Exam 1 - 2 Flashcards
(218 cards)
1
Q
4 ways that thermal energy is transmitted
A
conduction- heat from warmer to cooler - hot pack
convection - transfer of heat through movement of fluid or gases - hot tub
radiation - heat is transferred through space from one object to another - shortwave and microwave diathermy
conversion - heat generation from another source such as sound, electricity and chemical agents - tigerbalm and ultrasound
2
Q
cryotherapy
A
cold packs or ice - principle of conduction where the body part comes in direct contact with the cold agent
3
Q
magnitude of the temp change in the tissue will depend on 4
A
temp diff between the cold agent and the tissue
time of exposure
thermal conductivity of the area being cooled - muscle faster than fat
type of cooling agent
4
Q
4 things that cold applications do
A
induces vasoconstriction and therefore limits bleeding - swelling
analgesic - decrease pain fibre transmission
reduce inflammation - decrease metabolic rate
reduces muscle guarding/spasm - slows pain that causes spasm, decreases metabolic rate so decreases the irritating chemicals
5
Q
physiological effect of cold - 2
A
cold to skin at 10 degrees, vasoconstriction occurs - reduction of blood flow
hunting response - cold application for 15-30 mins causes a slight temp increase - fight response for hypothermia
6
Q
4 contraindications for cold application
A
allergy to cold - jt pain, swelling and hives
poor circulation - diabetes
circulatory impairment - Raynauds phenomenon - vasospasm of digital arteries lasting for min/hrs that could lead to tissue death
wound opening
7
Q
feeling of ice application
A
Cold - 0-3 mins
Burning - 2-5 min
Aching - 4-7 mins
Numbness 5-12 mins
8
Q
should you wrap ice
A
no - hunters response - but dont put chemicals directly on skin
9
Q
cryotherapeutic methods - 4
A
conduction
ice massage - frozen ice cups for small body parts
cold water/ice water immersion - gravity dependent use after initial acute stage
ice packs - with pressure in acute stage
vasocoolant sprays - freeze towel in a desert
- chemicals used to reduce muscle spasms/cramps to reduce nerve ending signals
10
Q
electrolyte for cramps
A
not much
11
Q
Thermotherapy - 2
A
application of heat to injuries
after initial inflammatory response has subsided after first 3 days
12
Q
5 physiological effects of heat
A
analgesic effects by gate control
vasodilation to increase bloodflow, circulation and removal of metabolic wastes
decrease muslce spasm caused by ischemia, decreases muscle spindle activity and increases blood flow to area
increase ROM - increases elasticity of lig, capsule, and muscle
increase local tissue temp
13
Q
for heat physiological responses to occur
A
heat must be absorbed into tissue to increase molecular activity - once absorbed it spreads to adjacent tissues
14
Q
5 contraindications of heat
A
loss of sensation to area immediately after injury - acute inflammatory state decreased arterial circulation eyes/genitals - gonads will die abdomen during pregnancy
15
Q
moist heat therapies - 4
A
moist heat packs -
whirlpool baths
paraffin bath - wax
contrast bath
16
Q
moist heat packs
A
conduction and convection
- relaxation and reduction in pain - spasmischemia - hypoxia pain cycle - hydroxalator pack - ongoing isometric
17
Q
whirl pool baths
A
- chronic for pitted edema - milk massage after heated - decrease swell
18
Q
paraffin bath
A
fighters and their knuckles
chronic extremity injuries
19
Q
contrast bath - 2
A
alternating vasoconstriction and vasodilation - ice and heat - 10-12 mins, hr/45min to remove existing swelling
new blood assists in removing edema by unclogging and vasculature
20
Q
knee - 4
A
tibiofemoral jt
frequently injured
complex jt
poor stability
21
Q
knee - type of jt and 4 movements
A
synovial, modified hinge jt
flex/ext/int rot/ext rot
22
Q
3 parts of the knee
A
femur - not congruent with tib,
tibia plateau
patella - sesamoid bone
23
Q
Fibula in regards to the knee
A
not involved and not weight bearing
site for muscle/lig attachment
sup tibiofib jt - head of fibula and LCL
posterolateral knee injuries
24
Q
patella - 3
A
largest sesamoid bone in the body
lined with hyaline cartilage
allows stronger muscle pull of quads due to changing the angle of the patellar tendon
25
menisci
| 4 functions
```
fibrocartlaginous discs in knee
improved congruency
aid in jt nutrition
transmit force
decrease contact load - slides nice together
```
26
medial vs lateral meniscus
c and o shaped
| med has less movement and high incidence rate
27
blood supply to meniscus - 3
only to outer 1/3
poor healing capacity
stitch a bucket handle
28
bursae of the knee
function
3 most injured
fluid filled sac
reduce friction across gliding surfaces
prepatellar, suprapatellar, infrapatellar
29
6 things that make up the knees stability
```
bone
lig
articular cartilage
jt capsule
tendons
menicus
```
30
ACL bands
attachment sites
function - 2
anteromedial
posterolateral
intermediate bands
ant/med aspect of tibia and lat femoral condyle
prevent ant translation of tibia relative to femur
secondary restraint to valgus (l-m)/varus (m-l) force
31
injury to acl
| diagnosis by different methods
damaged in 72% of knees with hemarthrosis
stick needle in and if there is blood - jt line swelling - divits on your knee and under your jt
85% can be detected by a skilled clinician
less than 80 for MRI and 80% get sent for 1, our clinic does 2.7 %
scope - 100%
32
PCL
O/A
function
less frequent in isolation - low surgical success
lat/pos tib to med femoral contyle
prevent pos translation of tib relative of the femur
33
MCL
O/A
function
lots of blood vessels and nerves
med femoral condyle to tib
resists valgus (lat to med) stress and lat rotation of the tib
34
LCL - O/A
| function
lat femoral condyle to head of fib
| resists varus stress
35
ant thigh muscles - 4
| function
4 muscles
vastus lat/med/intermedias/rectus femoris
knee extension
36
pos thigh muscles - 3
| function
biceps femoris - lat
semitendinosis - most prominent
semimembranosis - med to lat
knee flexion
37
special tests
| - 2
end of orthopedic test to verify to see if its what you think - provoking test so be careful
- degree of injury - proper decisions for management and RTP
38
muscle tests are also
exercises
39
Ant drawer for the knee
look for
false pos
false neg
ACL
laxity and stretched
great flexibility and laxity to begin with
contracted hamstrings - make sure they relax
40
when you're assessing, always
compare both sides
41
pos drawer
procedure
what to look for
PCL
stablize foot, put thumb on tibial tuberosity - apply force pos
sag sign
42
valgus stress test
| procedure
MCL - one shot bc they will tighten up after
supine with leg extended, holding the patients leg apply a medial force - look and feel for MCL laxity - fully extended then 30 degrees of flexion
43
varus test
LCL
| supine and hold their leg to apply slow lateral force and feel for laxity
44
faber position
boy cross legged position
flexed knee and, abduct and externally rotate
LCL - not definitive
45
apleys compression
procedure
signs
meniscus
prone with affected knee bent at 90 degrees
stablize thigh and apply downward pressure while rotating the lower leg internally and externally
med tear - externally rotate
lat - internal rot
46
why be careful with cartilage tests
you can lock it
47
MCL sprain
| MOI
often in conjunction with ACL tears
| direct blow to the lat aspect of knee or tibial ex rotation
48
grade 1 sprain
pain, slight swelling, no instability
49
grade 2 sprain
pain, mod swelling, unable to bear weight
50
grade 3 sprain
immediate severe pain, gross instability, swelling, unable to bear weight
51
management of sprains
depending on the degree/severity of the sprain
52
MCL management Grade 1
PIER, strengthening quads, hams, adductors, balance
53
MCL management Grade 2
PIER, crutches, strengthening, balance
54
MCL management Grade 3
PIER, doc, NWB, splint
55
LCL sprain
MOI
S&S - 5
```
Varus for and internal rotation of tib
lat knee pain
swelling/bruising
LCL laxity
tenderness
altered gait/WB
```
56
ACL sprain
| MOI
deceleration force with tib internal rotation and valgus force/hyperextension - sheer force - non contact
57
why are females at more risk of ACL injuries - 3
strength - eccentric loading of quads
anatomy - increased Q angle
hormonal changes
58
signs and symptoms of ACL injury
audible pop
immediate swelling - hemarthosis - jt line welling, hot, doesnt bend well
instability with ant drawer
59
management of ACL - 5
```
PIER
NWB
crutches
brace
doc
```
60
why sent acl to doc
damage will cause abnormal wear and tear to the knee which accelerates arthritis
61
what type of exercises for ACL rupture - 4
ROM
strengthening of ham, quad, glutes
functional exercises
proprioception
62
ACL surgery
| rehab protocols
focus on hamstring strength
patellar or hamstring tendon graft into ant aspect of tib to posteriolateral aspect of femur to approximate ACL
vary
63
PCL injury - 3
Quad strength
not as common
3-37% of all cases of hemarthrosis
64
MOI PCL strength
| signs and symptoms - 4
```
direct trauma or fall onto flexed knee - dashboard injury
audible pop
swelling
instability
sag sign -
```
65
5 management
```
NWB
doc
crutches
PIER
brace
```
66
4 rehab
ROM
strengthening
functional exercises
proprioception
67
PCL surgical?
not usual - poor post surgical success rates
68
why are medial tears more likely to happen?
lack of mobility
69
MOI of meniscal tears - 3
often happen with lig tears
| axial loading and rotation - forceful extention to flexion or flexion to extension
70
healing of meniscal tears
slow - poor blood supply - if you rest on it it will heal
71
SS for menical tear - 3
locking/giving away
jt swelling
pain with pivoting
72
management of meniscal tear - 5
```
PIER
strength of quads and hams
balance
stationary bicycle
surgical intervention
```
73
Why are meniscal injuries bad
poorly managed - change mechanics and premature arthritis
74
```
Bursitis
MOI
SS - 3
Management - 5
note
```
```
direct trauma or constant irritation due to repetitive stress
swelling, pain, enlarged bursal sac
pad it and dont make it worse
PIER
correct mechanical cause
address strength of quads, hams, core
foot mechanics
extracapsullar is better than intra
```
75
```
Patellar subluxation or dislocation
mistaken as
MOI - 2
predisposing factors - 5
SS - 4
management - 3
rehab
reduce
```
tibiofemoral problems
Valgus force with decel from quads, twisting/pivoting - large hips
wide pelvis, genu valgum, patella alta, weakness of VM and adductor magnus, pronation of the subtalar jt - pes planus
pain, swelling, deformity, loss of knee function
splint above and below, refer to rule out fracture - ER with straight leg, brace with hole in the middle, patella stabilizer
strengthen VM and adductors
flex hip and knee then lift leg slightly
76
```
Patellofemoral pain syndrome
prone lifestyle - 4
MOI
5 prone anatomy
4 SS
4 strengthening
4 stretching
tape?
```
```
sedentary, obesity, weakness, nutrition
chronic, improper tracking of patella
tight hams, ITB, increased pronation of foot/ankle, large Q angle, muscle imbalances
asymtomatic at rest
pain in ant, pain with knee flexion and stair climbing and hills, pos theatre sign
quads hams glutes core
quads hams ITB, gastroc
helps how the patella tracks, brace
```
77
Chondromalacia patella
MOI
4 SS
management
```
softening of the articular cartilage
chronic, exact cause is unknown but may be related to poor patellar tracking
pain under patella
pain with stair climbing
grinding with activity
pos theatre sign
rest
```
78
osgood schlatter disease
MOI
4 SS
5 management
enlarge soft tissue calcifying - boys that grow super fast
avulsion of patellar lig from tib tubercle due to excessive repeated strain - immature athletes/open growth plates
swelling, ant knee pain, pain with jumping, running, squatting, enlarged tub
PIER, cessation of causative act, may require casting, bracing, tape - rest, address muscular imbalances/mechanics, strength through eccentric, core, glutes
79
patellar tendonitis
MOI - 2
4 SS
5 management
jumper/kickers knee - proximal part of tendon
older athelete - 20 and up
overuse - eccentric more force than concentric
eccentric loading of quads cause tendon to become irritated,, maltracking patella
TOP inf pole of patella
pain during and post activity - worse with running and jumping, may swell, bony protuberance
PIER, find the cause - mechanics and movement pattern, improve flexibility, strengthen quads, glutes, core, cho pad strap to change the insertion pt of patellar tendon
80
ITB friction syndrome
MOI - 3
5 SS
management 4
tensor fascia - cross jt line
more common in ladies - knocked knee and use tensor fascia as a flexor
chronic, repetitive compression of ITB against lat fem condyles- inflammation
act with repetitive flex/ex of knee - running, cycling, swimming, rowing
muscular imbalance/weakness, abnormal gait, foot/knee alignment
pain up and down stairs, pain running esp downhill, pain at a specific time/distance during act, improves with rest/cessation of activity, TOP distal ITB
find the cause and treat it - terrain, footwear, mileage
stretch ITB, glutes, quad
strengthen - glutes, core
address gait patterns
knee and goot alignment
81
ladies and ITB friction
put them on an exercise program - some people are not made for running
82
runner 3 weeks out
treat symptoms
83
goals with blood borne disease
prevent the spread of infectious diseases
84
why is the spread of infectious disease a concern in sporting activities
close physical contact
85
failure to protect yourself from blood borne pathogens
may put yourself and others at risk as transmitter or carrier
86
bloodborne pathogens
| where is it - 4
pathogenic microorganisms that can potentially cause disease
present in bodily fluids such as blood, CSF, synovial fluid, other fluid types that may contain blood
87
possible blood borne diseases - 3
hepatitis B, C, HIV
88
HIV
human immunodeficiency virus
89
Virus - 3
very small, biggest is the size of smallest bacteria
invade other cells and hijack their cellular machinery to reproduce, attach to a cell and inject their genes or are swallowed up by the cell
parasitic organism
90
bacteria - 2
very large
| all the genetic materials necessary to replicate
91
hepatitis b
virus - attacks your liver
| get a shot
92
liver - 3
digest food, store energy, rid of poisons
93
will i die from hepatitis b - 3
most people dont
can cause permanent liver damage - cirrhosis
liver cancer maybe death
94
3 ways to get hepatitis b
high risk act with ind with hep b
born to a mother with hep b
contact with dried blood or contaminated surfaces
95
you can pass hep b to other if - 2
acute hep - just contracted
| chronic hep - carrier
96
7 symptoms of hep b
| note
flu like - fatigue, weakness, nausea, abdominal pain, headache, fever, possibly jaundice
may exhibit none and be a carrier - may take up to 2m to show up and may stay in your blood for m/yrs
97
will i get rid of hep b
acute - 9/10 will after a few months
| chronic - 1/10 - never rid of it - carriers
98
can hep b be prevented?
yes - 3 shots if you have never had it and get long lasting protection
99
hep c - 3
acute/chronic liver disease
most common bloodborne infection, may require a liver transplant
high probability from acute to chronic
100
spread of hep c - 3
contact with blood of an infected ind
- tattoo/piercing
- personal care items that might have traces of blood - needles or razors
101
SS for hep c
```
flu like
nausea
fatigue
muslce/jt pain
dark urine
loss of appetite
mild abdominal pain - URQ
jaundice
many are asymtomatic
```
102
prevention/management - 3
dispose of sharps properly
use barrier precautions such as gloves
no preventative vaccine -
- monitored by physician for liver disease and placed on certain meds
103
HIV transmission - 3
exposure to infected blood or other infected bodily fluids or by intimate contact
104
SS of HIV - 6
```
fatigue
weight loss
muscle or jt pain
painful or swollen glands
night sweats
fever
```
105
development of HIV
8-10 years before developing any SS
| ppl who test pos for HIV have a high probability of developing AIDS
106
acquired immunodeficiency syndrome - 5
collection of SS that are recognized as the effects of an infection or condition
do not have protection against the simplest infection
50% of aids become HIV in 10 yrs
2 years to live after SS
no vaccine and no cure
107
prevention of aids
ed
| how its contracted, safe sex, other personal protextion, dont share needles and protect from bodily fluids
108
4 sports that have the greatest risk for blood borne pathogens
boxing
martical arts
wrestling
rugby
109
4 sports that have the mod risk for blood borne pathogens
basketball
football
soccer
speed skating
110
low risk sports for blood borne pathogen
ind
111
4 universal precautions
cuts wounds and abrasions should be covered prior to competitions
bleeding on field has to be cleansed with disinfectant and covered appropriately
bloody uniform must be removed from athlete
blood rules
112
personal precautions- 7
latex gloves, double in heavy bleeding
washed skin with hot soapy water
wash hands between each patient contact
first aid kits must have gloves, resuscitation mouth pieces and towelletes for cleaning skin surfaces
clothes that come in contact with blood should be washed in hot water with chlorine bleach
dispose of bloody gloves, needle, razors in SHARPS container that has been labeled biohazardous waste
open wound - refrain from direct cont with ind until wound is healed
113
wound
| mechanical forces can injure soft tissue - 7
trauma to tissues that causes a break in the continuity of that tissue
rubbing, scraping, compression, pressure, tearing, cutting and penetration
114
wounds are classified by
mechanical forces that caused them
115
friction blisters
cont rubbing over the skin surface causes fluid to accumulate under
116
abrasion
scraped skin against a rough surface, top layer rubs away exposing capillaries
117
laceration
flesh irregularly torn - high risk of infection
118
avulsion wounds
tissue ripped away from body - major bleeding - reattached and transported in moist tissue with the athlete
119
incision
sharply cut, smooth edges
120
puncture wounds
penetration of the skin by a sharp object - can introduce bacteria into the bloodstream - physician
121
immediate care for wounds - 4
all are considered contaminated by microorganisms
clean and dress
soap and water or saline
dont use hydrogen peroxide immediately
122
dressing - 4
sterile
gauze/adhesive bandage
change frequently if draining
antibacterial ointment
123
good wound care - 3
min inflammatory process, speed healing and min scarring
124
When to suture - 4
deep wounds - lacerations, incisions, punctures - irregular edges
physician
immediately up to 12 hrs
approximate edges to min scar formation, tissue damage and inflammation
125
infection signs - 7
Swelling, heat, altered function, redness, pain, pus, fever
126
2 treatment for infections
oral/IV antibiotics
| tetanus vaccine - every 10 yrs
127
EAP is needed for
every team, sport, field, court
128
Activate EAP immediately bc
time is the essence when dealing with injury - permenant brain damage in 5mins with lack of o2
129
when do you establish EAP
prior to actual emergency and practice every mouth
130
primary concern of EAP
maintain CV and CNS function
131
3cs
charge person - most experienced
call person - designated by charge
control person - security/calm person
132
charge person - 4
leader and instructs member of med team
most important body part - head/neck for spinal and control cspine
most experience
direct assistants as needed
133
call person - 3
signalled by call person to call 911/landline/local number - knows
knows routes of ambulance to enter field of play - keys to admittance to field
knows location of nearest emerge medical facility
134
control - 5
everyone whos touching the patient needs to be authorized
control crowd - under 18 parent has to be there
bystanders away
assist charge when needed
liasises with other ppl but no med info for media
135
other than 3cs, what else does EAP need - 8
seperate EAPs and equipment needed at each
procedure for removal of equipment
location and accessibility of phones
transportation of athlete - ambulance or personal vehicles
procedure for amittance to emerge - under 16?
company? cant be trainer - AC, parent, chaperone
pertinent med info on a card ready to go with player
communication
136
legal aspects of EAP
everyone is under a legal duty to provide necessaries of life to a person under his/her care
137
how are you evaled?
vs my peers at your academic level
138
children in emergency situations
implied consent - signed release from parent
139
do we need consent for emergency care
yes but you can always call 911
140
unconcious victim
implied consent
141
must provide care if 2
duty to act
| person under your charge is injured
142
criminal negligence - 2
failed to act as another reasonable person
| failed to act that caused more injury or death
143
do we put others before us?
not if we are in danger - no fire no wire no gas no glass
144
7 things for trainer
```
latex gloves
scissors
face shield
tape for splinting
towel/sterile gauze pads
cell phone
tools for sport to remove equipment
```
145
infield injury assessment will
provide direction in the decision making process concerning emergency care
146
5 life threatening things that you should call 911 right away
```
airway
breathing
circulation
deadly bleeding
shock
CNS
```
147
UABCD
life-threatening - 911/ems
unconscious
airway and cspine control
breathing - look listen feel rate and quality
circulation - quality and rate, radial palpable - 80mmHg, radial not palpable - late shock - deadly bleed internal/external, faint beating heart
deadly bleeding - wet check and scan
148
Level of consciousness
```
AVPU
alert
verbal stim
physical stim
unconscious/unresponsive
```
149
some causes for unconsiousness
```
AEIOUTIPS
allergies
epilepsy
insulin/diabetic
overdose
underdose
trauma
infections
psychiatric
stroke & heat
```
150
after consciousness
expose and examine
focus on trunk - head spine and femur
monitor vital signs cont - between deadly bleeding and CNS - BP, pulse, respiration, skin temp, color, pupils, state of consciousness, weakness of movement, sensory changes every 5 mins
151
vital signs - 9
pulse - adult 60-80bpm, children 80-100, radial or carotid
respiration - 12 adults, 20-25 kids
bp 120/80 higher in males
temp
skin colour - red - heartstroke, high BP, elevated temp, pale - insufficient circulation, shock, fright, hemorrhage, insulin shock, blue - cyanosis, airway obstruction, respiratory insufficiency, not enough o2
pupils - small - depressant, dilated - head injury/stimulant, upper, not responsive to light,, use edge of light
state of consciousness
movement - inability to move - spinal cord injury
abnormal nerve response - babinsky reflex, numbness/tingling
152
perral
equal pupils round and reactive and accomodating to light
153
arterial blood
spurting
pulsating flow
bright red
154
vein blood
steady, flow flow
| dark red
155
capillaries blood
slow even flow
156
external bleeding
rest
elevation - reduce hydrostatic bp and facilitate venous and lymphatic drainage
direct pressure and pressure pts proximally to injury site over major artery - brachial/femoral
157
internal bleeding of head - 4
dizziness, ringing in ears, nausea, altered psychological functioning
158
internal bleeding
hard to determine byt altered functioning
| hospitalization and further diagnostics
159
abdominal injuries internal bleeding
rigidity, pain in other area, rebound tenderness, bulging, tummyache
160
shock - 4
possibility with any injury
potential goes up with fractures, severe bleeding or internal injuries
dim blood to circulatory system
not enough oxygen to tissues esp the NS
collapse of vascular system - widespread tissue death - death
161
Battle field colors
black - no ABC
red - mins
yellow - hours
162
hypovolemic shock
trauma causing blood loss and organs not supplied with sufficient o2 - not enough to pump and wont pump if there is an air bubble
163
respiratory shock
lungs unable to supply o2 to blood baused by pneumothorax - air/gas in pleura or injury to lung
164
neurogenic shock
general dilation of blood vessels and blood cannot service CV and cant supply to body
165
psychogenic shock
fainting/synocope caused by temp dilation of vessles and reduce blood to brain - not enough to go around
166
cardiogenic shock
inability to pump enough blood to body
167
septic shock
severe bacterial infection which causes small vessels to dialte
168
anaphylactic shock
allergic reaction
169
metabolic shock
severe illness goes untreated or extreme loss of bodily fluids - urination, vomiting, diarrhea
170
SS for shock - 9
```
LBP systolic below 90
moist, pale, cool, clammy
rapid and weak pulse
shallow and rapid respiration
personality changes - irritable, restless, disinterest, sudden excitement
nausea
extreme thirst
urinary retention
fecal incontinences
```
171
shock management for shock - 3
911
keep them warm
elevate their legs 12 inches
172
no life threatening
```
secondary survey
vital signs
history
SAMPLE and med bracelets
symptoms
allergies
medications
past medical history
last meal
events preceding accident
```
173
after the sample questions you look for 2
```
DCAPBLS
deformities
contusions
abrasions
penetrations
burns
lacerations
swelling
TIC
tenderness
instability
crepitus
```
174
where do you perform DCAPBLS
head neck chest abdomen pelvis extremiteis - arms legs fingers toes
175
brief neurological exam
AVPU
motor/myos/movement
sensation / derm
pupils
176
focused secondary survey
finish bandaging and splinting
177
secondary survey decisions - 4
| note
```
seriousness
type of first aid and immob
immediate referral to doc?
where are you going and how are you getting there
doc findings
```
178
emerge splinting - 3
suspected fracture should be splinted before moving
use anything
splint above and below an din the position it was found
179
3 types of splints
rapid form vacuum immob
- injuries angled and must be splinted in that position
- air sucked out of sleeve to give cardboard like rigidity
speed splint
- thick plastic
- bend and snap in place
- reusable
-xray permeable
air splint - filled with air after application to provide support
180
fitting of the crutch
6inches from outer margin of shoe and 2in in front
1 in from axilla to top of crutch
wrist - radial styloid level with hand grips and elbows at 30 degrees
181
fitting of cane
greater trochanter to gloor
182
walking with cane/crutches
tripod
- stand on one foot with affected off the ground
- crutche goes 12-15 in and they lean and straighten arms to swing through stationary crutches
repeat
183
proper injury care can only be provided if
nature and severity were understood
184
goal of eval process
perfect diagnosis, recovery, rehab
185
eval process must be
systematic and orderly
consistent
standardized
186
history
greatest clinical significance
MOI
Feel/hear
Result
age, gender, sport, position, what increases or decrease pain, med imaging, med records, reports of injury, fam history, pain and function scale
open ended questions - anything else?
red flags - severe relenting pain, pain unaffected by med or position, severe night pain, severe pain with out history of injury, severe spasm, BB change/dysfunction, elevated temp, psychological overlay - external blaming or too focused on pain
187
observation
```
explain process
dress and drape
manner/fluidity of movement
limping swelling discoloration deformity scars asymmetries
bilateral
pictures they tool
```
188
HORSPSS
```
in clinic assessment
history
observation
ROM - a and p
strength
palpation
special test
summary
```
189
ROM
```
active - contractile ability
- when and where pain
- intensity and quality of pain
- reaction to pain
- degree
pattern
rhythm and quality
willingness to move
passive - bones cartilage lig
- relaxed
- careful of over power, block in the middle is jt issues
- when and where pain
- intensity and quality of pain
- end feel
amt of PROM
all ROM of jt and bilaterally
```
190
strength
becareful if anything was pos
- resisted isometric movement for 6s - unaffected side first
muslce tendon or bone where tendon attaches is at fault - weakness
dont let me move you
191
strength of contraction
```
no palpable contraction or jt motion
1 palpable but no jt motion
2- unable to complet ROM with min gravity
2 complete ROM with min G
2+ initiate ROM with G
3- does not complete ROM with G but more than half
3 complete ROM without resistance
3+ <50% resis
4->50% resis
4+ near max
5 max
```
192
strong and pain free isometric
normal
193
strong and painful isometric
lesion in muscle or tendon
194
weak and painfree
nerve/musculotendinous rupture
195
weak and painful
serious - fracture to unstable jt
196
8 causes of muslce weakenss
```
strain
pain/reflex inhib - splint pain
peripheral nerve injury - distal
nerve root lesion - myotome - higher up
upper motor neuron lesion
tendon pathology
aculsion
psychological overlay
```
197
palpation - 4
know bony and surface anatomy
deep enough to distinguish diff structures
thumb and finger tips, back of hand
palpate unaffected, start away and move in - superficial to deep
198
6 things to note while palpating
tissue tension and texture - muslce spasm
tissue thickness and texture - swelling type
abnormalities
tenderness on palpation
temp
abnormal sensation - dyesthesia hyperesthesia, anesthesia, crepitus
199
special tests - 5
orthopedic and also exercises
delineate between structures in the same area
various tests for same structure - 2-3 min, 4 max
what am i looking for?
type of injury?
200
summary - 4
proper treatment plan
what do i see what should i do
reassurance
follow up before participation
201
injured body
affects the mind
202
neg psychological response to injury
longer and more difficult rehab
203
sports med personel and psychology of injury
significant impact
204
goal with their minds
mind and body ready for competition
205
Response to injury
diff for every one
206
injury severity classification
```
severity - length of rehab
short term <4wks
long >4wks
chronic - reoccurring
terminating - career ending
```
207
reactive phases of injury process
reaction to injury
to rehab
to return to play or career terminating
208
influences on responses - 5
```
severity of injury
coping skills
past history
social support
personality
```
209
3 predictors of injury
injury prone - risk takers, tender minded, apprehensive, overprotective, distracted, poor coping skills
stress and risk of injury
- neg stress, lack of focus, missing cues, muscle tension, peripheral stress - microsystem
overtraining
- imbalance between physcial load and coping capacity
staleness and burnout - decrease load to let them rest
210
4 coping sources
goal setting
social support systems
stress management skills
mental skills - pos self talk, thought stoppage
211
poor coping resources
vulnerable to higher lvls of stress and more difficulty dealing with stress response - increasing risk for injury
212
strong support systems
recover quickly from setbacks than those with a weak support system -
213
7 things an injured atheltes can lose
```
specific contest
opportunity to compete
financial incentives
starting sport
physical mobility
control over life
personal identity or sense of self
```
214
mitigating factors to dealing with an injury
```
emotional distress
injury site - reinjury
amt of pain
timing of injury
severity
```
215
factors arising during treatment
```
whom they blame - locis of control
degree of compliance with prescription
effectiveness of Rx perceived by athlete
reinjury druing Rx
pain
meds abuse
deterioration in psych functioning
support form others
fans/media
```
216
5 normal responses to an injury
```
anger/frustration
some denial and min of injury
concern about pain
discouraged
concern over losing conditions
```
217
5 possible warning responses to injury
fixation on injury - blame, tears, obsessed RTP
extensive denial, reinjury
dwell on minor aches and sensations despite reassurance
missing prescrived appts
overly worried about body image and weight
218
psych rehab for injury recovery
SCRAPE - needs
social support - part of a team, ppl they know and respect, similar injury, used with substance abuse, dont compare and always over estimate
confidence and competence - buy in, what were doing, what were expecting how well assess - increase function - obtainable goals and always optimistics
refer - know your limitations - anxiety, self esteem depression - report self harm
accomodate - wants vs needs - individualize - build trust - youre on the same team - flexibility in treatment schedule
physicological skills - imagery, goal setting, relaxation, confidential rehab journal for progress
educate - injury pathology, typical recovery time, necessary restricitons, rationale for therapeutic interventions - prognosis, contraindications - written/educational materials on the injury
