Common Presentations Upper and Lower Limb Injuries Nicole

Common Presentations Upper and Lower Limb Injuries Nicole Carr

History What where when how ? *** Mechanism is key What happened next ? pain swelling analgesia ice What has happened since ? better /worse /the same Has it happened before ? what happened then Other eg PMH Meds Employment Self employed Smoking USE NICE CKS AND NORTH & EAST DEVON FORMULARY

Causes: Congenital Neurological Vascular Neoplastic Infective Degenerative Autoimmune Environmental Metabolic Traumatic Inflammatory Unknown

Examination : consent ● Look ● Feel ● Move

LOOK Skin intact? Wounds? Scars. Foreign bodies, Compare with uninjured side. Bruising swelling deformity? Erythema, Colour

FEEL Identify/pin point pain Examine joint above , joint below (Domino effect) Leave specific area of pain til last Crepitus, foreign bodies, crunching, effusion, swelling, masses, temperature Enlocation

MOVE If appropriate! Consider analgesia. . . Inform patient. Active /passive /resisted

Investigations Xrays ? ? Bloods? Further imaging ?

Impression : Plan: Treatment: Follow up:

Shoulder conditions Neck/ elbow rule out involvement Dislocation? Subluxation? Disruption ? Fracture (acute/pathological) Inflammation (beware bilateral shoulder/girdle pain ? ? PMR) Frozen shoulder Degenerative Tendon/ ligament injury/ rotator cuff injury-sprain, tear Calcific Tendonitis Impingement

Elbows Dislocations Pulled elbows Fractures Inflammation - olecranon bursitis , tendinitis, Golfer’s (medial epicondylitis) Tennis (lateral epicondiylitis) Combination injury:

WRISTS Fracture, beware scaphoid pain Sprain (Ligaments) Strain (Tendons or muscles) Inflammation (tendonitis, De Quervain’s tenosynovitis, ) Carpal Tunnel Syndrome (median nerve compression) Degeneration

Hands and digits Fractures Dislocations Infections ( Paronychia, Whitlows, Pulp infection). Foreign bodies Nail (Subungual haematoma, avulsion, nail bed injury) Ligaments and tendons Mallet, Swan Neck, Boutonniere Degenerative

HIPS ? fracture, some ppl can walk on hip #s. ? Shortened & rotated, ? Mechanism Degenerative. Analgesia, Exercise +/- referral - physio Beware bilateral hip pain assoc with bilateral shoulder pain. ? ? PMR

KNEES ? Fracture ? mechanism. Tibial plateau ? Ottawa Knee Rules FFPFF Locking. True Locking = orthopaedic emergency Ligamentous , sprain, tear, rupture Meniscal Infective, pre-patellar bursitis (housemaid’s knee) cellulitis Degenerative, arthritis, wear and tear, normal

ANKLE ? fracture (minor # distal fibula treated as sprain , nwb bone) Ottawa Ankle Rules Ligamentous, sprain. Inversion , Eversion, RICE, walk on it.

FEET and TOES ? fractures (only metatarsals xrayed) Beware base of 5 th MT ? Jones # ONLY big toe xrayed. Other toes need to be angulated or rotated , or skin open with sufficient mechanism. Plantar Fasciitis FUNGAL skin, nails … ? Tea tree, medicated lacquer, oral anti-fungals… Bunions (bony deformity, ? shoes, treated on severity) Corns, verrucae

Safety Net & Follow up. Documentation Leaflets Web sites SOS Treatments Analgesia Advice Fracture Clinic Physio Referral Exercise Time Frame