Sports Medicine in your office: What not to miss!
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1 Sports Medicine in your office: What not to miss! 2018 Primary Care Approach to Treating the Injured Athlete May 4, 2018 John H. Wilckens, MD Associate Professor, Dept of Orthopaedic Surgery
2 Disclosures Wolters-Kluwers
3 Objectives Recognize how tumors or other serious Orthopaedic may present in your outpatient office Expand your differential to identify relatively rare conditions that may present with a common complaint What signs and symptoms that should raise a red flag
4 Why do we need this discussion? Most sports medicine practices are very busy Increased volume because of reduced reimbursements Improved access Improved networking
5 Typical Sports Medicine Practice patients a week Varied amount of ancillary help The worried well A lot of simple and straightforward problems
6 Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Osteosarcoma
7 Tumors Adolescent Primary-malignant Primary- benign Older Primary Metastatic Giant Cell Tumor
8 Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Chondrosarcoma
9 Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Metastatic Breast Ca
10 Infection Brodies abcess MRSA-CA
11 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
12 LisFranc Injuries Midfoot swelling Plantar ecchymosis Standing xrays CT vs MRI Any displacement surgery Negative stress views- non weightbearing
13 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
14 Ankle Sprains Most common sporting injury Most undertreated Taping vs bracing Ottawa criteria
15 Ankle Sprains Beware of medial swelling Deltoid sprain High ankle sprain NFL 4 week recovery Check subtalar motion Recurrent ankle sprains
16 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
17 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid ligament injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
18 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
19 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
20 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
21 Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
22 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
23 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
24 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
25 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
26 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
27 Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
28 Stress fractures Low risk High risk
29 High Risk Stress Fractures Femoral neck Tension vs compression Anterior tibia Dreaded black line Medial malleolus 5 th metatarsal Tarsal navicular
30 Low Risk Stress Fractures Nutritional evaluation
31 Spondylolysis Tight hamstrings Treatment controversial Watkins protocol
32 Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
33 Scaphoid fractures Snuff box tenderness 10%missed on initial XRAY SAC with thumb spica f/u 2-3 weeks Xrays negative with continued snuffbox tenderness CT vs MRI
34 Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
35 Central Slip injury Dorsal swelling of PIP Can lead to a boutonniere deformity Splint PIP in extension, allow DIP flexion
36 Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
37 Metacarpal fractures Check for rotational deformity Border digits
38 Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
39 Scapho-lunate injuries Perilunate dislocation Scapholunate gap DISI deformity on lateral xray Comparison views
40 Elbow Children physeal fractures Dislocation Essex- Lopressti
41 Elbow Children physeal fractures Dislocation - Simple - Complex Essex- Lopressti
42 Elbow Children physeal fractures Dislocation Essex- Lopressti
43 Knee Injuries in Skeletally Immature OCD Physeal fractures Apophyseal fractures Hemearthrosis -MRI Check hip ROM
44 Atraumatic Effusion Inflammatory arthropathy Gout Lyme s disease Lab workup
45 Knee Dislocation 2 ligament injury Suspect spontaneous reduction Document a good neurovascular exam Early referral to Ortho
46 Sideline Redflags Stridor Tachycardia Amnesia Prevention-Risk-Factors2.jpg?cda6c1
47 Thank you STL Surge (w permission)
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Index Note: Page numbers of article titles are in boldface type. A Achilles tendinopathy in dancers, 831 832 treatment of PRP in, 871 872 Achilles tendinopathy/tendonitis in ultramarathon athletes, 847
7/1/2012. Repetitive valgus stresses cause microfractures in the apophyseal cartilage (weak link) Common in year olds
1 2 3 4 5 6 7 When growing pains are not growing pains David W. Gray,M.D. Medical Director Orthopedics Differential Diagnosis Fracture Ligament Injury Disloclation Cartilage Injury Apophysitis Inflammation
Kineto. Orthopaedics & Rehabilitation Products
Member of Vincent Medical Holdings Limited Kineto Orthopaedics & Rehabilitation Products Our orthopaedic and rehabilitation products comprise of a variety of adjustable rehabilitation braces for support,
ORTHOPEDIC/SPORTS MEDICINE ROTATION SYLLABUS
ORTHOPEDIC/SPORTS MEDICINE ROTATION SYLLABUS Level of Training PGY 2 or PGY 3 Length of Rotation 8 weeks Preceptors /Attendings Name(s) and Titles Edward Forster, MD, (FMC faculty contact) Tallahassee
June 2013 Case Study. Author: T. Walker Robinson, MD, MPH, Nationwide Children s Hospital
June 2013 Case Study Author: T. Walker Robinson, MD, MPH, Nationwide Children s Hospital Chief Complaint: Right ankle pain HPI: A 10 year old female dancer presents to the clinic with a five day history
Physical Examination of the Foot & Ankle
Inspection Standing, feet straight forward facing toward examiner Swelling Deformity Flatfoot (pes planus and hindfoot valgus) High arch (pes cavus and hindfoot varus) Peek-a-boo heel Varus Too many toes
Differential Diagnosis
Case 31yo M who sustained an injury to L knee while playing Basketball approximately 2 weeks ago. He describes pivoting and hyperextending his knee, which swelled over the next few days. He now presents