Presentation on theme: "“Don’t Miss” Musculoskeletal Injuries"— Presentation transcript:
1“Don’t Miss” Musculoskeletal Injuries Chris G. Pappas, LTC, USA, MCLecture adapted and revised from:LTC Fred H. Brennan, Jr., DO, FAOASM, FAAFP
2GoalsBecome familiar with three “don’t miss” upper extremity musculoskeletal injuries.Become familiar with three “don’t miss” lower extremity musculoskeletal injuries.Utilize this knowledge in the evaluation and treatment of patients.
3Case #121 year old female volleyball player dove for a low ball and fell on outstretched right handImmediate wrist pain and pain with attempts at dorsi and palmar flexionNo gross deformityWhat is the possible diagnosis based on this mechanism of injury?
7Scapho-Lunate Dissociation Disruption of scapho-lunate ligamentFOOSH injuryTender over scapho-lunate interval+ Watson’s clunkLimited dorsiflexion> 3 mm diastasisScapholunate angle > 60 degrees
8Watson’s Test of the Wrist (scaphoid shift test)Press the scaphoid tuberosity on the palmar aspect while moving the wrist from ulnar to radial deviation.A painful "click" or "pop" identifies scaphoid instability or scapholunate separation.Scaphoid tuberclePainful click or clunk
9Treatment PRICE-M Thumb spica splint Avoid wrist pronation-supination Pain controlRefer to ortho hand within 72 hours
10Complications if Missed Chronic wrist painLoss of function and motionOsteoarthritis
13Scaphoid Blood supply arises distally Fractures of middle and proximal portion prone to nonunionGet a scaphoid view if suspectedIf initial film negative, but still suspected treat as a fracture and follow up with plain films or more advanced imagingMay be casted for up to 3 months
14Case #238 year old male got his right ring finger caught in a player’s shirt while playing touch footballFelt pop in his finger and developed painNow in your clinic 4 hours laterWhat are the possibilities?
15Case #2 Jammed finger Fracture DIP or PIP dislocation Mallet finger Jersey finger
16Exam --Finger held in forced extension --Tender along volar aspect of DIP--Unable to flex DIP
25Acute Compartment Syndrome Serious limb and life threatening conditionFractures, burns, crush injuries, arterial injuriesHand, forearm, arm, shoulder, back, thigh and foot
26Acute Compartment Syndrome Increased pressure within closed compartmentsCompartments of lower legBe careful with splinting and casting
27Diagnosis High index of suspicion: pain out of proportion Six P’s Pain, Pulseless, Paresthesia, Poikilothermy, Pallor, ParalysisLoss of normal sensation is a red flagTight compartmentsPressure> 30 mm Hg
29Complications if Missed RhabdomyolysisAcidosisIschemic contracturesHyperkalemiaDIC and sepsisLoss of limbDeath
30Case #426 year old sergeant playing basketball and “jammed” his left middle fingerPain and swelling of middle finger PIP joint (global)Pain with resisted flexion and extensionWhat are the possibilities?
31Case #4 Fractured phalanx Extensor tendon rupture Volar plate injury Tear of central band of extensor tendonMallet fingerPIP dislocation
32Exam Swollen PIP middle finger Tender over PIP, more so dorsally Pain with resisted extension over the PIPNo neuro compromiseFlexor tendons strength is 5/5Collaterals of PIP intactDIP intact to flexion/extension
52Femoral neck stress fracture Groin pain in runner or jumper- don’t ignoreFemale triad at increased risk as well as those with an increase in training and postmenopausal womenNeed to know which side the stress fracture is on (compression vs tension side)Plain films often negativeGet MRI
53Treatment If stress fracture by x-ray or further imaging Compression side12 weeks to heal +/- NWBTension sideOrtho consult/surgeryFemoral neck fracture-surgeryCross trainProper nutrition and calories
54Complications if Missed Stress to complete fractureAvascular necrosisChronic painEnd of career
55Take Home Points Fall on outstretched hand, think: Distal forearm fx. Scaphoid fxTFCCAP, Lat, Scaphoid and clenched fist viewsScapho-lunate dissociation
56Take Home PointsGrab injury with pain at distal phalynx, think jersey fingerCrush injury or worsening pain with immobilization, think ACS“Jammed” PIP…always test extension with resistance
57Take Home PointsMid-foot pain and inability to weight bear after foot axial load or twist, think Lisfranc injuryPersistent groin pain, especially in runner or jumper, rule out stress fracture of hip or pelvis