Anatomy of an Injury Michael Borkowski, MD, MPH

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Anatomy of an Injury Michael Borkowski, MD, MPH

  1. 1. Anatomy of an Injury Michael Borkowski, MD, MPH www.borkmd.com 262-703-9386
  2. 2. 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
  3. 3. 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
  4. 4. Types of Work Injuries Pulmonary Dermatologic Infection Psychiatric Cancer Audiologic (hearing) Ophthalmologic Nervous – Central (brain) – peripheral (nerves) Vascular Musculoskeletal
  5. 5. 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?
  6. 6. 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
  7. 7. Neuro-musculo-skeletal Injuries Spine Shoulder Elbow Wrist/hand Hip Knee Ankle/foot Nerve Bone Muscle Cartilage Tendon Ligament Bursa Disc
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. Outcomes Most conditions: Hurt…. ….improve……….resolve
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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)
  17. 17. 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
  18. 18. Other shoulder injuries: Acromial-clavicular joint Labrum: supports biceps Dislocation / instability Thoracic outlet: Nerve and/or artery compression
  19. 19. 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
  20. 20. 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
  21. 21. Hip Burstitis Iliotibial band Strain / Sprain Also known for arthritis, necrosis (bone death), and referred pain from back
  22. 22. 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
  23. 23. Ankle & Foot Ankle sprains Achilles tendinitis and ruptures Plantar fasciitis….an injury? Morton’s Neuroma Tarsal tunnel Peroneal nerve injury
  24. 24. Miscellaneous Fibromyalgia Myofascial pain syndrome Chronic fatigue Somatization: stress that manifests physically

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