing the upper arm To immobilize an open fracture of the upper arm (humerus): Expose the injury site. Cover the wound with a sterile dressing and check circulation. Pad and bandage the dressings. Pad lengthwise on both sides of the fracture site. Padding should be bulky enough to protect any protruding bone ends. Hold the padding in place with tape then bandage dressings tightly enough to hold padding and dressings in place. An arm sling provides full support for the arm-broad bandages above and below fracture site prevent arm movement. Pad under the elbow as needed to hold the arm in the position of comfort. Immobilizing an injured elbow The elbow can be severely sprained, fractured or dislocated. Immobilize the injury in the position found, if possible, or in the position of greatest comfort. Expose the injury and look for any open wounds. Check circulation below the injury and compare it with the other side. If circulation is impaired, get medical help quickly. If the elbow is bent so the arm is in front of the chest, immobilize the arm in an arm sling. Leave the sling loose at the elbow. Pad under the elbow, if necessary, to keep the arm in the most comfortable position and use a broad bandage to limit movement. If the elbow will not bend, support the arm at the wrist and use broad bandages and padding to immobilize the arm. Check circulation below the injury and compare it with the other side-if it is impaired, and it wasn't before, adjust the sling and/or bandages. Immobilizing the forearm and wrist Examine the injury and decide the best position for splinting-this is usually in the position found. Have the casualty or a bystander steady and support the injured arm. Measure the splint against the uninjured arm to make sure it is the right size. Pad the splint for comfort and to support the fracture. Position the arm on the splint with as little movement as possible. Once the splint is in position, have the casualty or bystander support it while you secure the splint. Start above the injury and bandage the splint and the arm snugly, but not too tightly. Leave the fingertips visible so you can check circulation below the injury and bandages. Use an arm sling to support the arm and hand, and prevent movement of the elbow with the fingertips exposed so you can check circulation. Immobilizing an injured hand When you suspect bones in the hand are fractured: Examine the injured hand and decide the best position for splinting-this is usually in the position of function. Have the casualty or a bystander steady and support the injury. If there are open wounds, place non-stick sterile dressings between the fingers to prevent the fingers sticking together. Measure the splint against the uninjured hand and arm to make sure it is the right size. Position the arm on the splint with as little movement as possible. Using a cushion as a splint A cushion or pillow works well because it lets the hand rest in the position of function and it is padded but also firm. It fully supports the wrist and lower arm. Secure the pillow with 2 broad bandages, making sure there is no pressure on the hand. Leave fingertips visible to check for circulation. Using a board A board works well because it is rigid, but, you must use padding to keep the hand in the position of function. Secure the splint with a roller bandage. Leave fingertips visible to check for circulation. Immobilize the arm in an arm sling tied to keep the lower arm and hand supported. Position of function The position of function is the position the uninjured hand naturally takes-palm down and fingers slightly curled. This position is safer and more comfortable than trying to flatten the hand against a flat surface. Immobilizing an injured finger or thumb Immobilize a fractured or dislocated finger or thumb in the position found. Expose the injury. Check the circulation below the injury. Immobilize the finger or thumb in the position of most comfort, which is usually the position of function. Use a splint, or if a splint is not available, secure the injured finger or thumb to the uninjured finger beside it. Use padding to provide extra support. Put on a St. John tubular sling to keep the injury elevated. Be careful not to put pressure on the injury. Check circulation below the injury. Give ongoing casualty care and get medical help. Fractured upper leg (femur) Signs and symptoms Pain, perhaps severe The foot and leg may roll outward Deformity and shortening of the leg Possible complications There can be internal bleeding, causing severe shock Immobilizing an injured upper leg (femur) A common fracture of the upper leg is a break at the neck of the femur. This is often referred to as a broken hip, and most commonly happens to elderly people. In a younger, healthy person, great force is needed to fracture the upper leg-always assess for a head or spinal injury. Have a bystander steady and support the injured limb. Gather the splinting materials. Measure the splint(s) against the uninjured leg. Put bandages into position. Pad the splints and position them as shown. Tie the bandages from chest to ankle-from the stable end to the unstable end. Give ongoing casualty care. Get medical help. If you are using a long and a short splint, place bandages at the ankles, calves, knees, above and below the fracture, hips and chest. Push bandages under the natural hollows of the body and position as shown above Place splints just below the armpit and just below the groin Extend both splints below the foot Tie off all bandages on the splint Immobilizing an injured knee Have a bystander steady and support the injured leg. Expose and assess the injury. If the leg is bent, keep it in the position of comfort. Depending on the injury, the casualty may be able to straighten the leg with your help. Don't try to straighten the leg if the pain increases or the leg does not move easily. If the leg won't straighten easily or without increased pain, splint in the position found. If the leg is straight Expose and assess the injury Carefully lift the injured leg and position a padded splintt Adjust the pads to fit the natural hollows of the leg Position 2 broad bandages and secure the splint to the leg-use a figure-8 at the ankle If the leg is bent Expose and assess the injury Position five broad bandages under the leg-two above the knee and three below Position padded splints on the inside and outside of the leg Secure the splint with the bandages, keeping the leg in the bent position Immobilizing an open fracture of the lower leg (tibia and/or fibula) When there is an open fracture, give first aid for the wound first and then immobilize the fracture. For the wound, apply a sterile dressing to prevent further contamination. To stop bleeding from the wound, apply pressure around the fracture, but not on it. Apply a dressing with padding on both sides of the fracture site. Secure this with a broad bandage tied tightly enough to put pressure on the padding. Always check circulation before and after dressing a wound of this type. A fractured lower leg is a common sports injury and open fractures are common. Immobilize a closed fracture the same way but without the dressings and bandages over the wound. A fracture is "open" when the skin is broken-the bone may stick out Expose the injury. Clothing is removed by cutting to minimize movement of the injured leg. Show a bystander how to steady and support the leg. Check the circulation below the injury. Give first aid for the open fracture wound. Leave the shoe on unless there is a wound to be examined. Cover the wound with a sterile dressing. The dressing should extend well beyond the edges of the wound. Put bulky padding lengthwise on both sides of the fracture, over the dressing, to protect the bone end and tape the padding in place. Tie a bandage over the padding and dressing tightly enough to put pressure on the padding, but not tight enough to cut off circulation-check circulation below the injury once the bandage is tied. Make sure there is no pressure on the bone ends. Immobilize the lower leg. Position the bandages and splints. Use splints long enough to extend from the groin to below the foot. The bystander doesn't let go of the leg until the first aider tells them to, which is after the last bandage is tied. Tie all knots on the splint for comfort. Position broad bandages to be tied at the thigh, knee, above and below the fracture and at the ankle. Tie the bandages starting at the thigh (the stable end) and working down. The bandage at the ankles is tied as a figure-8. Check the circulation below the injury; give ongoing casualty care. Get medical help. If you don't have splints... Use the uninjured leg as an anatomical splint by tying the legs together. Position padding between the legs (rolled-up blanket). Position and tie broad bandages at the thighs, knees, above the injury, below the injury and at the ankles. Tie a figure-8 at the ankles. Tie knots on padding for comfort Immobilizing an injured ankle The ankle should be immobilized whenever you suspect a sprain or a fracture. If the injury doesn't seem serious, or if the journey to medical help will be smooth, use a blanket splint or pillow splint to immobilize the ankle: Check circulation below the injury. Loosen footwear and immobilize the ankle with a pillow or rolled-up blanket and two broad bandages. Make sure the splint extends beyond the ankle. Secure the pillow with two broad bandages-use a figure8 at the ankle. Check circulation below the injury. Give ongoing casualty care and get medical help. Immobilizing an injured foot or toe Check circulation below the injury. Immobilize the ankle using a double figure-8: Untie shoe laces and tie the first figure-8 beginning at the sole of the foot and tying toward the leg. Tie the second figure-8 by wrapping the ends around the leg, crossing in front of the ankle and tying off on the sole of the foot. Tie off at the sole. Immobilize a fractured toe by taping it to the uninjured toe Beside it. Keep checking circulation, the injured area may swell. Strains When a muscle or tendon is moved beyond its normal range, this results in a strain, which is a stretch or tear injury. The signs and symptoms of a strain often show up many hours after the injury. Sudden sharp pain in the strained muscle Swelling of the muscles causing severe cramps Bruising and muscle stiffness Casualty may not be able to use the affected body part (loss of function) First aid for strains Perform a scene survey and a primary survey. Have the casualty stop the activity that caused the injury. Place the casualty in a position of comfort and assess the injury. If there is loss of function, immobilize the injury as for a fracture. Manage with RICE Rest Immobilization Cold Elevation Give ongoing casualty care. Get medical help. Position the casualty on the back with knees raised, or any preferable comfortable position at rest.