Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Injuries in Sport > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Anterior compartment of lower leg

A

Tbialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius
Deep peroneal nerve
Anterior tibial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lateral compartment of lower leg

A

Peroneus brevis, peroneus longus
Superficial peroneal nerve
Peroneal (perforating) arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Deep posterior compartment of lower leg

A

Tibialis posterior, flexor digitorum longus, flexor hallucis longus, popliteus
Tibial nerve
Posterior tibial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Superficial posterior compartment of lower leg

A

Gastrocnemius, soleus, plantaris

Cutaneuous nerves only e.g. sural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Night pain

A

Wakes you up at night

ask for systemic symptoms that indicate autoimmune diseases or cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tinnel’s sign

A

Light palpation on nerve reproduces symptoms of pins and needles/ tingling => irritated nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Foot dorsiflexion

A

10-15

Tibialis ant, EDL, EHL, peroneals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Foot plantarflexion

A

45-55

Gastroc, soleus, tib posterior, FDL, FHL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Foot inversion

A

30-40

Tibialis posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Foot eversion

A

15-25

Peroneals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Foot pronation

A

15-30

Eversion + Abduction + Dorsiflexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Foot supination

A

45-60

Inversion + Adduction + Plantar flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Over pronation (i.e. flat foot) causes

A 
flattening of long arch
movement mid-tarsal joints
rotation of tibia
functional q angle of knee
load on tibialis posterior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Isotope bone scan (IBS)

A 
Radioactive isotome -> inject Technetium-99 polyphosphonate
Triphasic bone scan 
- 0 mins: isotope angiogram
- 2 mins: blood pool
- 2 hr: delayed

Looking for hotspots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Stress fracture

A

Acute onset due to repetitive microtrauma
Imbalance between deposition/resorption
Low BMD
Fatigue of shock absorbing muscles

Point tenderness O/E
Crescendo night pain
Immediate pain on running
Training conditions - hard surface, increased intensity

Plain radiograph => callus at 2-3wks
IBS

Rest for 6-9wks until pain free
immobilise if severe
phased RTS
Internal fixation if not healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medial Tibial Stress Syndrome (Shin splints)

A

Cause unknown - theories of traction periostitis or tibial bending

lasts hrs to d
Typically within first 2 wks of new season
Aching during/after exercise
Able to exercise through pain
O/E Posterio-medial tenderness on distal third of tibia

RF: INTRINSIC - endocrine, bone geometry, biomech, nutritional; EXTRINSIC - surface, training error, footwear

Ix - XR, IBS, MRI

Rx - RICE for 7-10d, aerobic NWB fitness, podiatry for assessment

Prevent - gradual increased training, good dorsiflexion, flexibility pre-season, footwear, training surface, diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Chronic Compartment Syndrome

A

Increased pressure within a closed compartment due to inelastic fascia; caused by increased muscle volume due to continuous exercising
Compromised circulation and tissues

Starts within a few mins of exercise and stops after rest
Stops them from continuing
Associated numbness and weakness

Ix
Intra-compartmental pressure studies; insert cather in muscle and exercise for 5 min
Normal <10mmHg; Significant >30mmHg

Physio, orthotics, NSAIDS
Superficial fasciotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tibialis Anterior/ EDL/ EHL Tendinopathy

A

Overuse injury of dorsiflexors
Downhil running, tight shoelaces

TA => pain on resisted dorsiflexion
EDL => pain on resisted toe extension
EHL => pain on resisted halux extension

RICE, Rehab, injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tibialis Posterior/ FDL/ FHL Tendinopathy

A

Overuse of plantarflexors
Ballet dancers
Tom, Dick and nervous Harry

TP => post-medial calf -> medial melleolus -> navicular tuberosity ; pain on resisted inversion
FHL => Pain on resisted toe flexion

RICE, eccentrics, injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Popliteal artery entrapment syndrome

A

Claudication during exercise by head of gastrocnemius or thick fibrous band
Similar Sx to CCS
Tib posterior pulse disappears when acutely plantarflexed

Doppler, Arteriogram

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nerve entrapment

A

Superficial peroneal nerve (lateral compartment)
Pain and paraesthesia
Tinnel’s sign

Nerve conduction studies

steroid injection, surgical release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Fascial hernia

A

Anterior compartment defect

Similar Sx to CCS
Detectable swelling on standing/exercising -> disappears on lying

Subcutaneous fasciotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Knee - Per Anserinus (aka goose foot)

A

Sartorius, gracilis, semitendinosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lateral knee (superficial to deep)

A

ITB
Patella retinaculum
LCL and joint capuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Medial knee (superficial to deep)

A

Sartorius
Superficial MCL
Deep MCL and joint capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Back of the knee

A

PCL
Popliteus
Menisci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Function of popliteus

A

Unlocks tibia relative to the femur in flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MCL origin and Inserion

A

Origin - behind medial epicondyle

Insertion - 1cm below joint line

29
Q

Questions to ask about knee pain

A

VAS
Constant or related to activity
Anterior, stair climbing, prolonged sitting => PFP
Twisting/rotating => meniscal

30
Q

Questions to ask about knee instability

A

Pivoting/ twisting => ACL
Linear instability - stairs/ level ground => quads weakness
Side to side instability => PCL

31
Q

Mechanical symptoms of knee

A

Locking/ clicking/ snapping => bucket handle meniscal tear; loose body

32
Q

Other questions - knee

A 
treatment to date
benefits of previous treatment
athletic hx
PMH
Occupational Hx
33
Q

Knee examination

A

Inspection
Palpation
ROM and strength
Patella - tilt, apprehension, translation, crepitus, j-sign, q angle
Meniscus - McMurray’s, Apley’s, Thessaly’s
Ligamentous stability - anterior and posterior drawer, Lachman’s, Pivot-shift, quads active, varus/valgus, dial test, external rotation
Gait
Joint borders
Nerves and vessels

34
Q

J-sign

A

patella flips out laterally on flexion

35
Q

Zones of meniscal blood supply

A

Red red zone – very vascular – will heal more easily
Red white zone – medium blood supply
White white zone – inner  avascular

36
Q

Double PCL sign

A

Pathognomic of a bucket handle meniscal tear

37
Q

Management of Meniscal tear

A

Non-operative

  • <5mm stable peripheral tear
  • Degenerative tears
  • Associated ligamentous instabilities
  • Medically unfit

Surgically treated either by removal of the meniscus via arthroscopy, or using sutures

38
Q

Articular Lesions

A

Types

  • Partial thickness chondral lesions; avascular
  • Full thickness defects; potential to feel with fibrocartilage (type 1 collagen)
  • Traumatic vs insidious

Accelerate degenerative wear and loose body formation in joint capsule
structural abnormality in patella and joint

Ix
MRI with gadolinium
Other: AP XR, CT, PA XR in 45dg flexion

39
Q

Articular Lesions: Grades

A

Grade 0 - Normal bone
Grade 1 - 75% (soft cartilage and swelling)
Grade 2 - 50% (partial thickness defect with fissures)
Grade 3 - 25% (fissuring to subchondral bone)
Grade 4 - Down to subchondral bone

40
Q

Articular Lesions Management

A

Treatment for G3/4 after failed non-op
Avoid in obesity, inflammatory conditions, malalignment, meniscal defects, degenerative changes

Best options: ACI and OCD, OATS

Microfracture
Osteochondral Autograft Transplantation (OATS)
ACI and Osteochondral allograft (OCD) transplantation

41
Q

Microfracture

A 
For defects <4cm2 in patients <35yo
Creates a bigger defect and puncture holes to cause the bone to bleed and fill the defect with clot which will over time become fibrocartilage to relieve the pain
Immediate post-op ROM on CPM instituted
TWB for 6-8 weeks
Return to sport after 4-9 months
42
Q

Osteochondral Autograft Transplantation (OATS)

A

For younger patients with more demand on their knees
Allograft; lateral trochlear ridge taken from patient or cadaveric meniscus
NWB for 3 weeks
Full ROM immediately
4/12 return to sport

43
Q

ACI and Osteochondral Allograft transplantation

A

Autologous chondrocyte transplantation
Good results in larger defects
Better for patellofemoral joint
OCD has better results with non-op in pts with open growth plates

Immediate CPM
NBW until ROM and quads strength restored
FBW usually by 10-12/52
Possible off-loading brace use
Progressive walking programme from 12-32/52 (elliptical, swimming, cycling)
Jogging/aerobics 9-12/12
High impact sport at 12-18/12

44
Q

ACL Tear Treatment

A

Graft harvest from patella

Early ROM exercises!
Closed chain exercises emphasised in early rehab
Delay sports for 6-9 months

45
Q

PCL Tear Treatment

A

Isolated tear not treated

brace for 4wks
rehab
return to running soon
only 3rd degree tear needs surgical rx

PCL tear + another ligament tear => reconstruct both
post-reconstruction brace for 6-12 wks

46
Q

MCL Tear Treatment

A

Grade 1 &2 repair themselves with hinged brace for 6 wks
Closed chain exercises, jogging and treadmill start once contralateral quad strength is 80%
RTS once 80% max speed achieved

Grade 3 requires surgery if when in full extension knees moves excessively in valgus
Combined injury in 80%
Tibial sided tears require acute surgical repair
Stener lesions occur with avulsion fracture and will not heal without repair

47
Q

LCL Injury

A

Dial test

  • Prone at extension – externally rotate the legs – if asymmetry => LCL tear
  • Prone at 90 degrees flexion – externally rotate the legs – if asymmetry => PCL and LCL tear
48
Q

Patellar tendonitis

A 
Jumping athletes
Repetitive, forceful eccentric contraction
80-90% RTS
Physiotherapy = only treatment
Surgery has poor outcome
49
Q

Patellar instability

A

Caused by increased Q angle, i.e. valgus
Young females
Repaired by moving tibial tuberosity through osteotomy or MPFL reconstruction

50
Q

Sinus Tarsi Syndrome

A

Pain and instability following supinatory ankle sprain

Conical cavity between anterior and posterior talo-calcaneal joint; base lies over antero-lateral ankle
contains ligamnt and nerves

Clinical diagnosis
MRI for confirmation

Rx
Stapling
Injection

51
Q

Cuboid Syndrome

A

Acute or chronic
Following inversion injury
Common in over-pronated, hypermobile, pes cavus
Predisposing factors - Increase mechanical advantage of peroneus longus running under cuboid, over-corrected foot orthoses, poor footwear

Pain during activity on unever surface
Dull ache in 5th ray
Swollen foot, bruised
Severe => Limping, difficulty WB

MRI, Dynamic CT, XR, Vitamin D

RICE, Brace, Manipulation and taping, injection, orthotics, surgery

52
Q

Plantar Fasciitis injection

A

Steroid injection

Risk - potential fascial rupture and fat pad atrophy

53
Q

Achilles Tendinopathy

A

Common in primary care
Majority self-limiting in early phases
Debilitating with significant socio-economic impact

> 10% persistence of Sx and fail to respond to Rx
Surgery when persistence of >6month

54
Q

Mid-portion Achilles Tendinopathy

A

Aetiology unclear

  • training errors
  • overuse stresses
  • lack of flexibility

Intrinsic factors - tendon vascularity, GS dysfunction, age, sex, weight, height, pes cavus, lateral ankle joint instability
Extrinsic - change in training method, poor technique, previous injury, footwear, surface

Little or no inflammation
Degeneration - loss of collagen structure, scarring, cysts
Neo-vascularisation > neo-nerves; REDUCE NEO-VASCULARISATION REDUCE PAIN
immobilisation ineffective

55
Q

Tendinopathy spectrum

A

Reactive - non-inflammatory proliferative response in the cell and matrix

Dysrepair - Matrix breakdown and disorganisation

Degenerative - Progression of both matrix and cell changes, cell death/ apoptosis

56
Q

Tendinopathy Management

A 
Prevention - sensible training programme
Early medical attention
Rest from aggravating exercise
Modify activity
Deep friction massage
Gentle static stretch
Eccentric strengthening of gastoc-soleus muscle
Foot orthoses
Control of Sx
HVIGI
ESWT
Regenerative medicine
surgery
57
Q

Achilles tendinopathy treatment options

A 
Sclerosant
dry needling
GTN
ESWT
Regenerative medicine - PRP/ Autologous blood, stem cell, tenocyte implantation
Electro-coagulation
Radiofrequency
Corticosteroid
HVIGI
58
Q

10 days post HVIGI

A

High volume image guided injection - 40ml normal saline + 9ml 0.5% Marcaine + 20mg Depomedrone; injected under USS guidance betwen anterior aspect of tendon and Kager’s fat pad

  • 3 days relative rest. Avoid high impact, rushing around and stairs.
  • 3 days eccentric loading (Alfredsson or modified).
  • 3 days start sports or activity specific functional loading.
  • 10th day – start RTS specific rehabilitation programme.
  • Full training at 2-3 weeks depending on symptoms.
  • Repeat HVIGI only if still painful or AT reoccurs.
59
Q

Crisp-Padhiar Syndrome

A

Trauma
Presence of Os naviculare
Tibialis posterior tendinopathy and dysfunction
Acquired flatfoot
Os naviculare synchondrosis
Anomalous tibialis posterior attachment of Os naviculare

60
Q

Osteoarthritis of the foot

A

Cartilage deteriorates + Osteophytes + Altered joint mechanics
Pain, stiffness, swelling
Big toes - common cause of forefoot pain
Men

XR - Osteophyte, joint space narrowing, sclerosis, joint irregularities and bone cysts

61
Q

OA Classification

A

Radiographic classification

GRADE 0: Dorsiflexion 40-60° , Normal radiography , No pain.

GRADE 1 - Dorsi 30-40, Mild to mod osteophytes formation, good joint preservation

GRADE 2 - Dorsi 10-30, Moderate osteophyte formation, joint space narrowing, subchondral sclerosis

GRADE 3 - Dorsi <10, Marked osteophyte formation, loss of visible joint space, with or without subchondral cyst formation, constant to severe pain at extremeties

GRADE 4: Stiff joint, Severe changes with loose bodies and osteochondritis dissecans

62
Q

OA Treatment

A

CONSERVATIVE
NSAIDS. Glucosamine with chondroitin. Vitamins & Minerals.
Foot orthoses. Shoe modification (rocker). Modification of activity.
Physiotherapy.
MUA/Image guided injection – LA + Steroid, Ostenil mini, prolotherapy.

SURGERY
Cheilectomy
Dorsiflexion phalangeal osteotomy (Kessel-Bonney)
Metatarsal Osteotomy (Waterman’s decompression) Arthroplasty (Keller’s)
Arthrodesis - favoured procedures
Hemi-implants
Total joint replacement

63
Q

Freiberg’s Disease/Infraction

A

Infraction and fracture of metatarsal head
F>M 4:1
Pts 13-18yo
Common in 2nd and 3rd metatarsals; common with long second metatarsal

Disruption in blood supply due to micro-trauma or osteonecrosis and stress overloading > collapse of the 2nd metatarsal head

64
Q

Smillie classification (Freiberg’s disease)

A

Stage 1 - Subchondral fracture visible only on MRI

Stage 2 - Dorsal collapse of articular surface on plain radiographs

Stage 3 - Collapse of dorsal MT head, with plantar articular portion intact

Stage 4 - Collapse of entire MT head, joint space narrowing

Stage 5 - Severe arthritic changes and joint space obliteration

65
Q

Ainhum

A

Painful constriction of usually 5th toe

Resulting in autoamputation

66
Q

Loa loa filariasis

A

Infection Loa Loa (worm)
Hard soft tissue mass behind achilles tendon; superficial

XR - linear pearl-like calcification

Surgical removal

67
Q

Adnexal tumour of hallux

A

Rare

XR - multiple enchondroma
Malignant mixed chondroid syringoma

68
Q

Morton’s neuroma

A

benign fibrotic thickening of a plantar interdigital nerve
Irritation of nerve
degenerative process

Compression or entrapment of the nerve.
Stretching of the nerve.
Nerve ischaemia.

Avoid shoes with thin soles, high heels, or a constricting toe box.
Metatarsal pad
+/- NSAIDs

Injuries in Sport (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions