Adult Sports Medicine and Overuse Injuries Flashcards
What are extrinsic risk factors related to activity for sports injury?
increase in volume or intensity
change in type of exercise
change in foot wear or running surface
What are extrinsic drug related risk factors for sports injuries?
fluoroquinolones
corticosteroids
statins
estrogen
non-steroidal anti-inflammatory drugs (ibuprofen and naproxen)
What are intrinsic risk factors for sports injuries?
systemic issues such as diabetes, hypertension, and vascular disease
previous injury
genetic
obesity through increased load or systemic alterations that promote degeneration
focal, regional, generalized weakness
biomechanical and kinetic chain abnormalities such as an inflexible achilles tendon or calf muscle
What is the structure and function of tendons?
connect muscle to bone
strength related to thickness and collagen content
transmit force from muscle to bone and act as a buffer by absorbing external forces to limit muscle damage
1 cm2 is capable of bearing 500 to 1000kg
What is the makeup of the dry mass of tendons?
65-90% collagen type I
2% elastin
collagen fibers are generally oriented longitudinally, along the line of pull of the musculotendinous unit
oxygen consumption is 7.5x lower than muscle
What happens to collagen fibrils at the myotendinous junction?
inserted into the deep recesses formed by myocyte processes, allowing the tension generated by intracellular contractile proteins of muscle fibers to be transmitted to the collagen fibrils
this complex architecture reduces the tensile stress exerted on the tendon during muscle contraction
however, the myotendinous junction still remains the weakest point of the musculotendinous unit
Where are synovial tendon sheaths found?
in areas subjected to increased mechanical stress, such as tendons of the hands and feet, where efficient lubrication is required
What determines the tensile strength of tendons?
related to thickness and collagen content
a tendon with an area of 1 cm2 is capable of bearing 500 to 1000 kg
What are the common findings upon histological examination of tendinopathy?
disordered, haphazard healing with an absence of inflammatory cells
a poor healing response
noninflammatory intratendinous collagen degeneration
fiber disorientation and thinning
hypercellularity
scattered ingrowth
increased interfibrillar glycosaminoglycans
What are the three stages of healing of tendons?
inflammation, remodeling, and maturation
What are the risk factors of rotator cuff?
weakness or inflexibilities at distant structures
What is rotator cuff tendinopathy?
more common in the middle age than in early adulthood
can be associated with abnormal scapular motion
often responds to strengthening of shoulder girdle
What is achilles tendinopathy?
accounts for up to 30% of running injuries
more common in mid-substance (55-65%) than at the insertion (20-25%)
occurs in 4% of non-runners
occurs at midportion of tendon and at insertion of the calcaneous
What are the risk factors for achilles tendinopathy?
factors that affect vasculature and oxygen transport:
dyslipidemia
hypertension
obesity
diabetes
genetics
decreased calf strength
abnormal subtalar motion
medications - quinolones, corticosteroids, BCP
What is the clinical presentation of achilles tendinopathy?
generall occurs without a sudden injury
pain primarily with sport, sometimes with walking, not at rest
localized pain to mid-portion or insertion
generally not warm or erythematous
strength is normal
does not usually progress to rupture
often associated with nodularity at the midportion of the tendon
What is the treatment for achilles tendinoapthy?
relative rest, but can cross-train
heal lift if significant pain with casual walking
if no partial tear is present, often responds well to exercise therapy
can use injections or surgery as well
What is the pathology of achilles tendinopathy?
non-inflammatory intratendinous collagen degeneration
fiber disorientation and thinning
scattered vascular ingrowth (neovascularization)
gray-brown and amorphous
What is the prognosis of achilles tendinopathy?
most recover completely with treatment
if not recovering, review exercise program of consider different diagnosis
What is patellofemoral pain?
pain between the patella and femur
most common cause of anterior knee pain
one of the most common injuries in runners
pain more likely with going down stairs than up stairs
also occurs in non-athletes
25% of knee injuries
What are the risk factors for patellofemoral pain?
quadriceps and/or hip weakness or fatigue
shallow trochlea of femur
hyperlaxity of patella
increased Q-angle
ITB, quadriceps, and/or hamstring inflexibility
What is the basic pathology of patellofemoral pain?
not well understood
increased stress between the patella and femur
generally not overtly inflammatory
pain likely from increased pressure on subchondral bone