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…..

TENDON RUPTURE

• Quadriceps/ Patella

• Acute Rotator Cuff

• Distal Biceps

• Achilles

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

LIGAMENT INJURY—JOINT DISLOCATIONS

• SHOULDER

• KNEE

• ELBOW

• HIP

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

…..this does NOT feel good……

PATTERNS OF REFERRED PAIN

• SHOULDER—NECK

1. Pain: Deltoid vs. Radicular

• KNEE—HIP

1. Pain: Focal Knee vs. Groin