Presentation Suddenly or gradually, after lifting, sneezing, bending, or other movement, the patient develops a steady pain in one or both sides of the lower back. At times, this pain can be severe and incapacitating. It is usually better when lying down, worse with movement, and will perhaps radiate around the abdomen or down the thigh but no farther. There is insufficient trauma to suspect bony…

Presentation The patient, usually with a history of a previous knee injury, and often with previous knee locking, suddenly develops a mechanical inability to extend the knee fully. The knee may flex but not extend and may be causing mild to moderate pain. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member.…

Presentation Ligament sprains occur when a joint is distorted beyond its normal anatomic limits (as when an ankle is inverted, or a shoulder is dislocated and reduced). The patient may complain of a snapping or popping noise at the time of injury, immediate swelling, and loss of function (suggestive of grade II or III sprain or a fracture). Alternatively, the patient may come to the office…

Presentation In lateral epicondylitis, the patient complains of pain in the lateral elbow that frequently radiates down the lateral aspect of the forearm. Because the lateral epicondyle is the bony origin of wrist extensors, patients are usually involved in an activity that requires repetitive wrist extension, such as tennis or mechanical work. Occasionally, the patient can recall a specific injury to the area, but more often…

Presentation After twisting the knee during a fall or sports injury, the patient complains of knee pain, possible swelling, and variable ability to bear weight. There may be a joint effusion or spasm of the quadriceps, forcing the patient to hold the knee at 10 to 20 degrees of flexion. See Fig. 113.1 for normal anatomy. With an anterior cruciate ligament (ACL) tear, there will most…

Presentation A patient rapidly develops an intensely painful monoarticular arthritis, often in the middle of the night, but sometimes a few hours following a minor trauma. The first attack of acute gouty arthritis usually occurs between the ages of 40 and 60 years in men and after the age of 60 years in women. Any joint may be affected, but the most common is the metatarsophalangeal…

Presentation The patient is concerned about a rubbery, rounded swelling most commonly emerging from the dorsal or volar aspect of the wrist or the flexor tendon sheath of the hand. It may have appeared abruptly, been present for years, or fluctuated, suddenly resolving and gradually returning in much the same place ( Fig. 111.1 ). The patient often first notices it when a minor injury brings…

Presentation The patient injures the fingertip by falling backward and striking it on the floor or hitting it in some other way, causing sudden and forceful hyperextension at the distal interphalangeal (DIP) joint against resistance. Alternatively, this injury can befall a football player trying to tackle the ball carrier but only catching the jersey or belt with the distal phalanx of one finger ( Fig. 110.1…

Presentation The patient seeks help after a crushing injury to the fingertip, such as closing it in a car door. The fingertip will be swollen and painful, with ecchymosis. There may or may not be a subungual hematoma, open nail bed injury, or finger pad laceration. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you…

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Presentation The patient will have jammed a finger, causing a hyperextension injury that forces the middle phalanx dorsally and proximally out of articulation with the distal end of the proximal phalanx. A swollen, painful deformity of the proximal interphalangeal (PIP) joint will be present, unless the patient or a bystander has reduced the dislocation prior to presentation. There should be no sensory or vascular compromise. You’re…

Presentation A patient arrives with a tender fingertip injury with a noticeable deformity. There is a history of a sudden resisted flexion of the distal interphalangeal (DIP) joint, such as when the fingertip is struck by a ball or jammed against a stationary object, resulting in pain and tenderness over the dorsum of the base of the distal phalanx. This injury can occur with relatively minor…

Presentation The patient experiences an insidious onset of difficulty with tasks such as opening jars because of pain localized to the dorsoradial aspect of the wrist that is exacerbated with thumb and wrist motion, and which may also be present on awakening. On examination, the first dorsal compartment over the radial styloid is thickened and tender to palpation. Crepitus of the tendon may be felt on…

Presentation The patient presents after falling onto the buttocks or getting kicked in the sacrococcygeal synchondrosis during an athletic activity, complaining of pain at the tip of the spine that is worse with sitting and perhaps with defecation owing to the use of the levator ani and the anococcygeal muscles. There is little or no pain with standing, but walking may be uncomfortable. Because part of…

Presentation A patient presents with anterior shoulder pain after falling onto the lateral shoulder or, less commonly, an outstretched arm, or has received a direct blow to the clavicle. With distal clavicle fractures, patients may complain of pain on the top of the shoulder. There may be deformity of the bone with swelling, abrasion, and/or ecchymosis. This is usually seen in the midclavicle and is exquisitely…

Presentation The patient will complain of neck pain after any mechanism that caused forceful neck hyperextension followed by hyperflexion. This is most commonly seen after a motor vehicle collision when the vehicle is struck from behind, but sports injuries and falls may also cause this injury. Patients may present directly after sustaining the injury complaining of acute neck pain, may arrive the following day complaining of…

Presentation The patient complains of pain, tingling, or a “pins and needles” sensation in the hand(s) or fingers. There may be the sensation of swelling or tightness in the absence of edema in the affected hand(s) as well as the sensation of extreme temperature. Onset may have been abrupt or gradual, but the problem is most noticeable after extended use of the hand or when driving…

Presentation Following minimal trauma or repetitive motion, a nonarticular synovial sac or bursa protecting a tendon or prominent bone becomes swollen and possibly painful, inflamed, and fluctuant. It may be nontender or tender. The elbow, hip, knee, and shoulder are most commonly involved unilaterally. Olecranon bursitis of the elbow can be caused by trauma from a direct blow (often only causing acute hemorrhage into the bursa),…

Presentation The patient seeks help for painful swelling of the hand over the distal fifth metacarpal (MC) after punching an object or another person with a closed fist. It occurs commonly during fistfights or from punching a hard object, such as a wall or a filing cabinet, and may be an act of deliberate self-harm or a compulsive action while enraged. You’re Reading a Preview Become…

Presentation After jamming the tip of a partially or fully extended finger (resulting in hyperflexion of the proximal interphalangeal [PIP] joint) or with direct trauma over the joint, the patient develops a painful, swollen PIP joint. These injuries are seen in basketball players and martial artists, who use open-hand blocking techniques, as well as when an athlete’s hand is stepped on or after a volar dislocation…