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
Disclosures Wolters-Kluwers
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
Why do we need this discussion? Most sports medicine practices are very busy Increased volume because of reduced reimbursements Improved access Improved networking
Typical Sports Medicine Practice 50-70 patients a week Varied amount of ancillary help The worried well A lot of simple and straightforward problems
Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Osteosarcoma
Tumors Adolescent Primary-malignant Primary- benign Older Primary Metastatic Giant Cell Tumor
Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Chondrosarcoma
Tumors Adolescent Primary- malignant Primary- benign Older Primary Metastatic Metastatic Breast Ca
Infection Brodies abcess MRSA-CA
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
LisFranc Injuries Midfoot swelling Plantar ecchymosis Standing xrays CT vs MRI Any displacement surgery Negative stress views- non weightbearing
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
Ankle Sprains Most common sporting injury Most undertreated Taping vs bracing Ottawa criteria
Ankle Sprains Beware of medial swelling Deltoid sprain High ankle sprain NFL 4 week recovery Check subtalar motion Recurrent ankle sprains
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
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
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
Foot and Ankle LisFranc Injury Triplane fracture High ankle sprain Deltoid injury Achilles tendon rupture Posterior tibialis tendon tear Peroneal tendon subluxation Subtalar coalition
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Knee Locked knee Postero-lateral corner Extensor mechanism Stress fractures Pes Bursitis PCL SCFE Plateau fractures
Stress fractures Low risk High risk
High Risk Stress Fractures Femoral neck Tension vs compression Anterior tibia Dreaded black line Medial malleolus 5 th metatarsal Tarsal navicular
Low Risk Stress Fractures Nutritional evaluation
Spondylolysis Tight hamstrings Treatment controversial Watkins protocol
Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
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
Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
Central Slip injury Dorsal swelling of PIP Can lead to a boutonniere deformity Splint PIP in extension, allow DIP flexion
Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
Metacarpal fractures Check for rotational deformity Border digits
Hand and Wrist Scaphoid fracture Central slip Metacarpal fracture S-L injury
Scapho-lunate injuries Perilunate dislocation Scapholunate gap DISI deformity on lateral xray Comparison views
Elbow Children physeal fractures Dislocation Essex- Lopressti
Elbow Children physeal fractures Dislocation - Simple - Complex Essex- Lopressti
Elbow Children physeal fractures Dislocation Essex- Lopressti
Knee Injuries in Skeletally Immature OCD Physeal fractures Apophyseal fractures Hemearthrosis -MRI Check hip ROM
Atraumatic Effusion Inflammatory arthropathy Gout Lyme s disease Lab workup
Knee Dislocation 2 ligament injury Suspect spontaneous reduction Document a good neurovascular exam Early referral to Ortho
Sideline Redflags Stridor Tachycardia Amnesia http://www.howardluksmd.com/public/acl-injury- Prevention-Risk-Factors2.jpg?cda6c1
Thank you STL Surge (w permission)