Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Injuries and medical problems in sport > Bone stress injuries > Flashcards

Bone stress injuries Flashcards

You may prefer our related Brainscape-certified flashcards:
Sports Trivia flashcards USMLE® Step 1 flashcards
1
Q

Epidemiology

A

Difficult diagnosis- mimic other overuse injury + not often findings on x-ray
Majority of sports overuse injuries in track and field
20-60% incidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Main 3 locations for overuse bone stress injuries

A

tibia
metatarsals
navicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

State the locations of the low risk bone stress injuries

A

LOW RISK

  • posteromedial border of tibia
  • femur
  • 1-4th metatarsals
  • ribs
  • ulnar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

State the locations of the high risk bone stress injuries

A

HIGH RISK

  • anterior edge of tibia
  • neck of femur
  • navicular
  • 5th metatarsal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the issues associated with high risk bone stress injuries?

A
  • Delayed diagnosis
  • Delayed Tx

Leading to:

  • increased healing time
  • non-union
  • surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Role of Hx in BSI Dx

A
  • Sport
  • Event
  • Training intensity
  • Previous BSI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What specific questions should you ask about symptoms for a bone stress injury?

A
  • exercise related
  • progressively worse
  • intermediate
  • night pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are BSIs graded according to Sx frequency?

A

Grade 1: end of training
Grade 2: mid-training
Grade 3: whole training
Grade 4: Daily ctivities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What clinical tests are used for LL BSI

A
  • one leg hop test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DDx for BSI

A
  • bone contusion
  • osteomyelitis
  • neoplasm (lymphoma, leukaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

First line investigation for suspected BSI

A

Therapeutic USS
Most symptomatic point spotted at 2w/cm2 and decreased if painful by 0.1w/cm
80% sensitivity and 67% specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Second line Investigations for BSI

A

If therapeutic USS is positive –> MRI

If therapeutic USS negative –> x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gold standard investigation for bone stress injuries

A

MRI

Sensitive and specific, can be used to grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MRI BSI grading system

A 
Grade 0 = normal
Grade 1 = endosteal marrow oedema
Grade 2 = periosteal and endosteal marrow oedema
Grade 3=  Grade 2 and soft tissue oedema
Grade 4 = fracture line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What grade of BSI does the following MRI show

A

Grade 1: endosteal marrow oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What grade of BSI does the following MRI show

A

endoteal and periosteal marrow oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What grade of BSI does the following MRI show?

A

Grade 3- endosteal, periosteal and soft tissue oedema

18
Q

What grade of BSI does the following MRI show?

A

Grade 4: stress fracture

19
Q

Main objective assessment tool in the diagnosis of BSI

A

Diagnostic imaging

20
Q

Limitations of radiographs for BSI

A

often appear normal despite clinical Sx and signs suggestive of BSI

21
Q

what are the benefits and negatives of radioisotope bone scanning in diagnosis of BSI?

A

very high sensitivity 84-100%

HOWEVER:

  • low specificity (high false positive)
  • high radiation dose
22
Q

How does diagnosis and severity of BSI correlate with regards to Sx onset?

A
23
Q

Mx of BSI

A
  • Majority is conservative
  • Modify training- not rest
  • Medication
  • Physio modalities
  • Rehabilitation + dealing with predisposing factors
24
Q

Extrinsic risk factors for BSI

A

mileage
number of training cycles
inadequate recovery periods and training fatigued muscles
pace
downhill running
sports- track, basketball, gymnastics, running
harder running surface

25
Q

Intrinsic risk factors for BSI

A

External rotation of LL

Bony anatomy: leg length discrepancy, femoral anteversion, genu varum/valgum, narrow tibia

Muscle- small calf girth

Female 
Nutrition- low calcium/vit D, calorie deficit
Older age >20
aerobic fitness + sporting experience
Previous BSI
Smoking
FHx
26
Q

Phase 1 Mx BSI- Grade 1-3

A
  • control pain
  • NWB- swimming, core, stability
  • Local Tx- low intensity pulsed TUS

TILL AT LEAST ONE WEEK WITHOUT PAIN WALKING

27
Q

Phase 2 Mx BSI- Grade 1-3

A

Training modification:

  • local Tx- low intensity pulsed TUS- EWST
  • cycling, XT, stair stepper
  • deal with modifiable RF
28
Q

Phase 3 Mx BSI- Grade 1-3

A

Functional- RTP

  • Functional rehab
  • Sport specific
  • 10% increase every 10 days

aim to be free of symptoms on therapeutic USS

29
Q

Which stress fractures are low risk of non-union?

A
  • Femoral neck fractures of medial cortex
  • Tibial shaft fractures of the posteromedial cortex
  • distal 2-4 metatarsals
  • calcaneal fractures
  • fractures of fibula
  • fractures of pubic ramus
30
Q

Mx low risk stress fractures

A

conservative management
increase impact loading once ambulation and dat to day activity are pain free
treat underlying RF and modify training regimen

31
Q

Which stress fractures are at high risk of non-union?

A
  • femoral neck
  • tibial shaft anterior cortex
  • navicular
  • talus/medial malleolus/sesamoids
32
Q

How are stress fractures with high risk managed?

A
  • often require operative management

- risk of non-union or delayed union

33
Q

What grade BSI does this MRI show and what is the Mx?

A

Grade 3 BSI
fracture of navicular bone
Start conservative: non-weight bearing cast 6 weeks, then depends on pain- 86% rate of healing + boot
If this fails, surgical Mx

34
Q

Sx femoral stress fractures

A

pain in anterior inguineal area

35
Q

How are femoral stress fractures diagnosed?

A

70% with the hop test

36
Q

How are femoral stress fractures managed?

A

Compression-type fractures: conservative (RTP 8-16wks)

Tension-type fractures/displaced: internal fixation

37
Q

Mx of metatarsal fractures

A

2nd-4th:

  • 20% all lower extremity BSF
  • 4-6wks limited activities or casting 4-6wks

5th:

  • 6-8wks non-weight bearing cast
  • 70% healing without surgical fixation
38
Q

what is the highest demographic affected by tibial stress fractures

A

40-50% in athletes

39
Q

Mx tibial stress fractures

A

Can be posteromedial or anterior

1) conservative (ant)
2) aircast splinting if more severe Sx /not resolved conservatively
3) casting for mid-shaft fracture until pain free and radiographic evidence of healing
4) Surgery (intramedullary nailing +/- grafting) if no improvement after 6 months

40
Q

BSI grade and time to RTP

A

Grade 1: 3-4 weeks
Grade 2: 5-8 weeks
Grade 3: 9-16 weeks
Grade 4: 16+ weeks

41
Q

prophylaxis BSI

A

training is key prevention

  • periodisation- inc training over 3 weeks and follow with 1 week relative rest, allowing met adaptation
  • monitor loading and intensity
  • deal with modifiable RF
  • optimal nutriotion calcium vit D
42
Q

Summary BSI points

A

Injuries and medical problems in sport (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions