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Family Medicine > Case 4: Female with Sports Injury > Flashcards

Case 4: Female with Sports Injury Flashcards

1
Q

Compartment syndrome

A

Complication of extremity trauma due to rising pressure in muscle compartment that impairs perfusion to that same muscle compartment

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2
Q

Causes of compartment syndrome

A

Fractures
Crush injuries
Burns
Arterial injuries

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3
Q

Treatment of compartment syndrome

A

Emergent decompression via fasciotomy

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4
Q

6 P’s of compartment syndrome

A 
Pain - earliest sign
Pallor
Pulselessness
Paresthesia (itching, tingling) - most reliable sign
Perishing cold
Paralysis
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5
Q

Significant ankle injury features

A
  • immediate presentation
  • unable to weight bear (bearing weight = able to take 4 steps independently)
  • history of previous ankle sprain
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6
Q

Hearing a snap or a tear is diagnostic of

A

Knee injury (not ankle)

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7
Q

Characteristics considered when grading an ankle sprain

A
  • presence/absence of ligament tear
  • loss of functional ability
  • severity of pain
  • presence/severity of swelling
  • presence of ecchymosis
  • difficulty bearing weight (limited ability in taking 4 steps)
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8
Q

Grade 1 ankle sprain: stretching or small tear of ligament

A
  • mild tenderness + swelling
  • mild or no functional loss
  • no mechanical instability
  • no excessive stretching or opening of joint w stress
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9
Q

Grade 2 ankle sprain: incomplete tear

A
  • tenderness
  • mild/moderate pain, swelling, ecchymosis
  • some loss of motor function
  • mild/moderate instability
  • stretching of joint w stress with definite stopping point
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10
Q

Grade 3 ankle sprain: complete tear + loss of integrity of ligament

A
  • severe swelling (> 4 cm about the fibula)
  • ecchymosis
  • can’t bear weight
  • mechanical instability
  • stretching of joint w stress without definite stopping point
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11
Q

Mechanisms of injury of ankle sprains

A

a) plantar flexion and inversion (most common)

b) excessive eversion and dorsiflexion

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12
Q

Damaged structures in plantar flexion/inversion ankle sprain

A

Lateral stabilizing ligaments

  • anterior talofibular (most easily injured)
  • calcaneofibular (if injured = instability)
  • posterior talofibular (rarely injured)
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13
Q

Ankle anterior drawer test

A

Used to assess integrity of anterior talofibular ligament

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14
Q

Ankle inversion stress test

A

Used to assess integrity of calcaneofibular ligament

- invert patient’s ankle and assess for laxity

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15
Q

Excessive eversion and dorsiflexion leads to damage of what structures?

A

Medial stabilizing ligaments (less common than lateral because of bony articulation b/w medial malleolus + talus)

  • strong deltoid ligament
  • anterior tibiofibular ligament
  • bony martise
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16
Q

Examining injured lower extremities

A
  • always examine uninjured extremity first for baseline and to establish relationship w patient
  • excessive swelling/pain can limit exam up to 48 hrs after acute injury
17
Q

Crossed leg test

A

Have patient cross legs w injured leg resting at midcalf on knee to detect high ankle sprains: syndesmotic injury between tibia and fibula

18
Q

Differential for acute ankle pain following inversion injury (5 most likely)

A
  • lateral ankle sprain
  • peroneal tendon tear
  • fibular fracture
  • talar dome fracture
  • subtalar dislocation
19
Q

Less likely causes of acute ankle pain (4)

A
  • medial ankle sprain
  • syndesmotic sprain
  • fracture of tibia
  • arthritis of ankle
20
Q

Lateral ankle sprain

A

Present post-trauma with pain, warmth, some swelling - do not create a deformity

21
Q

Peroneal tendon tear

A

Due to inversion injury and may occur in conjunction with lateral ankle sprain
Main sx: persistent pain posterior to lateral malleolus

At risk with repetitive trauma

22
Q

Fibular fracture

A

Due to fall, athletic injury, or high velocity injury

- severe pain, swelling, inability to ambulate, deformity

23
Q

Talar dome fracture

A

Due to acute injury - can be missed on initial Xray

- biggest concern is avascular necrosis (due to interruption of blood supply)

24
Q

Subtalar dislocation

A

In setting of high energy injury - involve taleocalcaneal and talonavicular joints

With pain, swelling, deformity

25
Q

Medial ankle sprain

A

due to forced eversion

Injury to deltoid ligament

26
Q

Syndesmotic sprain

A

Involves interosseus membrane + anterior inferior tibiofibular ligament
- positive ankle squeeze test

27
Q

Fracture of tibia

A

After high velocity trauma

  • severe pain
  • cannot bear weight at all
  • visible malformation of extremity
28
Q

Arthritis of ankle

A

Less common than in other joints - chronic process in elderly - involves tibiotalar joint

Stiffness, swelling

29
Q

Ottawa ankle rules

A

Clinical Dx tool to evaluate adults with acute ankle and midfoot injuries

30
Q

Rules suggest Xray of ankle is needed if

A

a) pain in malleolar zone +
b) tenderness on posterior edge of medial or lateral malleolus OR inability to bear weight immediately after injury and in ED

31
Q

Rules suggest Xray of midfoot is needed if

A

a) pain in midfoot zone +
b) tenderness at either navicular bone or base of 5th metatarsal OR inability bear weight immediately after injury and in ED

32
Q

Cochrane review demonstrated….led to quicker return to sports, work in comparison to…

A

Semi rigid ankle support > simple wraps/bandages

33
Q

RICE for MSK injuries

A

Rest for 72 hrs after ankle sprain (but then start to stretch to preserve range of motion and improve function of forming scar tissue)

Ice several times for 10 min

Compression
Elevation

34
Q

Pain control for ankle sprain

A

Recommend 2-3 ibuprofen for pain up to 3x/day (after eating a snack) and no Hx of ulcers or problems w NSAIDs

35
Q

Ankle re-injury prevention (3)

A
  1. daily ankle exercises
  2. no flip flops or sandals until ankle has healed
  3. protective device on ankle when returning to sports
36
Q

Exercises to restore ankle strength

A
  • ankle inversion, ankle eversion, ankle plantarflexion, ankle dorsiflexion, calf stretching
  • single leg balancing
  • proprioceptive exercises (best type of exercise)
37
Q

Empiric Tx for uncomplicated UTI

A

3 days of trimethoprim/sulfamethoxazole (but only if there is <20% resistance)

Family Medicine (10 decks)

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