henry t. goitz, md academic chief – sports medicine institute director – education, research,...
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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
EXTREMITY “DON’T MISS” LESIONS*
• TENDON (Rupture/ Tears)
• LIGAMENT (Joint Dislocations)
• BONE
*MISSED EXTREMITY INJURIES THAT WILL GET YOU SUED…..
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)
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)
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)
ACHILLES TENDON RUPTURE
• HISTORY: Push Off, Tear, Kicked
• EXAM: Palpable Defect, Thompson Sign NO Plantar Flexion*
• X-RAY: Negative
• Management: Splint, Surgery (2 weeks)
“DON’T MISS” JOINT DISLOCATIONS’ ASSOCIATED CONDITIONS
• Deformity Obvious
• +/- Fracture
• Neuro Vascular Involvement
ANTERIOR SHOULDER DISLOCATION
• HISTORY: Fall, Arm Abducted, Externally Rotated, Painful
• EXAM: “Squared Off” Shoulder
• X-RAY: AP/ Axillary KEY
• TREATMENT: ED Reduction
POSTERIOR SHOULDER DISLOCATION
• HISTORY: Seizure, Electrical Burns
• EXAM: Can’t Externally Rotate
• X-RAY: AP, Axillary KEY
• TREATMENT: ED Reduction
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
ELBOW DISLOCATION
• History: Fall
• Exam: Gross Deformity
• X-ray: Gross Deformity, RadioCapitellar Line
• Management: Reduce, Check Stability via ROM, Splint vs. Sling vs. Brace
HIP DISLOCATION
• History: MVA Knee-Dash (Subluxation* in Sport)
• Exam: Limb Shortened, Externally Rotated
• X-ray: Dislocation*
• Management: Reduce, Crutch
* AVN risk
AC (AcromioClavicular) Separation
• History: Fall
• Exam: Range—Pain to Prominence
• Xray: Range—Normal to Prominance
• Management: Sling
PATELLA DISLOCATION
• History: Twist Knee
• Exam: Lateral, Painful Prominance
• X-ray: Dislocation
• Management: Extend Knee, Reduce Patella
PATTERNS OF REFERRED PAIN
• SHOULDER—NECK
1. Pain: Deltoid vs. Radicular
• KNEE—HIP
1. Pain: Focal Knee vs. Groin
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