ER Doctor Answers Injury Questions From Twitter

Dr. J. Mack Slaughter takes to Twitter to answer the internet's burning questions about injuries. What happens if you break a bone and don't set it? How can you tell if you've dislocated your shoulder? Why do shin splints hurt so much? Is it OK to treat a dog bite at home? Is an Achilles tendon tear the worst injury in sports? Dr. Slaughter answers all these questions and much more! Director: Justin Wolfson Director of Photography: Barry Bowden Editor: Richard Trammell Expert: Dr. J. Mack Slaughter Line Producer: Joseph Buscemi Associate Producer: Brandon White Production Manager: Eric Martinez Casting Producer: Nicole Ford Assistant Camera: Dayton Thomason Audio: Marcos Garcia Post Production Supervisor: Nicholas Ascanio Post Production Coordinator: Ian Bryant Supervising Editor: Doug Larsen

Video Transcript

J. MACK SLAUGHTER: In the emergency department all the time I'm like, I'm sorry, your bone is fractured, and they're like, phew, I'm just glad it's not broken. And I'm like, no, that's actually the exact same thing.

Hey. I'm Dr. J. Mack Slaughter and I'll be answering your questions from Twitter today. This is Injury Support.


This is from sid1998. "How many concussions is too many concussions? Asking for a friend."

I'm thinking by the way that you delivered that you're actually asking for yourself. A concussion is the state that you are in mentally, temporarily, after a mild traumatic brain injury. The symptoms range from decreased attention span, lethargy, or feeling really tired, feeling a little confused, severe headaches, light sensitivity and nausea, the feeling that you're gonna throw up.

So there's a very wide range of symptoms that you can have with this condition. It depends on the type of concussion, how big was the concussion, and also how severe were your symptoms afterwards.

I'd say the most feared outcome of multiple concussions is something called CTE, or chronic traumatic encephalopathy. People with chronic traumatic encephalopathy, a lot of them are boxers or football players who get repetitive head traumas, end up with very severe issues long-term, like dementia, really bad headaches, behavioral changes, aggressiveness, and suicidality.

There was one study that showed that about 17 concussions was the average of a lot of people who had chronic traumatic encephalopathy. But the answer is avoid concussions at all costs.

From hohlohlona. "What happens when you break a bone and don't set it back correctly?"

It depends on where the fracture is, how severe the fracture is, and how well aligned the bones are. I hear about people really hurting themselves, a bone is facing in the wrong direction and they're like, I'm gonna be a man and just fix it on the spot. Don't do that. You have no idea what injury that looks like under the surface of your skin.

It may not need any realignment at all. So do not try to set your bones back. Do not try to put your dislocations back in place. Please don't do this at home.

Also, is it going into a joint? A joint is basically where two bones meet. We have joints all over our body, and if a fracture goes into that joint, it's more important for that fracture to heal very, very well and for everything to be aligned because you can imagine if there are well, like, bone fragments inside the joint and then you try to move your extremity, it can be very painful and it can lead to a significant amount of arthritis long-term.

So go see an orthopedic doctor. Don't try to fix your own breaks at home. That's my answer.

From thisisntfabia. "I think I've dislocated my shoulder. Help. How do I know if I've dislocated it?"

First of all, you'll know if you have a dislocation or a fracture because it'll be one of the most painful things that you've ever experienced in your life. And these are things that need to be seen by doctors. So don't try to diagnose yourself at home using Doctor Google and try to pop things back in place.

But I will say, in the emergency department, before I get x-rays if somebody thinks that there's a shoulder dislocation, I will have them take the arm that's affected and try to touch the other shoulder. So if somebody has a shoulder dislocation, they're not going to be able to do it. So that's one of the things I do after I pop a shoulder back in place, which is awesomely satisfying I must say. We check to see if it's back in place before x-rays by seeing if that arm goes up to the contralateral shoulder, that is the opposite shoulder.

This question is from amserres. "How does one know when stitches are needed? Asking for a friend."

It's a difficult answer. There are certain stitches that we put in place because it's just gonna have a better cosmetic outcome. That is, it's gonna look better long-term. But there are other stitches, real, real deep lacerations that we absolutely need to stitch up.

For instance, if it gets deep enough to go to this layer called the fascia-- now, fascia is like really dense tissue, and that kind of holds certain structures in place. Think of it as like layering, like layering of a cake or something like that.

So that particular layer called the facial plain that separates those two areas a lot of times needs to be repaired. And so we'll put stitches in there to bring that back together. And if you don't, the muscles or structures that are under that facial plain can kinda herniate through and they'll cause you some issues.

Also, I should mention, there are absorbable sutures and there are non-absorbable sutures. There are certain stitches that we don't want your body to absorb. For instance, if there's a tendon that's been cut and we're repairing that, a lot of times we're going to use a non-absorbable suture, we want that stitch to stay in place because it takes a long time for tendons to heal fully.

There are other areas of the body or certain situations where we want the stitches to dissolve. And those dissolvable stitches or absorbable stitches are made out of either synthetic polymers or they're made out of animal intestines. So come to the emergency department and we might stitch you up with animal intestines.

All right. This next question is from Justin Wolfson. "I broke my femur in a car wreck and I have some Qs."

By the way, this is a terribly painful experience. So Justin Wolfson, my heart goes out to you, brother.

"How much force does it take to break a friggin femur? How do they get that rod in there? Don't I need that missing bone marrow? And how do these heal before this surgery existed?"

It's a lot of force. The answer is about 4,000 newtons of force. 4,000 newtons is about equivalent to 900 pounds here on Earth's gravity. So you can think of like a sea lion or a really big moose. That is the amount of force that it takes.

You think about surgeries in general as being very like gentle, precise operation. Orthopedic surgeries are not gentle. They're putting force in there. They're using muscles because it genuinely requires a significant amount of force to get these surgeries done and to put bones back in place.

To get that rod into your femur, they basically have to align it where the cavity is, where your bone marrow is, and it's called an intramedullary rod. They align it and they take a big old hammer and they go nonk, nonk, nonk, nonk, nonk, until it's all the way in there. So it is violent and it takes a lot of force, and it's impressive to see.

"Don't I need that missing bone marrow?"

No, you really don't. I mean, you have bone marrow throughout the rest of your bones. You'll be fine.

Last question, "how did these heal before the surgery existed?"

And the answer is very, very poorly. They probably didn't heal very well at all. That person maybe never walked again if you were in a car accident in the 1500s.

All right. The next question is from kiraankahlon. "Why are shin splints so painful?"

So shin splints are known as median tibial stress syndrome. And that's basically where there's inflammation of a lot of the structures that are there around your tibia. Your tibia is this long bone here in your lower extremity, right next to your fibula, which is the skinnier bone that runs along the side. Runners always get these shin splints. A lot of cheerleaders get shin splints, and these can be very, very painful.

Now, here's the thing, though, that pain should resolve with rest. Definitely get seen if that pain doesn't resolve with cessation of that activity.

This is from LondonHearts1. "What is a defibrillator? Do I have to be trained to use one?"

So a defibrillator is basically a device that administers electricity to the heart. The bottom part of your heart are the ventricles, and when the heart naturally does its thing, the top part squeezes first, the atria squeeze, the bottom part squeezes after. Boom, boom boom, boom boom.

So if the bottom part of the heart isn't given a good hearty squeeze there-- see what I did there with hearty? That was a total accident-- you're not going to get blood flow to your brain or your extremities and you're going to start dying.

When you go into these dangerous heart rhythms, you get electricity to the heart as soon as possible. Ask for an AED, or automatic external defibrillator. Don't be worried. You can do this, you can save someone's life. Call for 911 as well because they're trained. They're gonna know what to do, especially in the field.

But if you can get an AED, it'll tell you to put these pads on the chest and on the back, and you're gonna basically sandwich the heart, and that's gonna make it to where the electricity runs between the two pads.

If you don't have access to an AED and/or you're a professional, this is what you're gonna need. This is called a life pack. So this bad boy is over $50,000 worth of machine.

What we do is we hook this up to somebody's chest. When it's hooked up, you'll be able to see the rhythm that the heart is in. You'll be able to tell, is that person in ventricular fibrillation or ventricular tachycardia? And then we can determine, do they need defibrillation or do they need something called synchronized cardioversion?

This will basically take someone who is inevitably going to die and bring them back to life very rapidly. This is one of the best inventions that modern medicine has to be honest. So this thing is pretty amazing.

The next question is from PtWorx. And the question is, "what is the most serious or painful injury you've ever encountered?"

I mean, the most serious injuries are the ones where the patient comes in dead. But you classify traumas based on like what hit what. So you'll say like, motor vehicle versus like bicyclist, or train versus pedestrian. You can imagine that train versus pedestrian was the most serious thing that I've seen in the emergency department.

The guy, not to gross you out, but had a traumatic amputation, that is, his arm was ripped off from the force and he was already D-E-A-D, he dead by the time he came in. And so that is the most serious injury that I've seen.

Some of the most painful injuries that I see actually are ones that cause ischemia. Now, ischemia is lack of blood flow to tissue or lack of oxygen. So if there is an injury that either like rips the blood vessel apart or causes a certain abnormality that would decrease the blood flow to a certain area. That is exquisitely painful. Hopefully you never have to experience something like that in your lifetime.

And this is from mediocentr0. "Is an Achilles tendon tear the worst injury an athlete can get?"

So I should tell you what an Achilles tendon is. Rah, rah, rah, rah, rah, rah, rah, rah, rah. Your Achilles tendon is this tendon back here that attaches your calf basically to your foot and allows you to flex your foot.

And so when this pops, you can't do this anymore. And that's pretty important for running, walking, jumping, et cetera. This is a shocking, morbid injury.

But I would argue this is not the worst injury that an athlete can sustain because think about a spinal cord injury, man. You get a cervical spine injury, that is you essentially fracture the bones here in the neck and it ends up pushing on your spinal cord and you may never be able to walk, use your arms or legs. I think paralysis, that's the worst injury that an athlete can get.

All right. This next question is from LezDoMedLegal. "Is it OK to treat my dog bite injury at home?"

Absolutely not. These are at very, very high risk for infection. You need antibiotics. Also, when was the last time you got a tetanus shot? Also rabies? That's a problem.

Chances are pretty low. But if you get it, guess how fatal it is? 100%.

Now, if they can catch the animal and it's a stray animal, that's different. What they do is they watch the dog for multiple days, make sure they don't exhibit any signs of rabies. If they don't, then it's fine. You don't have to get all your rabies shots and stuff like that.

But if it's some rando dog that bit you, ran away, and you're never going to see it again, you need to get your rabies shot. You also wanna get x-rays to make sure there isn't a big old chunk of bone under the surface there because again, very, very high risk for infection.

From 41shiesty. "What is Tommy John surgery?"

Let me get my little arm model right here. This is your humerus, all right? This is your ulna right here and this is your radius. And what happens in people that require Tommy John surgery is they end up having a rupture of this tendon, called the ulnar collateral ligament.

The ulnar collateral ligament connects the humerus, which is this bone here, down to the ulna, and if you are throwing overhead, whoosh, all day, every day for years and years and years, you put yourself at risk, especially if you're putting a ton of force behind you and you're throwing fastballs. And once that thing pops, you're gonna have a lot of pain when you're throwing. It's gonna be really tender over that area where the ligament naturally is.

So what do they do during a Tommy John surgery? They end up taking a tendon to fix your ligament. They'll either take a tendon from your forearm, your hamstrings, or your foot, and they will reconnect those bones to kind of stabilize that area on the medial aspect of your elbow.

And you wonder, do you not need the tendon that they're taking out from the other area of your body? And the answer is, no, not really. You're gonna do fine without it.

P1P31150. I have no idea what that stands for. But, "how do you know if you have a broken rib? Asking for a friend."

It's always asking for a friend. It's gonna be very painful. If it hurts a lot or you're having any difficulty breathing, you absolutely need to be seen because you can have pain on one side and you think, oh, it's just a broken rib, whatever, they don't do surgery on that, which is true. But what can happen is that rib, if that fractures and pokes your lung, you can pop a lung. You can have a collapsed lung.

If you get air in your thoracic cavity that's outside of your lung, it can compress your lung to the point where one, you have difficulty breathing, and two, you can put so much pressure in the thoracic cavity that you can cut off blood supply to the heart. You can squeeze the blood vessels close that are responsible for getting blood back to the heart. You can imagine it's only a matter of time before you die if you're not getting blood flow to your heart because if you don't get blood flow to your heart, you don't get blood flow to the rest of your body.

So if you think you have a rib fracture, get seen. Might be more serious than you think

Next question is, "how to treat cooking oil burn? [BLEEP], I hate scars."

That was a quote. That was a quote. The answer is, you treat a cooking oil burn by getting seen in person. Unfortunately you do need to get seen. This isn't something you should be treating at home.

You have multiple different depths of injuries with burns. They pretty much all need some sort of antibiotic cream to put on there. Now, Neosporin does work really well for a burn, especially if it just looks like it's a sunburn and there's no bubbling or anything. That's probably gonna be a superficial thickness burn or a first degree burn.

But when you start getting into those deeper burns when it's bubbling up on the surface, go see a doctor to determine what depth of injury it is. And then long-term, depending on where the burn is, you may end up needing the skin graft, which is where they take skin somewhere else in the body and then we attach it to the area where the burn is because our skin provides a very important role.

It one, makes sure that we don't lose a lot of water to our environment. The skin also protects you against infection. So they're very, very high risk for infections.

Also, if the burn is over a joint, you can get scarring to kind of resist your normal movement of the elbow. And you may develop contractures and they may need to get essentially released surgically. So go see a doctor, especially if it is bubbling or turning a whitish color.

From StrawHatRuby. "What's the difference between a sprain and a strain?"

A sprain is when you have an injury to your ligaments. Ligaments directly connect bone to bone. Tendons are affected when you have a strain-- I almost said it wrong-- and tendons connect muscle to bone.

And how do kinda know difference between the two? It's difficult to say because both of them are very painful. But one of the big differences is that muscle strains can end up having a lot of cramping associated with the muscles.

Now, that technically can happen with sprains as well, just a little less likely, and you can have limited movement around that joint that's affected. Now, that's what the strain.

With a sprain you won't have as much muscle spasm and you may have more movement at that joint because the ligament that was there kind of stabilizing and holding it in place is injured, stretch, maybe totally torn. And so you may be able to move it more than you could before. You could have instability of that joint. So that's the difference between a sprain and a strain.

From luxembitch. "Can you break your funny bone? Not a rhetorical question. I really slammed that bitch on a changing room locker."

The funny bone can be a very painful injury and it's usually very temporary. But what happens is you have an ulnar nerve. You have this big old nerve right on the medial aspect, the middle side of your elbow, and that nerve is responsible for your ability to feel there. And so that's why when you hit it, your fingers might kind of like tense up and you get this really weird tingling sensation all the way down your hand. So no, you can't break your funny bone, but it can hurt a lot.

All right. That's all for now. Hope you guys learned something today. I'm Dr. J. Mack signing off.