Primary management

The initial treatment of a musculoskeletal injury should follow completion of the primary survey. The limbs should be inspected for signs of injury and the neurovascular status assessed (sensation, movement, colour and perfusion).

If there is any limb deformity, this should be corrected if possible after adequate analgesia, to restore anatomy and possibly circulation. The limb should then be immobilised in an appropriate splint. Neurovascular status should be reassessed and documented following reduction. This has historically often been neglected in the pre-hospital setting (Dean 2009).

Following any intervention, the patient should be reassessed, and any deterioration corrected if possible. The patient should then be extricated from the pitch safely (with cervical spine immobilisation, if indicated). The limb can then be further managed in a hospital setting.

Analgesia

Adequate analgesia is often forgotten (but not by the patient!) or left too late, but should be given as soon as it is safe to do so (after the primary survey and any life-threatening conditions managed). Unless there is a contraindication (head injury, altered level of consciousness or a chest injury), Entonox® (inhaled Oxygen: Nitrous Oxide) is quick and effective (but is not licensed or available in some parts of Europe).

More recently methoxyflurane (Penthrox®), an inhaled analgesic has become more widely available internationally and used increasingly in sports medicine. It has the advantage of being appropriate for use more widely in trauma including chest trauma with possible pneumothorax (unlike Entonox).

Traditionally, morphine has been the analgesic of choice for moderate to severe pain. However, with the restrictions now placed on the storage and use of morphine, either intravenous tramadol or paracetamol are alternatives. Another option is ketamine but this is also managed as a controlled drug and is not available in all countries.

Intravenous analgesia can only be administered by appropriately trained and certified registered healthcare professionals .

It is important that a player with a significant musculoskeletal injury is transported correctly and safely to an appropriate Emergency Department. All documentation, including SAMPLE history should accompany the player to hospital.