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ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES

ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES. HENRY T. GOITZ, MD Academic Chief – Sports Medicine Institute Director – Education, Research, Injury Prevention Center Co-Director – Orthopaedic Sports Medicine Fellowship DETROIT MEDICAL CENTER DETROIT, MICHIGAN.

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ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES

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  1. ACUTE MANAGEMENT OF TRAUMATIC SPORTS INJURIES HENRY T. GOITZ, MD Academic Chief – Sports Medicine Institute Director – Education, Research, Injury Prevention Center Co-Director – Orthopaedic Sports Medicine Fellowship DETROIT MEDICAL CENTER DETROIT, MICHIGAN

  2. EXTREMITY “DON’T MISS” LESIONS* TENDON (Rupture/ Tears) LIGAMENT (Joint Dislocations) BONE *MISSED EXTREMITY INJURIES THAT WILL GET YOU SUED…..

  3. TENDON RUPTURE Quadriceps/ Patella Acute Rotator Cuff Distal Biceps Achilles

  4. QUADRICEPS/PATELLAR TENDON RUPTURE HISTORY: Forceful Thigh Contraction/Push Off EXAM: Palpable Defect/ Extension Lag X-RAY: Patella Alta/Baja Management: Brace, Surgery (2 weeks)

  5. ACUTE ROTATOR CUFF RUPTURE History: Fall, Age >40 Exam: “Drop Arm” Sign (Can’t Abduct Arm), Weak External Rotation (Massive) X-ray: Negative MRI, U/S: Positive Management: Sling, Surgery (2 weeks)

  6. DISTAL BICEPS TENDON RUPTURE HISTORY: Lift Object, Painful Pop EXAM: Ecchymosis, +/- Popeye Muscle X-RAY: Negative MRI, U/S: Positive Management: Sling, Surgery (2 weeks)

  7. ACHILLES TENDON RUPTURE HISTORY: Push Off, Tear, Kicked EXAM: Palpable Defect, Thompson Sign NO Plantar Flexion* X-RAY: Negative Management: Splint, Surgery (2 weeks)

  8. “DON’T MISS” JOINT DISLOCATIONS’ASSOCIATED CONDITIONS Deformity Obvious +/- Fracture Neuro Vascular Involvement

  9. LIGAMENT INJURY—JOINT DISLOCATIONS SHOULDER KNEE ELBOW HIP

  10. ANTERIOR SHOULDER DISLOCATION HISTORY: Fall, Arm Abducted, Externally Rotated, Painful EXAM: “Squared Off” Shoulder X-RAY: AP/ Axillary KEY TREATMENT: ED Reduction

  11. POSTERIOR SHOULDER DISLOCATION HISTORY: Seizure, Electrical Burns EXAM: Can’t Externally Rotate X-RAY: AP, AxillaryKEY TREATMENT: ED Reduction

  12. KNEE DISLOCATION History: High Velocity/ Load Exam: Gross Deformity; Popliteal Artery Injury Peroneal Nerve Injury X-ray: Gross Deformity, MRI: 3 of 4 Ligament Tear Management: Reduce, Evaluate Vascular Status, Evaluate Neuro, Splint

  13. ELBOW DISLOCATION History: Fall Exam: Gross Deformity X-ray: Gross Deformity, RadioCapitellar Line Management: Reduce, Check Stability via ROM, Splint vs. Sling vs. Brace

  14. HIP DISLOCATION History: MVA Knee-Dash (Subluxation* in Sport) Exam: Limb Shortened, Externally Rotated X-ray: Dislocation* Management: Reduce, Crutch * AVN risk

  15. AC (AcromioClavicular) Separation History: Fall Exam: Range—Pain to Prominence Xray: Range—Normal to Prominance Management: Sling

  16. PATELLA DISLOCATION History: Twist Knee Exam: Lateral, Painful Prominance X-ray: Dislocation Management: Extend Knee, Reduce Patella

  17. …..this does NOT feel good……

  18. PATTERNS OF REFERRED PAIN SHOULDER—NECK 1. Pain: Deltoid vs. Radicular KNEE—HIP 1. Pain: Focal Knee vs. Groin

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