Case 4: Female with Sports Injury Flashcards Preview

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Flashcards in Case 4: Female with Sports Injury Deck (37):
1

Compartment syndrome

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

2

Causes of compartment syndrome

Fractures
Crush injuries
Burns
Arterial injuries

3

Treatment of compartment syndrome

Emergent decompression via fasciotomy

4

6 P's of compartment syndrome

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

5

Significant ankle injury features

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

6

Hearing a snap or a tear is diagnostic of

Knee injury (not ankle)

7

Characteristics considered when grading an ankle sprain

- 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)

8

Grade 1 ankle sprain: stretching or small tear of ligament

- mild tenderness + swelling
- mild or no functional loss
- no mechanical instability
- no excessive stretching or opening of joint w stress

9

Grade 2 ankle sprain: incomplete tear

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

10

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

- severe swelling (> 4 cm about the fibula)
- ecchymosis
- can't bear weight
- mechanical instability
- stretching of joint w stress without definite stopping point

11

Mechanisms of injury of ankle sprains

a) plantar flexion and inversion (most common)
b) excessive eversion and dorsiflexion

12

Damaged structures in plantar flexion/inversion ankle sprain

Lateral stabilizing ligaments
- anterior talofibular (most easily injured)
- calcaneofibular (if injured = instability)
- posterior talofibular (rarely injured)

13

Ankle anterior drawer test

Used to assess integrity of anterior talofibular ligament

14

Ankle inversion stress test

Used to assess integrity of calcaneofibular ligament
- invert patient's ankle and assess for laxity

15

Excessive eversion and dorsiflexion leads to damage of what structures?

Medial stabilizing ligaments (less common than lateral because of bony articulation b/w medial malleolus + talus)
- strong deltoid ligament
- anterior tibiofibular ligament
- bony martise

16

Examining injured lower extremities

- 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

Crossed leg test

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

18

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

- lateral ankle sprain
- peroneal tendon tear
- fibular fracture
- talar dome fracture
- subtalar dislocation

19

Less likely causes of acute ankle pain (4)

- medial ankle sprain
- syndesmotic sprain
- fracture of tibia
- arthritis of ankle

20

Lateral ankle sprain

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

21

Peroneal tendon tear

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

Fibular fracture

Due to fall, athletic injury, or high velocity injury
- severe pain, swelling, inability to ambulate, deformity

23

Talar dome fracture

Due to acute injury - can be missed on initial Xray
- biggest concern is avascular necrosis (due to interruption of blood supply)

24

Subtalar dislocation

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

With pain, swelling, deformity

25

Medial ankle sprain

due to forced eversion
Injury to deltoid ligament

26

Syndesmotic sprain

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

27

Fracture of tibia

After high velocity trauma
- severe pain
- cannot bear weight at all
- visible malformation of extremity

28

Arthritis of ankle

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

Stiffness, swelling

29

Ottawa ankle rules

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

30

Rules suggest Xray of ankle is needed if

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

Rules suggest Xray of midfoot is needed if

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

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

Semi rigid ankle support > simple wraps/bandages

33

RICE for MSK injuries

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

Pain control for ankle sprain

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

35

Ankle re-injury prevention (3)

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

36

Exercises to restore ankle strength

- ankle inversion, ankle eversion, ankle plantarflexion, ankle dorsiflexion, calf stretching
- single leg balancing
- proprioceptive exercises (best type of exercise)

37

Empiric Tx for uncomplicated UTI

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