What you don t want to miss

Transcription

1 March 25, 2009 Vishal Michael Shah, M.D. What you don t want to miss

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5 Spectrum of Injuries Contusions Sprains Dislocations Fractures Lacerations Tendon Avulsions Ligament Tears Overuse Injuries

6 FINGER AND HAND: What not to miss Mallet Finger Jersey Finger Dorsal PIP Dislocation Volar PIP Dislocation Nail Bed Laceration/Open Distal Phalanx Fracture Fractures of the Finger

7 MALLET FINGER Extensor Tendon Avulsion from the base of the distal phalanx

8 MALLET FINGER 6 WEEKS OF TREATMENT TO PREVENT SWAN NECK

9 JERSEY FINGER Flexor Tendon Avulsion from the base of the distal phalanx

10 JERSEY FINGER Surgical Repair Always Required Delay in Treatment More Than 7 Days Makes Primary Repair Difficult Delay Will Require Tendon Reconstruction Rather Than Repair, Not as Successful Lack of prompt treatment leads to permanent disability

11 DORSAL DISLOCATION VOLAR PLATE AVULSION

12 DORSAL DISLOCAION VOLAR PLATE AVULSION

13 VOLAR PIP DISLOCATION CENTRAL SLIP DISRUPTION Often missed, dislocated finger pulled on quickly Important: What was the direction of displacement DORSAL VOLAR

14 VOLAR PIP DISLOCATION CENTRAL SLIP DISRUPTION Untreated or Undiagnosed Will result in Boutonniere Deformity CENTRAL SLIP DISRUPTION

15 VOLAR PIP DISLOCATION CENTRAL SLIP DISRUPTION Test for Traumatic Boutonniere Deformity Elson s Test Finger over edge of table with PIP at 90 degrees Ask patient to extend against resistance If weakness or hyperext of DIP occurs=central slip rupture TREATMENT: EXTENSION SPLINT OF PIP

16 NAIL BED LACERATIONS/ OPEN DISTAL PHALANX FRACTURES

17 NAIL BED LACERATIONS/ OPEN DISTAL PHALANX FRACTURES

18 NAIL BED LACERATION/ OPEN DISTAL PHALANX FRACTURES Nail bed laceration with tuft fracture= Open Fracture Needs antibiotics Possible nail bed repair Possible surgery for debridement/fracture fixation Risk for infection, nail deformity, fracture nonunion if not adequately treated

19 FINGER FRACTURES GET AN X RAY!!

20 WRIST INJURIES: What not to miss Scaphoid Fractures Scapholunate Ligament Tears Perilunate Dislocations Acute Traumatic Carpal Tunnel Syndrome

21 SCAPHOID FRACTURES Fall on outstretched hand Persistent Wrist Pain in the Snuff Box Often subtle injuries and symptoms Initial radiographs often negative

22 SCAPHIOD FRACTURES REPEAT X RAY if pain persists Treatment more successful and recovery more complete if injuries are treated early before displacement

23 SCAPHOLUNATE LIGAMENT TEARS Similar symptoms and mechanism to scaphoid fractures Varying degrees of injury Missed injuries can lead to chronic arthritis and chronic instability GET X RAY for persistent pain

24 PERILUNATE DISLOCATIONS In spectrum of injury of scaphoid fracture and scapholunate dissociation Often missed in ERS Requires closed versus open reduction and surgical stabilization

25 ACUTE TRAUMATIC CARPAL TUNNEL SYNDROME Wrist injury (sprain, blunt injury, contusion) Negative X Rays Coach/Athletic Trainer say You re fine get back out there!!

26 ACUTE TRAUMATIC CARPAL TUNNEL SYNDROME Athlete complains of: Volar wrist pain with passive ROM of wrist and fingers Numbness in thumb, index finger, middle finger Treatment: Rest Ice NSAIDS Therapeutic splinting

27 ELBOW INJURIES: What not to miss OVERUSE INJURIES: Little Leaguer s Elbow Physeal Stress Fractures Avulsion Fractures OCDs of the Capitellum

28 EPICONDYLAR STRESS FRACTURES EPICONDYLAR Medial Elbow Pain, MEDIAL OVERLOAD AVULSION FRACTURE Worse with Increased/Prolonged Throwing

29 OLECRANON STRESS FRACTURE POSTERIOR OVERLOAD

30 OCD (Osteochondritis of the Capitellum) LATERAL OVERLOAD CAPITELLAR LESION LOOSE BODIES

31 Summary What not to miss FINGER/HAND Mallet Finger Jersey Finger Dorsal Dislocation Volar Plate Avulsion/Rupture Volar PIP Dislocation Central Slip Rupture Nail Bed Laceration/Open Distal Phalanx Fracture Pilon Fracture of the Finger WRIST Scaphoid Fractures Scapholunate Ligament Tears Perilunate Dislocations Acute Traumatic Carpal Tunnel Syndrome ELBOW OVERUSE INJURIES: Little Leaguer s Elbow Physeal Stress Fractures Avulsion Fractures OCDs of the Capitellum

32 Take Home Points A swollen finger can mean a lot of things Active ROM of all joints should be present Even if ROM normal, serious injury can be present Limited ROM/strength should not persist Note the direction of displacement if possible When in doubt, get an x ray, bring them in Playing through pain usually not good for young athletes with open growth plates THIS IS NOT A COMPREHENSIVE LIST

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