ABC of Sports Medicine: Management of the Acutely Injured JointBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6946.46 (Published 02 July 1994) Cite this as: BMJ 1994;309:46
- J B King
- JB King is director of the academic department of sports medicine at the London Hospital Medical College, consultant orthopaedic surgeon at the Royal London Hospital, and chairman of the British Association of Sport and Medicine.
Far too often treatment of injuries to major joints starts without a diagnosis being made.
In acute joint injury it may not always be possible to get a good history — for example, when a scrum has collapsed. In many cases, however, the story points to the eventual diagnosis. A fall on the point of the shoulder damages the acromioclavicular or sternoclavicular joint; a rugby tackle that knocks the leading arm into external rotation while abducted 90° indicates a shoulder dislocation; the non-contact twisting deceleration injury of the knee followed by a snapping or popping sensation and rapid swelling is usually associated with a torn anterior cruciate. So a history really is important and is well worth the time spent before the physical examination.
Diagnostic Not diagnostic
Look at the joint — Appreciable swelling will be apparent immediately, and deformity (such as patella dislocation) should not be missed. The step deformity of subluxed or dislocated acromioclavicular joints should be obvious, as would be the more subtle sharpening of the point of the shoulder when that joint is dislocated.
Feel the joint — The first thing to feel for is the tenderness, which is the marker of localised injury. Look at patients' faces for apprehension when you first touch them, because once you have hurt them you are going to lose their cooperation. It is essential to feel the landmark points around a particular joint. Using the ankle as an example, gentle but specific palpation over the swollen lateral structures will differentiate the tenderness of the fibula itself if it is fractured from the tenderness overlying the anterior component of the lateral ligament, which runs almost horizontally forward from the tip of the fibula and is far more often injured. In the knee it is important to remember that the lower …