Author: Ryan Circh, MD
- Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb
- Can results from traumatic deviating the thumb radially (abduction)
- Poor rabbits
- Have a low threshold for referral to hand surgery for follow up – treatment for minor injuries can be conservative but more severe require surgery to preserve function
- This injury should be placed in a thumb spica splint
- Radiographs are often negative unless an avulsion fracture is present
Editor’s note: to test for UCL injuries, I like this.
Schroeder NS, Goldfarb CA. Thumb ulnar collateral and radial collateral ligament injuries. Clin Sports Med. 2015 Jan;34(1):117-26. doi: 10.1016/j.csm.2014.09.004. Epub 2014 Oct 11. Review. PubMed PMID: 25455399.
Madan SS, Pai DR, Kaur A, Dixit R. Injury to ulnar collateral ligament of thumb. Orthop Surg. 2014 Feb;6(1):1-7. doi: 10.1111/os.12084. Review. PubMed PMID: 24590986.
Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
Author: Mark Hinton, MD
- Meniscus lock can occur with a tear leading to inability to extend the knee
- Treatment can include an intra-articular joint block followed by straightening
- Medial meniscus injuries are more common
Allum RL, Jones JR. The locked knee. Injury. 1986 Jul;17(4):256-8. PubMed PMID: 3770920.
Critchley IJ, Bracey DJ. The acutely locked knee–is a manipulation worth while? Injury. 1985 Jan;16(4):281-3. PubMed PMID: 3967919.
Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
Check out this episode!
Author: Ryan Circh, MD
- A “shoulder separation” is when the clavicle separates from the scapula – also referred to as an acromio-clavicular (AC) separation
- Diagnosis is clinical: pain over AC joint, pain with adduction, and difficulty raising harm past horizontal
- Early range of motion can be critical for recovery
Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998 Jan-Feb;26(1):137-44. Review. PubMed PMID: 9474415.
Monica J, Vredenburgh Z, Korsh J, Gatt C. Acute Shoulder Injuries in Adults. Am Fam Physician. 2016 Jul 15;94(2):119-27. Review. PubMed PMID: 27419328.
Author: Sue Chilton, MD
- An unusual cause of leg pain that can mimic sciatica/claudication
- Predominantly occurring in high endurance athletes, particularly cyclists and runners
- Check supine ABIs 1 minute after activity in the ED: a value < 0.5 is 80% sensitive
Mansour A, Murney S, Jordan K, Laperna L. Endofibrosis: an unusual cause of leg pain in an athlete. J Sports Med Phys Fitness. 2016 Jan-Feb;56(1-2):157-61. Epub 2015 Jul 3. PubMed PMID: 26140352.
Peach G, Schep G, Palfreeman R, Beard JD, Thompson MM, Hinchliffe RJ. Endofibrosis and kinking of the iliac arteries in athletes: a systematic review. Eur J Vasc Endovasc Surg. 2012;43(2):208–17.
Author: Sam Killian, M.D.
- Spinal cord injury without radiographic abnormality (SCIWORA) is a diagnosis defined as traumatic injury to spine with clinical sx of traumatic myelopathy (paraplegia, paresthesias, FND) without radiographic abnormalities.
- Term was established in 1970’s before MRI and accounted for about 15% of injuries at the time (mainly children). Today SCIWORA accounts for about 10% of spinal injuries.
- Belief is that injury causes subtle movement of the spinal cord from its natural position with resultant contusion or ischemia with subsequent deficits.
- Treatment involves prolonged immobilization (up to 12 weeks).
Walecki, J. (2014). Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) ? Clinical and Radiological Aspects. Polish Journal of Radiology,79, 461-464. doi:10.12659/pjr.890944
Author: Michael Hunt, M.D.
- Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain and weakness in the affected muscle, as well as dark urine.
- Diagnosis is made with creatinine kinase levels
- It can happen to extreme athletes after competition, but the most common presentation is in people who fall and are immobilized for long periods of time.
- Other causes include burns, crush injuries, viral infections (influenza), bacterial infections (Legionella), and medications (statins in adults, propofol in kids)
- Treatment is aggressive fluids
References: Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis ? an overview for clinicians. Critical Care. 2005;9(2):158-169. doi:10.1186/cc2978.
Author: Sam Killian, M.D.
- The tongue blade test is done for mandible fractures, which make up 40-60% of facial fractures.
- The test is done by having the patient bite down on a tongue depressor on one side of the mouth. The provider then tries to snap the tongue depressor. This is repeated on the other side of the mouth. The test is positive if the patient complains of pain before the depressor can be broken on either side.
- It has been compared to CT and X-ray and has a similar sensitivity and specificity (95% and 65%, respectively).
References: J. Neiner, et al. Tongue Blade Bite Test Predicts Mandible Fractures. Craniomaxillofac Trauma Reconstr. 2016
Author: Nick Hatch, M.D.
- The force required to break a clavicle is significant, so clavicle fracture may be associated with other injury (pneumothorax, vascular injury).
- Most fractures occur in the middle 1/3 of the clavicle.
- Traditionally, clavicle fractures have been managed without surgery. However, recent studies have shown that surgery may be beneficial in a larger population than previously thought.
Author: Donald Stader, M.D.
- The most common ankle injury mechanism is an inversion.
- Most common broken bone in the ankle is the fibula.
- During exam, it is important to palpate over the fibular head, medial and lateral malleoli, over the 5th metatarsal and over the cuboid bone. If no tenderness in these areas and the patient is walking – they have a sprain and can be sent home without imaging.
- In calcaneal fractures, make sure to image the lumbar spine since up to 30% of calcaneal fractures are associated with lumbar spine injury.