For the non-medically trained individual, assessing an orthopedic injury can be very stressful. There are some very simple steps anyone can use to determine if an injury in emergent or non-emergent. One acronym to use is CSM. This is a helpful way to remember what to check. Circulation: Check the circulation of the injured limb below the injury by feeling for a pulse or checking skin color. No or decreased pulse as well as very white or blue is an indication that there is decreased circulation and should be referred immediately. Sensation: Can the person feel you touching their limb below or at the injury site? Is there numbness or tingling? If they have numbness, tingling, or no feeling the injury should be considered emergent and referred immediately. Movement: Can the person move the extremity? Can they put weight on the extremity? Is there movement where there shouldn’t be, for instance in the shin bone area? If they cannot move it, put any weight on it or there is unnatural movement, the injury should be considered emergent and referred.
Here is an example: Billy crashed on his bike and injured his forearm. Ask Billy if he can move his fingers, wrist, and elbow. He can but with a great deal of pain. Next, check his fingernails. You squeeze them until they go white. As you let go, they quickly become reddish-pink again. This means he has good circulation. He can also feel you squeezing his fingernails indicating sensation. However, as you check sensation into the forearm, you notice some movement or crepitus in the bone which is also extremely painful. These factors would indicate that the injury is emergent and should be checked for fracture. CSM: Circulation, Sensation, Movement. These factors can help anyone determine if an orthopedic injury is emergent or non-emergent.
Meghan McKay, MEd, LAT, ATC