Podcast # 435 : UCL Injury

Author: Ryan Circh, MD

Educational Pearls:

  • 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.

References:

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

Podcast #403: Meniscus Lock

Author: Mark Hinton, MD

Educational Pearls:

 

  • 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

 

References:

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!

Podcast #382: Shoulder Separations

Author:  Ryan Circh, MD

Educational Pearls:

  • 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

References:

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.

Podcast #374: Iliac Artery Endofibrosis

Author:  Sue Chilton, MD

Educational Pearls:

  • An unusual cause of leg pain that can mimic sciatica/claudication
  • Predominantly occurring in high endurance athletes, particularly cyclists and runners
  • More common in men
  • Check supine ABIs 1 minute after activity in the ED: a value < 0.5 is 80% sensitive

 

References:

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.

Podcast #317: Elbow Dislocation

Author: John Winkler, M.D.

Educational Pearls:

-Lower mechanisms of injury have a lower chance of an associated fracture or major ligament injury.

-One major concern is having a fracture fragment in the joint (can lead to chronic arthritic pain).

 -Evaluation should involve checking the neurovascular status of the arm and reduce the fracture as soon as possible. Immobilize arm in a sling and consult orthopedics if there is intra-articular involvement.

References:

https://orthoinfo.aaos.org/en/diseases–conditions/elbow-dislocation/

Mehta, JA; Bain, GI. (2004). Elbow dislocations in adults and children. ?Clinics in Sports Medicine.? 23(4):609-27.

Podcast #312: SCIWORA

Author: Sam Killian, M.D.

Educational Pearls:

  • 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).

 

References:

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

Podcast #294: Rhabdomyolysis

Author: Michael Hunt, M.D.

Educational Pearls

  • 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.

Podcast #252: Mandible Fractures

Author: Sam Killian, M.D.

Educational Pearls

  • 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

Podcast #242: Clavicle Fracture Review

Author: Nick Hatch, M.D.

Educational Pearls

  • 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.

References: http://emedicine.medscape.com/article/398799-overview

Podcast #215: Ankle Pain

Author: Donald Stader, M.D.

Educational Pearls:

  • 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.

References: http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/physical-examination-info/ankle-physical-examination/