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Athletic Injuries > Midterm > Flashcards

Midterm Flashcards

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1
Q

Roll Up Injury

MOI, possible injured structures

A

External rotation forced into dorsiflexion from a fall on the ankle from behind
Possible injured structures: deltoid lig, fractured fib, AITFL
- don’t all have to happen and can occur in different order

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2
Q

Healthy Ankle Injury

MOI, injured structures, tests

A

Eversion and external rotation (most commonly in hockey skate or ski boot)
Injured structures: fracture of fibula with no injury to deltoid lig.
Tests: squeeze test and external rotation (both indirect)

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3
Q

High Ankle Sprain

MOI types, injured structures, signs, tests

A

MOI:

1) Dorsiflexion and eversion
2) external rotation of foot w/ internal rotation of leg
3) Postulated to be external rotation and hyperdorsiflexion

Injured structures: AITFL and interosseous membrane

Signs: minimal swelling (noncapsular), toe to heel ambulation, negative ant. drawer and talar tilt, empty end feel in dorsiflexion

Tests: squeeze test, external rotation, length of pain on interosseous

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4
Q

Lower Leg Tendinitis/Paratenonitis

Signs/symptoms, treatment

A

Signs: pain/crepitation of acute onset, red and hot, ankle movement makes it worse, positive STTT

Treatment: POLICE, address training issues, gradual return

TOO MUCH TOO SOON

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5
Q

Retrocalcaneal Bursitis

A 
Inflammation of bursa between tendon and calcaneus 
Usually chronic 
Structural irritants
Pain above insertion of Achilles tendon 
Pain with squeeze from side
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6
Q

Achilles Bursitis

A

Easy to correct
Pain with palpation on posterior aspect of heel
Shoes too tight/excessive friction

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7
Q

Achilles Tendinosis

What is it?, Causes, predisposing factors,

A

Chronic pathological changes brought on my repetitive micro trauma
Inflammatory cells are absent + rice crispies
Changes in collagen fiber structure (disarray + fewer nuclei) and vascularity (neovascularization)

Can be brought on by neglect of tendinitis and worsens with little recovery time

Predisposing facts: years of running, excessive pronation, training in cold climate, improper footwear

Remodel w/ alfredson’s painful heel drops (eccentric)

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8
Q

Stages of Tendinopathies

A

Stage 1 - no pain prior, pain until warm during, after pain goes away with rest

Stage 2 - pain in AM, pain during, pain after

Stage 3 - slight pain before, pain limits activity, no inflammatory mediators but wider b/c it is fraying

Stage 4 - pain even at rest, unable to exercise, may rupture if untreated

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9
Q

Achilles Rupture

A

More common in males in 30-40s
Sports that require rapid change in direction
Reports snap/pop + pain rapidly subsides
Pain 1-2 inches above insertion
Can do double leg heel raise but not single
Divot on palpation
Unable to plantar flex
No pain on stretch because it is completely torn
Positive thompson test
Immobilize w/ 2 cm heel lift for 8 weeks with exercise below neutral for week 2-4

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10
Q 
Compartment Syndrome
(2 types, 4 Ps)
A

Traumatic/Acute: due to direct trauma, can result in devastating injury and is a medical emergency

Exertional/Chronic: starts following increase FITT, usualyl worsens during running/jumping, cease with rest

Pain (out of proportion)
Paresthesia
Paralysis (late finding)
Pulse (lack of)

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11
Q

How to evaluate compartment syndrome?

A

Test strength 10x - looking for weaker, slower, more painful
Stretch muscle - muscles working anaerobically will have pain on stretch
Palpate - firm is bad
Skin colour - pale turn red, dark turn darker

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12
Q

Anterior Compartment of Leg

pain, strength, stretch, nerve, sensory area

A 
Pain: lateral tibia
Strength test: dorsiflexion
Stretch: plantar flexion
Nerve: deep peroneal
Sensory area: b/w 1st and 2nd toes
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13
Q

Lateral Compartment of Leg

A 
Pain: lateral malleolus
Strength test: eversion/plantar flexion 
Stretch: inversion/dorsiflexion 
Nerve: superficial peroneal 
Sensory area: dorsum of foot not near toes
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14
Q

Deep Posterior Compartment of Leg

A 
Pain: lower 1/3 postero-medial tibia
Strength test: inversion/plantar flexion
Stretch: eversion/dorsiflexion
Nerve: tibial
Sensory area: plantar foot (not heel)
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15
Q

Treatment for Compartment Syndrome

A

Slow warm up before activity
Icing after
Stretch before and after
Modify the activity that causes it

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16
Q

What causes Medial Tibial Traction Periostitis (MTTP)

(AKA Medial Tibial Stress Syndrome) - true shin splints

A

Causes by over pronation (due to weak muscles, fatigue, or shoe) and training errors - both cause athlete to modify weight acceptance
Caused by soleus and flexor digitorum longus b/c they eccentrically limit pronation

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17
Q

MTTP - Signs and Treatment

A

Signs: pain on medial tibia that improves with warm up and is worse after, rough/rice crispies over medial tibial margin, minimal STTT signs (can’t produce as much force as running)

Treatment: POLICE, stretch, strengthen to prevent overpronation, correct training errors

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18
Q

Tibial Stress Fractures

cause, presentation, treatment

A

Can be caused by repetitive impact but also if there is muscular imbalance pulling on bone (decreases bone density)

Proximal and anterior stress fractures in the tibia are more resistant to treatment - “anterior is awful”

Presentation: cavus (no shock absorption) or planus (pronated foot - no absorption), gradual onset by exercise, pain all the time and at night

Treatment: decrease weight bearing, pneumatic brace , address training errors, slow return, train in water instead

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19
Q

Which types of muscles are most at risk for strain?

A

Two joint muscles (gastrocs, rectus femoris, hamstrings) and muscles with more fast twitch fibers

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20
Q

Why does a muscle strain occur?

A

Forcible stretch of a passive or active muscle
The stretch must be past the resting length to cause damage
Commonly an eccentric contraction that causes it

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21
Q

Gastroc Strain

A 
Sudden onset
Medial head more susceptible
AKA tennis leg 
Sports with quick starts and stop 
Foot planted and extension of knee
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22
Q

Soleus Strain

A 
Slow onset
Usually lateral 
Calf is tight 
Common in severe pronators
Worse with walking and jogging than sprinting
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23
Q

Signs and symptoms of strain

A

Bruising, swelling, redness

Maybe palpable defect near MT junction

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24
Q

How to test for soleus vs gastroc strain?

A

Bent knee = soleus

Straight knee = gastrocs

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25
How to treat a strain?
Same as other acute and subacute but use concentric and eccentric actions (alfredson's)
26
Order of assessment
3 questions: life or limb, area stable, how to exit? Subjective/History: MOI, pain, sounds, prior injury, continue? Objective: - clear above and below - tests (ant. drawer, external rotation, squeeze) - palpate important structures (ottawa ankle/knee rules) - on sideline: AROM, PROM, resisted *if there is a fracture - no more tests
27
What grade means it is not safe to remove athlete from field weight bearing?
Anything above grade 1 Grade 1 - weight bearing Grade 2-3 - non weight bearing *even if it is grade 1 if the athlete does not feel comfortable - remove non weight bearing - better safe than sorry*
28
What pain characteristics should you ask about in the clinical assessment?
Sharp = nerve Localized and deep = bone Dull and achy = muscle Does it change? am/pm/sleep/activity
29
Why is it important if the joint is locking?
think about meniscus in the knee
30
Why is it important if the area feels like it is going to give way?
grade 3 injury
31
Difference between pain and discomfort
Pain changes the way you perform an activity, discomfort doesn't
32
What is the sideline testing progression for the "minor injury"?
Straight - angle - cut - accelerate/decelerate - explosive - jump/kick/spin/strike
33
Aside from the formal rehab what must the athlete be working on for return to sport?
Maintaining their conditioning | Let the athlete know what they can do, not just what they can't
34
What do you need to think about for sport specific skill progression?
speed, coordination, proprioception, cadence, quality, etc.
35
What are the three articulating surfaces in the knee?
1) Medial and 2) lateral tibiofemoral and 3) patellofemoral
36
Takes place between the bottom of the femur and the top of the menisci?
knee flexion and extension
37
Takes place between the bottom of the menisci and the tibia?
rotation/twisting
38
When does rotation of the knee occur and why? What is the difference between foot planted and femur fixed?
During the last few degrees of extension because the medial femoral condyle is larger than the lateral Foot planted = femur rotates medially Femur fixed = tibia rotates laterally
39
What muscle unlocks the knee?
Popliteus contracts to externally rotated the femur
40
Is the knee more stable in flexion or extension?
extension - poor bony fit in flexion
41
What muscles are the dynamic stabilizers of the knee?
hamstrings, quads, IT band, gastrocs
42
Is the MCL capsular or non capsular?
Capsular - slow capsular effusion
43
Is the ACL intracapsular or extracapsular?
Intracapsular - fast swelling (hemarthrosis)
44
Is the PCL intracapsular or extracapsular?
extracapsular
45
is the LCL capsular or extracapsular?
extracapsular
46
The lateral aspect of the knee is mainly support by___
Muscles ``` Biceps femoris IT band Popliteus tendon Capsular ligaments Lateral collateral ligament ```
47
Lateral knee injuries occur due to a ___. Isolated LCL tears are common/uncommon
varus force | Isolated LCL tears are uncommon
48
Characteristics of the LCL
lateral epicondyle of femur to fibular head extracapsular - minimal swelling primary STATIC restraint to varus force Takes load at 25-30 degrees because muscles change angle of pull
49
The medial aspect of the knee is supported by?
MCL is primary stabilizer (at 25-30 degrees) ACL/PCL Muscles - medial hamstrings, medial gastroc, quads boney structure
50
Characteristics of the MCL
capsular - slow swelling connects directly to MCL - likely injured together Medial femoral epicondyle to tibia has superficial and deep components
51
With a knee injury that has damaged the MCL, medial meniscus, what else is likely to be injured?
ACL | then PCL
52
Structure of the ACL
goes from anterior tibia to lateral femoral condyle has 3 bands - two of which are major: anteromedial (controls forward and back) and posterolateral (medial rotation) primary restraint for anterior tibial translation (greatest at 30 degrees)
53
Which cruciate ligament is stronger?
PCL
54
What does the ACL do?
restrict posterior translation of femur during weight bearing restrict anterior translation of tibia during non-weight bearing
55
The anteromedial band of the ACL tighten in __ | the posterolateral band of the ACL tightens in __
flexion | extension
56
Structure of the PCL
medial condyle of femur to posterior tibia | has anterolateral and posteromedial bands (opposite to ACL)
57
What does the PCL do?
restrict anterior translation of femur during weight bearing | restrict posterior translation of the tibia during non weight bearing
58
The anterolateral band of the PCL tightens in___ | The posteromedial band of the PCL tightens in __
flexion | extension
59
General ligament principles: Lateral rotation makes the __ tight Medial rotation makes the __ tight
lateral rotation - collateral | medial rotation - cruciate
60
What is the purpose of the menisci?
distribute nutrients on compression stabilize knee by increasing concavity Shock absorption (greatest at 90 degrees knee flexion)
61
Characteristics of the medial meniscus?
C shaped greater radius of curvature tight connection with MCL and capsule Poor mobility
62
Characteristics of the lateral meniscus?
O shaped smaller radius of curvature Attached loosely to capsule Increased mobility
63
Each meniscus has three zones, what are they and what is the implication?
red-red - heals well red-white white-white
64
What are the Ottawa Knee Rules? | What should you be suspicious of?
Xray when one of the following is present: Age greater than 55 or less than 18 Tender over fibular head or patella Inability to flex to 90 degrees (swelling/fracture) Inability to walk 4 steps Be suspicious of: MVA, young patients who could have avulsed a bone, clinically loose people
65
Important questions to ask people with knee injuries?
MOI - foot planted or not, contact or non contact, pop/crack were you able to continue? If not, how did you get of the field? Locking or giving way since?
66
MCL injury MOI
valgus force with or without external rotation | can occur in isolation
67
LCL injury MOI
less common but more complicated | varus with or without hyperextension
68
What is something done differently with knee injuries during the acute stage?
instead of restricting ROM, we want to maintain gentle flexion/extension and dynamic stabilizers (quads/hams)
69
ACL injury MOI
occurs with contact or non contact during cutting or single leg landing 1) deceleration/internal rotation 2) quads active - anterior tibia translation (main mechanism) 3) valgus after MCL can occur in isolation or with other structures NOT through hyperextension (protected in notch) **MAY SEE LATERAL JOINT LINE BRUISE - DO NOT CONFUSE WITH LCL**
70
Why are there more ACL injuries in females than males?
1) anatomical - smaller intracondylar notch, wider pelvis, ligament laxity 2) hormonal - estrogen (not well proven) 3) neuromuscular - increased quad activation between 10 and 30 degrees, activate quads before hams, cut and land differently
71
Knees should be bent on landing because __
the line of pull in flexion is more backwards vs in standing it is vertical
72
Findings on an ACL injury
``` Restricted movement in extension Lateral joint tenderness (bone bruise - do not mistake for LCL) Positive lachmans (better because in 20-30 flexion when ligaments are loose and hamstrings don't contribute as much) and anterior drawer (90 degrees) ```
73
During grade 3 ACL injuries what do we do in the acute stage?
prepare for surgery POLICE maintain quads/hams strength - required for surgery
74
PCL Injury MOI
Sports or MVA (dashboard injury) commonly due to hyperflexion valgus after MCL and ACL varus after LCL and ACL
75
Presentation of PCL injury
pop in posterior knee poorly defined pain in back of knee minimal swelling - extracapsular posterior drawer test and sag test positive
76
With ACL injury we want to strengthen __ | With PCL injury we want to strengthen __
ACL - strengthen hamstrings | PCL - strengthen quads
77
Acute meniscal injuries usually occur in (young/old) adults through combination of flexion, compression and rotation. In full flexion they accept __% of the laod
usually young adults | 85% of load at 90 degrees
78
Medial meniscus is __x more likely to be injured and MOI is?
5x more likely | MOI - internal femoral rotation and possible varus
79
Lateral meniscus MOI
hyper flexion or external rotation
80
Presentation of meniscus injuries
pain on squatting restricted ROM - locking quicker swelling if lateral (red-red) medial meniscus has less swelling positive mcmurrays (heel is pointed to side we are testing) distraction test should have no pain (pulling surfaces apart)
81
Factors indicating surgery for meniscus
locked knee severe twisting positive mcmurrays - pretty bad
82
With ankle injuries in acute stage we __ ROM and with knee injuries we ___ ROM
ankle - restrict | knee - maintain
83
Patella subluxation or dislocation MOI
``` moves out of groove laterally MOI: tibia ER and femur IR foot planted lateral/varus force knee usually in extension ```
84
Predisposing factors for patellar instability
patella alta (high riding) shallow LFC or flat patella mechanical dysfunction with excessive femoral internal rotation lax bodies
85
Symptoms/Signs of Patellar Dislocation
``` knee pop out pain until reduced fast swelling - hemarthrosis loss of knee function if still dislocated tender of MEDIAL border positive lateral apprehension ```
86
What injury has similar presentation to patellar dislocation?
ACL - because of the fast swelling and loss of knee function to tell them apart: ACL will hurt on lateral joint bruise and Patella has pain medially
87
To relocate patella:
slightly flex hip and slowly extend the knee | If it does not, do NOT force it because there be other injured structures - send for xray
88
How to treat someone who has dislocated their patella?
PROTECT POLICE maintain ROM strengthen associated structures
89
Why should we be cautious of the painful then suddenly not painful injury?
grade 3
90
What should you do on the primary survey?
U responsiveness (alert, verbal, pain, unresponsive) Airway breathing circulation spinal injury, deformation, bleeding, shock (if any of these activate EAP and go) if not then secondary assessment
91
Why do we clear above and below when doing onfield assessment?
to rule out injuries to other areas and assess athlete's tolerance to handling
92
Palpate the knee for:
ottawa knee rules (patella and fibular head) | MCL, LCL, hamstrings, ITB, joint lines
93
Knee tests:
``` patellar apprehension lachmans anterior and posterior drawer mcmurrays (meniscus) valgus/varus stress (MCL and LCL) ```
94
Hamstring strains are the most common and have high reoccurrence, what muscle is usually injured ?
biceps femoris active in terminal swing to initial stance often injured in terminal swing before heel strike (eccentric)
95
Intrinsic and extrinsic factors contributing to hamstring strain are:
intrinsic: age (over 23), previous injury, strength (quads more than hams), flexibility, lumbopelvic stability extrinsic: warm up, fatigue (muscles absorb less and change in coordination), training (increase in FITT)
96
Symptoms and signs for hamstring strain
sudden onset spasm (grade 1) or tear (grade 2-3) difficulty moving pain near head of biceps (MT junction) Bruising positive STTT palpable gap
97
Grade 1 strain
slight tightness 4-5/5 strength fewer than 20% torn
98
Grade 2 strain
pop or tearing sensation can't extend knee 2-3/5 strength 70-80% torn
99
Grade 3 strain
pop or tearing can't extend knee 0-1/5 strength more than 80% torn
100
Quadriceps Strain MOI
sudden forceful contraction of hip and knee most common in rectus femoris (2 joint) unlike hamstrings the tear is near distal MT junction, if they are proximal they are harder to rehab (bull-eye lesion) similar presentation to hamstring train
101
For strains it is important to ___
compression because it prevents blood from localizing
102
During the remodelling stage of strains it is important to work____
eccentrically and concentrically
103
``` Thigh contusion (AKA ___) MOI ```
AKA charlie horse usually result of impact to relaxed thigh intra or intermuscular
104
Signs and Symptoms of thigh contusion
``` may be able to continue sudden decrease of ROM following bruising STTT contraction may have palpable mass (do NOT massage out) ```
105
How to test for inter vs intramuscular contusion
prone knee bend | if knee bend is less than 90 degrees after 24-48 hours it is most likely intramuscular
106
Grade 1 quad contusion (mild)
greater than 90 degrees flexion may not remember sore after minimal strength lost
107
Grade 2 quad contusion (moderate)
45 to 90 degrees flexion tender to touch but finishes game loss of strength to pain
108
Grade 3 quad contusion (severe)
less than 45 degrees flexion rapid onset - may not finish game functional loss of strength
109
Key points with quad contusions
risk to rebleed in first 7-10 days hands OFF (nothing until after 48 hours to promote lymphatic drainage) no aggressive stretch past pain
110
How to treat a quad contusion in first 24 hours?
passively and painlessly flex knee to 120 degrees and wrap ice crutches every couple hours unwrap and pump to prevent blood clot
111
How to treat quad contusion after 24 hours?
idealize ROM idealize quad girth and firmness regain mobility donut pad for return to sport
112
Myositis Ossificans (types)
Periosteal - connected to bone Heterotopic - within muscle belly osteoblasts replace fibroblasts and form bone stops at 6-7 weeks w/ bone reabsorption muscles can't function properly
113
Risk factors leading to myositis ossificans from contusion
didn't control bleeding aggressively enough too vigorous therapy: massage, heat, stretch knee flexion less than 45 degrees 2-3 days post
114
Symptoms of myositis ossificans
increasing morning pain, activity pain, night pain Loss in ROM woody on palpation
115
Acute compartment syndrome of the thigh | What is the normal pressure, what can it get to?
normal 20 mmHg | can get to 80-100 mmHg
116
What muscles can be affected with hip and groin strains?
iliopsoas rectus femoris adductors (gracilis, pectineus, longus, brevis and magnus)
117
Adductors are usually ___ | Iliopsoas is usually ___
acute | chronic
118
Adductor strain | MOI and signs
``` sudden change of direction acute and well localized - belly of adductor longus pain with resisted adduction pain of passive hip abduction bruising ```
119
Treatment of adductor strain
control bleeding and swelling in first 48 | after 48 - focus on muscular imbalances, concentric and eccentric, rapid change of direction, exercise progression
120
Groin Strain - Hip Flexor MOI
forced extension and/or excessive contraction of flexors can be: rectus femoris (acute)- tenderness 8-10 cm below ASIS iliopsoas (chronic) - repetitive hip flexion, poorly localized deep pain
121
How to tell the difference between rectus femoris and iliopsoas for groin strain?
rectus - pain with flexed knee stretch, pain with active knee extension, positive elys (ipsilateral) and two joint with bent knee iliopsoas - pain with hip flexion stretch (straight knee), pain with resisted hip flexion with extended knee, positive thomas (contralateral) test and two joint straight knee
122
How to treat a groin strain?
POLICE concentric and eccentric address muscular imbalances wrap with hip spica
123
Groin Strain - Abduction, extension and external rotation MOI
combination of previous two (adductor and groin strain) largely due to eccentric movement common in hockey (skating) pain on resisted flexion, adduction and internal rotation look at: muscle imbalances, shooting style, flex of equipment
124
Hip Pointer injury MOI
iliac crest contusion and abdominal contusion disabling - crushing of soft tissue between hard objects common with improper equipment/placement immediate pain, decline in hip function, check pain through pelvic ring - pelvic crest can be fractured
125
Female genital injuries
straddle fall most common labial/vulvar contusion, perineal tearing, vaginal laceration contusion can cause hematomas that we must apply pressure to so it doesn't form a mass
126
Male genital injuries
Most common due to blunt trauma can be: - testicular/scrotal contusion (immediate excruciating that improves w/ cremasteric muscle spasm) -testicular torsion (testicle rotates on spermatacord) - due to forceful cremasteric contraction - medical emergency unilateral pain and testicle may not be vertical anymore

Athletic Injuries (3 decks)

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