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EPHE 344 > Final > Flashcards

Final Flashcards

1
Q

What are the most common mechanisms of injuries?

A

1) All out exertion
2) Contact
3) projectiles
4) body being thrown through air
5) repetitive movements
6) speed of sport
7) duration of activity (extended)
8) large number of participants in small area

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2
Q

What is load?

A

An external force acting on the body causing internal reactions within tissues

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3
Q

What is stiffness?

A

The ability of a tissue to resist a load. Greater stiffness=greater magnitude load can resist

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4
Q

What is stress?

A

An internal resistance to a load

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5
Q

What is strain?

A

The internal change in tissue resulting in deformation

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6
Q

What is the yield point?

A

The amount of deformation viscoelastic tissues can withstand before succumbing to stress

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7
Q

What are the 5 different types of mechanical stress?

A

1) Compression
2) Tension
3) Shearing
4) Bending
5) Torsion

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8
Q

How does compression cause damage?

A

A) axial stress along a structures longitudinal axis e.g. standing
B) Trauma along the long axis of a bone causing tissue failure due to excessive compressive loads e.g. burst fracture of the spine

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9
Q

How does tension cause damage?

A

Effects the linear stretch of tissues such as muscles or ligaments. Tension injuries result in tissue disruption along the length of a muscle or ligament e.g. hamstring strain

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10
Q

What is shear stress?

A

Stress that causes two opposing bones to become displaced on one another in parallel to the articular surfaces e.g. spondylolisthesis

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11
Q

How does bending effect bone?

A

Bending of the bone causes a pathological response, even if a fracture does not occur

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12
Q

What is torsion?

A

A twisting force that causes the tissues to fail e.g. ACL

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13
Q

What is the general system for classifying injuries?

A
  • Stage of injury or healing
  • Severity of the injury
  • Type of tissue damaged/injured
  • Type of mechanism (Mx)
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14
Q

What are the broad characteristics of a musculotenidous unit (MTU) injury?

A
  • High incidence in sport
  • Potential causes include electrolyte imbalance, antagonist/agonist failure, muscular strength imbalances
  • Generally involves large force producing muscles
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15
Q

What are the characteristics of a 1st degree sprain?

A

Some fibers torn or stretched. Full ROM, but painful

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16
Q

What are the characteristics of a 2nd degree sprain?

A

Multiple fibers torn. Contractions painful. Divot is palpable. Some swelling and discoloration. Decreased ROM

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17
Q

What are the characteristics of a 3rd degree sprain?

A

Complete rupture of tendon at MT junction or off bone. Significant impairment. Great deal of initial pain that tapers off due to nerve damage

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18
Q

What is the healing time of a muscle sprain?

A

6-8 weeks

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19
Q

What are muscle cramps and why do they occur?

A

Painful involuntary muscle contractions. Occurs in overload and fatigue of high demand activities due to altered neuromuscular. Usually occurs when the muscle is in a shortened position

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20
Q

What is muscle guarding?

A

Post injury, muscles in the surrounding area will contract to splint the area to limit motion thereby minimizing pain. Involuntary muscle contraction-NOT a muscle spasm

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21
Q

What are muscle spasms?

A

Involuntary reaction that interferes with voluntary movement by increasing muscle tension and shortening. May lead to muscle strains

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22
Q

What are the two types of muscle spasms and their characteristics?

A

Tonic: Rigid contraction that lasts for a period of time
Clonic: alternating involuntary muscle contractions and relaxations in quick succession

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23
Q

What is the breaking point of a tendon?

A

6-8% increase in length

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24
Q

How does repetitive stress weaken tendons?

A

Causes microtrauma and elongation which causes a fibroblast influx and increased collagen production

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25
Q

What are the ESSM of tendonitis?

A

E: Repeated microtrauma and degenerative changes associated with repetitive and overuse movements
S+S: obvious swelling, pain on movement, crepitus
M: Rest, use substitute activities

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26
Q

What is tendinosis?

A

Chronic tendon degeneration. Minimal inflammation, tendon sheath may be swollen with restricted and stiff.

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27
Q

What age group is tendinosis most prevalent in?

A

Middle age

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28
Q

How is tendinosis treated?

A

Stretching and strengthening

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29
Q

What is tenosynovitis?

A

Inflammation of the tendon sheath, usually in high friction areas. Usually occurs in long flexor digits of digits and biceps bracaii

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30
Q

What are the differences between chronic and acute tenosynovitis?

A

Chronic: Thickening of tendon with pain and crepitus
Acute: Rapid onset, crepitus, and diffuse swelling

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31
Q

What are contusions?

A

A bruise that results from a sudden traumatic blow that compresses soft or bony tissues

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32
Q

What is a potential complication of chronically inflamed and contused tissue?

A

Myositis ossificans

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33
Q

What are the components of a synovial joint?

A

1) Hyaline and/or articular cartilage
2) Fibrous connective tissue capsule
3) Ligaments
4) Capsule with synovial membrane
5) Joint cavity with synovial fluid
6) Blood and nerve supply
7) Muscles
8) Menisci (fibrocartilage)

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34
Q

What are ligamentous strains?

A

Result of traumatic tissue stress that forces the joint outside of its normal ROM. Causes stretching or tearing of ligamentous tissue

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35
Q

What are the characteristics of a Grade I ligamentous strain?

A

Minor fiber damage and minimal instability. Mild to moderate pain, minimal loss of function and swelling

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36
Q

What are the characteristics of a Grade II ligamentous strain?

A

Tearing of fibers with moderate instability. Moderate to severe pain, swelling, and loss of function

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37
Q

What are the characteristics of a Grade III ligamentous strain?

A

Complete tear, may sublux. Extremely painful initially, Inevitable loss of function, severe instability and swelling.

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38
Q

What is the difference between a subluxation and dislocation?

A

A subluxation is a brief transient injury involving partial dislocation and spontaneous joint relocation. A dislocation does not relocate and involves a complete disarticulation of a joint (usually synovial)

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39
Q

What is a separation?

A

Separation of a fibrous joint due to stretching and tearing of the supporting tissues

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40
Q

What does Wolff’s Law state?

A

That every change in bone form or function, or just function, is followed by architectural changes

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41
Q

What are some S+S of a bone fracture?

A

Deformity, pain, point tenderness, swelling, pain on active and passive movements. Possible crepitus.

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42
Q

What are the MOI that can result in a fracture?

A

Direct: At point of force application
Indirect: Sudden violent and forceful muscle contraction

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43
Q

What are some types of fracture?

A

Greenstick, comminuted, linear, butterfly, transverse, oblique, spiral, avulsion, impacted, depressed

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44
Q

How do stress fractures occur?

A

Number of possible causes: overload due to muscular contraction, altered stress distribution due to fatigue , changes in surface, rhythmic repetitive stress vibrations

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45
Q

What is the progression of stress fractures?

A

Focal microfractures, periosteal or endosteal response (stress fx), linear fractures or displaced fractures

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46
Q

How are stress fractures detected?

A

Early detection difficult, bone scan useful, xray after several weeks

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47
Q

What is HOPS?

A

History, observation, palpation, special tests

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48
Q

What is SOAP?

A

Subjective, Objective, Assessment, Plan

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49
Q

What are some pertinent questions when taking a history?

A

Chief complaint (S+S), What happened (MOI), When it happened, Where is the location of injury, Has this happened before (If so, when), Past medical history/injuries, Pain characteristics

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50
Q

What are the characteristics of nerve pain?

A

Bright, burning, sharp, specific distribution

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51
Q

What are the characteristics of bone pain?

A

Deep, piercing/sharp, localized. May be severe

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52
Q

What are the characteristics of vascular pain?

A

Diffuse, throbbing, generalized, may be referred from another area

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53
Q

What are the characteristics of muscle pain?

A

Dull, aching, referred to another area

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54
Q

What are the characteristics of ligament pain?

A

Dull/aching

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55
Q

What questions should be asked to determine pain characteristics?

A

Where is the pain? Does the pain change throughout the day? What makes it better? Worse? Do you feel any characteristics other than pain?

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56
Q

What questions should be asked about joints?

A

Does your joint “give out”? Do you experience any locking? Does it feel unstable or lax/loose?

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57
Q

What are some redflags?

A

Severe unremitting pain, pain unaffected by meds or position, severe night pain, severe pain with no history of trauma, severe spasm, bowel/bladder changes, changes in vision, swallowing or speech changes, changes in balance/coordination/falling, SOB, heavy chest

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58
Q

What are some general points to note during observation?

A

Posture deformity, how they’re moving, skin colour and texture, scars or atrophy, crepitus-snapping-or abnormal sounds, swelling-edema-colour-atrophy, attitude towards condition and examiner, willingness to move, facial expressions, grimace/wincing/gasping in pain

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59
Q

What does AROM test?

A

Both contractile and inert tissues

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60
Q

What does PROM test?

A

Bones, ligaments, fascia, nerves, etc.

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61
Q

What are some normal end feels?

A

Hard: Bone on bone
Soft tissue approximation
Firm/Capsular (Tissue stretch)

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62
Q

What are some abnormal end feels?

A

Springy block (rebounded), empty (none or arrested), spasm (guarding), loose (extreme hypermobility)

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63
Q

What neurological tests should be performed?

A

Cerebral function/Cranial nerves/Cerebellar function (head injuries, dermatomes, myotomes, reflexes

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64
Q

What are the three major stages of healing?

A

1) Inflammatory phase
2) Fibroblastic repair phase
3) Remodeling-maturation phase

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65
Q

What causes the initial reaction of the inflammatory phase?

A

Leukocytes and phagocytes

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66
Q

What is the goal of the inflammatory stage?

A

Protect, localize, decrease injurious agents, prepare for healing and repair

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67
Q

How can the inflammatory phase be characterized?

A

By SHARP or

  • Rubor (Redness)
  • Tumor (Swelling)
  • Color (heat)
  • Dolor (pain)
  • Functio laesa (loss of function)
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68
Q

What is the general progression of events during the inflammatory phase?

A

1) Injury to cell
2) Chemical mediators liberated (histamine, leukotrienes, cytokines)
3) Vascular reaction (Vasoconstriction->vasodilation->exudate creates stasis)
4) Platelets and leukocytes adhere to cell wall
5) Phagocytosis
6) Clot formation

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69
Q

What are chemical mediators derived from?

A

Invading organisms, damaged tissue, plasma enzyme systems, and WBC

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70
Q

What are histamines role in the inflammatory response?

A

Derived form mast cells. First to arrive. Causes vasodilation and changes cell permeability which contributes to swelling

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71
Q

What are leukotrienes and prostaglandin’s roles in the inflammatory response?

A

The impact the margination of leukocytes (ability to adhere to cell wall), increase permeability of fluid, protein, and nutrient passage (diapedesis), facilitates exudate formation extravascularly

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72
Q

What are cytokines role in the inflammatory response?

A

They regulate leukocytes and attract phagocytes

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73
Q

What is the initial vascular response?

A

Vasoconstriction, spasm, and coagulation

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74
Q

What happens when vasodilation occurs?

A

Initial increase in blood flow is seen, margination occurs (WBC can adhere to cell walls). Blood flow begins to decrease and blood viscosity increases resulting in swelling

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75
Q

What happens during clot formation?

A

Platelets adhere to exposed collagen leading to clot formation. Fibrinogen is released from severed vessels. The clots obstruct lymphatic drainage and aid in localizing the injury

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76
Q

What are the steps in clot formation?

A

Thromboplastin is formed. Prothrombin is concerted to thrombin as a result of its interaction with thromboplastin. Thrombin changes from soluble fibrinogen to insoluble fibrin coagulating into a network localizing the injury

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77
Q

What indicates the transition from the inflammatory phase to the fibroblastic repair stage?

A

When leukocytes phagocytize the debris

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78
Q

What is involved in chronic inflammation?

A
  • Occurs when inflammatory response does not eliminate injuring agent
  • Involves recruitment of leukocytes with macrophages, lymphocytes, fibroblasts, and plasma cells
  • granulation and fibrotic tissue continue to develop with highly vascular and loose CT
  • Typically associated with overuse, overload, cumulative microtrauma
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79
Q

What is the progression of the fibroblastic repair phase?

A

1) Capillary buds begin to proliferate (in response to hypoxia), creating revascularization
2) Capillaries and fibroblasts begin to synthesize granulation tissue (aka scar: matrix of both collagen and elastin.
3) Capillaries diminish after ~2weeks as collagen accumulates in granulation tissue
4) Tensile strength increases in proportion to collagen proliferation
5) As capillaries diminish scars fade from red to white

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80
Q

What factors should be considered while rehabbing during the maturation remodeling phase?

A

Initial healing must involve some mobilization, aggressive ROM and strength exercises should be done as tolerated, respect pain

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81
Q

What are some factors that impede healing?

A

Extent of injury, edema, hemorrhage, poor vascular supply, separation of tissue, muscle spasm, atrophy, corticosteroids, keloids and hypertrophic scars, infection, humidity, climate, oxygen tension, age, health, and nutrition

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82
Q

Why is cartilage difficult to heal?

A

Little to no blood supply. Articular cartilage that doesn’t clot and has no perichondrium heals very slowly

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83
Q

Why are surgically repaired ligaments stronger than those that heal naturally?

A

Decreased scaring

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84
Q

Why are intraarticular ligament tears difficult to heal?

A

Because synovial fluid will dilute the hematoma and prevent clotting and spontaneous healing

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85
Q

During initial phases of healing, why do tendons adhere to surrounding tissues?

A

Because they are not strong enough to operate on their own

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86
Q

What is the rate of nerve healing?

A

3-4 mm per day

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87
Q

Can regeneration take place in a nerve cell?

A

No, only in a nerve fiber

88
Q

What are the 5 stages of acute fracture healing?

A

1) Hematoma formation
2) Cellular proliferation
3) Callus formation
4) Ossification
5) Remodeling

89
Q

When can fractures begin remobilization?

A

Once a hard callus is visible on xray

90
Q

What are some factors that can impede fracture healing?

A

1) Poor immobilization
2) Poor blood supply
3) Infection

91
Q

What are some short term goals of injury rehabilitation?

A

Control pain and minimize swelling, maintain/improve flexibility, enhance core stability, restore/increase strength and endurance, reestablish neuromuscular control/proprioception/balance, maintain cardiorespiratory fitness, functional progressions

92
Q

What are the long term goals of injury rehabilitation?

A

Return to practice/competition as quickly and safely as possible

93
Q

What are some factors to consider when considering a return to play plan?

A

MOI, age, major anatomical structures involved, injury severity, stage of tissue healing, type of sport or activity, chronicity of the injury

94
Q

How does cryotherapy manage pain and swelling?

A

Decreased blood flow, inflammation, cellular waste production and local metabolic rate, pain perception, tissue extensibility, muscle guarding, and muscle fatigue

95
Q

What are some contraindications of cryotherapy?

A

Allergy or hypersensitivity to cold (e.g. cold urticaria), Raynaud’s phenomenon, anesthetic skin, advanced diabetes

96
Q

How can isometric exercise be beneficial when full ROM is contraindicated?

A

Increases static strength, decreases atrophy, increases muscle pump. Helps manage swelling

97
Q

What are the four key elements of neuromuscular control?

A

1) Proprioception and kinesthetic awareness
2) Dynamic stability
3) Preparatory and reactive muscle characteristics
4) Conscious and unconscious functional and motor patterns

98
Q

What is balance?

A

The integration of muscular forces, neuromuscular sensory information from mechanoreceptors, and biomechanical feedback

99
Q

What do the physiological effects of thermotherapy depend on?

A

Type of heat, intensity, duration of application, and tissue response

100
Q

What are some desirable effects of thermotherapy?

A

Increased extensibility of collagen fibers, decreased joint stiffness, reduced pain, muscle spasm relief, reduced inflammation-edema-and exudate in post acute phase, increased blood flow

101
Q

What are the modalities of thermotherapy?

A

1) Conduction e.g. moist hot packs, paraffin baths (max 30 min) (min. 47 degrees C)
2) Convection e.g. hot tub
3) Radiation e.g. infrared therapy
4) Conversion e.g. A535

102
Q

What are some special considerations when using thermotherapy?

A

1) Never apply heat where there is a loss of sensation
2) Never apply heat immediately after an injury
3) Never apply heat where there is decreased arterial circulation
4) Never apply heat directly to eyes or genitals
5) Never heat the abdomen during pregnancy
6) Never apply heat to any part of the body that shoes acute signs of inflammation

103
Q

What are some of the mechanical responses to massage therapy?

A

Encourages venous flow and mild stretching of tissue. Positively affects scar tissue.

104
Q

What are some of the physiological responses to massage?

A
  • Increased circulation, aiding of circulation and removal of metabolites, overcoming venostasis
  • Reflex effect
  • Relaxation
  • Stimulation
105
Q

What are some massage stroke modalities?

A

1) Effleurage (stroking)
2) Petrissage (Kneeding)
3) Tapotement (cupping, hacking, oscillation/jostling, knocking (stimulating vs. sedating)
4) Friction

106
Q

What are the ESSM of Sever’s Disease (Apophysitis of calcaneus?

A

E: Traction injury at Achilles insertion
S+S: Pain occurs at posterior heel below Achilles attachment in children and adolescent athletes. Pain occurs during vigorous activity
M: Ice, rest, stretching, and NSAIDS. Heel lift may be beneficial

107
Q

What is the ESSM of Retrocalcaneal Bursitis (Haglund’s Deformity or “pump bump”) ?

A

E: Inflammation of bursa beneath Achilles tendon. Result of pressure and rubbing from shoe. Chronic, may take extensive time to resolve.
S+S: Pain with palpation superior and anterior to Achilles tendon insertion. Swelling on both sides of the heel cord.
M: Manage inflammation, routine stretching of Achilles, heel pads to reduce stress, donut pad to reduce pressure, change footwear

108
Q

What is the ESSM of Tarsal Tunnel Syndrome?

A

E: Any condition that compromises Tom, Dick, or Harry. May result from previous fracture, tenosynovitis, acute trauma or instability, excessive pronation
S+S: Burning, tingling, and pain along medial and plantar aspect of foot. Increased pain at night.
M: Manage inflammation, orthotics

109
Q

What is the ESSM of Pes Planus?

A

E: Poor biomechanics, wearing tight shoes, overweight, trauma, or excessive exercise placing stress on arch
S+S: Pain, weakness, or fatigue; flattened appearance of arch
M: Leave it alone of no problems develop. Orthotics and/or taping if problematic

110
Q

What is the ESSM of Pes Cavus?

A

E: Higher arch than normal, associated with excessive supination, attenuated high medial longitudinal arch
S+S: Poor shock absorption resulting in metatarsalgia, foot pain, clawed or hammer toes. Associated with tight Achilles and plantar fascia; heavy callus development on ball of foot and heel.
M: Leave it alone of not causing issues, orthotics, stretch Achilles and plantar fascia

111
Q

ESSM: Plantar fasciitis

A

E: Tight heel cord, cavus foot or hyperpronation, changes in footwear or training surface, excessive training
S+S: Point tenderness medial heel/medial arch, “first step” pain
M: Orthoses/heel cup, arch taping/night sprint, massage and vigorous stretching

112
Q

ESSM: Metatarsal Stress Fractures

A

E: Common in runners/jumpers, most frequent in 2nd MT (“March fracture”). Associated with increases in training, changes in surface, inappropriate training footwear, flat feet and bunions
S+S: Dull ache during exercise progressing over 2-3 weeks from diffuse pain to localized pain at rest
M: Limit WB and cross train with NWB, determine cause, gradual return

113
Q

ESSM: Bunion (Hallux Valgus Deformity)

A

E: Lateral deviation of hallux and exostosis of 1st metatarsal head. Associated with increased pronation, genetics, footwear
S+S: Tenderness, swelling, and enlargement of joint initially, results in angulation, walking becomes painful
M: Wear correct fitting shoes, appropriate orthotics, pad over first metatarsal head, tape splint between first and second toe. Foot exercises for flexor and extensor muscles. Bunionectomy may be necessary.

114
Q

What is a Bunionette (Tailor’s Bunion)?

A

A bunion that affects the 5th metatarsophalangeal joint causing the fifth toe to deviate towards the fourth.

115
Q

ESSM: Sesamoiditis

A

E: Caused by repetitive hyperextension of first toe or landing on 1st MP joint
S+S: Pain and tenderness under great toe, especially during push off
M: Treat with orthotic devices including metatarsal pads and arch support. Decrease activity to allow inflammation to subside

116
Q

ESSM: Metatarsalgia

A

E: Pain in ball of foot. Tight gastroc-soleus complex or fallen arches, increased callus formation
S+S: Transverse arch flattened, pain with WB, cavus foot may also cause problems
M: Metatarsal pad, stretching heel cord and strengthening intrinsic foot muscles

117
Q

ESSM: Sprained toe

A

E: Generally caused by kicking non-yielding object. Hyperextension of 1st MP joint = “turf toe”
S+S: Pain and immediate swelling, discoloration within 1-2 days. Stubbed toe stiffness and residual pain will last several weeks
M: RICE, buddy toe or turf toe taping, shoe modification WB as tolerated

118
Q

ESSM: Subungual hematoma

A

E: Direct pressure, dropping object on toe, kicking another object, repetitive shear forces on toe nail (improperly fit shoes, running down hill)
S+S: Accumulation of blood under nail, extreme pain, loss of toe nail
M: Relieve pressure within 12-24 hours, use sterile drill or lancet to puncture nail

119
Q

ESSMP: Ingrown toenail

A

E: Usually great toe, result of lateral pressure from shoes, poor nail trimming, and repeated trauma
S+S: Pain, redness, and swelling around irritated section
M: Conservative management = soaking foot in warm water for 20 minutes, place cotton under edge of nail to separate from skin. If chronic remove edge of nail and apply antiseptic compress until inflammation stops
P: Proper fitting shoes and socks, Weekly toe nail trimmings (straight across), Leave nail long enough to clear skin

120
Q

ESSM: Tinea pedis

A

E: Most common form of superficial fungal infection-highly contagious
S+S: Extreme itching on soles of feet, between and on top of toes. Appears as dry scaling patch or inflammatory red scaling papules forming larger plaques. May develop secondary infection from itching and bacteria
M: Topical antifungal foot agents and good foot hygiene

121
Q

ESSMP: Blister

A

E: Result of a shearing force that produces a raised area that accumulates with fluid
S+S: Hot spot, sharp burning sensation, painful. Superficial area of skin raised with clear fluid
M: See wound management
P: Use of dust or powder to prevent friction, 2 pairs of socks if feet are sensitive or perspire easily, appropriate shoes that are broken in, pad hot spots, lubricants

122
Q

What weight bearing tests should be examined while looking at an ankle injury?

A
  • Walk on toes (plantar flexion)
  • Walk on heels (dorsiflexion)
  • Walk on lateral borders of feet (inversion)
  • Walk on medial borders of feet (eversion)
  • Hop on injured ankle
123
Q

What are the Ottawa Ankle rules for determining of an xray is needed?

A
  • Pain in midfoot or malleolar area
  • Tenderness over inferior or posterior pole of either malleoli
  • Inability to bear weight (4 steps independently, even if limping) at time of injury and/or evaluation
  • Tenderness along base of 5th metatarsal or navicular bone
124
Q

What structures are usually damaged with an inversion ankle sprain?

A

Anterior talofibular ligament (ATF). Posterior talofibular ligament (PTF) and calcaneofibular ligament (CF) can be damaged with increased force

125
Q

ESSM: 1st degree inversion sprain

A

E: Occurs with plantar flexion and adduction. Causes stretching of ATF ligament
S+S: Mild pain and disability; weightbearing is minimally impacted, point tenderness over ligaments and not laxity
M: RICE for 1-2 days, limited weight bearing initially followed by aggressive rehab, tape may be added for additional support, return to activity after 7-10 days

126
Q

ESSM: 2nd degree inversion sprain

A

E: Moderate inversion sprain, increased disability, increased days off
S+S: Pop or snap, moderate pain, difficult to weight bear, tenderness and edema/bruising
M: RICE for at least the first 72 hours, XRAY to rule out fracture, crutches 5-10 days, progress to WB. Begin ROM exercises early with tape/brace. Long-term disability-chronic instability, increased risk of reinjury. Rehab required to prevent reinjury.

127
Q

ESSM: 3rd degree inversion sprain

A

E: Relatively uncommon, extremely disabling. Caused by significant force, damages all structures.
S+S: Severe pain, swelling, hemarthrosis, discoloration. Inability to bear weight.
M: RICE, XRAY, cast, surgery, extensive rehabilitation

128
Q

ESSM: Eversion sprain

A

E: damages deltoid ligament, possible fracture
S+S: High pain, inability to bear weight, pain with ab/adduction
M: RICE, rule out fracture. Same course of treatment is inversion. Taping is NEUTRAL

129
Q

ESSM: Syndesmotic sprain

A

E: Damaged from high ankle dorsiflexion and/or ER. Often injured with medial and lateral ligaments
S+S: Can initially appear benign or present as ankle sprain. Marked pain or tenderness over syndesmosis. Pain in dorsiflexion or eversion (Active, passive, and resisted), joint weakness, inability to bear weight
M: difficult to treat as requires months of treatment, same course of treatment as other sprains. NO INITITAL WEIGHTBEARING. Cuff style tape job

130
Q

ESSM: Ankle fracture

A

E: Number of mechanisms e.g. avulsion, bi-malleolar fracture
S+S: Significant pain and swelling with possible deformity
M: RICE to edema and bleeding, walking cast or brace, immobilization lasting 6-8 weeks

131
Q

ESSM: Acute Achilles Strain

A

E: Common in sports, often occurs with sprains or excessive dorsiflexion
S+S: Pain can be mild to severe, most severe injury is partial/complete avulsion and rupturing of the Achilles
M: Pressure and RICE should be applied. A heel lift, stretching and strengthening should be reintroduced ASAP

132
Q

ESSM: Achilles Tendonitis

A

E: Inflammatory condition of tendon and/or sheath. Causes scaring that can restrict movement in sheath, exacerbated by decreased flexibility
S+S: Generalized pain and stiffness, localized proximal to calcaneal insertion, may limit strength. Aggravated by hill workouts, may progress to morning stiffness, crepitus with active PF and passive DF. Chronic inflammation may lead to thickening
M: Resistant wo quick healing due to slow healing nature of tendon. Must reduce stress on tendon and reduce structural issues (orthotics, mechanics, flexibility). NSAIDS/cryotherapy. Strengthening must progress slowly to not irritate tendon (ECCENTRIC!!!!)

133
Q

ESSM: Achilles Tendon Rupture

A

E: Occurs with sudden stop/go. Forceful plantar flexion with knee moving into full extension. Commonly in athletes >= 30 yoa. Generally has issue of chronic inflammation.
S+S: Sudden snap with immediate pain which rapidly subsides. Point tenderness, swelling, discolouration, decreased ROM. Obvious indentation. Occurs 2-6 cm proximal to calcaneal insertion.
M: Usually involves surgical repair. Non operative treatment include: NSAIDS, RICE, non-weight bearing cast 6 weeks, weightbearing cast 2 weeks (75-90% function). Rehab ~6months. Consists of ROM and wearing 2 cm lifts in both shoes

134
Q

ESSM: Gastrocnemius strain

A

E: Susceptible to strain near MT attachment. Caused by quick start or stop or jumping. Muscular fatigues with fluid-electrolyte depletion and cramping.
S+S: Depends on grade, variable amount of swelling, pain, and muscle disability. May feel like being “hit in the leg with a stick”. Swelling, point tenderness, and functional loss of strength
M: RICE. Grade 1 should apply gentle stretch after cooling. Weightbearing as tolerated, heel wedge should be used to reduce calf strain while walking

135
Q

ESSM: Fibularis Tendon Subluxation

A

E: Occurs in sport with dynamic forces being applied to ankle
S+S: Snapping in and out of groove with activity, pain and instability (Resisted eversion replicates subluxation). Present with bruising, tenderness, edema, and crepitus over tendon.
M: Compression with felt horseshoe, RICE, NSAIDS, and analgesics. Rehab or surgery if conservative treatment fails

136
Q

ESSM: Shin contusion

A

E: Direct blow, affecting periosteum
S+S: Intense pain, rapidly forming hematoma with jelly like consistency (May also have compartment syndrome and/or tibial fracture).
M: RICE, NSAIDS, analgesics as needed. Maintain compression for hematoma. Fit with donut pad and hard shell for protection. If not managed properly may progress to osteomyelitis.

137
Q

ESSM: Muscle contusion

A

E: Contusion of leg, usually gastroc.
S+S: Bruise may develop, pain, weakness, and partial loss of limb function. Palpation may reveal hard rigid area due to bleeding and muscle guarding.
M: stretch to prevent spasm. Apply cold compression and ice. Wrap or tape to stabilize the area

138
Q

ESSM: Medial tibial stress syndrome

A

E: Pain in anterosuperior or anteromedial shin. “Catch all” for stress fractures, muscle strains, chronic or exertional anterior compartment syndrome. Caused by repetitive microtrauma. Weak muscles improper footwear, training errors, tight heel cord, hypermobile, or pronated feet , forefoot dysfunction can contribute
S+S: Four grades of pain
1) Pain after activity
2) Pain before and after activity, not affecting performance
3) Pain before, during, and after activity, affecting performance
4) Pain is so severe, performance is impossible.
Pain increases with active plantar flexion
M: Physician referral for XRAY and bone scan, activity modification, correction of abnormal biomechanics, ice massage to reduce pain and inflammation, flexibility program for gastroc-soleus complex, arch taping and/or orthotics

139
Q

ESSM: Compartment syndrome

A

E: 1) Acute compartment syndrome. Occurs secondary to acute trauma, medical emergency
2) Acute exertional compartment syndrome. Evolves with mild to moderate activity.
3) Chronic compartment syndrome. Symptoms arise consistently at certain point during activity.
S+S: Deep aching pain and tightness due to swelling and pressure. Often bilateral. Reduced circulation and swelling of foot occurs. Symptoms relieved with cessation of exercise. Activity-related pain begins at a predictable time.
M: May present as medical emergency to reduce swelling or release fascia. RICE, NSAIDS, analgesics as needed

140
Q

ESSM: Stress fractures of leg

A

E: Hypermobile pronators = fibula, rigid pes cavus = tibia. Runners = lower third, dancers = middle third. Usually in unconditioned, inexperienced individuals. Often training errors involved. Component of female athlete triad.
S+S: Pain more intense after exercise. Point tenderness. Bone can (stress fracture versus periostitis)
M: Discontinue stress for 14 days. Use crutches for walking. Weightbearing can return when pain subsides. Cycling before running. After pain free for two weeks, gradual return to running. Biomechanics must be addressed

141
Q

What are some common acute knee injuries?

A

Ligamentous sprains, muscle strains, contusions, meniscal tears, patellar dislocation, fracture

142
Q

What are some common chronic knee issues?

A

Patello-femoral pain syndrome, bursitis, patellar tendonitis, osgood schlaters disease

143
Q

What are the SSM of general knee 1st degree ligamentous strains?

A

S+S: No tearing, no laxity, minimal swelling.
M: Rest from sport 7-10 days, RICE, ROM and strength, balance and proprioception exercises, maintain cardiorespiratory fitness, tape for support

144
Q

What are the SSM of general knee 2nd degree ligamentous strain?

A

S+S: Moderate damage partial tearing, some laxity with solid end feel, slight swelling and increased pain, moderate to severe joint tightness, decreased ROM
M: RICE 48-72 hours, use crutch in acute phase. Rest from sport 2-4 weeks. May brace prior to ROM exercises. Gradual progression from isometric and closed kinetic chain . Maintain cardiovascular fitness

145
Q

SSM: General 3rd degree knee ligamentous strain?

A

S+S: Complete tear of supporting ligaments, complete loss of stability during motion, loss of motion due to effusion and guarding, immediate pain that builds as swelling increases, no ligamentous end feel at passive end range
M: RICE, conservative v. surgical, limited immobilization with a brace, progressive weight bearing and increased ROM over 4-6 weeks

146
Q

ESS: MCL Strain

A

E: Blow from lateral side causing tension on medial knee

S+S: Swelling and pin dependent on severity, pain on medial side

147
Q

ESS: LCL Strain

A

E: Varus force, generally with tibia internally rotated

S+S: Pain, tenderness, and swelling lateral joint line over LCL. May cause irritation of peroneal nerve

148
Q

EMOISS: ACL Strain

A

E: Direct contact (20%), non-contact (80%)
MOI: Deceleration, hyperextension, “unhappy triad”, anterior force to tibia with knee flexed to 90 degrees, IR of leg with body in ER, leg ER with valgus force
S+S: Pop with severe pain and swelling, sudden “giving way” and inability to WB, positive special tests, rapid swelling at joint line peaking 24-84 hours later

149
Q

Why are females more likely (3-5x) to experience an ACL injury than males?

A

Potential explanations include

1) Hormonal influence: Menstrual cycle related changes in estrogen levels can alter ligament elasticity making them more vulnerable
2) Anatomical: Women have slightly smaller ACL and have a smaller intercondylar notch
3) Neuromuscular risk factors: Core stability, strength, proprioception,

150
Q

ESSM: PCL Strain

A

E: Most at risk at 90 degree flexion or fall on bent knee, “dashboard injury”
S+S: “Sag sign”, Similar to ACL with less swelling and little instbaility
M: Quad strengthening, operative v. nonoperative

151
Q

ESSM: Meniscal injuries

A

E: Medial meniscus more commonly injured, “unlucky triad”, decreased mobility in comparison to lateral. Most common MOI is rotary force with with knee flexed or extended. Tear depends on MOI.
S+S: Effusion within 48-72 hour period, joint line pain and loss of motion, intermittent locking and giving way, pain with squatting, portions may become detached causing locking , giving way, or catching in the joint
M: RICE, splint, crutches

152
Q

ESSM: Patellar dislocation

A

E: Deceleration with simultaneous cutting force in opposite direction. Direct blow to patella when knee is flexed and planted. Quad pulls patella out of alignment. May be predisposed “increased Q angle”, repetitive subluxation will stress medial constraints
S+S: Pain and swelling, restricted ROM. Results in loss of function
M: Immobilization, RICE, immediate medical attention. Immobilization 4-6 weeks with crutches, muscular strengthening

153
Q

ESSM: Patellar fracture

A

E: Direct or indirect trauma (extreme pull of tendon). Semi-flexed position with forcible contraction
S+S: Generalized joint pain, pain disability, potential deformity
M: XRAY, RICE and splinting if fracture found

154
Q

ESSM: Osgood Schlatter’s Disease

A

E: Traction injury, repetitive stress on immature tibial tuberosity from quad contraction
S+S: Swelling, point tenderness at tuberosity, enlarged bony deformation, Pain with kneeling, jumping, running
M: RICE, activity modification, Cho-Pat brace, isometrics for quadriceps and hamstrings

155
Q

ESSM: Patellofemoral pain syndrome

A

E: Joint aggravation due to flexion/extension stresses. Result of lateral deviation while tracking in femoral groove. Tight structures, pronation, increased Q angle, insufficient medial musculature
S+S: Tenderness of medial facet during running, jumping, stairs, squatting. Dull ache in center of knees, patellar compression will elicit pain and crepitus/grinding, “movie goer’s sign”, overpronation
M: RICE, activity modification, patellar brace of McConnell tape job, correct biomechanical issues/strength/flexibility

156
Q

ESSM: Patellar tenonitis

A

E: Jumping or kicking, overpronation, running on hard surfaces, rapid increase in running, sudden or repetitive extension
S+S: 3 phases of pain
1) Pain after activity
2) Pain during and after
3) Pain during and after for prolonged durations, may become constant

Pain in one or more of the following: Inferior pole of the patella, mid tendon region, insertion at the tibial tuberosity

M: RICE, heat, patellar tendon bracing, transverse friction massage, eccentric strengthening (stops and drops)

157
Q

EMOISSM: Iliotibial band syndrome

A

E: Caused by repetitive/overuse conditions, structural mal-alignment, structural asymmetries, training errors. Leg length discrepancies, genu varum, over pronation, sudden changes in training surfaces-equipment-distances, tight TFL/glut max, hip weakness
MOI: Compression and friction forces to lateral femoral condyle
S+S: Pain after running or going downstairs, point tenderness at Gerty’s tubercle
M: RICE, correction of malalignment, proper warm up and stretching, activity modification, orthotics

158
Q

ESSM: Bursitis (knee)

A

E: Acute, chronic, or recurrent swelling. Overuse.
S+S: Prepatellar bursitis may be localized swelling above knee that is palpable. Swelling in popliteal fossa may indicate a Baker’s cyst. Pes anserine bursitis is localized inframedially to tibial tuberosity
M: RICE, activity modification and protective foam donut pad, aspiration and steroid injection if chronic.

159
Q

What are some acute hip/thigh injuries?

A

Contusions, myositis ossificans, strains, sprains (RARE),(hip), femoral fracture, hip dislocation

160
Q

ESSM: Quad contusions (general)

A

E: exposed to blunt trauma, contusions usually develop as a result of severe impact and resultant muscle compression. Extent of force and degree or thigh relaxation determines depth and level of functional disruption that occurs
S+S: localized pain, bleeding, swelling and temporary loss of function
M: RICE in knee flexion position, crutches, NSAIDS, ROM and stretching exercises, Protect upon return to play, no heat or massage initially (recommended during rehab)

161
Q

What are the characteristics of a 1st grade quad contusion?

A

Little to no pain, mild hemorrhaging, no swelling, mild point tenderness, no disability re ROM

162
Q

What are the characteristics of 2nd grade quad contusion?

A

Mild pain and swelling, mild to moderate hemorrhaging, mild point tenderness, mild disability (>90 degree knee flexion), limping

163
Q

What are the characteristics of a 3rd degree quad contusion?

A

Moderate pain and swelling, moderate disability (>45 , <90 degree flexion), obvious limping

164
Q

What are the characteristics of a 4th degree quad contusion?

A

Severe pain and swelling. severe disability (<45 degree knee flexion), potential muscle herniation, obvious limp or inability to bear weight

165
Q

ESSM: Myositis ossificans

A

E: Formation of ectopic bone following trauma to muscle
S+S: pain, weakness, swelling, tenderness, decreased ROM and function, XRay shows deposits 2-6 weeks post
M: Manage conservatively, regain ROM. Physician referral

166
Q

ESSM: Hip pointer contusions

A

E: Direct blow to iliac crest or abdominal musculature
S+S: Pain, spasm, swelling, transitory paralysis of soft structures. Decreased rotation of trunk and/or hip/thigh flexion
M; RICE for 48 hours, ice massage, protection upon RTP. May need physician referral to rule out fracture

167
Q

How does a 1st degree quadricep sprain present?

A

Limited swelling and tightness, near normal gait, mind point tenderness and discomfort during palpation, soreness during movement, (<20 percent of fibers torn)

168
Q

How does a 2nd degree quadricep sprain present?

A

Pain and swelling noticeable upon palpation. May note palpable divot. Pain with resisted muscle testing. Limping. Muscle spasm. (<70% fibers torn)

169
Q

How does a 3rd degree quadricep sprain present?

A

Rupturing of tendinous or muscular tissue. Major hemorrhage and edema. Major disability and loss of function. Pain and palpable defect or mass (>70% fibers torn)

170
Q

ESSM: Quadriceps strain

A

E: Sudden stretch or violent forceful contraction of hip and knee into flexion or knee flexion with hip extension
S+S: Pain, spasm, delayed bruising, swelling, loss of function, decreased ROM and strength of extensors
M: RICE, crutches and wrap, later use of a sleeve. Progress to pain free ROM, isometrics and stretching. May require 12 weeks RTP

171
Q

ESSM: Hip flexor strain

A

E: Sudden overstretch into hyperextension
S+S: Pain, swelling, delayed, bruising and disability, decreased ROM and extensor strength
M: RICE, crutches, hip spica wrap

172
Q

ESSM: Hamstring sprain

A

E: Eccentric load in hip flexion and knee extension, sudden explosive contraction or direction change/accel/decel. Fatigue, posture, leg length discrepancy, imbalances, hamstring dominance
S+S: Pain, swelling, decreased ROM and function, delayed bruising, spasm
M: RICE, crutches and wrap, conservative treatment with gradual ROM and strengthening

173
Q

ESSM: Adductor strain

A

E: overstretch into abduction; abduction, ER, hip extension
S+S: sudden twinge or tearing, pain, swelling, delayed bruising, decreased ROM and strength
M: RICE, rest is key (crutches), hip spica

174
Q

ESS: Legg-Calve-Perthes Disease and Slipped Capital Femoral Epiphyses

A

LCP Disease: 4-10 yoa, boys>girls. Disrupts circulation to femroal head ->necrosis
SCFE: Affects 10-17, boys>girls. idiopathic. Often very tall and thin, or obese.

S+S: Groin pain associated with a trauma (25% of the time), or slow onset over weeks-months as a result of stress, limited range and limp. LCP may refer to knee or abdomen

175
Q

ESSM: Hip dislocation

A

E: rarely in sport, posterior dislocation when traumatic force applied along long axis of femur
S+S: flexed, adducted, and internally rotated thigh, deformity, pain, muscular spasm, neurological problems
M: 911 (blood and nerve supply may be compromised). Immobilization and crutch use

176
Q

ESSM: Femoral fracture

A

E: Significant trauma; fall from height, direct blow, MVA, osteoporosis
S+S: Pain, swelling, deformity (shorter appearance). Muscle guarding, hip add. and ER
M: 911. Treat for shock. Verify neurovascular status and vitals.

177
Q

ESSM: Femoral stress fracture

A

E: Overuse (10-25%) , endurance athletes, downhill running, jumping, female athlete triad
S+S: Persistent pain in groin/thigh. Antalgic gait (i.e. limp) during activity. Loss of glut med stabilization
M: Prognosis may vary dependent on location (femoral neck v. shaft)

178
Q

ESSM: Osteitis pubis

A

E: Repetitive stress on pubic symphysis and adjacent muscles. Seen in distance runners, soccer, football, and wrestling.
S+S: Pain in groin and pubic symphysis. Point tenderness, pain in running, sit ups, squats. Acute cases can be the result of a bicycle seat.
M: Rest, NSAIDS, gradual return to activity

179
Q

What are some common acute shoulder injuries?

A

Fractures (clavicular, humeral), Sprains (SC, AC, GH), Strains (deltoid, biceps, triceps), Ruptures (biceps), GH dislocation/subluxation

180
Q

What are some common chronic shoulder injuries?

A

RC impingement syndrome, bicep tendonitis, sub acromial tendonitis

181
Q

What is a common shoulder MOI?

A

FOOSH

182
Q

ESSM: Clavicular Fracture

A

E: FOOSH, fall on tip of shoulder, or direct impact. Primarily in middle 1/3. Often greenstick.
S+S: Generally presenting with supporting of arm, head tilted towards injured side with chin turned away. May appear lower. Palpation may reveal SHARP and/or deformity.
M: Treat for shock. Sling and swath. Transport to hospital. Likely braced for 6-8 weeks

183
Q

ESSM: Humeral Fracture

A

E: Direct blow or FOOSH. Proximal fracture often associated with dislocation.
S+S: SHARP, neurovascular changes. May be mistaken for contusion or dislocation
M: Treat for shock. Splint and sling prior to transport.

184
Q

ESSM: Acromioclavicular sprain

A

E: Direct impact/falling on point of shoulder. FOOSH. Graded 1-6 dependent on severity.
S+S: Mild to severe pain, swelling. Altered ROM (abd/add). Step deformity.
M: Ice, stabilization, referral. Aggressive rehab

185
Q

What are the grades and characteristics of a acromioclavicular sprain?

A

Grade 1: No disruption
Grade 2: Tear of AC ligament, partial displacement
Grade 3: Rupture of AC and CC ligaments
Grade 4: Posterior displacement of lateral clavicle
Grade 5: Complete ligament rupture; tearing of deltoid and trapezius attachments
Grade 6: Inferoposterior displacement

186
Q

ESSM: Glenohumeral sprain

A

E: forced abd. and/or ER or direct blow
S+S: Pain during movement especially when re-creating MOI. Decreased ROM and pain with palpation.
M: RICE for 24-48 hours. Sling. Important to regain full ROM and strength

187
Q

ESSM: Acute dislocation/subluxation

A

E: Anterior dislocation associated with anterior force; forced abd and ER. Posterior (1-4%), Inferiorly very rare
S+S: Anteroinferior: flattened deltoid, head in axilla, arm carried in slight. abd,ER. Moderate pain and discomfort.
Posterior: severe pain and arm held in add. and IR
M: RICE and reduction by physician. Immobilization sling and swath. Isometrics while in sling

188
Q

ESSM: Subacromial bursitis/shoulder impingement

A

E: A mechanical compression. Bursal and/or tendinous inflammation. Contributing factors include joint laxity, postural malalignments and repetitive overhead motions
S+S: Diffuse pain around acromion, pain with OH activities. Progresses in stages over time
M: Active rest, correct biomechanics

189
Q

ESSM: Bicipital tenosynovitis and tendinopathy

A

E: Repetitive, overhead, ballistic activity that irritates tendon and sheath, improper mechanics, impingement.
S+S: Tenderness over bicipital groove, selling, crepitus due to inflammation. Pain when performing overhead movements.
M: control inflammation followed by a gradual program of strengthening and stretching

190
Q

ESSM: Biceps rupture

A

E: Result of powerful contraction, typically near muscle origin.
S+S: Patient hears resounding snap, sudden and intense pain, deformity, weakness in elbow, flexion and supination
M: Ice, sling, refer to physician

191
Q

What are some common acute elbow injuries?

A

Contusions, olecranon bursitis, sprains, strains, dislocations, fractures

192
Q

What are some common chronic elbow injuries?

A

Tennis elbow (lateral epicondylitis), golf elbow (medial epicondylitis), olecranon bursitis

193
Q

ESSM: Elbow contusions

A

E: Result of direct blow or repetitive blow (may develop to myositis ossificans)
S+S: Swelling (rapidly after irritation of synovial membrane or bursa), localized pain, bruising, decreased ROM. May have paresthesia
M: RICE for at least 24 hours. May need XRAY to rule out fracture

194
Q

ESSM: Olecranon bursitis

A

E: Acute and chronic. Direct blow; pressure and friction
S+S: Pain (?), swelling, point tenderness, limited ROM, especially flexion
M: RICE, compression pad, NSAIDS. May need to be aspirated.

195
Q

ESSM: Elbow strains

A

E: Movement beyond normal ROM, sudden eccentric loading, repetitive microtears
S+S: Point tenderness in muscle or MTJ. Swelling, bruising, possible deformity. Pain with active and resisted motions.
M: RICE, sling in severe cases

196
Q

ESSM: Elbow sprains

A

E: FOOSH (hyperext.),valgus or varus force, repetitive motion.
S+S: Joint tenderness, painful ROM, laxity with stress tests, swelling, decreased ROM.
M: RICE, tape brace or sling, NSAIDS. Surgery may be required (TOMMY JOHN)

197
Q

ESSM: Elbow dislocation

A

E: FOOSH forcing hyperext., severe twist while flexed. Bones may be displaced A/P or laterally
S+S: Swelling, severe pain, disability, deformity, snapping or cracking sensation. Possible neurovascular complications. May involve radial head fracture
M: Cold and pressure immediately with sling in most comfortable position. Transport to hospital for reduction. Monitor neurovascular function. Strengthening exercises for shoulder and hand. Myositis ossificans potential complication.

198
Q

ESSM: Elbow fracture

A

E: Fall on flexed elbow, direct blow, FOOSH. FOOSH often fractures humerus above condyles or between condyles. Repetitive or sudden contraction of flexor-pronator group. Avulsion (“Little league elbow”)
S+S: May not result in visual deformity. Hemorrhaging, swelling, spasm, pain
M: Monitor neurovascular status. Immobilize and transport. Surgery used to stabilize adult unstable fractures. Early ROM exercises

199
Q

ESSM: Lateral Epicondylitis

A

E: Repetitive microtrauma with insertion of extensor muscles on lateral epicondyle. Tendinosis without inflammation. Incorrect racquet or grip size, string tension too high, poor technique, eccentric loading of extensors during deceleration phase
S+S: Aching pain in region of lateral epicondyle. Pain worsens and weakness of wrist and hand develop. Elbow has decreased ROM and weakness with resisted wrist extension
M: RICE, NSAIDS, and rest. ROM exercises, deep friction massage, mobilization and stretching in pain free ranges. Use of counter force or neoprene sleeve. Mechanics and skills training required to avoid recurrence.

200
Q

ESSM: Medial epicondylitis

A

E: Repeated forceful flexion of wrist and extreme valgus torque in elbow, May involve pronator teres, flexor carpi radialis and ulnaris, and palmaris longus tendons. Can be associated with ulnar nerve neuropathy
S+S: Pain produced with forceful extension or flexion, Point tenderness and mild swelling. Passive movement of wrist seldom elicits pain. Active does.
M: Sling, cryotherapy, rest, or heat through ultrasound. Analgesic and NSAIDS. Curvilinear brace to reduce elbow stressing. Severe cases may require splinting and complete rest for 7-10 days.

201
Q

What are some common acute wrist and hand injuries?

A

Contusions, sprains, strains(mallet finger, boutinniere deformity), fractures (Colle’s, scaphoid, metacarpals-Boxer’s , Bennett’s, phalanges), dislocations (lunate, MCP, PIP, DIP)

202
Q

What is a common chronic wrist and hand injury?

A

Wrist ganglion

203
Q

ESSM: Wrist sprain

A

E: Most common wrist injury. Falling on hyperextended wrist, FOOSH, violent flexion or torsion. Multiple incidents may disrupt blood supply.
S+S: Pain, swelling, and difficulty with movement.
M: May need XRAY. RICE, splint, analgesics. Tape for support.

204
Q

ESSM: Phalange sprain

A

E: Direct blow to finger tip, valgus or varus strain. May damage DIP, PIP, MCP joint capsule/ligament
S+S: Pain, swelling, point tenderness, instability, loss of ROM.
M: RICE, splinting, XRAY if fracture is suspected.

205
Q

ESSM: Thumb (UCL)/ Gamekeepers sprain

A

E: Thumb MCP is forced into abd and hyperext.
S+S: Pain, swelling, instability, loss of function (cannot pinch grip)
M: RICE, NSAIDS, splint/tape, refer for xray if suspecting fracture or instability

206
Q

ESSM: Strains-mallet finger

A

E: Direct blow to finger tip avulsing extensor tendon
S+S: Pain and swelling at DIP, point tenderness, instability, loss of ROM, cannot extend DIP.
M: RICE, splint, refer if fracture suspected

207
Q

ESSM: Strains-boutinniere deformoty

A

E: Rupture of extensor tendon at middle phalanx due to trauma to finger tip. Extensor tendon slides below axis of PIP causing DIP to extend and PIP to flex
S+S: pain, swelling, point tenderness, instability, deformity, loss of ROM
M: RICE, splint, refer

208
Q

ESSM: Strains-jersey finger

A

E: Rupture of flexor digitorum profundus tendon from distal phalanx. Mechanism is rapid extension from active flexion. Typically the 4th digit.
S+S: Loss of ROM(cannot flex DIP)
M: RICE, splint, refer

209
Q

ESSM: Strains-trigger finger

A

E: Tenosynovitis of flexor tendons of wrist, fingers, thumb, abductor, pollicis. Formed nodule or thickened sheath, cannot glide uninterrupted.
S+S: Locking, painful popping sensation that is palpable and audible
M: RICE, NSAIDS, immobilization

210
Q

ESSM: Strains-Dequervain’s Tenosynovitis

A

E: Stenosing tenosynovitis in thumb extensor and abductor caused by repetitive use/overuse of wrist and thumb.
S+S: Point tenderness and weakness with thumb extension and abduction, aching pain that increases with wrist abduction-may snap or catch.
M: RICE, NSAIDS, immobilization

211
Q

ESSM: Fractures-Distal ulna and radius

A

E: FOOSH, Direct blow.
Colles’: occurs in distal radius with dorsal displacement of distal segment. FOOSH.
Smith’s: Occurs in distal radius with palmar displacement of distal fragment. Reverse FOOSH.
S+S: “fork deformity”. Neurovascular concerns. Fracture without deformity may be confused with severe sprain.
M: Immobilize and refer to physician. In children, injury may cause lower epiphyseal separation.

212
Q

ESSM: Fractures-Scaphoid

A

E: FOOSH, MVA. Concerns re poor healing. Often mistaken for a sprain.
S+S: Pain, swelling, point tenderness in snuff box, increased pain with wrist extn and radial dev.
M: RICE, splint, refer

213
Q

ESSM: Fractures-metacarpal

A

E: Direct axial or compressive force, Boxer’s fracture 4th or 5th MC. Bennett’s fracture 1st MC/CMC
S+S: pain, swelling, and inability to grip. Point tenderness and crepitus
M: RICE, splint, refer

214
Q

ESSM: Dislocation-finger

A

E: Damage to collateral ligaments and plate. MCP: rare, Twist or shear. PIP: hyperext. and axial load. DIP: usually dorsal.
S+S: Pain and swelling over joint. Point tenderness, obvious deformity.
M: RICE, splint, refer. Buddy taping post splint.

215
Q

ESSM: Wrist ganglion

A

E: Synovial cyst (herniation of joint capsule or synovial tendon sheath of tendon). May appear following wrist strain or repetitive injury
S+S: Generally appears on back of wrist. Palpable soft, rubbery, or hard mass. May be painful.
M: May be self limiting, aspiration, or surgical removal.

216
Q

ESSM: Carpal Tunnel Syndrome

A

E: Compression of median nerve in tunnel due to inflammation. Compounded by overuse, direct trauma, or anatomical anomalies.
S+S: Sensory and motor deficits. Thumb weakness. Awakening pain.
M: RICE, NSAIDS. May require further medical intervention.

EPHE 344 (2 decks)

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