**3. Addressing musculoskeletal injuries**

It is valuable to have as much insight as possible about the incident, even the site of the incident, as any information may aid in weighing the level of trauma, things like the patient position, causative mechanism of injury (penetrating, blunt, crushing…), bleeding at the scene, exposed bone or fracture ends, open wounds, any deformity or dislocation, motor and/or sensory deficits, delays in transportation, limb function, perfusion, and neurological changes. 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:


and proximal ends, and the tendon binds to the periosteum of individual bones at the muscle's origin and insertion. As muscles contract, tendons transmit the forces to the relatively rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing

A ligament is a small band of dense, white, fibrous elastic connective tissue [2] that connects both ends of bones together in order to form a joint and they transfer force from one bone to the other allowing movement [6]. Most ligaments limit dislocation or prevent certain movements that can cause injury or tears. Since they are elastic tissue, they increasingly lengthen when under pressure; when the force exceeds the limit of elasticity, the ligament can handle; it becomes susceptible to damage which can result in severe injuries and tears or in an unstable joint movement. 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

A bursa is a small synovial fluid-filled sac contained within white fibrous connective tissue which is lined internally with synovial membrane. It provides a cushion between bones and tendons and/or muscles around a joint. The fluid-filled sac can be found in multiple regions

them to function as springs during locomotion, thereby saving energy.

**2.5. Ligaments**

**Figure 3.** Anatomy of synovial joint.

172 Essentials of Accident and Emergency Medicine

extent [7].

**2.6. Bursa**

in the body mostly around joints [2].

This should cover the basic general approach of these injuries.
