Musculoskeletal Trauma

Aka: Musculoskeletal Trauma, Orthopedic Trauma, Musculoskeletal Injury, Soft Tissue Injury

1. See Also
   1. Musculoskeletal Injury Management
   2. Trauma Evaluation
   3. Cervical Spine Injury
   4. Lumbar Spine Trauma
   5. Thoracic Spine Trauma
   6. Rib Fracture or Flail Chest
   7. Pelvis Fracture
   8. Hip Fracture
   9. Musculoskeletal Exam
   10. Neurologic Exam
   11. Musculoskeletal Anatomy
   12. Musculoskeletal Injury
   13. Fracture
   14. Ligament Sprain
   15. Tendon Strain
   16. Contusion
   17. Apophyseal Injury
2. Types: Soft Tissue Injury
   1. See Skin Foreign Body
   2. See Burn Injury
   3. Laceration
      1. Consider open Fracture (some Lacerations originate from the inside)
   4. Ligament Sprain
      1. Injury to ligament or capsule
   5. Tendon Strain (Tendinopathy)
      1. Injury translated at musculotendinous junctions
   6. Contusion
      1. Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue
   7. Apophyseal Injury (children)
      1. Secondary ossification sites for tendon insertions, which may be injured with overuse prior to Growth Plate closure
      2. Examples
         1. Little Leaguer's Elbow
         2. Osgood-Schlatter Disease (knee)
         3. Sever's Disease (heel)
3. Types: Fractures
   1. See Fracture
   2. See Stress Fracture
   3. See Epiphyseal Fracture (children)
4. Types: Nerve Injuries
   1. General
      1. Peripheral Nerve Injury
      2. Compartment Syndrome
   2. Shoulder and Brachial Plexus
      1. Brachial Plexus Injury
      2. Axillary Nerve Injury
      3. Long Thoracic Nerve Injury
      4. Suprascapular Nerve Injury
      5. Spinal Accessory Nerve Injury
   3. Elbow and wrist
      1. Median Nerve Injury at the Elbow
      2. Median Nerve Injury at the Wrist (Carpal Tunnel)
      3. Radial Nerve Injury at the Elbow
      4. Radial Nerve Injury at the Wrist
      5. Ulnar Neuropathy at the Elbow (Cubital Tunnel)
      6. Ulnar Nerve Injury at the Wrist (Ulnar Tunnel)
   4. Spine
      1. Cervical Radiculopathy
      2. Lumbar Radiculopathy
   5. Buttock and legs
      1. Sciatica
      2. Piriformis Syndrome
      3. Meralgia Paresthetica
      4. Tarsal Tunnel
5. Types: Regions
   1. Spine and proximal nerves
      1. Cervical Spine Injury
      2. Lumbar Spine Injury
      3. Brachial Plexus Burner
      4. Thoracic Outlet Syndrome
   2. Upper extremity
      1. Shoulder Pain
      2. Rotator Cuff Injury
      3. Hand Injury
      4. Wrist Injury
   3. Lower extremity
      1. Hip Pain
      2. Knee Injury
      3. Leg Pain
      4. Foot Pain
6. Types: Mechanism
   1. Falls
      1. Fall on Outstretched Hand
      2. Fall on Shoulder
   2. Work and chores
      1. Occupational Injury
      2. Lawn Mower Injury
   3. Sports
      1. Bicycling
      2. Cross Country Skiing
      3. Golf Injuries
      4. Running Injury
      5. In-line Skating
      6. Scuba Diving
      7. Surfing
   4. Skin and Soft Tissue Injury
      1. Laceration
      2. Puncture Wound
      3. BIte Wound
7. History
   1. See Trauma History (SAMPLE History)
   2. Background
      1. Hand dominance (for upper extremity injuries)
      2. Profession or sports
   3. History of Present Illness
      1. Mechanism of injury
      2. Protective equipment
      3. Regions of injury
   4. Past medical history
   5. Last Tetanus Vaccination (if skin penetration)
8. Exam
   1. See Brief Musculoskeletal Exam
   2. See Neurologic Exam
   3. See Trauma Secondary Survey
   4. See Hand Neurovascular Exam
   5. Approach: Every extremity injury
      1. Mnemonic: "joint above, joint below, circulation, motor and Sensation, skin and compartments"
      2. Include examination of joint above and below the involved joint
      3. Include Sensory Exam, Motor Exam, Reflex Exam and vascular exam (pulses, Capillary Refill)
      4. Include skin and compartment exam
      5. Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas
   6. Upper extremity
      1. Shoulder Exam
      2. Elbow Exam
      3. Hand Exam
      4. Wrist Exam
   7. Lower extremity
      1. Hip Exam
      2. Knee Exam
   8. Spine
      1. Neck Exam
      2. Low Back Exam
9. Precautions: Assess for Fracture (Especially in children)
   1. Ligaments and Tendons are stronger than Growth Plate
   2. Bone Fractures less often after Growth Plate fusion
10. Complications: Pitfalls
    1. Injuries with risk of vascular compromise (consider angiography)
       1. Posterior Knee Dislocation
       2. Supracondylar Femoral Fracture
       3. Suprecondylar Humeral Fracture
    2. Compartment Syndrome
       1. Consider Compartment Pressures
    3. Epiphyseal Fracture (children)
       1. Ligaments and Tendons are stronger than Growth Plate
       2. Bone Fractures less often after Growth Plate fusion
11. Management
    1. See Musculoskeletal Injury Management