Ch. 44 Sports Medicine Flashcards
What is the potential biomechanical dx for lateral epicondylosis?
Posterior deltoid weakness
What is the potential biomechanical dx for hamstring strain?
Tight hamstring
Weak gluteal musculature
What is the potential biomechanical dx for metatarsal fx?
Supinated foot
What is the potential biomechanical dx for athletic pubalgia?
Weak core muscles
Tight hip girdle
What is the potential biomechanical dx for Shoulder impingement w/ rotator cuff strain?
Periscapular weakness or inhibition
What is the potential biomechanical dx for patellofemoral syndrome?
Quad & glut weakness/inhibition
Overpronation
What is the potential biomechanical dx for repetitive ankle sprains?
Weak peroneals
Proprioceptive dyfxn
What should all “pre-rehab” programs address?
Strength
Flexibility
Endurance
Describe the wind up phase of throwing
Start: pitcher initiates motion
Stop: max knee lift of the lead leg when ball removed from glove
Few injuries during this phase
Describe the early cocking/stride phase of throwing
Stride leg and hip/knee of pivot leg extend toward batter propelling body into stride
Throwing shoulder ABD/Ext/ER into “semicocked position”
Which shoulder muscles are used during the early cocking phase?
SA & trap protract & upwardly rotate scapula
Middle deltoid ABD
Supraspinatus positions humeral head
Describe the late cocking phase of throwing
Max shoulder ER
Amount of ER correlates with speed of ball
What are the dynamic stabilizers of the anterior shoulder?
Long head of the biceps
Subscapularis
Pec major
what are the static stabilizers of the shoulder?
Glenohumeral ligaments
Capsule
Labrum
What are common injuries during the late cocking phase of pitching?
Anterior instability Internal (posterior-superior) impingement Type II SLAP lesion Articular surface rotator cuff tears Bicipital tendinopathy Ulnar collateral ligament injury
Describe the acceleration phase of throwing
Shoulder moves from 175 deg ER to 90-100 deg IR at ball release
Shoulder ABD fixed at 90 deg
What determines arm position in vertical plane?
Trunk lateral flexion
What does hanging or dropping elbow result in?
Reduced pitch velocity
Risk of rotator cuff or UCL injury
Describe the deceleration phase of throwing
Eccentric muscle force of posterior shoulder girdle to decelerate rapid IR
Start: ball release
Stop: arm reaches 0 deg IR
Describe the final phase of throwing
Passive phase
Body catching up with throwing arm
What are common injuries from deceleration phase of pitching?
Posterior instability
Isolated rotator cuff tears
SLAP lesions
How does the gait cycle change with increase speed?
Stance phase decreases
Double limb support not present with running
How is foot strike with slower running and walking?
Heel to toe
What happens to foot strike with increase speed?
Forefoot strike with lowering heel to ground
Sprinting: forefoot
What is the entry or catch phase of swimming?
hand entry into the water until beginning of backward movement
What is the pull phase of swimming?
hand in vertical plane of shoulder
What is the push phase of swimming?
Hand below shoulder & pushes through water until its exit at greater trochanter
What is the recovery phase of swimming?
Aerial return of hand
Which muscles contribute to propulsion phase of swimming?
ABD/ER move to ADD/IR
Major: pec major & lat dorsi
Minor: SA, subscap, teres major
What is a common injury with breaststroke?
Medial knee injury with inc valgus load
MCL sprain
Medial plica/synovitis
What should be the focus of swimming pre-rehab?
Scapular stabilization
Endurance training og SA & lower trapezius
Stretching IR, posterior capsule, cervical & thoracic mobilization
What should the goal of ACL injury prevention be?
Inc knee & hip flexion during landing
Balance quad to hamstring activation ratio
What is doping?
Any substance or method used to increase performance
How can Tylenol blunt the anabolic response of muscle to exercise?
Max dose can dec prostaglandins produced after eccentric exercise
What can NSAIDs inhibit?
Prostaglandin E2 which plays a role in bone healing
Which forms of steroids are prohibited by WADA?
Oral
Rectal
IV
IM
Why are diuretics banned in some sports?
Theoretically increase urine ouput to mask use of other banned agents
Why are beta-blockers banned in some sports?
Anxiolytic effects
What is Erythropoietin (EPO)?
Glycoprotein hormone produced at kidney in response to tissue hypoxia to inc erythrocytes
What is Cr?
Compound made from amino acids glycine, arginine, and methionine
What is Cr phosphate supplementation proposed to do?
Benefits short duration, high-intensity, repetitive exercise by enhancing triphosphate regeneration
What are the goals of PPE?
ID life threatening conditions
ID cond that limit competition
ID factors that predispose injury
Meet legal requirements of state & institution
What is benign exercised associated collapse?
Form of postural HOTN from blood pooling in legs when pt stops running and leg muscles no longer acting as a venous pump
Tx of exercise associated collpase
Oral rehydration
Lying athlete down with legs & pelvis above heart level
Tx if exercise associated collapse does not respond after 30 minutes of conservative tx
Orthostatics
Electrolyte assessment
IVF
DDx of exercise associated collapse
Benign exercise associated collapse Cardiac arrest Heat illness/stroke Hypoglycemia Hyponatremia Hypothermia Muscle cramps Neuro conditions
What are the sx of exercise associated hyponatremia?
Lightheadedness Nausea HA Vomiting Confusion Obtundation Seizures Death
What is the pathophysiology of exercise associated hyponatremia?
Fluids shifts from low osmotic pressure in blood causing cerebral edema and neurogenic pulmonary edema
What are RF for exercise associated hyponatremia?
Weight gain during race
Marathon time >4 hrs
BMI extremes
What are the fluid replacement guidelines in a marathon?
Drink when thirsty
400-800 ml (14-27 oz)/hr racing
What is heat exhaustion?
Inability to continue to exercise in the heat but is NOT related to body temperature
What is heat stroke?
Multi-organ system failure secondary to hyperthermia
Which age group is not recommended to return to play after a concussion the same day?
<18 yo
Adult professionals may return
Who should get neuro imaging after concussion?
Suspected intracranial ABN
Prolonged LOC
Focal neuro deficits
Progressive decline in neuro status
When can RTP be considered after concussion?
After patient is asx of concussion sx
What is the cause of a stinger/burner?
Tensile (stretch) or compressive injury to the cervical nerve root or brachial plexus
Who is more likely to get a tensile injury to the brachial plexus?
Young athletes with weaker neck and shoulder girdle strength leaving them at risk for lateral neck bending and ispilateral shoulder/arm depression
Who is more likely to get a compression injury to the cervical nerve root?
Older, stronger and experienced athlete from forceful cervical extension and rotation narrowing the neural foramen
ex) professional defensive backs or offensive lineman
What is the clinical presentation of a stinger?
Sudden onset of burning pain in one upper limb in a single dermatome lasting seconds to minutes after a traumatic event
What are the MC dermatomes stingers happen in?
C5, C6 or C7
Which stingers should be evaluated for SCI?
Bilateral sx
Motor impairment
Multiple stingers
Which patients with stingers can RTP the same day?
Sx fully recover in <15 minutes
If a patient has multiple stingers when can they RTP?
Holder for number of weeks that correspond to stingers in a season or if >3 stingers end the season
Which athletes are MC to present with exericesed induced bronchospasm (EIB)?
Cross-country skiers
Winter sports
Runners
What is the proposed mechanism of EIB?
Water loss and cooling in the airway that occurs with hperventilation triggers bronchoconstriction
What are tx for EIB?
Warm up prior to sport
Short, vigours bursts of exercise (15-20 minutes) prior to competition
Short-acting beta-agonist 15 min prior to exercise
Adding cromolyn if sx persist and then inhaled corticosteroids
What are common causes of anemia in athletes?
Iron def
Physiologic or Pseudoanemia
Foot-strike hemolysis
What will be shown on labs in iron def anemia?
Microcytic anemia
Ferritin <30 ng/mL
TIBC elevated
What is pseudoanemia?
Seen in endurance athletes
Lower Hgb due to plasma volume expansion causing dilution
What is foot-strike hemolysis?
RBC destruction in feet from running impact
Which athletes are at a higher risk for an eating disorder?
Femailes Gymnastics Figure skating Dancers Distance runners Divers Swimmers
What is anorexia?
Body wt 15% below expected
Morbid fear of fatness
Feeling thin when fat
Amenorrhea
What is bulimia nervosa?
Binge eating 2/wk for at least 3 mo
Loss of control over eating
Purging behavior
Overconcern with body shape
Describe L1 locomotor impairment the cycling athlete
Minor or no lower limb impairement
Describe L2 locomotor impairment the cycling athlete
Disability in one leg but able to pedal normally w/ or w/o prosthesis
Describe L3 locomotor impairment the cycling athlete
Lower extremity disability, pedal using one leg, w/ or w/o upper limb disability
Describe L4 locomotor impairment the cycling athlete
Severe disability affecting both lower limbs, w/ or w/o upper limb disability
