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