“Don’t Miss” Musculoskeletal Injuries.pptVIP

“Don’t Miss” Musculoskeletal Injuries Chris G. Pappas, LTC, USA, MC Lecture adapted and revised from: LTC Fred H. Brennan, Jr., DO, FAOASM, FAAFP Goals Become 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. 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 Wrist sprain Scaphoid fracture Distal radius or ulna fracture Distal R-U joint disruption TFCC tear Carpal ligamentous injury Case #1 What next? Exam Inspection, Range of motion, Neurovascular status, Palpation Is an x-ray needed? Wrist Xrays Scapho-Lunate Dissociation Disruption of scapho-lunate ligament FOOSH injury Tender over scapho-lunate interval + Watson’s clunk Limited dorsiflexion 3 mm diastasis Scapholunate angle 60 degrees 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 PRICE-M Thumb spica splint Avoid wrist pronation-supination Pain control Refer to ortho hand within 72 hours Complications if Missed Chronic wrist pain Loss of function and motion Osteoarthritis Same patient Scaphoid fracture Scaphoid Blood supply arises distally Fractures of middle and proximal portion prone to nonunion Get a scaphoid view if suspected If initial film negative, but still suspected treat as a fracture and follow up with plain films or more advanced imaging May be casted for up to 3 months Case #2 38 year old male got his right ring finger caught in a player’s shirt while playing touch football Felt pop in