common injuries Flashcards
t/f isolated high ankle sprain is common
false
other injuries with high ankle sprain
bone bruise OA deltoid lig fib fracture lateral ankle sprain
History for high ankle sprain
anterior pain between tib and fib
pain during WB/push off
physical exam of high ankle sprain
AITFL tendor on palpation
short stance phase
toe walking
special tests for high ankle spr
external rotation test squeeze test DF maneoever one leg hop cross leg test fibular translation drawer test
is there swelling in high ankle sprain
usually not much
___ of all ACL injuries are non contact
70-80
common mechanism for non contact ACL
plant and cut
single leg jump landing
is there a gender discrepancy after puberty for females and ACL
no
why females at more ACL risk
intrinsic factors (increased dynamic q angle, quad dominate, smaller ACL)
extrinsic factors (nm control, mm recruitment)
name two neuromuscular patterns
glute dominance
quad dominance
why is quad dominance a problem
creates anterior shear on knee
glute dominance encourages what activation
glute and ham activation
when is one leg hop test positive
unable to complete 10 reps without significant pain
are special tests accurate to determine degree of injury
no
AITFL and PITFL contribute to __ of joint stability
77
__ ligmanet important in mortise stability
deltoid
only __ movement when AITFL PITFL
1-1.9mm
three ways to classify the high ankle sprains
chronologically
radiographyically
functionally
chronological classifcation
acute (within 3 weeks)
subacute (3 weeks to 3 months_
chronic (beyond 3 months)
aim of ACL injury prevention
modify extrinsic factors
improve landing
proprioception
nm recruitment
easier to get back from high ankle or lateral ankle sprain
lateral is easier
name two injury prevention programs
PEP
FIFA11
high ankle sprain managemnt
conservative if no fracture / significant tear
surgical (severe)
pre op acl goals
control pain, swelling normal ROM gait pattern LE strength balance
risk of young athlete having ACL surgery
damage the growth plate leading to leg length discrepancy
risk of non surgical option
risk of future meniscal tears and chondrol injury
what 4 things are ACL management guided by
skeletal maturity
physiological maturity
chronological maturity
extent of acl tear
Management Phase 1 high ankle sprain
protect decrease inflammation PRICE immolve non weight bearngg
management phase 2 high ankle
mobility strength increase function partial WB bilateral balance join goes to restore Df
when to progress from phase 2-3 in high ankle
ambulate full WB without pain
may still need brace or heel lift
management stage 3 high ankle sprain
increase function, unilateral balance / strength
treadmill, squatting, lunges
when to progress management phase 3-4
can perform singles leg calf raises
AITFL injury often accompanied by
interosseous ligament tear
management phase 4 high ankle
return to sport
cutting, jumping
plyometrics
when to end phase 4
full ROM, no swelling / effusion
able to run, cut, pivot
without symptoms
mechanism for high ankle sprain
planted foot with IR of leg
ER of talus in mortise
hyperdorsiflexion
inversion
PF
example sport high ankle sprain
skiing
when is ER stress test positive
reproduce pain
cross leg positive test
pain at tib fib joint
Df maneuver postiive
pain at distal tib fib joint
fib translation test positive
pain and laxity
stabilization test postive
decreased pain
when to progress pain management phase 1-2
when pain and swelling controlled and have minimal antalgic gait with PWB
most hamstring strains occur during __ loading
eccentric or initial contact (concentric)
is there a high re injury rate in hamstring
yes
types of hamstring injuries
high speed running (bicep femurs)
stretching (semi-mem)
predisposing strains
Weak / Tight hamstrings Previous injury Age Training error Inadequate warm up Technical Nuerla tension LSPS SIJ Envioremnt (surface, footwear) core
differential diagnosis for hamstrings
piriformis syndrome
compartment syndrome
adverse neural tension
subjective for hamstring
is there tightness
aggravated by running/ sprinting
objective exam hamstring
observation, bruise
altered movement
mm length
mm strength
common predisposing factor hamstring
SIJ anterior innominate lesion
how to classify hamstrings
grade 1-3 or MRI
MRI classification for hamstring
Myofacial
mm tendon
intratendinous
myofacial hamstring
sudden or gradual onset, ROM is good - recovery 5-10 days
mm tendon junction
sudden onset, reduced ROM, slower recover (14-28 days)
intratendinous hamstring injury
sudden onset, sig loss in ROM, 6-9 weeks recovery
acute phase hamstring treatment
modified rest, compression, ice
avoid soft tissue work
avoid static stretching, assisted heel slides, mini squats
repair phase hamstrings
modalities DTF / soft tissue strength flexibility core proprioception
remodelling stage hamstrings
DTF
strength
flexibilty
running progressions
hamstring return to play criteria
pain free palpation
flexible
arent scared
completed functional progressions
sport hernia symptoms
pain with sneeze / cough
apprehension to move
location / duration of pain
signs of sport hernia
pain with functional testing (sit up, hop tests)
is there a gold stand hernia diagnosis
no
based on history and assessment
assessment fo hip joint lesion
FADDIR
stress fractures are diagnosed via
bone scan
osteitis pubis history
long recovery time, can’t push through
how to assess osteitis pubis
TOP of pubic tubercle
pain with loading of pubic symphysis
does MRi help diagnose pubic sympthsis
helpful to see edema and degenerative changes
adductor strain signs and symptoms
matching MOI pain weakness TOP deformity
iliopsoas strain / bursitis
deep groin pain above or below inguinal ligament
clicks / snags
pain after activity
TOP
sport hernia conservative treatments
core shorts
dynamic warm up
graduated return to activty
symptoms won’t resolve >6-8 months
what position for GH dislocation
Abd ER
type of labrum tears
slap lesion (bicep)
bankart (lower labrum)
what nerve can be damaged in anterior dislocation
axillary
axillary nerve travels through what
quadrangle space
if there nerve is damaged too what do you do
continue with GH joint dislocation (scap stabilization, strength, functional)
criteria for return to play GH dislocation
complete resolution of acute signs
full AROM / PROM
no apprehension in position of risk
progressive functional tests
what are the chances of re dislocating shoulder
90-95% if you’re under 20
less and less if you’re older
can you have instability post shoulder dislocaiton shoulder
yeah less than 10%
