Anatomy of an Injury Michael Borkowski, MD, MPH
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Transcript of Anatomy of an Injury Michael Borkowski, MD, MPH
Anatomy of an Injury
Michael Borkowski, MD, MPH
www.borkmd.com
262-703-9386
Injury Severity, Diagnosis & Causation History - not always accurate when
compensability or “Gain” is on the line Physical Exam - performed and
interpreted accurately? Tests - false positives and false
negatives
Controversies
Multiple areas or systems
Point-in-Time Cumulative Pain=Injury? Type of Doctor Agendas
Motivation Injury Prone Egg Shell Event is injurious for
one worker but not another.
Domino effect
Types of Work Injuries
Pulmonary Dermatologic Infection Psychiatric Cancer
Audiologic (hearing) Ophthalmologic Nervous
– Central (brain)– peripheral (nerves)
Vascular Musculoskeletal
Exposure
Important to know mechanism of energy transfer (heights, weights, force)
Characterize frequency, duration, postures, etc.
Use of Personal Protective Equipment Extraordinary exposure? Work vs. normal wear?
Semantics:What’s in a name?
Diagnostic terms should not describe injury or mechanism:– Cumulative Trauma Disorder– Repetitive strain– Bulge, blown– Tear, torn– Herniated– overuse
Neuro-musculo-skeletal Injuries Spine Shoulder Elbow Wrist/hand Hip Knee Ankle/foot
Nerve Bone Muscle Cartilage Tendon Ligament Bursa Disc
What they do...
Nerve: Sensation or instruct muscles Bone: Support, protection, make blood Muscle: Movement Cartilage: Protect surfaces and joints Tendon: Connect muscle to bone (strain)
Ligament: Hold bones together (sprain)
Bursa: Sacs that protect friction points Disc: Cushion
More Terms:
Pathogenesis: Start/cause of condition Pathophysiology: How symptoms
manifest Referred pain: Pain location is not always
where the problem is! Exacerbation: Flare in symptoms Aggravation: Objective worsening or
progression
Body’s Response to Injury
IMMEDIATE– Splinting (spasm)– Swelling
(inflammation)– Early Bruise
(ecchymosis)– parathesias
(numbness,tingling)– altered sensation or
movement (praxia)
DELAYED– Crepitus– persistent or delayed
swelling (edema)– Late Bruise (color
changes)– Infection, atrophy,
arthritis– Maladaptive – Nerve changes
Symptoms / Responses
Helps determine severity of condition Helps pinpoint if / when an injury
occurred Assists in return to work and disability
determination Employer’s / Supervisor’s response
dictates success of management
Outcomes
Most conditions: Hurt….
….improve……….resolve
Some do not……….WHY?
Wrong diagnosis Bad doctor Other conditions that delay healing Other problems occur (muscle
imbalance, deconditioning, etc) Patient has another agenda Getting older & Job getting harder
Spine
Cervical: nerves to arms, breathing Thoracic: posture Lumbar: Nerves to legs, bowel and
bladder Sacrum: Sacro-iliac joint (back to pelvis
connection) Intricate muscles, ligaments, discs and
joints that make it hard to locate pain
Spine
Compression: Potential injury to vertebral body, disc
Acceleration/deceleration: Joints and posterior elements of vertebra
Torsion/bending: disc– internal disruption, bulge, desiccation and
herniation– chemical vs. mechanical irritation
Cervical / Lumbar Radiculopathy Loss of or altered sensation following a
specific distribution (more sensitive)
Loss of strength or endurance to specific muscles
Altered reflexes (DTRs)
Shoulder
Rotator cuff - a product of circulation, ligament and bursa
Location/configuration of bones encourages impingement (compression of RTC tendons)
Rotator cuff depresses shoulder Tendinitis>>partial tear>>full tear
Other shoulder injuries:
Acromial-clavicular joint Labrum: supports biceps Dislocation / instability Thoracic outlet: Nerve and/or artery
compression
Elbow
Tennis elbow (lateral) from impact or wrist extension activities
Golfer’s elbow (medial) from impact of wrist flexion)
Olecranon bursitis: pressure posteriorly Ulnar neuritis (inflammation) vs.
neuropathy (damage) from impact or tethering (bend) of nerve behind elbow
Wrist & Hand DeQuervains: forceful twist of wrist.
Carpal tunnel: Compression of median nerve?
Triangular fibrocartilage complex tear Trigger Finger: Forceful compression of flexor tendon
pulleys
Compression syndrome Radial & ulnar arteries / nerves Intersection syndrome: forceful flex/extend
Tendinitis / Strains / Sprains
Hip
Burstitis Iliotibial band Strain / Sprain
Also known for arthritis, necrosis (bone death), and referred pain from back
Knee
Anterior and posterior cruciate ligaments: Susceptible to twist or impacts to a planted leg
Bursitis: nursemaid’s knees Meniscus tear vs. degeneration Collateral ligament sprains Patellofemoral pain
Ankle & Foot
Ankle sprains Achilles tendinitis and ruptures Plantar fasciitis….an injury? Morton’s Neuroma Tarsal tunnel Peroneal nerve injury
Miscellaneous
Fibromyalgia Myofascial pain syndrome Chronic fatigue Somatization: stress that manifests
physically