Nearly 1/12 through my residency - 3 out of 36 months! This month I am on sports medicine - a rather laid-back rotation compared to some. My days are spent in clinic, at university athletic training rooms and sports events. I've seen some pretty cool stuff and learned how to examine most joints in the body.
Today I saw a high school kid with a football injury - got hit from the side and busted his knee. The x-ray showed a fracture through one side of the growth plate in the femur and into the joint - a Salter Harris Type III fracture. I know that doesn't mean much to most of you, but it was pretty cool to see it on the x-ray, CT and MRI. Very interesting case!
Last week I saw another pretty interesting case - a girl with an osteochondritis dissecans lesion. This is where a portion of the bone near the joint, just under the cartilage, is damaged from lack of adequate blood supply. The bone gets fragmented and the overlying cartilage can break off and travel into the joint space and cause pain. In this case, the fragment was 2.5 x 1.5 cm and had traveled from inside the knee up to the lateral thigh just above the knee. I could feel the cartilage piece under the skin! Okay, so not cool for the patient, but a great learning case.
Our sports medicine faculty serve as team physicians for several of the local high school and university teams. I am required to attend at least 4 sports events this month. My first was a Wichita State University volleyball game. The WSU team (the Shockers) are in the top ten ladies volleyball teams in the country supposedly. Of course, the night I saw them they lost - oh well. The game was great, but no inuries - except wounded pride, I suspect. Last week I attended a high school football game that was much more eventful. We had a shoulder dislocation, an ankle sprain/fracture, a hypoglycemic episode (one of the flag carriers in the marching band) and a case of cervical cord neuropraxia (CCN). CCN happens when a player gets hit with his neck extended, putting pressure on the spinal cord. Usually, there is some underlying cervical stenosis - narrowing of the spinal canal in the neck, predisposing the person to compression of the cord when the neck is over-extended. This results in temporary numbness, tingling and sometimes weakness/paralysis of the upper and/or lower extremities. Most players recover in a few minutes, and I don't think there are any cases of permanent paralysis. However, in the case of a narrow cervical spinal canal, the patient is at risk of recurrent injuries, and that is not a good thing. Anyway, the kid who got hurt at the football game had already had several similar episodes, so he needs to get an MRI before he will be allowed to play again. Unfortunately, this game ended with a score of 59 to 0 (the team we represented lost dismally - they were definitely at a disadvantage compared to the well-equipped private school team they were playing).
Last week I got to inject a patient's sacroiliac joint. The patient was having a lot of pain in his hip/back just where the sacral spine meets the pelvic girdle. It's a fairly big joint, but not always that easy to palpate depending on how much soft tissue the patient has on his/her backside. I got it on the first try though, which is good since I was using a 1-1/2 inch long needle!
I love this program! I get to do so many hands-on things. Last week I got to play around with the ultrasound machine with one of my pregnant patients. I'm still learning how to navigate around - it's so much fun seeing baby's face, hands, feet, heart...! What a great job I have!
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