Tag Archives: ortho

visual aids: shoulder joint injection/aspiration

16 Dec

are you a visual learner?  need some quick-refresher visual aids for your next shoulder injection/aspiration?  take a gander at a few of these:

ASPIRATION:

some nice Images in EM from the May ANNALS by Zala & Soskin, including:

(septic joint, so the effusion was not subtle)

 

INJECTION (normal shoulder) –via this SonoSite video:

shoulderinj

 

INJECTION (dislocated shoulder) –via ALiEM video (neat tip: use a spinal needle–its deeper than you think):

shoulderinj2

 

Have at it.  The SonoSite video has some nice pictures, but a monotone narration.  The ALiEM video is a bit more dynamic, if you’ve got the extra few minutes.

 
References: annals images; SonoSite video; ALiEM video

Management of Metacarpal Fractures

8 Dec
  • These fractures account for 40% of all hand injuries
  • treatment based on which metacarpal and the acceptable angulation of the fracture; general rules to remember:
    • index 10°
    • long 20°
    • ring  30°
    • little 40°
  • physical exam pearls:
    • fight wounds over MCP joint are open until proven otherwise
    • assess malrotation by examining “cascade” -> line up fingernails while fingers in full flexion

 

 

  • reduction and splinting if acceptable angulation and no immediate operative indications
    • “jahss” technique for reduction -> flex the patient’s MCP and PIP 90°, then apply dorsal force to proximal phalanx

 

    • intrinsic plus technique for splinting -> MCP flexed to 60-70°, IP fully extended, and wrist held in 10° less than maximal extension.

 

Submitted by Kelly Estes.

 

Sources: Content and Picture1 (orthobullets.com), Picture 2 (Aliem.com)

improvised Stryker for compartment pressure

3 Nov

came across a good picture that helps describe an improvised tool to measure compartment pressure, if you can’t find a Stryker needle/device:

mano

basic setup:

  • 18-gauge needle connected by IV tubing to a stopcock.
  • 20 cc syringe is attached to the stopcock and used to draw a small amount of saline halfway into the tubing.
  • other port of the stopcock is attached by IV tubing to a blood pressure manometer.
  • All ports of the stopcock are then opened
  • air is slowly injected with the syringe until the air/fluid column in the tubing begins to move toward the needle.
  • pressure at which this happens approximates the tissue pressure.

 

Some numbers for reference:

  • normal compartment pressures < 10 mm Hg
  • 30 mm Hg call surgeons for immediate surgical decompression.
  • 20 to 25 mm Hg are worrisom; 25 to 30 mm Hg may demand surgical decompression based on clinical findings.

 

References: uptodate.com; CALS website (w/ picture); FP notebook

visual aid: biceps tendon rupture

24 Oct

Good visual aid from the September EP Monthly mag.  The article has some deeper info, but in a pinch, remember to look for this:

a.k.a. the Popeye deformity.

There you go.

 

References: epmonthly article; popeye

wrist X-ray review resource

3 Oct

Came across this very nice site that’s quite handy for brushing up on your wrist bones & X-ray skills.  Personally, I find that the rollover feature (put the cursor over the image to get your cheat-sheet labeling of the bones) very useful.

The site has other anatomical radiology tutorials as well, but the wrist came up lately, and seemed like a good time for a refresher.

wrist

Check it out!

 

References: radiology masterclass site (w/pictures).

Examination of the collateral ligaments of the thumb

23 Sep

Gamekeeper’s thumb or skier’s thumb -> injury to ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint

 

  • due to forceful abduction and hyperextension
  • clinical presentation of pain at the base of thumb
  • stabilize the MCP joint, then apply a valgus force (radially deviating the thumb) while positioned in flexion and extension
    • In 30-40 degrees flexion, the “proper” UCL can be assessed for laxity
    • In extension, the “accessory” UCL can be assessed for laxity
    • To test for a completed UCL tear, you must examine both the proper and accessory components
  • If in doubt, place a thumb spica splint and refer to a hand specialist

 UCL

 

Submitted by K Estes.

 

Source: EM:Rap (text and photo)

great visual: hematoma block

11 Sep

if you have 10 seconds only, check out this great picture for those visual learners from an old EP Monthly article:

 

if you have more than 10 seconds to spare…

 

HEMATOMA BLOCK (check out this previous post for another nice review):

  • draw up 10 cc or so of 1-2% lidocaine
  • clean site
  • insert needle into fracture spot, confirmation by
    • ultrasound
    • needle “falls” into the fracture with loss of resistance
    • flash of blood
  • infiltrate 8-12 cc lidocaine
  • wait 5-10 minutes
  • reduce away

 

References: EP monthly article; picture