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Common Athletic Injuries > Ankle-->hip > Flashcards

Ankle-->hip Flashcards

1
Q

inflammatory response 1 (macrotrauma)

A

acute-physical damage to capillary wall–>plasma + RBC’s + hemoglobin leak into interstitial space
-swelling and edema-blood migrates to skin and often causes ecchymosis

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2
Q

haemotoma

A

accumulation of necrotic debris at the site of injury

  • removed by phagocytosis and proteolytic enzymes before healing can occur
  • cells around it need nutrients and O2-cell death can cause Secondary Hypoxic Tissue Necrosis
  • leads to swelling, pain, spasm, necrotic debris, and reduced joint motion due to pain
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3
Q

inflammatory response 2 (chronic microtrauma)

A
  • capillary is dilated by chemical mediators (histamine, bradykinin) and space b/t cells allows some plasma proteins to leak out/fat molecules to leak in (Transudate=RBC free exudate, which doesn’t cause discoloration)
  • osmotic gradient upset leads to greater net filtration and then swelling and edema
  • eg achilles tendonopathy (chronic tendonitis) from wearing high heels (short) all day then running (trauma on tendon)
  • leads to pain, swelling, spasm, necrotic debris, and reduced motion
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4
Q

effects of edema on ligaments

A
  • disruption of a ligament inside a capsule causes swelling and pushes ligament ends away from each other
  • can form block of scar tissue–>bones further apart and greater joint laxity
  • importance of reducing edema ASAP and as much as possible-joint should be locked w/ligaments in shorter position (functional) can reduce laxity by causing some adhesions to form
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5
Q

treatment for most injuries

A

Rest
I: decrease pain, spasticity, and facilitate local blood flow to depth of about 5mm (ie, good for bony areas)
C: reduces edema (if the pressure is hard enough w/out occluding blood flow). Never wear at night b/c hyperemia happens
E: assist lymphatic drainage

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6
Q

when/where do you see the ecchymosis?

A

in subacute injuries (48-72hours after) and below the site of injury b/c of gravity
-ie a bang on the hip could possibly cause pain closer to the knee if ecchymosis goes that far

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7
Q

predisposition and causes of shock

A

illness, extreme fatigue, extreme dehydration, high anxiety

causes: extreme blood loss, pain, and/or psychological trauma

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8
Q

symptoms and treatment of shock

A

Sx: pallor of skin, clammy skin, weak rapid pulse and weak shallow breathing
Tx: 911, lay athlete flat, maintain body temp and monitor vitals, O2 if available, elevate legs slightly (controversial). also stop bleeding

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9
Q

secondary survey

A

HOPES- history, observation, palpatation, evaluation of function, selective tissue tensions

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10
Q

crural joint

A

-tibiofibular joint
-talofibular joint
-talotibial joint
does sagital plane movements of dorsiflexion and plantarflexion

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11
Q

subtalar joint

A

talus and calcaneas articulations

supination/pronation

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12
Q

midtarsal joints

A

b/t other tarsal bones

contribute to pronation/supination + some abduction/adduction

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13
Q

ankle bony stabablizers

A

-malleoli hold dome of talus

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14
Q

ankle static stabalizers (lateral)

A

bone: lat maleoulus
1. anterior tibiofibular ligament-holds them together
2. anterior talofibular-stops anterior motion of bones
3. calcaneal fibular-stops calcaneous from rotating down
4. lateral talocalcaneal
dynamic: peroneus brevis and logus (weak)

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15
Q

ankle static stabalizers (medial and anterior)

A

anterior
bone: wide margin of talus
static: joint capsule
1. anterior tibiofibular lig- syndesmosis joint (proximal and distal)
dynamic ant. compartment muscle and peroneus tertius

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16
Q

medial ankle stabalizers

A

bone: medial malleolus
1. deltoid ligament-stops pronation
2. spring ligament and short plantar ligament maintain longitudinal arch
dynamic: medial flexor group, tibialis anterior

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17
Q

cavus foot

A

high arch, permanent supination-good jumpers and leapers

  • usually have clawed toes due to natural tension on flexor digitorum and flexor hallucis longus tendons
  • rigid bone structure, doesn’t loosen to absorb the force
  • common anterior compartment syndrome, stress fractures in tibia
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18
Q

planus foot (functional)

A

flat foot, excessive pronation
-can cause knee, hip, back problems
-sustentaculum tali roates down w/ the calcaneas (it’s usually stacked on top)
-the talus is no longer supported and subtalar valgus occurs
-can see a bend in the achilles b/c of extreme pronation
-disapate forces easily but inefficient toe off b/c can’t supinate to make rigid bone structure
+ internal torsion of femur

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19
Q

foot biomechanics: from heel plant to toe off

A

heel plant: subtalar joint and foot slightly supinated
-shock goes up calcaneas
midstance: joints unlock as foot pronates to absorb shock
toe off: supination and subtalar/midtarsal locking to provide rigid lever for propulsion

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20
Q

hyperdorsiflexion

A

talus wedges b/t bones and pushes malleolus away (if rotation happens)

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21
Q

hyperplantarflexion

A

can pull ant talofibular and and deltoid ligaments

-overstretches anterior capsule–>laxity in joint line

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22
Q

hallux valgus

A

mech: valgus displacement of 1st MTP joint
cause: genetic, mm imbalance, shoe fit
tx: taping, muscular control
- predisposition to bunions

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23
Q

morton’s neuroma

A

mechanism: enlargement from compression of interdigital nerve body
cause: shoe fit too narrow
tx: bare feet, wide forefoot shoes, surgery
- nerve thickens myelin sheath when compressed

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24
Q

morton toe

A

mx: elongated 2nd metatarsal, can cause sesamoiditis
cause: genetic
tx: nothing, proper fit shoes
- 2nd MT accepts too much ground reaction forces–>can stress fracture 2nd metatarsal
- PIP joint can buckle

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25
Q

claw toes

A

mech: contracture of DI
cause: cavus foot, short shoes
tx: stretching toes to dorsiflexion, correct shoe fit

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26
Q

tennis toe

A

mx: shear across unguum
cause: too short or long toenails
tx: shoe fit, hygiene

27
Q

ingrown toenail

A

mx: lateral growth of nail
cause: poor hygiene (maybe narrow shoes also)
tx: v cut in nail

28
Q

astro toe

A

mx: hyperextension of MTP joint, subperiosteal haematoma of sesamoid bone inside flexor hallucis brevis
cause: lack of forefoot cushion
tx: treatment for hyperextension, atro pads/more forefoot cushion

29
Q

heel bruise

A

mx: subperiosteal haematoma
cause: contusion to calcaneal tuberosity
tx: taping and bilateral heel pads

30
Q

runner’s bump

A

mx osteoblastic activity
cause pressure to posterior aspect of calcaneus from rigid heel counter in motion control shoes
tx felt donut

31
Q

plantar faciitis

A

mx: excessive tension on plantar fascia
cause: excessive pronation-as arch drops foot lengthens and inflammation can happen
tx arch support and strengthening intrinsic mm
important to find specific cause of stretching (could be from pelvis)

32
Q

achilles tendonitis

A

mx: traction forces on tendon
cause: excessive pronation, uphill running
- cavus foot b/c calcaneus is pulled down and achilles is lengthened on the bottom
- high heels
tx: bilateral heel lifts, rest, stretching and strengthening

33
Q

achilles tendon rupture

A

mx eccentric contraction
cause landing from dismount or changing direction quickly
-chronic inflammation causes necrotic tissue and debris that makes the tendon weaker
tx surgery, complete repair can take 6mo

34
Q

styloid avulsion

A

mx eccentric contraction of peroneals (brevis tendon)-b/c lig stronger than bone in pre pubitals
cause: planterflexion + inversion during contraction (jumping or landing)
tx surgery

35
Q

metatarsal fracture

A

mx: axial load, transverse load
cause: kicking something (axial) or getting stepped on (transverse)
tx: soft-cast, surgery not typically needed unless bones are displaced

36
Q

malleolar fracture

A

mx: avulsion (lig pulling), compression
cause: extreme eversion or extreme inversion
tx surgery

37
Q

maisonneuve (fibular)

A

mx transverse compression of tibia (external rotation of a fibula)
cause: sliding tackle, kick, extreme inversion
tx surgery if displaced
-young ppl tend to fracture up higher, adults in middle

38
Q

chronic compartment syndrome

A

mx: intrafacial swelling
cause: rapid hypertrophy-too little space for exercise hyperemia, inflammatory response
tx: rest, stretching, anti-inflammatory maybe
- cavus and planus foot more susceptible

39
Q

acute compartment syndrome

A

mx: intrafacial swelling
cause: acute trauma over affected compartment (usually anterior)
sx: loss of motor function, pain (common for chronic and acute)
tx: if symptoms worsen when activity is stopped its a medical crisis-hemorrhaging

40
Q

tibial stress syndrome

A

mx: stress fx to lower 1/3 of tibia, internal rotation of tibia
cause: pronation or cavus foot poor force distribution
sx pain over lover 1/3k bump @ fracture, made worse w/exercise
tx: rest until 10 days pain free`

41
Q

generic shin splints

A

pain in lower 1/3
inflammation of interosseus membrane
tx: low dye tape job

42
Q

knee stabalization

A

boney-none

static: cruciates, collaterals, and joint capsule

43
Q

dynamic stabalizers

A

pes anserinus, gastrocnemius, extensors and flexors

44
Q

ACL Rupture

A

from lateral femoral condyle

mx: anterior translation, excessive valgus stress, excessive internal or external (tears as wraps around condyle), tibial rotation, hyperextension w/internal rotation
- extrasynovial, so sometimes no swelling (rapid internal rotation w/no force)

45
Q

dynamic stabalizers

A

pes anserinus, gastrocnemius, extensors and flexors

46
Q

LCL

A

Mx excessive varus stress or internal tibial rotation

sx: +ve varus stress test or apley distraction, no end point

47
Q

LCL

A

Mx excessive varus stress or internal tibial rotation

sx: +ve varus stress test or apley distraction, no end point

48
Q

subpatellar pain syndrome

A

mx: lateral tracking of patella
-tightness of TFL pulls on IT band
cause: insufficient vastus medialis, problematic Q angle
Sx: subpatellar crepitus-can feel soft spot in cartilage (chondromalacia)
-stage 2, tissue dries up and starts to crack
-stage 3, crab meat stage
tx: strengthen vastus medialis and patellar stabalization
-braces, surgery

49
Q

tibial tubercle traumatic apophysitis

A

mx distraction force on tibial tubercle from repetitive concentric or eccentric contraction

cause: jumping, skateboarding, dismounts
- traction forces pull growth plate away from bone-it eventually calcifies and becomes a bump (bigger on dominant leg)
sx: pain at tibial tubercle, worse w/exercise-pad in case they fall
tx: regulate exercise to tolerance levels and protect bump

50
Q

tibial tubercle traumatic apophysitis

A

mx distraction force on tibial tubercle from repetitive concentric or eccentric contraction

cause: jumping, skateboarding, dismounts
- traction forces pull growth plate away from bone-it eventually calcifies and becomes a bump (bigger on dominant leg)
sx: pain at tibial tubercle, worse w/exercise-pad in case they fall
tx: regulate exercise to tolerance levels and protect bump

51
Q

prepatellar bursitis

A

mx: repetitive microtrauma or single insult
cause: falling on hardwood, kick, kneeling for long periods, a rock
sx: golf-ball like swelling, usually little pain or dysfunction
tx: RICE, spontaneously resolves

52
Q

dislocated patella

A

mx: patella alta and excess Q angle increase risk, extreme lateral excursion is mx
sx: deformity, pain 3+
tx 911

53
Q

IT band friction syndrome

A
  • genu varus
  • tight IT rubs on lat epicondyle
  • caused by tight TFL and IT band cont w/ retinaculum–can pull on this and move patella out of place
    test: pressure on lat epicondyle while weight bearing at 30 deg flexion
54
Q

IT band friction syndrome

A
  • genu varus
  • tight IT rubs on lat epicondyle
  • caused by tight TFL and IT band cont w/ retinaculum–can pull on this and move patella out of place
    test: pressure on lat epicondyle while weight bearing at 30 deg flexion
55
Q

origin pull hamstring strain

A

same mxs

sx: pain w/deceleration, doesn’t hurt when accelerating, pain at ischial tuberosity, loss of function
tx: same +massage @ischial tuberosity

56
Q

origin pull hamstring strain

A

same mxs

sx: pain w/deceleration, doesn’t hurt when accelerating, pain at ischial tuberosity, loss of function
tx: same +massage @ischial tuberosity

57
Q

myositis ossificans

A

mx: ossification of CT (perimysium): ectopic bone formation
sx: reduce range of motion, X-Ray
- can’t be removed unless matured, can take a yr to recover from

58
Q

myositis ossificans

A

mx: ossification of CT (perimysium): ectopic bone formation
sx: reduce range of motion, X-Ray
- can’t be removed unless matured, can take a yr to recover from

59
Q

thigh contusion grades

A

I and II: ice in flexed position
grade III bed rest for 48 hours not flexed
stop activity imediately

60
Q

femoral torsion

A

anteversion=pigeon toed

retroversion

61
Q

why is abduction difficult?

A

greater trochanter compresses superior acetabular labrum

62
Q

hip pointer

A

sx: exxhymosis, pain w/abdominal use
mx: subpeiostial haematoma from macroinsult to iliac crest
tx: RICE, can numb the area b/c another hit won’t likely do that much more damage
- as pain subsides athlete can walk/run faster and faster

63
Q

hip pointer

A

sx: exxhymosis, pain w/abdominal use
mx: subpeiostial haematoma from macroinsult to iliac crest

64
Q

osteitis pubis/pubic apophysitis

A

-stress fx at pubic tubercle in adults-feels like groin pull that doesn’t respond to treatment
-unknown mx-in runners, rugby, and soccer…
inflammation of growth plate in pre-pubitals
-no activity b/c pulls on pubic tubercles! long time to heal

Common Athletic Injuries (2 decks)

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