Exam 1 - 2 Flashcards
4 ways that thermal energy is transmitted
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
cryotherapy
cold packs or ice - principle of conduction where the body part comes in direct contact with the cold agent
magnitude of the temp change in the tissue will depend on 4
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 things that cold applications do
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
physiological effect of cold - 2
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
4 contraindications for cold application
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
feeling of ice application
Cold - 0-3 mins
Burning - 2-5 min
Aching - 4-7 mins
Numbness 5-12 mins
should you wrap ice
no - hunters response - but dont put chemicals directly on skin
cryotherapeutic methods - 4
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
electrolyte for cramps
not much
Thermotherapy - 2
application of heat to injuries
after initial inflammatory response has subsided after first 3 days
5 physiological effects of heat
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
for heat physiological responses to occur
heat must be absorbed into tissue to increase molecular activity - once absorbed it spreads to adjacent tissues
5 contraindications of heat
loss of sensation to area immediately after injury - acute inflammatory state decreased arterial circulation eyes/genitals - gonads will die abdomen during pregnancy
moist heat therapies - 4
moist heat packs -
whirlpool baths
paraffin bath - wax
contrast bath
moist heat packs
conduction and convection
- relaxation and reduction in pain - spasmischemia - hypoxia pain cycle - hydroxalator pack - ongoing isometric
whirl pool baths
- chronic for pitted edema - milk massage after heated - decrease swell
paraffin bath
fighters and their knuckles
chronic extremity injuries
contrast bath - 2
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
knee - 4
tibiofemoral jt
frequently injured
complex jt
poor stability
knee - type of jt and 4 movements
synovial, modified hinge jt
flex/ext/int rot/ext rot
3 parts of the knee
femur - not congruent with tib,
tibia plateau
patella - sesamoid bone
Fibula in regards to the knee
not involved and not weight bearing
site for muscle/lig attachment
sup tibiofib jt - head of fibula and LCL
posterolateral knee injuries
patella - 3
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
menisci
4 functions
fibrocartlaginous discs in knee improved congruency aid in jt nutrition transmit force decrease contact load - slides nice together
medial vs lateral meniscus
c and o shaped
med has less movement and high incidence rate
blood supply to meniscus - 3
only to outer 1/3
poor healing capacity
stitch a bucket handle
bursae of the knee
function
3 most injured
fluid filled sac
reduce friction across gliding surfaces
prepatellar, suprapatellar, infrapatellar
6 things that make up the knees stability
bone lig articular cartilage jt capsule tendons menicus
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
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%
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
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
LCL - O/A
function
lat femoral condyle to head of fib
resists varus stress
ant thigh muscles - 4
function
4 muscles
vastus lat/med/intermedias/rectus femoris
knee extension
pos thigh muscles - 3
function
biceps femoris - lat
semitendinosis - most prominent
semimembranosis - med to lat
knee flexion
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
muscle tests are also
exercises
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
when you’re assessing, always
compare both sides
pos drawer
procedure
what to look for
PCL
stablize foot, put thumb on tibial tuberosity - apply force pos
sag sign
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
varus test
LCL
supine and hold their leg to apply slow lateral force and feel for laxity
faber position
boy cross legged position
flexed knee and, abduct and externally rotate
LCL - not definitive
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
why be careful with cartilage tests
you can lock it
MCL sprain
MOI
often in conjunction with ACL tears
direct blow to the lat aspect of knee or tibial ex rotation
grade 1 sprain
pain, slight swelling, no instability
grade 2 sprain
pain, mod swelling, unable to bear weight
grade 3 sprain
immediate severe pain, gross instability, swelling, unable to bear weight
management of sprains
depending on the degree/severity of the sprain
MCL management Grade 1
PIER, strengthening quads, hams, adductors, balance
MCL management Grade 2
PIER, crutches, strengthening, balance
MCL management Grade 3
PIER, doc, NWB, splint
LCL sprain
MOI
S&S - 5
Varus for and internal rotation of tib lat knee pain swelling/bruising LCL laxity tenderness altered gait/WB
ACL sprain
MOI
deceleration force with tib internal rotation and valgus force/hyperextension - sheer force - non contact
why are females at more risk of ACL injuries - 3
strength - eccentric loading of quads
anatomy - increased Q angle
hormonal changes
signs and symptoms of ACL injury
audible pop
immediate swelling - hemarthosis - jt line welling, hot, doesnt bend well
instability with ant drawer
management of ACL - 5
PIER NWB crutches brace doc
why sent acl to doc
damage will cause abnormal wear and tear to the knee which accelerates arthritis
what type of exercises for ACL rupture - 4
ROM
strengthening of ham, quad, glutes
functional exercises
proprioception
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
PCL injury - 3
Quad strength
not as common
3-37% of all cases of hemarthrosis
MOI PCL strength
signs and symptoms - 4
direct trauma or fall onto flexed knee - dashboard injury audible pop swelling instability sag sign -
5 management
NWB doc crutches PIER brace
4 rehab
ROM
strengthening
functional exercises
proprioception
PCL surgical?
not usual - poor post surgical success rates
why are medial tears more likely to happen?
lack of mobility
MOI of meniscal tears - 3
often happen with lig tears
axial loading and rotation - forceful extention to flexion or flexion to extension
healing of meniscal tears
slow - poor blood supply - if you rest on it it will heal
SS for menical tear - 3
locking/giving away
jt swelling
pain with pivoting
management of meniscal tear - 5
PIER strength of quads and hams balance stationary bicycle surgical intervention
Why are meniscal injuries bad
poorly managed - change mechanics and premature arthritis
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
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
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
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
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
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
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
ladies and ITB friction
put them on an exercise program - some people are not made for running
runner 3 weeks out
treat symptoms
goals with blood borne disease
prevent the spread of infectious diseases
why is the spread of infectious disease a concern in sporting activities
close physical contact
failure to protect yourself from blood borne pathogens
may put yourself and others at risk as transmitter or carrier
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
possible blood borne diseases - 3
hepatitis B, C, HIV
HIV
human immunodeficiency virus
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
bacteria - 2
very large
all the genetic materials necessary to replicate
hepatitis b
virus - attacks your liver
get a shot
liver - 3
digest food, store energy, rid of poisons
will i die from hepatitis b - 3
most people dont
can cause permanent liver damage - cirrhosis
liver cancer maybe death
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
you can pass hep b to other if - 2
acute hep - just contracted
chronic hep - carrier
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
will i get rid of hep b
acute - 9/10 will after a few months
chronic - 1/10 - never rid of it - carriers
can hep b be prevented?
yes - 3 shots if you have never had it and get long lasting protection
hep c - 3
acute/chronic liver disease
most common bloodborne infection, may require a liver transplant
high probability from acute to chronic
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
SS for hep c
flu like nausea fatigue muslce/jt pain dark urine loss of appetite mild abdominal pain - URQ jaundice many are asymtomatic
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
HIV transmission - 3
exposure to infected blood or other infected bodily fluids or by intimate contact
SS of HIV - 6
fatigue weight loss muscle or jt pain painful or swollen glands night sweats fever
development of HIV
8-10 years before developing any SS
ppl who test pos for HIV have a high probability of developing AIDS
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
prevention of aids
ed
how its contracted, safe sex, other personal protextion, dont share needles and protect from bodily fluids
4 sports that have the greatest risk for blood borne pathogens
boxing
martical arts
wrestling
rugby
4 sports that have the mod risk for blood borne pathogens
basketball
football
soccer
speed skating
low risk sports for blood borne pathogen
ind
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
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
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
wounds are classified by
mechanical forces that caused them
friction blisters
cont rubbing over the skin surface causes fluid to accumulate under
abrasion
scraped skin against a rough surface, top layer rubs away exposing capillaries
laceration
flesh irregularly torn - high risk of infection
avulsion wounds
tissue ripped away from body - major bleeding - reattached and transported in moist tissue with the athlete
incision
sharply cut, smooth edges
puncture wounds
penetration of the skin by a sharp object - can introduce bacteria into the bloodstream - physician
immediate care for wounds - 4
all are considered contaminated by microorganisms
clean and dress
soap and water or saline
dont use hydrogen peroxide immediately
dressing - 4
sterile
gauze/adhesive bandage
change frequently if draining
antibacterial ointment
good wound care - 3
min inflammatory process, speed healing and min scarring
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
infection signs - 7
Swelling, heat, altered function, redness, pain, pus, fever
2 treatment for infections
oral/IV antibiotics
tetanus vaccine - every 10 yrs
EAP is needed for
every team, sport, field, court
Activate EAP immediately bc
time is the essence when dealing with injury - permenant brain damage in 5mins with lack of o2
when do you establish EAP
prior to actual emergency and practice every mouth
primary concern of EAP
maintain CV and CNS function
3cs
charge person - most experienced
call person - designated by charge
control person - security/calm person
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
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
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
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
legal aspects of EAP
everyone is under a legal duty to provide necessaries of life to a person under his/her care
how are you evaled?
vs my peers at your academic level
children in emergency situations
implied consent - signed release from parent
do we need consent for emergency care
yes but you can always call 911
unconcious victim
implied consent
must provide care if 2
duty to act
person under your charge is injured
criminal negligence - 2
failed to act as another reasonable person
failed to act that caused more injury or death
do we put others before us?
not if we are in danger - no fire no wire no gas no glass
7 things for trainer
latex gloves scissors face shield tape for splinting towel/sterile gauze pads cell phone tools for sport to remove equipment
infield injury assessment will
provide direction in the decision making process concerning emergency care
5 life threatening things that you should call 911 right away
airway breathing circulation deadly bleeding shock CNS
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
Level of consciousness
AVPU alert verbal stim physical stim unconscious/unresponsive
some causes for unconsiousness
AEIOUTIPS allergies epilepsy insulin/diabetic overdose underdose trauma infections psychiatric stroke & heat
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
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
perral
equal pupils round and reactive and accomodating to light
arterial blood
spurting
pulsating flow
bright red
vein blood
steady, flow flow
dark red
capillaries blood
slow even flow
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
internal bleeding of head - 4
dizziness, ringing in ears, nausea, altered psychological functioning
internal bleeding
hard to determine byt altered functioning
hospitalization and further diagnostics
abdominal injuries internal bleeding
rigidity, pain in other area, rebound tenderness, bulging, tummyache
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
Battle field colors
black - no ABC
red - mins
yellow - hours
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
respiratory shock
lungs unable to supply o2 to blood baused by pneumothorax - air/gas in pleura or injury to lung
neurogenic shock
general dilation of blood vessels and blood cannot service CV and cant supply to body
psychogenic shock
fainting/synocope caused by temp dilation of vessles and reduce blood to brain - not enough to go around
cardiogenic shock
inability to pump enough blood to body
septic shock
severe bacterial infection which causes small vessels to dialte
anaphylactic shock
allergic reaction
metabolic shock
severe illness goes untreated or extreme loss of bodily fluids - urination, vomiting, diarrhea
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
shock management for shock - 3
911
keep them warm
elevate their legs 12 inches
no life threatening
secondary survey vital signs history SAMPLE and med bracelets symptoms allergies medications past medical history last meal events preceding accident
after the sample questions you look for 2
DCAPBLS deformities contusions abrasions penetrations burns lacerations swelling TIC tenderness instability crepitus
where do you perform DCAPBLS
head neck chest abdomen pelvis extremiteis - arms legs fingers toes
brief neurological exam
AVPU
motor/myos/movement
sensation / derm
pupils
focused secondary survey
finish bandaging and splinting
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
emerge splinting - 3
suspected fracture should be splinted before moving
use anything
splint above and below an din the position it was found
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
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
fitting of cane
greater trochanter to gloor
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
proper injury care can only be provided if
nature and severity were understood
goal of eval process
perfect diagnosis, recovery, rehab
eval process must be
systematic and orderly
consistent
standardized
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
observation
explain process dress and drape manner/fluidity of movement limping swelling discoloration deformity scars asymmetries bilateral pictures they tool
HORSPSS
in clinic assessment history observation ROM - a and p strength palpation special test summary
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
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
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
strong and pain free isometric
normal
strong and painful isometric
lesion in muscle or tendon
weak and painfree
nerve/musculotendinous rupture
weak and painful
serious - fracture to unstable jt
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
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
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
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?
summary - 4
proper treatment plan
what do i see what should i do
reassurance
follow up before participation
injured body
affects the mind
neg psychological response to injury
longer and more difficult rehab
sports med personel and psychology of injury
significant impact
goal with their minds
mind and body ready for competition
Response to injury
diff for every one
injury severity classification
severity - length of rehab short term <4wks long >4wks chronic - reoccurring terminating - career ending
reactive phases of injury process
reaction to injury
to rehab
to return to play or career terminating
influences on responses - 5
severity of injury coping skills past history social support personality
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
4 coping sources
goal setting
social support systems
stress management skills
mental skills - pos self talk, thought stoppage
poor coping resources
vulnerable to higher lvls of stress and more difficulty dealing with stress response - increasing risk for injury
strong support systems
recover quickly from setbacks than those with a weak support system -
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
mitigating factors to dealing with an injury
emotional distress injury site - reinjury amt of pain timing of injury severity
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
5 normal responses to an injury
anger/frustration some denial and min of injury concern about pain discouraged concern over losing conditions
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
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
