acute injuries

Case Study: Volleyball player rolls ankle landing on another player’s foot.
- Initial Check: Assess for point tenderness on lateral and medial malleolus.
- Lateral Malleolus: Yes, tender.
- Medial Malleolus: No, not tender.
- Assessment for Inversion Ankle Sprain:
- Point tenderness on the base of the fifth metatarsal: Yes.
- Point tenderness on navicular: No.
- Weight Bearing: Unable to bear weight or walk four steps.
- Conclusion: Clinician should consider an X-ray due to tenderness on lateral malleolus and inability to bear weight.
Additional Considerations:
- If death point tenderness is higher on lateral malleolus and other signs are negative: may not need X-ray.
- Look for bruising, swelling, and pain in other areas for additional signs of injury.

Subluxation: A partial dislocation that goes back into place.
Dislocation: Full dislocation, where the joint is completely out of its articulation.
- Medical Emergencies: Knee and hip dislocations are commonly worrisome and may require immediate referral.

Rotator Cuff Tear:
- Mechanism: Acute trauma or impingement.
- Symptoms: Loss of range of motion, weakness, pain, and stiffness, primarily affecting the supraspinatus.
- Management: Typically nonsurgical unless chronic conditions arise requiring surgical intervention. Strengthening of lower extremities and core is essential.
Biceps Brachii Rupture:
- Mechanism: Powerful contraction, usually at the bicipital groove near muscle origin.
- Signs: Instant pain, audible pop, visual deformity (Popeye sign), and inability to flex elbow properly.
- Management: Ice, arm sling, referral for assessment, likely surgery.
Finger and Wrist Deformities:
- Mallet Finger: Disruption of extensor tendon, inability to extend the distal interphalangeal joint (DIP) following forced DIP flexion.
- Management: Splinting in extension for 6-8 weeks generally resolves the injury.
Jersey Finger: Opposite of Mallet Finger, inability to flex the DIP occurring from forced DIP extension.
- Management: Typically requires surgical reattachment due to tendon attachment location.

Sternoclavicular (SC) Joint Sprain:
- Mechanism: Occurs due to indirect force or blunt trauma.
- Grades of Sprain:
- Grade 1: Pain with slight visibility.
- Grade 2: Pain with some subluxation, swelling, and decreased range of motion.
- Grade 3: Gross deformity, potential dislocation, severe symptoms.
- Management: PRICE protocol, potential surgical intervention for severe cases, especially if there is posterior displacement threatening vital structures.
AC Separation: Commonly referred to as a separated shoulder.
- Mechanism: Direct blow or upward force on the humerus.
- Management: Ice, stabilization, referral for X-ray; surgery may be needed in severe cases.

Mechanism: Most common in repetitive trauma such as throwing sports.
- Symptoms: Pain along medial elbow, point tenderness over UCL, potential paresthesia due to ulnar nerve involvement.
- Management: May require Tommy John surgery. Gradual rehabilitation takes significant time (22-26 weeks post-surgery).
Common Mechanisms Leading to Elbow Injuries: Majority occur during forced abduction, throwing motions, or hyperextension resulting in strain or tears of the UCL.

Wrist Sprains:
- Mechanism: Often from forced hyperextension (falling on an outstretched hand).
- Common Symptoms: Tenderness between the radius and scaphoid, pain on dorsal wrist, and pain with passive extension.
- Management: PRICE protocol, bracing, and improving strength and range of motion.
Gamekeeper's (Skier's) Thumb:
- Condition: UCL injury at the MP joint of the thumb due to forceful abduction.
- Management: PRICE, splinting or potential surgical reattachment.

Clavicular Fractures:
- Mechanism: FOOSH. Occurs primarily at the middle third of the clavicle.
- Symptoms: Head tilted towards injured side, visible deformity, pain, swelling, point tenderness.
- Management: Immobilization, potential surgery depending on severity.
Scaphoid Fractures:
- Commonest wrist fracture with FOOSH mechanism. Point tenderness in the anatomical snuff box.
- Symptoms: Often initially negative on X-ray; requires follow-up.
- Management: Surgery needed for fixation due to poor blood supply of the scaphoid.
Colles' and Smith's Fractures:
- Colles' (Dorsal angulation): Result in dinner fork deformity.
- Smith's (Volar angulation): Known as garden spade deformity.
Boxer's Fracture: Fracture of the 5th metacarpal often from punching objects.
- Management: Surgical intervention may be required if displaced.

Shoulder Dislocations: Commonly occur anteriorly or posteriorly due to trauma.
- Symptoms: Visual deformity, severe pain, and inability to move.
- Management: PRICE, immobilization, and possibly surgical intervention for recurrent dislocations.
Elbow Dislocations: Occur from FOOSH mechanisms.
- Management: Do not attempt to relocate in a general care setting due to potential nerve damage; requires emergency management.

Labral Tears: Often associated with shoulder dislocation; can be acute or chronic.
- Symptoms: Clunking or instability in the shoulder, requiring rehab or surgery depending on severity.
General Care for Upper Extremity Injuries:
- Rehabilitation: Always progressive based on symptoms and injury severity.
- Follow-up Care: Essential to monitor for complications and proper healing.

Note: Ensure familiarity with injury mechanisms, grading systems, management protocols, and symptoms for various upper extremity injuries - these will be heavily tested.
Remember: Open communication and observation in practical settings will enhance understanding of these injuries in action.
Preparation: Review definitions, assessments, and management strategies outlined on presented slides, particularly those with smiley faces, indicating key areas for exam focus.