Injuries Flashcards
(27 cards)
Rotator Cuff Strain
Supraspinatus most frequently injured
MOI: Violent pull to the arm, abnormal rotation, FOOSH
History: Throwing injuries, repetitive strain
Observation: Swelling over rotator cuff
Palpations: Point tenderness over rotator cuff, usually at insertion
S/S: Moderate to severe pain in shoulder, weakness with muscle contraction
Treatment: PIER, ROM exercises when pain free, start strengthening early ~ isometric -> concentric -> eccentric
Tendonitis
Common shoulder tendonitis occurs in rotator cuff, biceps, triceps
Inflammation of the tendon
History: Gradual onset, overuse, repeated microtrauma
Observation: Swelling and pain that move with the tendon
Palpations: Diffuse tenderness
S/S Pain and irritation at tendinous attachment
Bicipital Tenosynovitis
Tenosynovitis of the long head of biceps muscle is common with throwing athletes
MOI: Repeated forced internal rotation of the upper arm produces chronic inflammatory condition of synovial sheath
History: Common in pitchers, tennis players, javelin throwers
S/S: Athlete complains of ache in anterior and media shoulder
Treatment: Rest, cryotherapy, ultrasound, strengthening
Clavicular Fractures
MOI: Fall on outstretched arm (FOOSH), fall on tip of shoulder or direct impact
History: Athlete heard a snap/crack/pop and felt immediate pain
Observations: Deformity, bump often on middle third of clavicle
Palpations: Swelling, mild deformity, pain/tenderness
S/S: Generally presents with supporting of arm, head titled towards injured side with chin turned away, clavicle may appear lower
Treatment: Sling and swatch, refer to MD for x-ray, figure 8 brace to stabilize
Scapular Fractures
Less frequent in sport
Well protected by bony border and cushion of muscle
MOI: Result of direct impact or force transmitted up through hand, elbow, or shoulder
History: Pain with movement, unwilling to move arm
Observations: Swelling and point tenderness
Palpations: Pain over scapula and surrounding areas, muscle spasm
S/S: Pain during shoulder movement, swelling and point tenderness
Treatment: Supporting sling, refer to MD for x-ray asap
Sternoclavicular Sprain
Relatively uncommon in sports
MOI: Indirect force, direct blow to clavicle, twisting or torsion of posteriorly extended arm
History: Pain with arm movement
Observations: Medial end of clavicle can be displaced upward and forward, either posteriorly or anteriorly
Palpations: Pain on palpation of joint, deformity at SC articulation
S/S:
- 1st Degree: Little pain and disability with some point tenderness but no joint deformity
- 2nd Degree: Subluxation of SC joint, visible deformity, pain, swelling, point tenderness, inability to fully abduct arm or x-flexion
- 3rd Degree: Complete dislocation, gross displacement of clavicle at its sternal junction, swelling and disability
Treatment: Reduction by physician, immobilization in proper position for 3-5 weeks, followed by graded reconditioning exercises
Acromioclavicular Sprain
Very frequent in sports, mostly collision type
MOI: Direct blow to tip of shoulder, pushing the acromion process downward, or by an upward forced exerted against the long axis of the humerus
History: Pain with arm movement, may not be willing to move, history of “shoulder separation”
Observations: Swelling and point tenderness at AC joint articulation
Palpations: Tender on palpation over AC joint, deformity with acromion appearing higher than opposite side, muscular spasm in upper fibres of trapezius
S/S:
- 1st Degree: Point tenderness, discomfort on movement, no deformity, mild stretching of AC ligaments
- 2nd Degree: Rupture of superior and inferior AC ligaments, displacement and prominence of lateral end of clavicle when compared to opposite side, point tenderness on palpation of injury site, inability to fully abduct or x-flex (2nd degree may require surgery to restore stability)
- 3rd Degree: Dislocation, rupture of AC and CC ligaments, gross deformity, prominence of outer clavicular head, severe pain, loss of movement and instability of shoulder complex
Treatment: PIER, sling, referral to MD for imaging, immobilization, strengthening as soon as pain free
Glenohumeral Joint Sprain
Often affects joint capsule and rotator cuff muscles
MOI: Forced abduction, external rotation, direct blow
Observations: Swelling and point tenderness at GH articulation
S/S: Athlete complains of pain on arm movement, especially when MOI is reproduced
Treatment: PIER 24-48 hours, immobilization with sling, cryotherapy, ultrasound, massage, passive + active ROM exercises to restore movements
Anterior GH Dislocation
MOI: Forceful abduction and external rotation (Arm tackle or abnormal force to an arm that’s executing a throw, awkward FOOSH)
History: Acute traumatic mechanism, chronic dislocations
S/S: Severe pain and disability, torn capsular and ligamentous tissue, possibly tendinous avulsion of RC muscles, profuse hemorrhage
Observations: Flattened deltoid contour, athlete carries arm in slight abduction and external rotation
Palpations: Humeral head will be palpable through axilla
Treatment: Immediate reduction by physician, control of hemorrhage by ice packs, immobilization for ~3 weeks, initiate muscle reconditioning ASAP
Posterior GH Dislocation
MOI: Forced adduction and internal rotation, fall on an extended and internally rotated arm
History: Severe pain and disability
Observations: Arm fixed in adduction and internal rotation, deltoid muscle is flattened, acromion and coracoid are prominent, head of humerus may be seen posteriorly
Palpations: Humeral head will be palpable posteriorly
Treatment: Refer to MD for x-ray, examination and reduction, immobilization in slight abduction and external rotation for 3-6 weeks followed by AROM and pain-free strengthening exercises
Impingement Syndrome
Mechanical compression of supraspinatus tendon, subacromial bursa and long head of biceps tendon due to decreased space under coracoacromial arch
MOI: Overhead repetitive activities
History: Feels like a “pinching” with overhead movements
Observations: Postural malignments, kyphotic posture, rounded shoulders
Palpations: Pain on palpation at subacromial space
S/S: Diffuse pain, decreased strength of external rotators compared to internal rotators, tightness in posterior and inferior capsule
Treatment: PIER, pendulum exercises, joint mobilization to increase subacromial space
Bursitis
Chronic inflammatory condition due to trauma or overuse -irritation of the subacromial bursa
MOI: Direct blow, FOOSH, throwing injury
History: Athlete is unable to move shoulder, especially in abduction and rotation
Observations: Muscle atrophy may appear from disuse
Palpations: Rebound pain and tenderness on palpation in subacromial space
S/S: Pain with motion and positive impingement tests
Treatment: Cryotherapy, ultrasound and NSAID’s to reduce inflammation, remove mechanisms precipitating condition, maintain full ROM to reduce chances of contractures and adhesions from forming
ACL Sprain
Special tests: +ve anterior drawer test, +ve Lauchman’s test, pain with active and passive extension at end range
S/S: Moderate to severe deep or anterior knee pain, feeling of giving way or “just not feeling right”, hamstrings may feel extremely tight (Spasm = protective mechanism)
Treatment: Immediate referral to physician, immobilize, PIER, if surgery required out for minimum of 6 months-1 year
PCL Sprain
PCL prevents 90% of all posterior translation of tibia
Mechanism: Hyperflexion injury, knee flexed 90 degrees with an anterior force on tibia, fall on anterior aspect of knee with a plantar flexed ankle
Etiology: Dashboard injury, pop/snap felt or heard
Observation: Large effusion and hemarthrosis occur within first 2 hours
Palpations: PCL too deep to palpate ligament itself. Surrounding structures should be checked for
Special tests: +ve posterior sag test, +ve reverse Lauchman’s test, patellofemoral pressure due to extensor mechanism holding tibia in reduced position
S/S: Intense pain and a sense of stretching are felt in posterior knee with full rupture, autonomic response of dizziness, sweating, faintness or slight nausea
MCL Sprain
MCL prevents valgus stress
Mechanism: Valgus injury
Etiology: Direct blow from lateral side of the knee, external rot, lateral movements, cutting, landing off balance
Observation: Large effusion and hemarthrosis occur within first 2 hours
Palpations: Pain on medial joint line
Special Tests: Valgus stress test
LCL Sprain
LCL prevents varus stress
Mechanism: Varus stress of knee
Etiology: Wrestling athlete, opponent in between legs and delivers an excessive varus force, may hear or feel a pop
Observations: Minimal swelling because not attached to joint capsule
Special test: Varus test, but in opposite direction
S/S: Sharp lateral pain
Meniscus Injuries
Medial is less mobile and most often injured
Mechanism: Sharp, medial or valgus stress (Often combined with MCL sprain)
History: Felt a pop or snap, occurred during quick cutting movements
Observation: Joint Effusion
Palpations: Joint Line Pain
S/S: Locking, clicking pain with stairs, pain with squatting, amy not have any pain
Special tests: Mcmurray’s, Apley’s compression test
Treatment: PIER, crutches, may require surgery, recovery often quick <4 weeks
Patellar Fractures
Typically involve the inferior pole of the patella
Mechanism: Direct trauma
Etiology: Direct blow to the knee, knee on knee collision
Observations: Deformity or swelling
Palpations: Likely will not let you palpate due to pain
S/S: Extreme pain on the patella, deformity, loss of quadriceps function
Special Tests: +ve tuning fork, +ve squeeze test, +ve tap test
Treatment: Immediate referral, PIER, immobilization 4-6 weeks then partial weight-bearing is allowed
Quadriceps Contusion
Mechanism: Severe impact to the relaxed thigh, which compresses the muscle against the femur
Etiology: Direct blow to quad
Observations: Hemorrhage, bruising, swelling, decreased ROM
S/S: Pain, weakness
Palpations: Point tenderness over contusion
Special Test: Pain on palpation + MOI
Treatment: Ice on stretch, crutches during acute phase, constant compression( pad and protect)
Myositis Ossificans Traumatica
Mechanism: Severe blow or repeated blows to the thigh, secondary to a contusion, unresolved blood leads to calcification in the muscle
Observations: Swelling, decreased ROM
Palpations: Sore to touch
S/S: Pain, weakness, may even be visible on x-ray
Treatment: If painful and restricted ROM surgery may be necessary conservative care is ultrasound to break down calcium
Quadriceps Strain
Mechanism: Sudden fall on a bent knee or stretch of quad, insufficient warm up, rapid contraction, jumping or kicking
Observation: Pain in quad/anterior thigh, weakness with ROM knee extension
Hamstring Strain
Mechanism: Overstretching or forceful contraction
Observation: Pain in hamstring/posterior thigh, weakness on ROM knee flexion
Adductor Strain
Mechanism: Rapid contraction, overstretching of inner thigh muscles
Observation: Weakness on ROM hip adduction, pain in inner thigh/groin area
Bursitis
Mechanism: Inflamed bursae from repeated kneeling, patellar tendinitis, forceful blow
Etiology: C/O, chronic achy pain, repetitive strain
Observations: Localized swelling, looks like bag of water
Palpations: Rebound pain on palpation
Special Tests: Diagnostic ultrasound, rebound pain
Treatment: Acitvity as able, PIER, pulsed ultrasound, NSAIDs
