above hip Flashcards
vertebrae features
cervical: superior facing facet joints
- movement along transverse plane
thoracic: prominent spinous processes, posterior facet orientation, movement along frontal plane
lumbar: prominent transverse processes, for attachment of stabalizing muscles, facet orientation lateral, movement along sagittal plane
what can cause a stress fracture of vertebra and where does it happen?
force applied by spinous process below in extension can cause stress fx to pedicle
when are intervertebral disc herniations common?
in 40s b/c of lost muscular tone and ability to react quickly
which disc herniation is typically asymptomatic?
anterior-no nerve at front
compression fx of C-spine
=cervical vertebral bodies break at weakest part and can cause lesion to cord itself
MX: axial load to cervical vertebral bodies
cause: landing on crown of head (30 DEGREES FLEXION) or spearing
=when spine is straight so natural curvature is not there to be a spring
spondylitis
spondylolysis
spondylolystesis
- generic inflammation
- stress fx to pedicle
- split facet joints from extreme extension so that they no longer move with each other
- gymnastics, chronic injury
functional scoliosis
S shaped spine, when bent over spinous processes pull into a straight line
- functional from loading too heavily/improperly before stabilizers are ready
- could be pulled by musculature from improper stability or could be too tight or lose on one side
- difficult to get rid of b/c can’t isolate a few levels of spinal mm
stingers/burners
-unilateral
mx: stretch to brachial plexus by depression of shoulder girdle and side flexion of neck–>transient loss of depolarization and lower limb use
sx: loss of motor and sensory function
tx: remove from participation, strengthen sternocleidomastoid by resisted flexion
- stay out of activity until grip strength is equal on both sides
stingers/burners
-bilateral
- from compression/axial load to nerve roots like crown of head hit
sx: loss of sensation on both sides
tx: doctor, correct mistake (nothing in sport should put them at that kind of risk) - high rate of reoccurance
thoracic muscle spasm
diaphragm spasm
- can’t breathe out
- wind knocked out of you
- reduce anxiety and make sure no pain in ribs after
- diaphragm usually from solar plexus blow
which joint has the greatest range of motion in the body?
shoulder,+ most unstable
why is the shoulder unstable
- glenoid fossa small and flat, humerus can slide
- glenoid labrum (not articular cartilage) doesn’t make the joint too much deeper
what is the best position for the hands when the shoulder is bearing weight?
externally rotated
what is the least stable position of the shoulder?
90 deg abducted and externally rotated
-why you shouldn’t catch yourself
causes of shoulder dislocation
- eccentric pec contraction + weak rotator cuff makes axis of rotation change from shoulder to hand when catching yourself
- hit to throwing arm-changes axis of rotation to hand/where you are being hit
- skidding on the ground (capsule and tricpes are the only things to stop the humerus from moving down)
- nothing to stop ant. motion except capsule and biceps
shoulder-static stabilizers
-anterior
- corco-acromio lig prevents head of clavicle from superior excursion
- coraco-clavicular lig-restricts elevation of shoulder
- acromio-clavicular lig-horizontal plane
- sterno-clavicular lig
dynamic shoulder stabilizers
biceps (long head) triceps (long head) -coracobrachialis -pectoralis major -rotator cuff muscles
rotator cuff
- teres minor
- supraspinatus
- infraspinatus
- subscapularis
function: fix head of humerus to glenoid cavity and stabilize shoulder - important to activate stability in rotator cuff muscles as well as strengthening them by internal/external rotation exercises
which muscle is indicated when there’s pain below the head of the humerus?
which muscle when it’s higher?
- teres major and lat dorsi (attach where pec tendon is)
- supraspinatus-attaches on top
posterior shoulder stabilizers
supraspinatus, infraspinatus, teres minor, teres major, triceps, deltoid
how does the arm get to 180?
120 degrees of abduction comes from gleno-humeral motion
60 remaining comes from rotation split evenly b/t AC and SC joint
-pins or screws in clavicle can cause loss of ROM from lift in SC or AC joint
throwing tendonitis
mx: blocked humeral rotation, acceleration (pec major) or deceleration
(rotator cuff issue)
-sx: pain during acceleration phase
-prevention: strong rotator cuff, long follow through, warm up and stretching
what would indicate a labral tear instead of throwing tendonitis?
-lower pain, humerus is pulled forward and rotator cuff mm must hold the joint together
shoulder dislocation types
anterior: subcoracoid-humerus under coracoid process
subglenoid
posterior: post lip of scapula makes post dislocation difficult b/c humerus has to go out and around the back
-possible by hitting a tree or something
what’s the difference b/t a shoulder dislocation and separation
separation=at AC joint (ie still a joint dislocation or subluxation)
shoulder dislocation
mx: direct blow, change in shoulder fulcrum from blocking fall or throw)
sx: extreme pain, obvious loss of joint conformation, humerus in axilla
tx: monitor vital signs distally (pull arm away from body b/c humerus could be lying on top of a blood vessel), emergancy
recurrent dislocations
-rotator cuff, capsule, or labrum damage possible
shoulder separation
A-C separation
mx: scapular retraction or depression
cause:
- fall on outstretched arm (inward scapular rotation, acromion compresses A-C joint)
- front of shoulder (retraction of scapula and distracts joint), fall on point of shoulder (scapula rotates downward and distracts the joint)
shoulder separation grades
grade 1-minor distension, no tearing/obvious deformity, reduced ROM
grade 2-typically no damage to coraco-clavicular ligaments, loss of function, pain, visable lift to AC joint
3-loss of function and strut (shoulder falling on rib cage), clavicle can be flipped in the air, usually pain negative
RTA when pain is tolerable except grade III (surgical)
shoulder impingement
could be from
1. subacromial bursitis
2. coracoacromial ligament
3. supraspinatus tendon
abduction causes compation of these (bursa protects ligaments)
-many swimmers have subacromial bursa removed so they can internally rotate and abduct but this puts the tubercle further under the acromion and cause more bone on bone action
forearm extensors
forearm flexors
- extensors from lateral epicondyle
- from medial epicondyle
medial epicondylitis
little league elbow
mx: traction on apophysis
sx: pain w/ resisted wrist flexion
tx: ICER, strength and flexibility
- not at all common in adults
lateral epicondylitis
tennis elbow
mx: eccentrics during backhand (ball hitting racket) or repetitive extension of wrist
sx: pain w/ resisted extension of middle digit
tx: RICE, strength and flexibility-freefall weights and catch
elbow dislocation
mx: hyperextension, rotation
sx: shortened arm, obvious deformity, pain
tx: immobilize and transport, ice
forearm fx
radius breaks higher
ulna breaks lower
-radius bears force b/c bigger bone distally, force is transferred through the interosseus membrane at the elbow b/c the ulna is bigger
ulnar deviation might cause
radial might cause
-styloid fx
-scaphoid (isthmus), high incidence of non-union b/c of minimal pain
can tell scaphoid fx from no power in opposition
scaphoid fx
mx: hyperextension or radial deviation
sx: painful ROM or opposition
tx cast and immobalization for 12 weeks then tape w/ contact wrist
metacarpal fx
mx: axial load, transverse blow
cause: punching something
sx: swelling, pain
tx: ORIF (if phalange is rotated it will mess up grip/fist
finger dislocation
mx: hyperextension, axial load
sx: deformity, pain
tx: reduction, spilint, ice
- if side to side, collateral ligament is damaged
mallet finger
ruptured extensor tendon
mx: hyperflexion
cause: ball on end of finger causing hyperflexion
sx: lack of DIP extension
tx: refer for splint
swan neck deformity
mx progression from mallet finger from rupture of extensor hood mechanism
-tendon contraction pulls PIP into hyperextended position
sx deformity
tx: refer to orthopaedic
boutinniere deformity
mx: hyperflexion of PIP
cause: arthritis?
sx: hyperextension of DIP
tx: refer for splinting
wrist fractures
cause: fall on outstretched arm, rolling into hyperflexion (smith’s)
smith’s=flexion fx of radius
colles=extension fx of radius
tx: emerg/immobalize
meninges
dura mater, venous supply arachnoid, subarachnoid space (w/ arterial supply), pia mater
epidural hemorhhage
top of dura, localized bleeding and clotting
subdural hemorhhage
venous blood drains to base of brain and depresses respiratory center
-blood does not clot
subarachnoid hemorrhage
car accident level trauma not in athletics
coup and contracoup
-hit smashes skull into brain (acclerating blow), then brain smashes into skull when hitting the ground (decelerating blow, always worse)
concussion (TBI)
- disturbance in brain function from indirect or direct force to head
- usually results in disturbance of brain function rather than damage to structures
when to suspect consussion
symptoms like headache, dizziness, etc, physical signs (unsteadiness), cognitive signs, abnormal behavior
concussion grade I
- no LOC
- dizzy
- glazed eyes
- no other symptoms
- recheck every 15 min
grade II
-possible LOC
-symptoms beyond 15 min
-retrograde amnesia
-no neurologic signs
RTA w/MD clearance
grade III
- possible LOC
- minor signs and symptoms persist beyond 15 min
- evidence of post traumatic amnesia
- evidence of neurologic signs
- emergency
on field protocol 1
- w/LOC, assume C-spine
- don’t let athlete move
- do sensory testing bilaterally, ask athlete to respond when they feel something
- do motor testing from distal to proximal (resistance, NO JOINT MVMT), upper and lower, test bilaterally
concussion protocol
-if issue here, it’s grade III
-ask how injury happened
-palpate for fx deformity
-tell them 3 colors and 2 objects, retest in 5 min
-ask date, count backwards by 3’s etc.
-check pupils for response to light and tracking
-check for CSF (skull fx)
eg rhinorrhea (nose) or ottorrhea (eyes)
nystagmus
involuntary rapid eye movement, may be grade II concussion
protocol III
-ask athlete if they think they can move their head
-ask to sit up, support head
-ask to see pain free ROM of head, no extension
at sideline: check balance, coordination (finger to nose and hopping)
retest in 10
what does not being able to hop indicate
grade III concussion (won’t be able to coordinate muscles)
lucid interval
blood may drain slowly and pressure builds up slowly but at a certain point causes respiratory symptoms
-wake up every two hours and purpose of re-testing
secondary impact syndrome
concussion sensitizes brain to subdural hemmorhage w/ another one
chronic traumatic encephalopathy
- degenerative changes form repetitive mild TBI
- was called ‘demential pulgilistica’
- associated w/tau protein, no screen
lacerations
suture if jagged edge, in hair, irregular shape, bleeding to much
steristrip if small w/ straight edge and clean
jaw fx: lower mandible
- sometimes painful, sometimes not
- nausea
- teeth knocked loose
jaw fx: zygomatic arch
depression fx: pushes bones in
numbness over zygoma, no pain
-can’t tell from front, have to look from above
-nausea common
eye trauma-hyphema
meniscus of blood, refer
corneal abrasion
cause: clothes across eye or something in it
sx: gritty feeling
tx: cover, rest, opthalmic antibiotic
cauliflower ear
mx: dermis/epidermis separation by friction, edema
- sx: swelling, redness, sensitive to touch, feels hot
tx: emerg for draining and packing
swimmer’s ear
mx: infection by pseudemonas organisms or surface bacteria
sx: canal is sore and swollen
tx: antibiotic cream
prevention: dry ear, no Q tips
nosebleeds
tx: apply pressure for 5-10 min and then slowly release sides of nose so blood can clot behind
- tilt head to bleeding side
- ice compress over bridge of nose
deviated septum
=broken nose
-sometimes not actually deviated so urgent care usually waits
tinea pedis/cruris
athlete’s foot
sx: rash b/t toes and spreads
tx: expose to light, air circulation, use antifungal for 2 mo or it comes back
tinea corporis
ringworm
nail fungus
sx: deformed nail, darker color
tx: oral or cream antifungal
warts
=metabolic byproducts of the virus growth,
tx liquid nitrogen
plantars warts
tx: salicate plasters until exposed, then liquid nitrogen
- refer to MD
molluscum contagiosum
half dome, shiny and silvery looking bumps
-can get from contact, highly contangious
impetigo
contagious-can get on contact
-always has yellowish crust
tx antibiotic cream
dermatitis
remove from possible contact
scabies
=a mite, causes itchy pimple bumps
highly contagious
-sx: raised papillae, like pimple w/out white head
tx: cover entire body w/kwellada lotion a bunch
inflammation vs infection
skin may be curled and bumpy, imflammation just causes discoloration
anti-inflammatories
steroidal: cortizone/cortisol
anti-inflammatories non-steroidal
ASA asprin
NSAID-ibuprofen, fenoprofen, and then prescription clinoril, sindulac, and indocin
aceylsalicylic acid
anti-imflammatory, antipyretic (fever reducer), analgesic (pain)
-side effects include GI, pepitc ulcers, platelet dysfunction
NSAID meds
same effects, side effects include GI, dry mouth, tinnitus
phenylbutazone
-rapid reduction in inflammation
-strong, used in horses
side effects include aplastic anemia, agranulocytosis, hypersensitivity, embryotoxicity
what’s a major danger w/ phenobutazone?
hypersensitivity can happen
-usually a local reaction the 1st time and systemic the next
codeine
-very pain relieving, fast acting
side effects: very addictive, GI, dry mouth
acetaminophen
analgesic and antipyretic (not anti-inflammatory)
side effects: less GI upset, no platelet dysfunction
hypnotics/benzodiazipans
calming, mild sedation
-decreased muscle tonus and anti-convulsant
side effects: habituation/withdrawl and increased reaction time
pain spasm cycle med combo
analgesic during day, muscle relaxant at night to attack spasm issue that causes pain
methocarbomol
=mm relaxant that’s not seditive
- decreased tonus
- decreased alertness though
- and increased reaction time
fourimethane
topcial anaesthetic
lidocaine
xylocaine
local anaesthetics
DMSO (dimehtylsulfide)
decreased swelling, inflammation, pain
side effects: garlic breath, change in cell membrane permiability (useful for getting medication in in arthritis)
–actually and industrial cleaner
caffeine
-peripheral vasodilation, cerebral vasoconstriction
-increased FFA utalization
-CNS stimulant
side effects: hydrolytic (takes fluid needed for thermoregulation), increased BP, extrasystole, diuretic, increased GI mobility
ephedra
benzadrine
epinephrine/norepinephrine
amphatamines
- increased alertness, sense of confidence, decreased sense of fatigue
- confusion, poor judgement
what are the 3 things in hydroxycut?
caffeine, ephedra, asprin
what is too hot + how to prevent heat stress?
check humidity is not over like 80 when it’s hot out
- prevent heat stress with loosely knit clothes and ventilation over the head!
- stay active to maintain body temp
- increase food intake and stay hydrated
- cover/ventilation over head
heat cramps
- severe mm spasm from dehydration or electrolyte loss (fatigue contributes)
tx: stretching (PNF), rest, rehydration
heat exhaustion
sx: shock like symptoms
- rapid, weak pulse
- shallow breathing
- pallor
- cool, clammy skin
- dizzy/uncordinated
- dilated pupils
tx: rest, rehydration, ice to exposed arteries
heat stroke
sx: rectal temp above 41 celcius, dry, flushed skin (breakdown of thermoregulation, no evaporation)
- nausea, vommiting, rapid pulse, gasping, constricted pupils
- LOC, seizures, syncope
tx: 911, force evaporation or whole body immersion if possible, do not move abruptly and cool down before transport
when is heat stress likely?
w/in first 3 days
- temp differential is important, not absolute temp as much
- most acclimatization occurs w/in 4-7 days
hypothermia
stage 1 when you can’t stop shivering-rewarm/get out of clothes
2-violent jerky movements, slurred speech-warm fluid and clothing
30-32-muscular rigidity, irrational, amneisia-rewarm by conduction sandwhich
-stage where people have complete indifference for their situation
less than 30-stuperous, LOC, muscular rigidity, arrhythmias
-no sudden movements
splenic rupture
- increased risk with splenomegaly (mono)
- kehr’s sign: pain referred to L shoulder and upper 1/3 of arm
peritonitis
appendicitis
peritonitis=inflammation of the peritonial lining/pain in lower abdomen
-if there’s pain on the way up, it’s probably appendicitis, which shifts when you release quickly
rigid abdomen
- from muscle spasm
- from infection
- blood in the peritoneal cavity
liver injury
- can feel hepatomegaly + harness under rib cage
- usually jaundiced
- refer immediately
sudden athlete death
- marfan’s syndrome
- mitral/tricuspid valve dysfunction
- increased BP and thermoregulatory stress from ephedra
- heart contusion from hit to breast plate
pneumothorax
spontaneous blowout of lung wall, loss of pressure gradient in pleural cavity and collapse of lung
haemothorax
puncture of lung by rib, red froth at mouth, collapse of lung
-shortness of breath, easily fatigued
