The skeleton is the framework around which the body is constructed and on which all the tissues of the body depends for support. So that we can move, the skeleton is jointed at several places. Muscles attached to the bone work to make them move.

Skeleton
Joints
Muscles
Fractures
Dislocations
Soft Tissue Injuries
Arthritis
Back Ache
Bunions and Gout

Skeleton

What follows is a list of the major bones of the body that comprise the skeleton

• Head:
  The head is made of a number of fused plates in the adult, unfused in the newborn, making up the skull. The jawbone is also known as the mandible.

• Upper limb:
  The shoulder girdle is comprised of the collarbone (clavicle) and shoulder blade (scapula), attached at the shoulder joint to the upper arm bone (humerus). The clavicle holds the upper limb away from the chest. The bones of the lower arm are termed the ulna and radius. The hand bones are sometimes referred to as carpals.

• Ribcage:
  The ribcage is constructed of 12 curved ribs attached to the spine at the back, 10 of which are attached to the sternum (breastbone) by cartilage.

• Spine:
  A column of small bones, called vertebrae, form the backbone, or spine. The top 7 are called cervical vertebrae, the next 12 thoracic, then 5 lumbar vertebrae, followed by the sacrum and coccyx.

• Pelvis:
  This basin-shaped structure is attached to the lower spine.

• Lower limbs:
  The thighbone (femur) joins the pelvis at the hip joint. The leg is jointed at the knee, which is protected at the front by the kneecap (patella), and at the ankle. The shinbone (tibia) and fibula to the foot (tarsal) join them.
  

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Joints

Wherever one bone meets another, there is a joint. There are two main joints--movable and immovable. Movable joints allow movement between adjacent bones and are of three types:

• Gliding joints:
  These are shaped to allow only slight gliding or rocking movements. Examples are the joints between the vertebrae, hands and feet.

• Ball and socket joints:
  The round head of one bone fits into the cup-shaped cavity of another. The swiveling action allows movement in all directions. Examples are the shoulder and hip.

• Hinge joints:
  The surfaces of the bone ends are contoured together to allow bending (flexion) and straightening (extension) in only one plane. Examples are the elbow and knee.

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Muscles

Muscles cause various parts of the body to move by their relaxation and contraction. There are two types:

• Voluntary muscles:
  The muscles are controlled at will and are attached to the bones by bands of strong, fibrous tissue (tendons). They operate in-groups, so that as one contracts, the other relaxes.

• Involuntary muscles:
  These operate internal organs and work continuously. For example, the intercostal muscles between the ribs that control breathing, and the cardiac muscles that control the beating of the heart.

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Fractures

A fracture is a break or crack in the bone. Generally, considerable force is required to break a bone, but old or diseased bones become fragile. Conversely, young bones, that are still growing, are supple and may split, bend, or crack, rather than break. Any type of fracture may be associated with an open wound and complicated by damage to other structures. There are three main types:

• Simple Fracture:
  This is simply a clean break or crack in the bone.

• Comminuted Fracture:
  This term is applied to a fracture with multiple bone fragments.

• Greenstick Fracture:
  A split in a young immature bone, common in children.

Fractures can also be classified as open or closed. Open fractures, sometimes called compound fractures, are where the overlying skin is broken and the bone may be exposed to contamination from the skin surface and from the air. When the skin around a fracture is intact, the injury is known as a closed fracture. There will often be bruising and swelling. It should also be noted that a bone might break distant to the point of impact.

Treatment:
In some cases, broken bones will be obvious; the limb may be bent at an impossible angle, or the bone may have torn through the skin. In other cases, the injury may appear to be a severe sprain. A broken bone may usually be differentiated from a severe sprain by limitations in mobility, or in the case of hand or wrist injuries, the inability to grip effectively with the affected hand. If the skin has not been broken, the limb should be straightened and returned to its normal configuration, splinted securely, elevating the limb as much as is comfortable and possible. In some cases, such as broken ribs, this is obviously not possible. However, an attempt should be made to prevent motion of the bone as much as possible. Treat as for internal bleeding.

If the skin has been broken, the wound should be treated carefully. First control the bleeding. Once you have that stopped, immobilize the bone as much as possible, elevate it and cleanse the wound with redwort, as the risk of infection is great. Numb the wound thoroughly and then make your assessment. It may be that you can manipulate the bone, stitch the wound and splint it.

Some fractures may require amputation, with some resulting in paralysis, and others in death. It should be noted that fractures to the femur are serious and may result in substantial bleeding and therefore present risk to life.

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Dislocations

Displacement of a bone at a joint can be caused by a strong force wrenching the bone into an abnormal position, or by violent muscle contractions. There may also be associated tearing of the ligaments. Those joints most often affected include the shoulder, thumb, finger and jaw. It can be difficult to distinguish a dislocation from a fracture.

Dislocations are usually differentiated from fractures by a severe and 'sickening' pain rather than just tenderness over the bone. As the treatment can be considerably painful you should first administer Fellis. Then maneuver the joint back into its socket, treat for soft tissue swelling and immobilize it.

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Soft Tissue Injuries

These are injuries that affect the ligaments and muscles. A sprain is an injury to a ligament at, or near, a joint, and is most frequently caused by a wrenching movement at the joint, which tears the surrounding tissues. Muscles and their tendons may also be over-stretched and torn by violent or sudden movement. Muscle damage can occur in one of three ways:

• Strain:
  A partial tearing of the muscle, often at the junction of the muscle and the tendons that joins it to a bone.

• Rupture:
  Complete tearing of the muscle, which may occur, in the fleshy part or in the tendon.

• Deep Bruising:
  This may be extensive where there is a large bulk of muscle.

• Treatment:
  Sprains, strains and deep bruising are very common, especially amongst dragonriders. They are all treatable by following the 'RICE' procedure:

  • R Rest the injured part
  • I Apply ice or a cold compress
  • C Compress the injury
  • E Elevate the injured part
    
    
    
  The affected area should be immobilized as much as possible. In some cases, a light wrapping with bandages will be enough to accomplish this; in others splinting may be required. Leg and ankle injuries may require the patient to get around with crutches for a few days. The patient should be cautioned to use care when resuming normal activities, as the injured area will be weak and may be more prone to re-injury for several sevendays. More serious injuries may cripple the patient unless some interventive surgery is performed. This is a very tricky procedure though and should only be considered when no alternatives remain.

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Arthritis

Joints may become affected by inflammatory or degenerative changes, which will cause pain and stiffness of the joints. This condition is generally known as arthritis. The age of onset differs in each individual, but generally there is swelling and deformity of the joint, with pain and limitation of movement. There is little treatment available, apart from diagnosing pain relief for the joint area, usually a topical application of numbweed. However, fish liver oil and yellow citrus oil have been showed to allay the symptoms if taken regularly.

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Back Ache

Pain in the back can be caused by muscular strains, 'slipped' disks or from a disease of the bones and joints. Most commonly it is caused by strain of the muscles surrounding the back. This condition should be treated with rest and gentle movements, where the patient should be advised to keep their back straight. An application of numbweed and massage of the area may also help.
'Slipped' disks should also be treated with bed rest. Rest should be proscribed for two sevendays, sometimes more. This often allows the protrusion to be reabsorbed back into the disk and the damaged capsule to heal. If symptoms do not improve with simple rest, you may apply traction using weights to pull the vertebrae apart and so promoting return of the disk to its normal position. Patients should be warned that there is a likelihood of recurrence, and that exercise and correct posture are necessary to prevent this.

Another common cause of backache is the minor displacement of the many small joints between the vertebrae. Manipulation of the spine can encourage the spine to return to its natural alignment, as can gentle massage.

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Bunions and Gout

Bunions are unsightly deformities of the joint at the base of the big toe. The site is likely to be tender, swollen, and pus may be present. Strapping, splinting and attention to wearing comfortable shoes/boots many improve matters by reducing pressure. However, other than relief there is no treatment.

Gout is a defect in the blood, which causes the accumulation of waste products. Symptoms are usually sudden, affecting a single joint. It can be extremely painful, so much so that the patient may not be able to bear the weight of a sheet over the area. There is usually heat, swelling, redness, excruciating pain and tenderness. After the first attack more can be expected within a Turn if no treatment if forthcoming. Patients benefit from the application of anti-inflammatory agents, such as chamomile. Basil has some benefits, as has the application of numbweed to reduce pain.

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