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MSK/Derm > Adult Sports Medicine and Overuse Injuries > Flashcards

Adult Sports Medicine and Overuse Injuries Flashcards

1
Q

What are extrinsic risk factors related to activity for sports injury?

A

increase in volume or intensity

change in type of exercise

change in foot wear or running surface

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2
Q

What are extrinsic drug related risk factors for sports injuries?

A

fluoroquinolones

corticosteroids

statins

estrogen

non-steroidal anti-inflammatory drugs (ibuprofen and naproxen)

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3
Q

What are intrinsic risk factors for sports injuries?

A

systemic issues such as diabetes, hypertension, and vascular disease

previous injury

genetic

obesity through increased load or systemic alterations that promote degeneration

focal, regional, generalized weakness

biomechanical and kinetic chain abnormalities such as an inflexible achilles tendon or calf muscle

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4
Q

What is the structure and function of tendons?

A

connect muscle to bone

strength related to thickness and collagen content

transmit force from muscle to bone and act as a buffer by absorbing external forces to limit muscle damage

1 cm2 is capable of bearing 500 to 1000kg

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5
Q

What is the makeup of the dry mass of tendons?

A

65-90% collagen type I

2% elastin

collagen fibers are generally oriented longitudinally, along the line of pull of the musculotendinous unit

oxygen consumption is 7.5x lower than muscle

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6
Q

What happens to collagen fibrils at the myotendinous junction?

A

inserted into the deep recesses formed by myocyte processes, allowing the tension generated by intracellular contractile proteins of muscle fibers to be transmitted to the collagen fibrils

this complex architecture reduces the tensile stress exerted on the tendon during muscle contraction

however, the myotendinous junction still remains the weakest point of the musculotendinous unit

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7
Q

Where are synovial tendon sheaths found?

A

in areas subjected to increased mechanical stress, such as tendons of the hands and feet, where efficient lubrication is required

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8
Q

What determines the tensile strength of tendons?

A

related to thickness and collagen content

a tendon with an area of 1 cm2 is capable of bearing 500 to 1000 kg

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9
Q

What are the common findings upon histological examination of tendinopathy?

A

disordered, haphazard healing with an absence of inflammatory cells

a poor healing response

noninflammatory intratendinous collagen degeneration

fiber disorientation and thinning

hypercellularity

scattered ingrowth

increased interfibrillar glycosaminoglycans

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10
Q

What are the three stages of healing of tendons?

A

inflammation, remodeling, and maturation

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11
Q

What are the risk factors of rotator cuff?

A

weakness or inflexibilities at distant structures

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12
Q

What is rotator cuff tendinopathy?

A

more common in the middle age than in early adulthood

can be associated with abnormal scapular motion

often responds to strengthening of shoulder girdle

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13
Q

What is achilles tendinopathy?

A

accounts for up to 30% of running injuries

more common in mid-substance (55-65%) than at the insertion (20-25%)

occurs in 4% of non-runners

occurs at midportion of tendon and at insertion of the calcaneous

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14
Q

What are the risk factors for achilles tendinopathy?

A

factors that affect vasculature and oxygen transport:

dyslipidemia

hypertension

obesity

diabetes

genetics

decreased calf strength

abnormal subtalar motion

medications - quinolones, corticosteroids, BCP

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15
Q

What is the clinical presentation of achilles tendinopathy?

A

generall occurs without a sudden injury

pain primarily with sport, sometimes with walking, not at rest

localized pain to mid-portion or insertion

generally not warm or erythematous

strength is normal

does not usually progress to rupture

often associated with nodularity at the midportion of the tendon

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16
Q

What is the treatment for achilles tendinoapthy?

A

relative rest, but can cross-train

heal lift if significant pain with casual walking

if no partial tear is present, often responds well to exercise therapy

can use injections or surgery as well

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17
Q

What is the pathology of achilles tendinopathy?

A

non-inflammatory intratendinous collagen degeneration

fiber disorientation and thinning

scattered vascular ingrowth (neovascularization)

gray-brown and amorphous

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18
Q

What is the prognosis of achilles tendinopathy?

A

most recover completely with treatment

if not recovering, review exercise program of consider different diagnosis

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19
Q

What is patellofemoral pain?

A

pain between the patella and femur

most common cause of anterior knee pain

one of the most common injuries in runners

pain more likely with going down stairs than up stairs

also occurs in non-athletes

25% of knee injuries

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20
Q

What are the risk factors for patellofemoral pain?

A

quadriceps and/or hip weakness or fatigue

shallow trochlea of femur

hyperlaxity of patella

increased Q-angle

ITB, quadriceps, and/or hamstring inflexibility

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21
Q

What is the basic pathology of patellofemoral pain?

A

not well understood

increased stress between the patella and femur

generally not overtly inflammatory

pain likely from increased pressure on subchondral bone

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22
Q

What is the physical therapy program for patellofemoral pain?

A

strengthening of quadriceps, hip abductors, and hip external rotators

providing stretches for areas of inflexibility, such as at the iliotibial band or hamstrings

23
Q

What is the recommended management of patellofemoral pain?

A

evaluate and treat biomechanical issues that are associated

  • inflexibal iliotibial band, quadriceps, and hamstrings
  • recommend arch support if flexible overpronation exists

generally responds well to a therapeutic exercise program

24
Q

What is the presentation of patellofemoral pain?

A

non-focal anterior knee pain

sudden or gradual onset

some describe weakness or giving way

overt swelling is rare

tenderness at the patellar facets, not at joint lines

dynamic valgus

25
Q

What is the treatment for patellofemoral pain?

A

comprehensive rehab to address inflexibilities, strengthen quads and hip, or kinetic chain abnormalities

knee brace and/or taping

meds (analgesics/NSAIDs) - won’t fix problem

modification of activity

26
Q

What are the three grades of muscle strain?

A

grade I - microscopic tear

grade II - macroscopic partial tear

grade III - complete tear

27
Q

What characterizes muscle strain?

A

occur more commonly in muscles that corss two joints

injury occurs at musculotendinous junction

generally heal well without long-term sequelae

10-55% of all sports injuries

include hamstrings, calf, and quadriceps - all two joint muscles

28
Q

What are the most common sprains?

A

inversion ankle sprain

29
Q

What is the pathology of muscle strain?

A

result from excessive intrinsic tensile force

injury at myotendinous junction

soft tissue bleeding

30
Q

stage I healing of injured soft tissue

A

inflammatory phase

red and white blood cells infiltrate

initiation of angiogenesis

removal of necrotic material

31
Q

stage II healing of injured soft tissue

A

proliferative phase

infiltration of myocytes

production of collagen (type III)

32
Q

stage III healing of injured soft tissue

A

remodeling phase

consolidation phase

maturation phase

33
Q

What is the presentation of muscle strain?

A

sudden onset of pain

decellerated injury

stops sports play

impaired function

pain +/- weakness

TTP at site of injury

34
Q

What is the treatment for muscle strain?

A

initially rest for 4-7 days

RICE principle - rest, ice, compression, elevation

progress from strengthening and stretching to agility and trunk stab exercises

35
Q

What ligaments are usually inolved in sprains?

A

involves injury to the anterior talofibular ligament (ATFL), calcaneofibular ligament, or the posterior talofibular ligament, with the ATFL affected most commonly

36
Q

What is the pattern of occurance of ankel sprains?

A

2 million per year

2.15 per 1000 person-years

peak incidence 15-19 years old

half occur during athletic activity

static restraints to maintain joint stability

37
Q

What are the risk factors for ankle sprains?

A

strength

propioception/balance

range of motion

landing after a jump

ATFL most commonly injure

38
Q

What is the clinical presentation of ankle sprains?

A

sudden onset

inversion and plantar flexion

often with impaired function

mild focal to diffuse generalized lateral ankle swelling

may have laxity

39
Q

What is the treatment of ankle strains?

A

may immobilize briefly

taping or bracing reduces recurrence

rehab - train for coordination and balance prevents recurrence

training does not prevent 1st sprain

40
Q

What is the prognosis of ankle sprains?

A

pain decreases within the first two weeks

most have full recovery

up to 1/3 have pain and/or a recurrence at one year

41
Q

What is involved in the management of sprains?

A

after a period of protected weightbearing rehabilitation exercises needed to be instituted to minimize risk of recurrent sprains in the future

1) start with basic range of motion exercises and isometric strengthening
2) as ligament heals progress to closed kinetic chain exercises that incorporate challenging balance
3) incorporate sport-specific exercises in preparation for return to sport
4) if doing well but has mild pain with sports play initially, could use ankle brace for a brief period of time

42
Q

When do stress fractures occur?

A

when excessive loads are applied to a bone whose mechanical strength is normal

10-20% of consultations in sports medicine practice

training errors common cause in runners

tibial shaft stress fractures account for about 50%

other sites include metatarsals and femoral shaft or neck

43
Q

What are some major risk factors of stress fractures?

A

intrinsic factors - female, poor nutrition, exercise experience, older age, bony anatomy, etc.

extrinsic factors - training errors, downhill running, harder surface, meds that affect bone density

44
Q

What are risks for low bone density?

A

abnormal menstrual cycles

nutritional deficiencies

health associated with low bone density

45
Q

What is a recommended exercise program for achilles tendinopathy?

A

eccentric exercise program

3 sets of 15 reps 2x/day

should cause some pain

may take weeks to improve

46
Q

Where are stress fractures most common?

A

tibia

metatarsals

pelvis

femur

can arise at any other site as well, though less common

47
Q

When do stress fractures usually occur?

A

after increase in activity, such as suddenly running twice the distance one is usually running

48
Q

What is the grading of stress fractures?

A

grade 0

grade 1 - periosteal edema

grade 2 - marrow edema

grade 3 - more severe marrow edema

grade 4a - intracortical signal changes

grade 4b - linear region of intracortical signal change

49
Q

What is the proper management of stress fractures?

A

generally responds well to a period of protected weightbearing followed by a gradual return to activity

need to treat underlying causes for low bone density

needs brace or crutches

pain-free activity

treat underlying causes of ow bone density

gradual return to athletic

50
Q

What is the prognosis of patellofemoral pain?

A

good to excellent

may take weeks to improve

if major anatomic abnormalities persist, may need surgery

minimal chance of recurrence

51
Q

What is the prognosis of muscle strain?

A

most recover without significant sequelae

the more severe the strain, the longer the recovery

52
Q

What is the pathology of stress fractures?

A

bone fatigue - normal bone

bone insufficiency - abnormal bone

bone remodels constantly through a balance between osteoclastic and osteoblastic activity

53
Q

What is the presentation of stress fractures?

A

sudden onset with progression of pain

pain with most steps

in female, often with risk factors

take detailed history on training and for risk factors

TTP focally at site of pain with some swelling

MSK/Derm (54 decks)

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