“Don’t Miss” Musculoskeletal Injuries - USAFP Home Page.pptVIP

“Don’t Miss” Musculoskeletal Injuries Fred H. Brennan, Jr., DO, FAOASM, FAAFP Medical Director, Seacoast Center for Athletes Head Team Physician, University of New Hampshire Goals Learn to identify three “don’t miss” upper extremity musculoskeletal injuries. Learn to identify three “don’t miss” lower extremity musculoskeletal injuries. Utilize this new knowledge and teach other health care providers. Case #1 21 year old female volleyball player dove for a low ball and fell on outstretched right hand Immediate wrist pain and pain with attempts at dorsi and palmar flexion No gross deformity What is the possible diagnosis based on this mechanism of injury? Case #1 Scaphoid fracture Distal radius or ulna fracture TFCC tear Distal R-U joint disruption Carpal ligamentous injury Do You Want An X-ray? Wrist X-rays Scapho-Lunate Dissociation Disruption of scapho-lunate ligament FOOSH injury Tender over scapho-lunate interval + Watson’s clunk Limited dorsiflexion 3 mm diastasis (“Madonna sign”) Watson’s Test of the Wrist Watsons test (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. Treatment Thumb spica splint PRICE-M Refer to ortho hand within 1 week for ORIF Avoid wrist pronation-supination Pain control Complications if Missed Chronic wrist pain Loss of function, motion, and strength Osteoarthritis Case #2 38 year old male got his right ring finger caught in a player’s shirt while playing touch football Felt pop in his finger and now has pain Now in your clinic 4 hours later What are the possibilities? Case #2 Fracture DIP or PIP dislocation Extensor tendon injury Flexor tendon injury Collateral ligament tear Exam Do You Want an X-ray? X-rays Jersey Finger Rupture of FDP tendon Inability to finger tip Splint in position Repair within 7 days Complications if Missed Retraction into palm of