Athletic Injuries Flashcards
What is primary prevention?
Preventing the situation from happenings all together
What is the most important role in injury prevention?
Minimize activity related injury
Aspects of primary prevention?
Athlete - technique, neuromuscular function
Surrounding - floor friction, playing rules
Equipment - shoe friction
What is secondary prevention?
Things to protect the athlete should a potentially dangerous situation arise
Aspects of secondary prevention?
Athlete - training status, falling techniques
Surrounding - safety nets
Equipment - tape/brace, protective equipment
What is tertiary prevention?
Reducing the consequences of injury
Aspects of tertiary prevention?
Athlete - rehabilitation
Surrounding - emergency medical coverage
Equipment - first aid equipment, ambulance
What are the four principles of athletic equipment?
Deflection
Dissipation
Deformation
Absorption
Principles of deflection?
Hard
Smooth
Round
Purposes of open cell foam?
Decreased density allows for more absorption at low force
Purposes of closed cell foam?
Increased density allows for greater resistance at high force
Components of sport specific equipment analysis
Biomechanics of body part
Individual activity level
Specific protection/performance demands
What are you trying to protect against
Purposes of a curved last shoe?
Neural for stability
Purposes of a straight last shoe?
Stability for motion control
For flat footed people (whose feet turn in)
Purposes of a slip lasted shoe?
Increased flexibility
For people with high arch
Purposes of a board lasted shoe?
Increased torsional resistance to pronation
For people with flat feet and an increased need for stability
Purposes of polyurethane?
For heavier runners
In heel of dual density midsoles
Purposes of EVA?
Lighter - increases durability when compressed
In toe in dual density midsoles
In whole midsole for single density midsoles
What type of shoe does a person with a rigid foot need?
Curve last with sufficient cushioning
Neutral cushioning shoes are best for… because they have…
Neutral foot
High arch
Single density midsoles
Mild torsional rigidity
Slip last
Curve last
Stability shoes are best for… Because they have…
Mild over pronators
Double density midsole
Moderate to extreme torsional rigidity
Curve last
Board last
Motion controlled shoes are best for… Because they have…
Severe over pronators
Triple density midsoles
Extreme torsional rigidity
Board last
Straight last
What is civil liability?
When a person engaged in conduct that results in harm to another private individual
What is criminal liability?
When a person contravenes social standards as expressed by criminal laws
What is a intention tort?
Harm was intended to another
What is an unintentional tort?
When a person ought to have foreseen that his or her actions would cause harm
What are the elements of negligence?
Duty of care
A breach of the standard of care
Damage or injury that results from the breach
Components of a EAP?
Event Dates Location Address Phone EMS access
What does the charge person do?
Decides when to activate EAP
Makes decisions if there is a spinal/life threatening condition
What does the control person do?
Keeps people back and assists the charge person
What does the call person do?
Contacts EMS
What is a traumatic injury?
Occur suddenly and have clearly defined cause or onset
What is a overuse injury?
Occur slowly over time secondary to the repetitive dynamics of the sport or movement in question
What is a isometric contraction? How much force is produced?
Muscle contraction in which length of muscle stays constant
Moderate force
What is a concentric contraction? How much force is produced?
Muscle shortens while contracting against resistance
Reduced force with increases speed
What is an eccentric contraction? How much force is produced?
Muscle lengthens while contracting against resistance
Maximal force
Increased force with increased speed
What types of muscle injuries are there?
Distentions
Direct trauma
What is a muscular distention injury?
Stains
Usually occur at musculotendinous junction
More common in 2 joint muscles
What is a grade 1 muscle strain?
Less than 10-20% of fibres torn or stretched
Near full ROM with some discomfort near the end
Good strength (4-5)
Slight pain and discomfort
What is a grade 2 muscle strain?
20-80% of fibres are torn Significantly decreased ROM (50%) with some discomfort near the end Poor strength (2-3) Significant pain and discomfort High bruising Can have palpable divot
What is a grade 3 muscle strain?
80-100% rupture of fibres
PROM only
Poor strength (0-1)
Variable pain
What is grade 5 muscle strength?
Normal
Full strength throughout the available range compared to the other side
What is grade 4 muscle strength?
Good
Near full strength through available range when compared to other side
What is grade 3 muscle strength?
Fair
Full ROM against gravity only (not against external resistance)
What is grade 2 muscle strength?
Poor
Can complete full ROM (with gravity eliminated)
What is grade 1 muscle strength?
Trace
Able to feel a muscle contraction but there is no movement at the joint
What is grade 0 muscle strength?
Nothing happens when the person tries to contract
What is a intramuscular injury?
No injury to fascia Blood trapped in muscle Longer healing time Increased compartmental pressure Chemical irritation (due to pooling of blood)
What is intermusclar injury?
Fascia is injured Blood flows out between the muscles Heals faster No increased pressure Blood can be absorbed
What are tendons made of?
Composed of 80-90% Type 1 collagen - arranged in parallel bundles of various sizes
What type of tendon injuries are there?
Traumatic
Overuse
What is tendinitis?
The inflammation of the tendon itself and is relatively rare
What is paratenonitis? How is it caused?
The inflammation, pain and crepitation of the paratenon as it slides over the structure
Acute irritation
Usually triggered by external factors: rubbing of bone or equiptment, external factors (“too much too soon”),
What are the characteristics of ligaments?
High content of elastic (higher than tendons)
Well innervated
Important for proprioception and rehabilitation
Built in wave like crimp to the ligament
What are the 3 types of ligaments?
Intra articular
Capsular
Extra capsular
What are the properties of an intra articular ligament? (Healing, blood supply) Example?
Inside a joint or joint capsule
Total rupture will not heal
Blood supply from ends, minimal to middle portion
ACL
What are the properties of a capsular ligament? (Healing, blood supply) Example?
Where ligament projects as a thickening of a joint capsule
Total rupture has excellent healing
Good blood supply
MCL
What are the properties of an extra articular ligament? (Healing, blood supply) Example?
Outside the joint capsule
Total rupture will not heal
Blood supply from ends, minimal to middle
LCL
Ligament injuries are closely correlated to _____?
Load deformation curve
What is phase 1 of the load deformation curve?
Toe region
Initial concave region
Represents normal physiological range of strain (3-4%) when the crimp in the ligament flattens out
Reversible
What is phase 2 of the load deformation curve?
Linear region
Pathological irreversible ligament elongation
Intramuscular and intermuscular cross links are broken until macroscopic failure is clinically evident
Early part = grade 1 sprain
Later part = grade 2 sprain
What is phase 3 in the load deformation curve?
Rupture region
Failure point is a 10% till complete rupture (90% of fibres torn)
Grade 3 sprain
What is a grade 1 sprain?
Full ROM
Slight pain on palpation
No joint laxity/good stability
What is a grade 2 sprain?
Significant loss of motion
Significant pain on palpaption
Joint laxity
What is a grade 3 sprain?
Loss of motion
Pain on palpation
Gross laxity
How can you tell the difference between a fracture and a bruise at the time of injury?
Indirect pressure will cause fracture pain.
What are the 3 phases of healing?
Inflammatory phase
Repair phase
Remodelling phase
How long does the inflammatory phase last?
3-4 days
How long does the repair phase last?
3 days - 6 weeks
How long does the remodelling phase last?
6 weeks - 1 year
What happens in the inflammatory phase?
Primary damage: damage at time of injury (immediately irreversible)
Secondary damage: damage by release of proteins and other body processes such as edema, decreased blood flow and oxygen.
Symptoms of inflammatory phase?
Redness Swelling Hot Pain Loss of function
What does the subcycle in the inflammatory phase include? What is its long term effect?
Pain, muscle spasm, ichemaia (decreased blood flow/oxygen to tissue)
Increases possibility of atrophy over time
What are the 6 steps of cell injury?
Injury to cell
Chemical mediators liberated - histamines, leukotrienes, cytokines
Vasoconstriction (10 mins) then vasodilation
Marination (neutrophils adhere to vascular wall)
Diapedesis (fluid through cell wall)
Phagocytosis
Clot formation
What happens in the repair phase?
Scar formation (fibroplasia) and repair of injured tissue Growth of epithelial capillary buds into the wound is stimulated by lack of oxygen Body lays down Type 3 collagen which is delicate and disarrayed
What happens in the remodeling phase?
Increased stress and strain causes the collagen to change from type 3 to type 1
There is normally a strong neurovascular scar by the end of 3 weeks
What is Wolf’s Law?
Bone and soft tissue will respond to the physical demands placed them, causing them to strengthen along lines of tensile force
What are pain receptors called?
Nocioceptors
What do nocioceptors respond to?
Mechanical stimulation
Thermal stimulation
Chemical stimulation
What type of fibres do nocioceptors transmit their information to?
Afferent fibres
In the gate control theory, what happens there is no stimulation?
Both large A and small C nerve fibres are quiet and the substantia gelatinosa (inibitory interneuron) blocks the signal in the T cel that connects to the brain.
The gate is closed
No pain
In the gate control theory, what happens with painful stimulation?
C fibres become active and bloack the inhibitory substantia gelatinosa and activate T cells.
The gate is open
Pain
In the gate control theory, what happens with non painful stimulation?
Large A Beta are active which activates the substantia gelatinosa which blocks the signal to the T cell
The gate is closed
No pain
What are the two pain signal carriers?
A delta
C fibres
What are the characteristics of A delta fibres?
Myelinated Fast Large diameter Respond to touch, pressure and temperature In skin
What are the characteristics of C fibres?
Unmyelinated Slow Respond to pain and temperature Located in skin and deep tissue Small WIll continue to fire for a long period after initial injury
Types of A beta input?
Pressure
Vibration (4 Hz x 10 mins)
Position finger
After 10 mins of the same stimulation, you will need to change the stimulation input to continue to block C fibre signals because A beta fibres will accomodate but C fibres will not
What area of the body responds best to cyrotherapy?
Joints, then muscle, then fat (based on fluid content)
What are the physiological responses to cryotherapy?
Breaks pain/spasm cycle
Decreases blood flow, capillary permeability, metabolic rate, collagen elasticity
Increases joint stiffness
Won’t reduce swelling that is present but will prevent more from accumulating
Decrease C fibre conduction rate
Physiological responses to thermotherapy?
Increases blood flow, capillary permeability, metabolic rate, collagen elasticity
Decreases joint stiffness, muscle spasm
Can flush swelling out - based on timing (NOT DURING inflammatory phase)
What are the goals for treating injuries in the inflammatory phase?
Decrease swelling, pain, inflammation
Optimize healing environment
How to treat injuries in the inflammatory phase?
Call da POLICE!
Protect Optimal loading Ice Compression Elevation
What is the best way to limit a hematoma?
Compression
Other than A beta fibres, how can you externally knock out C fibres?
Cooling by 4 degrees
What are the goals for treating injuries in the repair phase?
Protect from further damage
Increase blood flow and ROM
How to treat injuries in the repair phase?
Heat for 10-15 mins
Idealize ROM
Start low level strength and proprioception exercise?
Increase as able to weight bearing status
GENTLE and PAIN FREE
What is type 1 diabetes?
10% of diabetic population
Pancrease can’t produce enough insulin (can’t get sugar out of blood into the cells)
Dependence on exogenous insulin
What is type 2 diabetes?
90% of diabetic population
Not enough insulin produced and/or significant resistance at cellular level
What is hyperglycemia?
Sugar is present in blood stream but cant' get into tissues Body starts converting fat for energy Acidosis (fruity smell in breath) Frequent urination Possible coma
Treatment: bring to emergency medical practicioner
What is hypoglycemia?
Too much insulin in blood causing low levels of blood glucose
Decreased nutrients to the brain
Insulin shock/reaction
Treatment: give sugar
What are the signs and symptoms of hyperglycemia and hypoglycemia?
Altered level of consciousness - dizzy, drowsy, confused
Rapid breathing
Rapid pulse
Feeling ill
What is epilepsy?
The recurrence of unprovoked seizures
What are the 2 types of seizures?
Generalized - bilateral discharge involving entire cortex
Partial/focal - occurs in 1 part of brain
What are the types of generalized seizures?
Convulsive tonic clonic seizure - athlete falls to ground, goes through tonic chase of muscle stiffness, followed by clonic phase of muscle twitches
Non convulsive absences - sudden interruption of activity followed by a blank stare
What are the types of partial seizures?
Simple - without loss of awareness
Complex - alteration of awareness
What do you do when an athlete is having a seizure?
Do not restrain the athlete or place objects in their mouth
Protect the head
Remove closeby objects
Position in recovery position (on side) when done
What are the main causes of seizures?
Stress
Sleep deprivation
Fever/illness
Menses
What effect does exercise have on seizures?
Decreases seizure frequency
Increases seizure threshold
What is asthma?
Chronic inflammatory disorder of the airways
Excess mucus production and bronchial smooth muscle contraction
Maximal EXPIRATORY flow rate is reduced
What effect does exercise have on bronchiospasm?
Exercise triggers bronchoconstriction because it leads to dehydration of the lung’s airways
Symptoms peak 8-12 mins after exercise.
What are the objectives of a PPE?
Detect conditions that would restrict participation
Detect conditions that may be life threatening or disabling
Injury prevention evaluation
Meet legal and insurance requirements
Initiate and establish a rapport with athletes
Provide an opportunity for counselling
Establish a data base and record keeping system
When does a PPE occur?
4-6 weeks before the season
What are the different methods for evaluation?
Office based
Station based
What are the pros and cons of an office based evaluation for a PPE?
Get to meet with athletes more personally - athletes are able to tell Drs things in confidence
Time consuming, expensive
What are the pros and cons of station based evaluation for PPE?
Athetle meets more examiners (more than just Dr), fosters improved communication by the medical team itself, reduce staff burn out
Less personal
What are the components of a PPE?
Complete medical history MSK Medical evaluation form Visual acuity Quick mental processing form (SCAT3, McGill) Player status form
What is the strongest indpendent predictor of sports injury?
Previous injury!
Brought to attention by complete medical history
How long does a MSK take? What will it detect?
90 seconds
Will detect 90% of significant musculoskeletal injuries
What are the red flags for bone and soft tissue tumors?
Night pain, fever, loss of appetite, unwarranted fatigue, weight loss
What are the red flags for rheumatological conditions?
Morning stiffness, rashes, fingernail pitting, bowel disturbances, eye irritation, reports of a single or multiple swollen joints with no history or trauma or injury
What are the red flags for vascular conditions?
Tenderness on palpation of tissue, local heat, swollen, red/pale/blue
What are the red flags for infection?
Bone pain in children (at night or with activity), hot swollen (with no history of major trauma)
What questions would you want to ask for clearing athletes to play? (PPE)
Is there a problem that places the athlete at an increased risk of injury?
Is any other participant at risk of injury because of this problem?
Can the athlete safely participate with treatment of this problem?
Can limited participation be allowed while treatment is initiated?
If clearance is denied for certain activities, what other activities could the athlete participate in?
Is consultation with another health care provider necessary to answer any of the above questions?
The United States Preventative Services Task Force has 2 requirements for an effective screening process, what are they? Does the PPE satisfy these requirements?
Can detect target conditions earlier than without screening
Screening and treatment should improve likelihood of a favourable outcome
No, for the most part PPEs cannot satisfy these requirements, because:
No compelling evidence that PPE can accurately predict or prevent orthopaedic injury or cardiovascular sudden death
Advising students about rules and equipment may decrease mortality and morbidity more effectively than the PPE exam.
Can PPE identity medical adn orthopaedic problems of sufficient severity to place the athlete at risk for injury or illness?
No
Can the PPE identify correctable problems that may impair the athletes ability to perform?
Yes
Can the PPE help maintain the health and safety of the athlete?
Yes
Can the PPE assess fitness level for specific sports?
Yes
Can the PPE educate athletes and parents concerning sports, exercise, injuries, and other health related issues?
Yes
What is a concussion?
A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.
What are the two types of concussions?
Linear and rotational
What is a linear concussion?
Injury at impact site; brain strikes skull on opposite side.
What is a rotational concussion?
Brain strikes skull on other side; brain rotates - stretching or tearing structures and vessels at it shears on itself.
What are the 4 types of symptoms of a concussion?
Somatic, emotionality, cognitive, sleep disturbance.
What are some somatic concussion symptoms?
Visual problems, dizziness, balance difficulties, headaches, light sensitivity, nausea
What are some emotional concussion symptoms?
More emotional thank usual, sadness, nervousness, irritability
What are some cognitive concussion symptoms?
Attention problems, memory dysfunction, fogginess, cognitive slowing
What are some sleep disturbance concussion symptoms?
Difficulty falling asleep, sleeping less than usual
What is the most common symptom of a concussion?
Headache (71%)
What are the most common symptoms of concussions within 3 days of injury?
Headache (71%), feeling slowed down (58%), difficulty concentrating (57%), dizziness (55%)
Is there any symptom that is always present after a concussion?
No
How can concussions be caused? (Give %)
60% - a direct blow to the head, face or neck
40% - elsewhere on the body with an impulsive force transmitted to the head
What is the minimum force needed to cause a concussion?
Force foes not factor in on symtom severity.
Will a mouth guard protect you from concussions?1
No
What are the grades of concussions?
There is no such thing as minor/severe/graded concussions.
How many symptoms need to be present to determine status at time of injury?
Cannot make prognosis at time of injury.
What is a factor at time of concussive injury that may modify management?
LOC for over 1 minute.
What does tonic posturing or convulsive movements tell us at time of concussive injury?
Nothing - they are usually benign and require no specific management.
What are some concussive modifiers?
Symptom duration over 10 days, LOC over 1 minute, frequency of concussive injuries, timing since last concussive injury or traumatic brain injury
Child and adolescent < 18 years old.
Migraine, depression or other mental health disorder, ADHD, learning disabilities, sleep disorders
What could be more important that the presence of amnesia alone? (Concussions)
Nature, burden and duration of clinical post concussive symptoms
How to check for mental status of concussed athlete?
(Child)SCAT3
Why does someone have to monitor concussed athletes after the injury? For how long?
For 4 hours someone needs to watch for presence/symptoms of hematomas (wake up every 2 hours if at night)
How are concussions in children different than concussions in adults?
The developing brain is more vulnerable to injury. Children never return to play on the same day.
How long does it take to recover from a concussion with 15 mins or less of on field symptoms?
7 days
What is the average amount of time required for high school students to return to baseline level of cognitive functioning after a concussion?
30 days
What is the average amount of time required for college students to return to baseline level of cognitive functioning after a concussion?
7 - 10 days
What is the average amount of time required for professional athletes to return to baseline level of cognitive functioning after a concussion?
3-5 days (based on career goals and not health)
How long does the period of vulnerability last?
14 days
What is the period of vulnerability?
Higher demand for glucose in the brain but dramatic decrease in metabolic rate and initial drop in blood flow.
When can athletes suffer from second impact syndrome? (Concussions)
In the period of vulnerability (14 days)
Who is most likely to have second impact syndrome? (Concussions)
Under 21 years old
What happens in second impact syndrome? (Concussions )
Catastrophic increase in intracranial pressure
What are the 5 stages of return to play after a concussion?
No activity, light aerobic exercise, sport specific exercise, non contact training and drills, full contact practice, return to play
Following return to play protocol after a concussion, what are the goals/plan for stage 1 - no activity?
Complete physical and cognitive rest. Goal: recovery
Following return to play protocol after a concussion, what are the goals/plan for stage 2 - light aerobic exercise?
Walking, swimming, biking. Keep intensity below 70% of max. (Talk test). Goal: increase heart rate
Following return to play protocol after a concussion, what are the goals/plan for stage 3 - sport specific exercise?
No head impact activities. Goal: add movement.
Following return to play protocol after a concussion, what are the goals/plan for stage 4 - non contact training drills?
Progression to more complex drills. Goal: coordination, cognitive load
Following return to play protocol after a concussion, what are the goals/plan for stage 5 - full contact practice?
Normal training. Goal: restore confidence, assess functional skills.
Following return to play protocol after a concussion, what are the goals/plan for stage 6 - return to play?
Normal game play
How long must you wait between stages after being symptom free - following return to play guidelines after a concussion?
24 hours
What happens if you experience symptoms while following the return to play guidelines after a concussion?
Go back to the last stage where you were symptom free.
What is the most common reason why athletes do not report a concussion?
Didn’t think it was a serious enough injury.
Following a possible c-spine injury, what 3 questions do you need to answer while on the field?
Is the athlete at risk?
Are they anatomically stable?
How to get the athlete off the field?
What are the 4 steps following a suspected neck injury?
Stabilize the c spine
Assure the athlete and tell them not to move
Get brief history and subjective report.
Begin palpation and assessment.
What is a stinger burner injury?
Traction or compression of BP trunks - roots C5 and C6
What are 3 ways a stinger burner injury can occur?
Forever neck extension and rotation to the injured side.
Shoulder distracted downward from head and neck (most common)
Blow to supraclavicular fossa.
How long does a stinger burner injury last?
Heals quickly - within minutes.
Symptoms of stinger burner injuries?
Unilateral symptoms:
Sensory changes for lateral arm over deltoid, radial side of arm and thumb
Motor changes for shoulder abduction and elbow flexion
What is the the return to play protocol following a stinger burner injury?
Same game if quick resolution to symptoms, full ROM and strength, mentally ready
What are the two mechanisms of injury of a c spine injury?
Axial load - vertical compression
Compression - flexion
What is a axial load c spine injury?
When neck is straight causing burrs fracture (usually) at C4-C5
What is a compression neck injury?
When the anterior portion compresses and the posterior portion elongates.
What are the immediate symptoms of a c spine injury?
Neck pain on central palpation of spinous processes
Bilateral neural findings
What do you need to palpate when assessing a c spine injury?
Upper back, neck, shoulder, clavicle and sternum
What is a dermatome?
Cutaneous area receiving the greater part of its innervation from a single spinal nerve?
What are myotomes?
A muscle receiving the greater part of its innervation from a single spinal nerve
What nerve root innervates muscles for neck flexion?
C2
What nerve root innervates muscles for side neck flexion?
C3
TWhat nerve root innervates muscles for shoulder shrug?
C4
What nerve root innervates muscles for shoulder abduction?
C5
What nerve root innervates muscles for elbow flexion?
C6
What nerve root innervates muscles for elbow extension?
C7
What nerve root innervates muscles for thumb extension?
C8
What nerve root innervates muscles for spreading fingers?
T1
What nerve root innervates muscles for hip flexion?
L1 and L2
What nerve root innervates muscles for knee extension?
L3
What nerve root innervates muscles for ankle dorsiflexion?
L4
What nerve root innervates muscles for 1st toe extension?
L5
What nerve root innervates muscles for plantar flexion?
S1
What nerve root innervates muscles for knee flexion?
S2
What nerve root innervates muscles for foot intrinsics?
S3
What are the 3 high risk factors that mandate a X-ray according to the Canadian c spine rules?
Over 65 years old, dangerous MOI, paresthesia in extremities
What are the low risk factors that allow for safe assessment of a c spine injury and do not require an x ray according to the Canadian c spine rules?
Simple rear end MVA, able to sit, delayed neck pain, absence of spinous process pain
What is the degree of rotation you must be able to actively complete following a c spine injury to not have an x ray according to the Canadian c spine rules?
45 degrees to each side
What are the commands for a log roll procedure?
“Prepare to roll”
“Roll”
In what position should the head be immobilized following a c spine injury? Why?
Neutral - because reduces spinal cord compromise, may facilitate airway management and application of immobilization devices.
What are the 3 general contradictions to moving the c spine to neutral?
If movement increases pain/symptoms, induces muscle spasm or compromises airway
If there is resistance
If the person is apprehensive
What is the best way (tools) to remove a helmet following a c spine injury?
Use a cordless screwdriver and scissors.
Never untie straps.
Should a hockey helmet be removed following a c spine injury?
No. Only on rare occasions.
Should a football helmet be removed following a c spine injury?
Only when also removing shoulder pads.
What are the reasons warranting helmet removal following a c spine injury?
If after a reasonable time the fade mask cannot be removed to gain access to airway.
If even after the face mask is removed you can’t access airway.
If helmet/chin straps do not hold head securely when immobilized.
If shoulder pads are removed.
What are the reasons warranting shoulder pad removal following a c spine injury?
Multiple injuries requiring access to shoulder
Ill fitting pads that do not immobilize spine
If CPR is necessary
If helmet is removed.
How many people does it take to do a vertical lift onto a spinal board?
8
How many people does it take to do a log role onto a spinal board?
Minimum 3
In what order should you strap someone onto a spinal board?
Thorax, head, lower limb
What does SOAP stand for?
Subjective
Objective
Analysis/ assessment
Plan
What is the most important aspect of evaluation?
Subjective
How much can you learn about someone’s injury from subjective assessment?
80-90%
What is a symptom?
Organic manifestation which only the patient is aware of.
What is a sign?
Observants of physical phenomenon indicative of a conditions presence.
What is the order of assessment?
Subjective Observation STTT: AROM, PROM, resisted movements Neuro sensation/reflex Special tests Palpation
Who developed the theory of selective tissue tension testing?
Dr James Cyriax
What tissues are inert?
Ligaments, bursa, capsules, fascia, nerve roots, dura mater
What tissues are contractile?
Muscles, tendons, tenoperiosteal insertion
What should the therapist be feeling for during PROM?
End of range
What does an end feel of soft tissue approximation tell us?
Normal for elbow and knee flexion
What does an end feel of bone-on-bone tell us?
Normal for elbow extension
What does an end feel of capsular tell us?
Normal for hip rotation
What does an end feel of springy block tell us?
Abnormal - like compressing a spring.
What does an end feel of spasm/stretch tell us?
Abnormal - involuntary contraction that prevents motion secondary to pain (guarding)
What does no end range tell us?
Grade 3 sprain
What position are the patients in during resisted movements?
Neutral - isometric contraction
When interpreting resisted movements, what does strong and painless mean?
Both muscle and nerve are normal.
When interpreting resisted movements, what does strong and painful mean?
Nerve is normal, minor problem with muscle
When interpreting resisted movements, what does weak and painless mean?
Possible nerve lesion, old/complete muscle rupture
When interpreting resisted movements, what does weak and painful mean?
Possible nerve lesion, significant acute muscle tear
At what point in the assessment do you do manual muscle testing?
Special tests
What is a grade 1 sprain?
Pain
Full ROM
Stable
What is a grade 2 sprain?
Significant loss of ROM
Significant pain
Slight instability and laxity
What is a grade 3 sprain?
Minimal pain
Minimal active ROM
Gross instability and laxity
What is the most important joint within the shoulder?
Scapulothroacic
How much if the shoulder is part of the upper extremity?
70%
Where does a shoulder separation occur?
Acromioclavicular joint and sternoclavicular joint
Where can a shouder fracture occur?
Humerus, clavicle, scapula
Where does a shoulder dislocation occur?
Glenohumeral joint
How much of the clavicles surface area is in contact with the manubrium?
25%
What is the most unstable shoulder joint?
Sternoclavicular
What is the movement of the clavicle when the arm moves through flexion and or abduction?
Retracts, elevated and rotates posteriorly
What are the most common causes of injury of the sternoclavicular joint?
MVA and sport injuries