Musculoskeletal Injuries

Video 27 of 46
6 min 28 sec
English, Español
English, Español

The musculoskeletal system is actually the combination of two specific systems – the muscular system and the skeletal system, including each of your 206 bones. And let's not forget the ligaments, tendons, and joints that hold it all together.

Breaks, strains, sprains, and soft tissue injuries are some of the most common types of injuries that you'll likely encounter, in everyone from the elderly to youth sports participants.

How to Assess and Handle a Musculoskeletal Injury

As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim.

Are you OK? Can you hear me?

If the patient is conscious and responsive, ask yourself if there are other medical emergencies that would warrant calling 911 and activating EMS? If not, continue with your assessment.

Introduce yourself to the victim: "Hi, my name's _____. I'm a paramedic. I'm going to ask you some questions."

"Do you remember what just happened?"

"How much pain or discomfort are you in?"

So long as the patient is conscious, alert, and breathing normally, activating EMS can likely wait while you investigate further, as calling 911 is often not required with these types of injuries.

Pro Tip #1: The real question that needs answering is this: Does this injury require activating EMS, a visit to the ER, or is it something the patient can shake off?

So, how do we answer that question?

With musculoskeletal injuries, the patient will often times be self-splintering – instinctively holding the area in pain – when you find them. That injury will be obvious, so make sure you also look for those that aren't.

"Do you hurt anywhere else?"

Also begin to further assess the injured area. If clothing is in the way, cut around that area to expose the injury. Look for bruising, swelling, some kind of deformity or abnormal angulation, bone fragments, bleeding, etc.

Do you see any signs of a serious injury? Or a developing condition?

How is the victim's skin color? Are the nail beds bluish or pink and normal? Poor circulation can be serious and warrants an immediate 911 call.

Ask the patient how he or she feels. People, especially adults, have a sense of whether or not an injury is serious. With children, you may have to read between the lines a bit and pay more attention to body language and whether they're becoming more concerned about the injury or less concerned.

If the two of you are coming to the same conclusion – that maybe the injury isn't that bad, help them walk it off, so to speak. Assist them in whatever way they need – getting to their feet or by helping to support their body weight.

If it's not bad, as you suspected, they'll be fine. However, if the inverse is obvious, that the patient is in pain and the injury is now causing more discomfort, help them back into a comfortable position, call 911, and help protect and stabilize the injured area as best as you can until help arrives.

Pro Tip #2: If you can safely stabilize an injury, do so. But make sure stabilization won't cause secondary problems, increase the patient's discomfort, or aggravate the injury.

Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.

Remember, if you begin seeing signs of shock, cover the patient with a blanket or coat and try to keep them as warm as possible. Any signs of shock demand an immediate 911 call.

A Word About the Musculoskeletal System

Injuries to muscles, bones, and joints can be difficult to detect. Knowing the specific mechanisms of the injury will provide important clues about which body parts are likely injured.

There are three basic mechanisms of injury:

  • Direct force – when the injury is located at the point of impact
  • Indirect force – when the injury is located some distance from the point of impact
  • Twisting force – when the injury is caused by a rotating force

There are four basic types of musculoskeletal injuries to keep in mind when assessing patients, each of which is caused by one of the mechanisms above.


Fractures are bones that are broken or damaged – chipped, cracked, etc. Fractures can either be closed, meaning the skin over the injury is intact. Or they can be open, in that the injury is exposed, making it much more serious.

Open fractures are more prone to infection. And they can include excessive bleeding that may be difficult to control.


Dislocations are the displacement of a bone. When a severe force causes a bone to move one joint away from its normal position, this is known as a dislocation.

Dislocations also typically result in ligaments and tendons that have been stretched, torn, or displaced. Shoulders and fingers dislocate more easily than other areas of the body.


Sprains occur when ligaments are torn or stretched. The greater the number of ligaments involved, the more severe the sprain.


Strains are similar to sprains but involve muscles and tendons instead of ligaments. And as tendons are stronger than muscles, making them more resistant to injury, when dealing with strains, they're more likely to involve a muscle than a tendon.