Dem Bones – Musculoskeletal Injuries & How to Treat Them
What’s a musculoskeletal injury? These are injuries to our muscles and bones. They have names like sprains, strains, and fractures and happen from things like slips, trips, falls, and whacks. This video (at the bottom) and blog post go through what musculoskeletal injuries are, how to treat them, basic information on splinting, and where to go for hands on training. On the water, we can think of musculoskeletal injuries as two different kinds: stable and unstable.
Treating Stable Injuries
In a stable injury, though something is injured, we are able to safely use it without causing pain or further damage. For instance a twisted ankle that you can still walk on or a strained wrist you can still use to grind a winch. Stable injuries tend to swell more slowly, we can bear weight on them and the CMTSs are intact (normal). CMTS stands for Color, Motion, Temperature and Sensation. It’s a quick and easy way to check how an injured part is doing. For instance, in an injured wrist or arm, we check the fingers to make sure they are pink, able to move normally, warm and we’re able to feel them being touched. Abnormal CMTSs might look like fingers that are pale or dusky, have a decreased ability to move, are cool, and numb or tingly. For an injured leg, we would check the CMTSs of the toes. Capillary refill is also a useful tool for assessing an injured part. This is done by pushing on the nail beds of either the fingers or toes. Nail beds are normally pink, turn white when we push on them, and when we let go, they should turn back to pink in less than 3 seconds. If the capillary refill time is slower than 3 seconds, it could be a sign that the injury is worsening or that a splint is too tight and should be loosened. If the CMTSs or capillary refill are abnormal, the injury needs medical care when possible.
The treatment for stable injuries is aimed at reducing swelling and controlling pain. The acronym to remember how to treat stable injuries is RICE. This stands for Rest, Ice, Compression and Elevation. Rest the injured part. Only participate in activities that don’t hurt. If it hurts, don’t do it! Apply ice to the area 4-6 times each day for 20 minutes each time. The best ice pack is ice cubes in a zipper bag, wrapped in a cloth or paper towel. Frozen peas or corn will work in a pinch. Consider applying a compression bandage (a fancy name for an Ace™️ wrap) to make the injury feel more comfortable. A sling or splint may be helpful, depending on what part is injured. Make sure to check the CMTSs before and after applying a compression bandage, sling or splint. Elevate the injured part up above the level of the heart as often as possible to reduce swelling and pain. Acetaminophen (Tylenol®️) and/or ibuprofen can be used to reduce pain and swelling.
Unstable Musculoskeletal Injuries
Unstable injuries are more serious injuries. These are injuries that we’re unable to safely use or bear weight on without causing further damage. Unstable injuries tend to swell more rapidly, have impaired CMTSs, compromised circulation or obvious deformity. The treatment of unstable musculoskeletal injuries is similar to stable injuries with the goal of controlling pain and reducing swelling, however we also need to protect them from further injury. These injuries require medical care. While we wait for help to arrive or while we transport the injured sailor to medical care there are things we can do. We still rest the injured area, apply ice, elevate to reduce swelling, and give pain medications as directed, as we did for stable injuries, but now splinting the injured area is a priority.
In the stable injury we used splints for comfort. In an unstable injury we must splint to preserve circulation and prevent further damage. Splints aboard differ from shore splints in one critical way. On a boat, we never apply a splint that our patient can’t get out of himself in the event he needs to swim or get into a lifeboat. To create a good splint, think small and simple. Make sure the splint is long enough and padded. Splint the injury in a position for comfort. The only reason to ever manipulate an injury is to restore circulation and it is a very slow and gentle process. Never, ever yell “LOOK AN EAGLE!”, and yank. The gentle manipulation of expensive parts is what sailors do best, so if this skill interests you please consider further training such as a Wilderness First Responder class.
A triangle sling is a great way to immobilize any injury from the collar bone down to the wrist. An Ace™️ wrap can be added to hold the arm securely against the body. When using a sling, make sure the hand is inside the sling so that the wrist is supported. Nerve damage can occur if the hand is left flapping in the breeze outside of the sling. Buddy taping works wonderfully for injuries to fingers and toes. This is simply taping a finger or toe to the one next door with a little padding in between. The digit next door acts as the splint to immobilize the injured part. SAM splints are an awesome addition to the well stocked medical kit. They are a foam covered aluminum roll that can be cut to size and molded to fit almost anywhere, then secured in place with an Ace™️ wrap.
Check the CMTSs (as above) before and after splinting. Recheck them often looking for changes. Changes may indicate that the splint is too tight or that the musculoskeletal injury is worsening and needs medical care more quickly.
Please Invest in Some Training!
Please learn some basic first aid, or even better Wilderness First Aid. On the water, we can be a long distance from medical care, a long time from help arriving to us, and we have limited supplies, bodies and technology. This is remote medicine. With some education, practice and a well stocked medical kit, you’ve got this!
Interested in some training for yourself and your team? I offer onboard medical trainings customized to your boat’s and team’s needs. Through a combination of classroom and onboard/hands on activities, we review common scenarios, practice classroom learning, and even pull out your onboard first aid kit and go through what everything is and how to use it in an emergency. Whether you’re gearing up for racing season, preparing for an offshore trip, or setting out to sail the world, a personalized, one-on-one medical training with your gear and your crew will make you that much more prepared.
Remember, I’ve got your back.