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NMSK1 - physio 1 > injuries of the thigh and lower leg > Flashcards

injuries of the thigh and lower leg Flashcards

1
Q

Describe a quadriceps contusion

A
  • **bruising to the quads **with a resulting haematoma
  • usually due to a** direct blow **to the thigh
  • very common esp in contact sport eg rugby, GAA, hockey etc
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2
Q

what is an intramuscular vs intermuscular haematoma?

A
  • intramuscular - inside the muscle
  • intermuscular - outside the muscle
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3
Q

what is a grade I quad contusion?

A
  • superficial intramuscular bruising that produces mild bleeding and swelling
  • little pain and mild point tenderness
  • active knee rom is greater than 90 degrees
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4
Q

what is a grade II quad contusion?

A
  • deeper bruise, moderate pain and swelling and discolouration
  • active knee ROM is between 45 and 90 degrees
  • may have antalgic gait - limping
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5
Q

what is a grade III quad contusion?

A
  • deep intramuscular bruising
  • pain may be more severe
  • oedema and bruising
  • active knee ROM is less than 45 degrees
  • may report more loss of function
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6
Q

what are the signs of a quad muscle lesion on contraction, stretch and palpation?

A
  • contraction - pain and weakness on resisted extension
  • stretch - reduced ROM due to pain
  • palpation - pain over area and palpable haematoma
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7
Q

what is the acute management of a quad contusion involve?

A
  • stop playing
  • POLICE
  • crutches
  • strapping
  • no heat, massage, forcefyl stretching or injection in first 72 hours
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8
Q

what is there a risk with if the contusion is severe?

A

there is a risk of rebleed in 7-10 days

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9
Q

what does the rehab progression of a quadricep contusion involve?

A
  • NSAIDS’s
  • gentle knee AROM
  • NWB exercises eg cycling or swimming
  • isometric quads and hamstring exercises
  • progress to concentric and eccentric strengthening
  • progress weight bearing
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10
Q

what is a complication that can arise with a quadricep contusion & how might this arise?

A
  • myositis ossificans
  • when the quads bleed, a cascade of cellular responses can occur and cause heterotrophic bone formation
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11
Q

which quadricep muscle is most likely to tear/strain?

A

rectus femoris - as connected to 2 joints

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12
Q

what is the rehab of a quadricep muscle strain similar to?

A

quad contusion rehab

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13
Q

describe the pathology of a hamstring strain

A
  • eccentric injury
  • injured during high speed running
  • mainly the biceps femoris
  • injured with hip flexion and knee extension -= eg kicking or sprinting
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14
Q

what are the non modifiable risk factors for a hamstring strain?

A
  • age
  • previous injury
  • race/ ethnicity
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15
Q

what are the modifiable risk factors with a hamstring strain?

A
  • strength
  • lumbopelvic core stability
  • fatigue
  • muscle characteristics
  • fitness level
  • training volumes
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16
Q

describe a grade I hamstring strain

A
  • microtearing of a few muscle fibres
  • local pain and slight pain with muscle activation and stretch
  • tightness and stiffness
  • minimal strength loss
17
Q

describe a grade II hamstring strain

A
  • moderate tearing of muscle fibres
  • local pain but a larger area
  • greater pain with muscle stretching and activation
  • stiffness, weakness and possible bruising
  • limited ability to walk for 24-48 hours
18
Q

Describe a hamstring grade III tear

A
  • complete tear of the muscle
  • swelling and bruising
  • possible palpable mass of muscle tissue at the tear site
  • extreme difficulty or inability to walk
19
Q

what kind of clinical signs and symptoms are picked up in a patient with a suspected hamstring strain in a subjective exam?

A
  • acute episode of overload or specific trauma
  • there may or may not be a popping sensation
  • functional loss and difficulty with walking - as hamstrings are important during the swing phase of gait
20
Q

what would be observed in a physical exam of a hamstring strain?

A
  • possibly antalgic gait
  • swelling and pain on palpation
  • reduced AROM and PROM
21
Q

what does the rehab (first 0-7 days) after a hamstring strain involve?

A
  • POLICE
  • pain free ROM
  • gradually introduce stretching
  • soft tissue massage and trigger point release
  • NSAIDS - useful for severe strains
22
Q

what does rehab (7 days onwards) of a hamstring strain involve?

A
  • increasing ROM
  • strengthening - isometric first then progressing to concentric and eccentric
  • sport specific training
23
Q

How can you prevent hamstring injuries?

A
  • warm ups
  • stability training
  • strength training
  • flexibility exercise
  • nordic hamstring exercise
24
Q

under what circumstances would surgical repair of a hamstring be advised?

A
  • certain proximal and distal avulsion injuries (when forceful muscle contraction pulls off some bone)
  • recommended when 2 tendons are retracted
25
Q

what are the 2 heads of the gastrocnemius muscle called?

A
  • medial head
  • lateral head
26
Q

why is the gastrocnemius vulnerable to injury?

A
  • as it crosses the 3 joints - knee, ankle and subtalar joint
27
Q

describe the epidemiology of a calf muscle strain

A
  • occurs in sport in younger patients - eg soccer, tennis, long distance running
  • prevalent in middle to older ages
28
Q

what can cause (aetiology) a calf muscle strain?

A
  • sudden eccentric contraction, acceleration from a stationary position
  • eg lunge forward, foot drops into dorsiflexion
29
Q

what can be picked up during a subjective exam of a patient with a suspected calf strain?

A
  • sudden sharp pain over muscle belly
  • if deeper, poorly localised pain and also cramping injury
  • feeling as if you have been kicked
  • may report swelling and bruising
  • difficulty weightbearing and walking
30
Q

what can be observed in a physical exam of a calf strain?

A
  • observing for swelling & bruising
  • antalgic gait
  • contraction test -unable to either double or single leg heel raise
  • palpation - tender at site of muscle tear
31
Q

describe a grade I calf strain

A
  • sharp pain
  • may be able to continue playing
  • pain on unilateral calf raise
  • time frame before return to sport -= 10-12 days
32
Q

Describe a grade II calf strain

A
  • unable to continue activity
  • pain in unilateral calf raise
  • limited dorsiflexion
  • time frame for return : 2-4 weeks
33
Q

describe a grade III calf strain

A
  • unable to continue activity as there is severe pain
  • thompson test is positive
  • may need surgery
34
Q

what are other conditions that may present similarly to a calf strain?

A
  • DVT
  • DOMS
  • achilles tear or rupture
  • achilles tendinopathy
  • lumbar spine referral
35
Q

what does the physiotherapy management of a calf strain involve?

A
  • may be conservative or surgical depending on the grade of tear
  • early loading
  • protected WB
  • isometric exercises
  • calf raises as soon as possible
  • retrain balance and proprioception
36
Q

what would the surgical management of a grade III calf strain involve?

A
  • immobilised 6-8 weeks or surgical repair followed by immobilisation x 6-8 weeks
  • graded return to full weight bear
  • restoring ROM strength and function
  • graded return to sport

NMSK1 - physio 1 (36 decks)

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