Ortho
Musculoskeletal Trauma
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Musculoskeletal Trauma
, Orthopedic Trauma, Musculoskeletal Injury, Soft Tissue Injury
See Also
Musculoskeletal Injury Management
Trauma Evaluation
Cervical Spine Injury
Lumbar Spine Trauma
Thoracic Spine Trauma
Rib Fracture
or
Flail Chest
Pelvis Fracture
Hip Fracture
Musculoskeletal Exam
Neurologic Exam
Musculoskeletal Anatomy
Musculoskeletal Injury
Fracture
Ligament Sprain
Tendon Strain
Contusion
Apophyseal Injury
Types
Soft Tissue Injury
See
Skin Foreign Body
See
Burn Injury
Laceration
Consider open
Fracture
(some
Laceration
s originate from the inside)
Ligament Sprain
Injury to ligament or capsule
Tendon Strain
(
Tendinopathy
)
Injury translated at musculotendinous junctions
Contusion
Blunt injury disrupts soft tissue (skin,
Muscle
) capillaries and venules, resulting in
Hemorrhage
into local interstitial tissue
Associated complications
Compartment Syndrome
Myositis Ossificans
Local Pressure tissue necrosis
Morel-Lavallee Lesion
Apophyseal Injury
(children)
Secondary ossification sites for tendon insertions, which may be injured with overuse prior to
Growth Plate
closure
Examples
Little Leaguer's Elbow
Osgood-Schlatter Disease
(knee)
Sever's Disease
(heel)
Types
Fracture
s
See
Fracture
See
Stress Fracture
See
Epiphyseal Fracture
(children)
Types
Nerve Injuries
Gene
ral
See
Motor Strength
(
Myotome
)
See
Sensory Level
(
Dermatome
)
Peripheral Nerve Injury
Compartment Syndrome
Shoulder
and
Brachial Plexus
Brachial Plexus Injury
Axillary Nerve Injury
Long Thoracic Nerve Injury
Suprascapular Nerve Injury
Spinal Accessory Nerve Injury
Elbow
and wrist
Axillary Nerve Injury
(e.g.
Anterior Shoulder Dislocation
,
Proximal Humerus Fracture
)
Deltoid motor weakness
Lateral
Shoulder
numbness
Musculocutaneous Nerve Injury (e.g.
Anterior Shoulder Dislocation
)
Elbow
flexion motor weakness
Radial
Forearm
numbness
Median Nerve
Injury
Median Nerve Injury at the Elbow
Median Nerve
Injury at the
Wrist
(
Carpal Tunnel
)
Distal
Median Nerve
injury (e.g. wrist
Fracture
or dislocation)
Thumb and Index opposition (OK sign) motor weakness
Thenar eminence or distal index finger numbness
Anterior Interosseous nerve injury (
Median Nerve
branch injury, e.g.
Humerus
supracondylar
Fracture
in children)
Index finger DIP flexion motor weakness
Radial Nerve
Injury (e.g. distal
Humerus Shaft Fracture
,
Anterior Shoulder Dislocation
)
Radial Nerve Injury at the Elbow
Radial Nerve Injury at the Wrist
Thumb and finger extension and metacarpophalangeal joint (MCP joint) motor weakness
Dorsal hand first webspace numbness
Ulnar Nerve
Injury (e.g. elbow injury)
Ulnar Neuropathy at the Elbow
(
Cubital Tunnel
)
Ulnar Nerve Injury at the Wrist
(
Ulnar Tunnel
)
Finger abduction motor weakness
Hypothenar eminence or fifth, small finger numbness
Spine
Spinal Cord Syndrome
Cervical Radiculopathy
Lumbar Radiculopathy
Buttock and legs
Sciatica
Piriformis Syndrome
Meralgia Paresthetica
Tarsal Tunnel
Femoral Nerve Injury (e.g. Public Ramus
Fracture
)
Knee
extension motor weakness
Anterior knee numbness
Obturator Nerve Injury (e.g. Obturator ring
Fracture
)
Hip adduction motor weakness
Medial thigh numbness
Posterior Tibial Nerve Injury (e.g. posterior
Knee Dislocation
)
Toe flexion motor weakness
Plantar foot numbness
Superficial peroneal nerve injury (e.g. fibular neck
Fracture
, posterior
Knee Dislocation
)
Ankle
eversion motor weakness
Lateral foot dorsum numbness
Deep peroneal nerve injury (e.g. fibular neck
Fracture
,
Compartment Syndrome
)
Ankle
and toe dorsiflexion motor weakness
Dorsal foot first and second web space numbness
Sciatic nerve injury (e.g. posterior
Hip Dislocation
)
Ankle
dorsiflexion (or plantar flexion) motor weakness
Foot
numbness
Superior Gluteal Nerve Injury (e.g.
Acetabular Fracture
)
Hip abduction motor weakness
Upper buttock numbness
Inferior Gluteal Nerve Injury (e.g.
Acetabular Fracture
)
Hip extension motor weakness (at gluteus maximus)
Lower buttock numbness
Types
Regions
Spine and proximal nerves
Spinal Cord Syndrome
Cervical Spine Injury
Lumbar Spine Injury
Brachial Plexus Burner
Thoracic Outlet Syndrome
Upper extremity
Shoulder Pain
Rotator Cuff Injury
Elbow Pain
Hand Injury
Wrist Injury
Lower extremity
Hip Pain
Knee Injury
Leg Pain
Ankle Fracture
Foot Pain
Types
Mechanism
High velocity injury
Motor Vehicle Accident
Falls
Fall on Outstretched Hand
Fall on Shoulder
Work and chores
Occupational Injury
Lawn Mower Injury
Sports
Bicycling
Cross Country Skiing
Golf Injuries
Running Injury
In-line Skating
Scuba Diving
Surfing
Skin and Soft Tissue Injury
Penetrating Trauma
(e.g.
Gunshot Wound
,
Stab Wound
)
Blast Injury
Laceration
Puncture Wound
BIte
Wound
Burn Injury
History
See
Trauma History
(
SAMPLE History
)
Background
Hand dominance (for upper extremity injuries)
Profession or sports
History of Present Illness
Mechanism of injury
Protective equipment
Regions of injury
Past medical history
Last Tetanus
Vaccination
(if skin penetration)
Exam
See
Brief Musculoskeletal Exam
See
Neurologic Exam
See
Trauma Secondary Survey
See
Hand Neurovascular Exam
Approach: Every extremity injury
Mnemonic: "joint above, joint below, circulation, motor and
Sensation
, skin and compartments"
Include examination of joint above and below the involved joint
Include
Sensory Exam
,
Motor Exam
,
Reflex Exam
and vascular exam (pulses,
Capillary Refill
)
Include skin and compartment exam
Mallon (2013)
Shoulder
Disorders, EM Bootcamp, Las Vegas
Upper extremity
Shoulder Exam
Elbow Exam
Hand Exam
Wrist Exam
Lower extremity
Hip Exam
Knee Exam
Ankle Exam
Spine
Spinal Cord Syndrome
Neck Exam
Low Back Exam
Mnemonic
C3-4-5 keeps the diaphragm alive (Spontaneous Breathing)
S2-3-4 keeps the stool off the floor (Reflex
Defecation
Center)
Precautions
Assess for
Fracture
(Especially in children)
Ligaments and Tendons are stronger than
Growth Plate
Bone
Fracture
s less often after
Growth Plate
fusion
Complications
Pitfalls
Injuries with risk of vascular compromise (consider angiography)
Posterior
Knee Dislocation
Supracondylar
Femoral Fracture
Suprecondylar
Humeral Fracture
Compartment Syndrome
Consider
Compartment Pressure
s
Epiphyseal Fracture
(children)
Ligaments and Tendons are stronger than
Growth Plate
Bone
Fracture
s less often after
Growth Plate
fusion
Management
See
Musculoskeletal Injury Management
References
(2018)
ATLS
, ACS, Chicago, p. 161
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