Common Orthopedic Injuries Explained

JUNE 18, 2010
Orthopedic injuries are a common reason why patients across the country come to see their primary care physicians. Preparing healthcare providers to better understand the causes for these aches was the focus of the Orthopedic Demonstration session today, June 18, at Pri-Med NY 2010.
In his presentation, titled “Evaluation of Common Knee Injuries,” Frank J. Domino, MD, discussed the anatomical and mechanical factors of knee injuries, common complaints, and appropriate physical exam skills to evaluate patients.
Domino is an associate professor and clerkship director in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School.
He began his presentation by giving the audience a quick refresher on the anatomy of the knee and the assessment of a sprain. A first degree sprain is the stretching of a ligament, a second degree sprain is the stretching of a ligament with partial tearing, and a third degree sprain is the complete tear of a ligament, he said.
There are three main components of a physical exam of knee injuires, he said, they are: rolling the leg and assessing for effusion (effusion indicates an injury within the joint), the second is to perform rotation of motion (0-140 degrees) evaluations, which may be limited by effusion or meniscal tear, and the last is an ACL/PCL evaluation, which may include the Lachman’s test, or anterior posterior draw, he said.
With an ACL injury, a pop is usually heard, he said, which is accompanied by swelling in the first two hours. This can usually be assessed by x-rays or an MRI.
To assess lateral and medial knee pain, Domino said, physicians should perform the three main components mentioned earlier for a physical exam, but also add palpitations of the joint line, meniscus testing, and collateral testing. He highlighted the McMurray’s Test as one effective meniscus test.
In osteoarthritis patients it is more common to find medial knee pain versus lateral, he said. These patients usually present with six common issues, he said. These patients are usually over 50 years old, experience morning stiffness for less than 30 minutes, have bony enlargement, and have bony tenderness, he said.
In her presentation, titled “Low Back Pain: On Stage Demonstration,” Joanne Borg-Stein, MD, focused on the importance of the history and physical examination of the acute low back pain patient.
Borg-Stein, assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, participated in a live demonstration of practical examination skills and provided an overview of treatment strategies.
Acute lower back pain is the fifth most common reason for all physician visits, Borg-Stein said, and 90% of US adults will experience back pain at some point in their lives.
Receiving a detailed account of the patient’s back pain history is essential in treating the patient, Borg-Stein said.  The patient history should include data on the onset of pain (time of day or activity), the location of the pain (specific site), the type and character (sharo, dull, stiff), aggravating and relieving factors, medical history of previous injuries, psychosocial stressors, and more.
Borg-Stein also said it was important to look out for LBP mimickers. These include: pelvic pathology, soft tissue injuries, or hip pathology.
A physical exam for LBP should include observing posture, expressions and behavior, examining specific sensitive areas indicated by the patient history, performing neurologic evaluations and performing a back examination that includes palpitation tests, range of motion tests, and more.

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