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SPSC 3276 Injuries > Final Cards > Flashcards

Final Cards Flashcards

1
Q

Wrapping definition

A
  • application of non-adhesive cloth wrap or tensor
  • tensors provide excellent compression, but not support
  • focus on reducing by-products of inflammation, initially
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2
Q

Taping definition

A
  • application of adhesive backed tape
  • provide support and compression
  • does not allow for underlying swelling
  • used in later stages of injury
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3
Q

KT tape

A
  • first developed in 1979
  • adopted by high performance athlete (athletes only represent about 15% of users)
  • requires training for application: costly
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4
Q

KT tape effects

A
  • lifts skin increasing space between epidermis and fascia - helps with lymph circulation and blood flow
  • relieves pain by releasing compression on nociceptors (sensory receptor for pain)
  • simulates neuroreceptors in skin and fascia stimulating proprioception
  • mechanical correction of underlying soft tissue (corrects positional errors)
  • increase ROM and improves muscle contraction
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5
Q

Tensor (compression) key ideas

A
  • don’t impair circulation distal to site of compression
  • never wear to bed
  • overlap layers by 1/2
  • keep roll firmly wound and roll off bottom of tensor
  • begin distally and progress proximally
  • do not use excessive tension
  • test for circulation, no tingling or numbness
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6
Q

Cloth wrap key ideas

A
  • economical and reusable protection for an ankle that has not recently been sprained
  • it will not prevent all ankle sprains but may reduce severity of a sprain
  • allows practice of the heel lock (designed to lock the ankle bones of the sub-talar joint)
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7
Q

Purpose of taping

A

1) support:
- supports ligaments and joint capsules of unstable joints
- limits excessive or abnormal movements
2) enhance:
- enhance proprioceptive feedback
3) support (injuries)
- support injuries to musculotendinous unit by compression and limiting movement

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8
Q

When to tape

A
  • injury prevention
  • acute injury management (only for support- when acute management do not use for return to play)
  • return to activity (after rehab)
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9
Q

When not to tape

A
  • when further assessment is required
  • after an acute injury has occurred
  • functional disability/limited ROM
  • swelling
  • after cold application
  • pre-puberty (10-14 years of age)
  • for certain sports
  • if you are unsure/unfamiliar with athlete’s condition
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10
Q

General considerations of taping

A
  • familiarity with athletes condition
  • familiarity with severity of injury
  • familiarity with the stage of healing of the injury
  • understanding of the physical requirements of the sport/activity
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11
Q

Skin preparation when taping

A
  • hair should be shaved
  • Skin: clean, dry, free from oil, etc. covered irritation with a bandage before taping
  • underwrap should be used if skin is irritated by the tape
  • tufskin for better adhesion (avoid fingers and toes)
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12
Q

Positioning of the athlete when taping

A
  • support structure to be tapes
  • should be comfortable
  • should pay attention and hold body part in an appropriate anatomical position
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13
Q

Positioning of taper during taping

A
  • should be comfortable
  • watch for excessive postural strain on back
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14
Q

Common taping mistakes

A

Shadows, windows, wrinkles

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15
Q

How to avoid common taping mistakes

A
  • constant tension
  • overlap by 1/2
  • reapply if you mess up
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16
Q

Tape removal

A
  • use sharks/tape cutters and take care of skin and other delicate structures
  • cut tape on the medial side of the leg, posterior medial malleolus
  • apply counter pressure to protect skin
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17
Q

Three different tape strips

A

Anchors, functional tape strips, close off strips

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18
Q

Types of functional tape strips

A
  • figure 8s
  • heel locks
  • spicas
  • spirals
  • stirrups
  • fans
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19
Q

Describe the evaluation of an athletic injury

A
  • begins when the injury occurs
  • continues through the healing process
  • goes until injured area has been rehabilitated and athlete returns to activity
  • ongoing process
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20
Q

KEAP

A

Requirements of athletic injury assessment/evaluation
Knowledge
Experience
Acquired skill
Practice

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21
Q

When should you assess the injury? Why?

A
  • ASAP after occurrence
  • not assessing quickly could lead to misjudgement in referral mode
  • ongoing process
  • constant assessment and reevaluation
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22
Q

Where should you assess the injury?

A
  • ideally the location at which the injury occurred
  • depends on severity of injury
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23
Q

What should not be done during an on-field assessment?

A

Recovering clothing or equipment - this can be done off field when necessary to assess

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24
Q

In what circumstances should you not move the athlete?

A

If you suspect:
- head or neck injury
- fractured spine or long bone
- major joint dislocation
- if athlete is unwilling to move

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25
Q

Assessment considerations (4 points with specifications)

A

Personal assessment skills:
- be alert during athletic activity
- observe all athletes
- remain calm and use good judgement
Know the sport:
- fundamentals/ injury patters
Know your athletes:
- medical history and personalities
Experience

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26
Q

Assessment procedures

A

Primary survey
Secondary survey
Documentation

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27
Q

What is included int he primary survey of an injury?

A

ABCs

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28
Q

What is included in a secondary survey?

A

HOPS

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29
Q

HOPS

A

History
Observation
Palpitation
Special tests

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30
Q

History on field vs off field

A

On field:
- mechanism of injury
- noises
- done this before?
- pain scale
Off field:
- detailed open ended questions
- listen to athlete explain the injury in exact detail
- good communication with the athlete is the key

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31
Q

Observations on vs off field

A

On field:
- quickly survey entire scene
- obvious fractures/dislocations
- swelling of exposed area
- bleeding
- deformity
- compare both sides
Off field:
- swelling
Redness
Discolouration
Look at athletes reactions to questions and palpitations

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32
Q

Palpitation on vs off field

A

On field:
- fracture/dislocation
- pain on palpitation, assist with localizing the injury
- feel swelling/temperature
Off field:
- fracture/hot spot
- Pain on palpitation
- crepitation: grating, grinding sensation

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33
Q

Special tests on vs off field

A

On field:
- active ROM
- weight bearing
Off field:
- functional tests: active/passive/resistive ROM
- specific stress tests evaluating joint stability
- bilateral comparison

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34
Q

Active ROM

A

Athlete initiates movement through as much range as possible

Tests: strength of surrounding
- contractile structures (muscle/tendon)
- inert structures (bone/ligament)

  • ROM of joint
  • athletes willingness to move
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35
Q

Passive ROM

A

Examiner moves the joint through entire ROM (athlete is relaxed)
- go until “end feel” is reached
- do not force the joint if athlete is unwilling to move due to pain or spasm

Tests:
- inert (bone/ligament)
- severity of structure injured

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36
Q

Resistive ROM

A

Examiner provides resistance
(Counter-pressure) against a joint and the athlete attempts to move

Tests:
- contractile structures: strength/weakness of joint contraction with or without pain

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37
Q

Testing sequence

A

1) always perform active testing first
2) if athlete is unwilling to move or feels pain on active movement then do not perform passive an resisted

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38
Q

Special testing: stress testing

A
  • stress testing is used to test joint integrity
  • examiner determines which tests will assess the condition most effectively
  • only those test that are deemed to be absolutely necessary should be performed
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39
Q

Referral

A
  • pain and muscle spasm can restrict motion and cause an inaccurate result
  • once HOPS is complete, make an assessment of injury severity and what you think the problem is (Not a diagnosis) and decide on your method of referral
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40
Q

Label the joints of the shoulder

A

A - acromioclavicular joint
B - sternoclavicular joint
C - gleno-humeral joint

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41
Q

Label the anatomy of the shoulder

A

A - humerus
B - tendon of biceps brachii
C - subacromial space
D - coracoacromial ligament
E - acromion process
F - superior acromioclavicular ligament
G - coracoclavicular ligament
H - clavicle
I - costoclavicular ligament
J - anterior sternoclavicular ligament
K - interclavicular ligament
L - articular disk
M - manubrium of sternum
N - Coracold process
O - scapula

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42
Q

Label the structures within the glenohumeral joint

A

A - acromion process
B - Coracoid process
C - articular capsul
D - glenohumeral ligaments
E - glenoid labrum
F - glenoid cavity
G - tendon of subscapularis
H - long head of biceps brachii

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43
Q

Label the structures of the glenohumeral joint

A

A - coracohumeral ligament
B - anatomical neck
C - greater tubercle
D - lesser tubercle
E - humerus
F - bicep brachii
G - scapula
H - glenohumeral ligaments
I - coracoid process
J - acromion process

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44
Q

Label the yellow nerve

A

Brachial plexus axillary nerve

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45
Q

Label the purple

A

Subdeltoid bursa

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46
Q

Label the muscles

A

A - subscapularis
B - teres major
C - latissimus dorsi

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47
Q

Label the muscles

A

A - subclavius
B - pectoralis minor
C - pectoralis major (cut)
D - abdominal fibres
E - costal section
F - sternal section
G - pectoralis major and clavicular section
H - anterior deltoid

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48
Q

Label the muscles

A

A - anterior deltoid
B - middle deltoid
C - posterior deltoid

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49
Q

Label the muscles

A

A - trapezius
B - serratus posterior inferior
C - latissimus dorsi
D - teres major
E - rhomboid major
F - deltoid
G - rhomboid minor
H - levator scapulae

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50
Q

Label the muscles

A

A - supraspinatus
B - infraspinatus
C - teres minor

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51
Q

Label the muscles

A

A - serratus posterior superior
B - teres minor
C - levator scapulae
D - supraspinatus
E - infraspinatus
F - teres minor
G - teres major

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52
Q

Label the muscles. What region of the body is this?

A

A - supraspinatus
B - teres minor
C - infraspinatus
D - subscapularis

Rotator cuff

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53
Q

SITS

A

Rotator cuff muscles:
Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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54
Q

What are the rotator cuff muscles responsible for?

A

Supraspinatus = abduction
Infraspinatus = external rotation
Teres minor = external rotation
Subscapularis = internal rotation

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55
Q

Movements of the shoulder

A

Flexion/extension
Abduction/adduction
Horizontal abduction/adduction
Internal/external rotation
Circumduction

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56
Q

Active ROM ranges (degrees) in shoulder

A

Flexion = 0 -180
Extension = 0 - 60
Abduction = 0 - 180
Adduction = 0 - 50 - 70
Horizontal abd/adduction = 0 - 130
Internal rotation = 0 - 60 - 100
External rotation = 0 - 90

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57
Q

Scapulohumeral movments explained

A

Scapulohumeral rhythm = once the arm gets above a certain degree of movement, the humerus and scapula move continuously and synchronously at a 2:1 ratio which allows increased range of motion at the glenohumeral joint (avoids impingement)

  • coordinated movement
  • 1 degree of scapular rotation for every 2 degrees of humeral movement is needed to facilitate full, normal shoulder motion
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58
Q

Degrees of scapulohumeral movement

A
  • initial 30 of glenohumeral abduction does not incorporate scapular motion(setting phase)
  • 30 - 90 the scapula abducts and upwardly rotates 1 for every 2of humeral elevation
  • above 90 the scapula and humerus move in 1:1 ratio
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59
Q

What range does scapulohumeral rhythm movement occur?

A

30-90 degrees

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60
Q

What movement does the yellow depict?

A

Scapulohumeral movement/ rhythm

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61
Q

Movements of the scapula

A

Abduction/adduction
Elevation/depression
Upward/downward rotation
Protraction/retraction

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62
Q

What point of reference is used for upwards/downward rotation of the scapular

A

Glenoid fossa

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63
Q

Movements that create protraction of the scapula

A

Downward rotation
Abduction
Anterior tilt

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64
Q

Moments that create retraction

A

Upward rotation
Adduction
Posterior tilt

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65
Q

Label the muscles

A

A - sternocleidomastoid
B - deltoid
C - pectoralis major
D - sternum
E - biceps brachii
F - subclavius
G - clavicle
H - subscapularis
I - pectoralis minor
J - coracobrachialis
K - serratus anterior
L - humerus

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66
Q

What movements is the deltoid responsible for?

A

Anterior deltoid = flexion
Middle deltoid = abduction

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67
Q

What movement is the pectoralis major responsible for?

A

Flexion

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68
Q

What are the major anterior chest muscles

A

Deltoid
Pectoralis major
Serratus anterior

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69
Q

What movement is the serratus anterior responsible for?

A

Scapula abduction

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70
Q

What is the coracoid process a critical anchor for?

A
  • pectoralis minor
  • coracobrachialis
  • short head of biceps brachii
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71
Q

Label the ligaments attached to the coracoid

A

A - transverse scapular ligament
B - coracoacromial ligament
C - trapezoid ligament
D - consider ligament
E - coracoclavicular ligaments
F - pectoralis minor
G - coracobrachialis
H - short head of biceps

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72
Q

What are the major muscles of the posterior neck/back?

A

Trapezius
Rhomboids
Latissimus dorsi
Posterior deltoid

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73
Q

Movements of the trapezius

A

Separated into 3 regions:
Upper fibres = extend neck, elevate scapula
Middle fibres = adduction scapula
Lower fibres = depress scapula

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74
Q

Rhomboids muscles description

A

Deep to trapezius muscle
Responsible for scapular retraction

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75
Q

Label the muscles of the rhomboids

A

A - acromion process of scapula
B - deltoid
C - trapezius
D - rhomboid major
E - rhomboid minor

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76
Q

Label the muscle and the movement its responsible for

A

Latissimus dorsi for adduction

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77
Q

Label the minuscule and the movement responsible

A

Posterior deltoid for extension

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78
Q

Anterior palpitations in the upper body

A
  • stern also notch
  • sternoclavicular joint (ligament)
  • clavicle
  • lesser tuberocity
  • bicipital grove
  • greater tuberocity
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79
Q

Posterior palpitations of the upper body

A
  • acromion process
  • acromioclavicular joint
  • scapular spine
  • medial border of scapula
  • inferior ankle of scapula
  • lateral border of the scapula
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80
Q

Clavicle fractures sign and management

A
  • tent deformity at fracture site
  • managed with figure 8 brace or some need surgery
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81
Q

Label the type of clavicular fractures and the chances of it occurring

A

Left to right:
Lateral: 15%
Middle: 80%
Medial: 5%

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82
Q

Sprain and separations of the AC joint mechanism, signs, and symptoms

A

Most common
- forced blow to tip of shoulder
- pain with forced motion
- swelling
- decreased ROM
- joint instability

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83
Q

What is occurring in the two photos

A

Direct vs indirect AC sprain

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84
Q

Classification of acromioclavicular joint sprains

A

Type I: first degree
- stretch or partial damage of AC ligament and capsule
Type II: second degree
- rupture of
Ac ligament and partial train of coracoclavicular ligament
Type III: second degree
- rupture of AC ligament and coracoclavicular ligament
TYPE IV-V: third degree
- rupture of AC ligament and coracoclavicular ligament and tearing of deltoid and trapezius fascia

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85
Q

Shoulder dislocations

A
  • glenohumeral most commonly dislocated joint
  • forced abduction and external rotation
  • humeral head is anterior to glenoid fossa (95%)
  • avulsion fracture common with first dislocation
  • always refer to physician for reduction and x-rays, never reduce yourself (don’t put it back yourself)
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86
Q

Label the different shoulder positions

A

Left to right:
Normal anatomy
Anterior dislocation
Posterior dislocation

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87
Q

Glenoid labrum

A

Fibrocartilage rim that lines the glenoid fossa

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88
Q

SLAP lesion

A

Superior Labrum Anterior to Posterior injury
- may include long head of biceps tendon

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89
Q

What injury is pictured?

A

SLAP lesion

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90
Q

What injury is pictured? What is the mechanism?

A

Bankart lesion:
- a bogey bankart occurs when the labrum is avulsed and the glenoid has been fractured
- associated with recurrent anterior shoulder instability
- tears may also come from degeneration or trauma

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91
Q

Label the anatomy

A

A - labrum
B - long head of the biceps muscle
C - glenoid cavity

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92
Q

What injury is this? Label the anatomy

A

Glenoid labrum tear
A - tear
B - glenoid cavity
C - glenoid labrum

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93
Q

Common chronic injuries in the shoulder

A

Strains and impingements:
- rotator cuff strain
- rotator cuff impingement

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94
Q

Impingement syndrome

A
  • tendons of the rotator cuff are pinched as they pass between the top of the humerus and the acromion
  • progressive degeneration changes to the supraspinatus, bicep tendon, and/or bursae
  • trauma causing swelling in increased friction in the area
  • deep pain around acromion
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95
Q

Biceps brachii rupture

A

Rupture can occur when an unexpected force applied to the bicep muscle
- attempting to catch morning, fall with elbow in flexed position

96
Q

Tendonitis in the shoulder aka throwers arm

A
  • overuse from throwing
  • rapids overhead move et involving excessive elbow flexion and supination
  • irritates rotator cuff tendon of biceps tendon (bicipital tendonitis)
97
Q

Thoracic outlet syndrome

A
  • thoracic outlet: anterolateral aspect of neck
  • compression of neuromuscular structures at the thoracic outlet (vein, artery m nerves)
  • compression at three locations:
    1) scalene triangle
    2) costoclavicular space
    3) sub coracoid space
98
Q

Label the locations of the thoracic outlet

A

A - scalene triangle
B - subcoracoid space
C - costoclavicular space

99
Q

TOS: mechanisms, signs, and symptoms

A

Overhead rotational stresses with muscle leads aggravate:
1) nerves compressed:
- aching pain
- pins and needles sensation
- numbness into arm (medial side into ulnar nerve aspect)
- weak grip strength and muscle atrophy
2) vein compressed:
- deems, stiffness into hand
- cyanosis in arm
3) rapid onset of coolness, numbness in entire arm, fatigue after overhead activity
4) seen in overhead athletes
- swimmers, weightlifting, volleyball

100
Q

Another name for effort thrombosis

A

Paget-Schroetter syndrome

101
Q

Treatment of acute injuries in the shoulder

A
  • signs for immediate referral
  • control inflammation (ice packs, spica)
  • immobilize and transport to hospital
  • vigorous rehab will be required to reduce chance of more dislocations
102
Q

What situations should immediate referral be conducted in the shoulder

A
  • obvious deformity suggesting fracture, separation, or dislocation
  • significant loss of motion or weakness in myotomes (group of muscles innervated by the motor fibres of a single nerve root - cervical region for shoulder)
  • joint instability
  • abnormal sensation in shoulder, arm, hand
  • absent or weak pulse distal to injury
  • any significant unexplained pain
103
Q

Painful arc sign

A
  • active abduction of shoulder through full range and pain between 60-120 degrees
  • positive for impingement
  • pain between 170-180 degrees is positive for AC joint injury
104
Q

What test is this? What does it assess?

A

Apley’s scratch test
A - medial rotation and adduction
B - medial rotation, extension, and adduction
C - abduction, flexion, and lateral rotation

105
Q

Special tests for acromioclavicular instability

A
  • piano key sign
  • AC distraction and compression
106
Q

Special test for glenohumeral instability

A
  • apprehension test (crank test) - shoulder subluxation
  • sulcus test - glenohumeral instability
107
Q

Rotator cuff special tests

A
  • drop arm/empty can test - supraspinatus
  • open door test/lateral rotation - teres minor, infraspinatus
  • lift off test/internal rotation - subscapularis
108
Q

Special tests for bicipital tendonitis

A

Speeds and yergasons

109
Q

Thoracic outlet syndrome special tests

A

Addison test

110
Q

Two aspects of rehab of shoulder complex

A

Immobilization and general body composition

111
Q

Immobilization during rehab of the shoulder complex

A
  • will vary depending on injury
  • isometrics can be performed during immobilization
  • time in brace or splint are injury specific
  • ROM and strengthening are dictated by healing
112
Q

General body conditioning for rehab of shoulder complex

A

Maintain cardiovascular endurance through sucking, running and walking

113
Q

Flexibility in shoulder rehabilitation

A
  • Codman’s pendulum exercises should begin early
  • progress to active assisted ROM in pain free range
  • should be performed in conjunction with rotator cuff and scapula strengthening exercises
114
Q

Strengthening for shoulder rehab

A
  • isometric exercises first
  • progress to more dynamic exercises
  • neuromuscular control (must regain appropriate firing sequence for specific mercies, proprioception, CKC and OKC are necessary in complete rehab plan)
115
Q

Functional progress of shoulder rehab

A
  • incorporation of sport specific skills
  • strengthening that involves PNF patters (resembles throwing)
  • gradual and progressive increase in angular velocities
116
Q

Return to activity for shoulder rehab

A
  • based on pre-established criteria
  • functional performance testing
  • object measures of strength and performance
117
Q

Movements of the elbow

A

Flexion/extension
Pronation/supination

118
Q

Label the bones of the elbow

A

A - humerus
B - radius
C - ulna

119
Q

Label the elbow

A

A - humerus
B - radius
C - ulna

120
Q

Label the elbow. Is this the anterior or posterior side?

A

A - humerus
B - lateral epiconcyle
C - capitulum
D - radial head
E - radial tuberosity
F - radius
G - ulna
H - coronoid process
I - trochlea
J - medial epicondyle
K - coronoid fossa
L - medial supracondylar crest

Anterior

121
Q

Label the elbow. Is this the anterior or posterior side?

A

A - humerus
B - olecranon
C - radial head
D - radius
E - ulna

122
Q

Carrying angle

A
  • formed by long axis of humerus and midline of forearm
  • larger angles are considered abnormal
  • disappears when the elbow is extended and the forearm is pronated
123
Q

Carrying angles in males vs females

A

Females > males
Male norms: 11-14 degrees
Female norms: 13–16 degrees

124
Q

Cubical valgus

A

Formed by long axis of humerus and midline of forearm

125
Q

Cubical varus

A

Usually develops secondary to condylar humerus fracture

126
Q

Two ligaments of the elbow

A

Ulnar (medial) collateral ligament:
- anterior part
- oblique part
- posterior part
Radial (lateral) collateral ligament

127
Q

Bursa in elbow

A

Olecranon bursa

128
Q

Origin, insertion, innervation, and action of biceps brachii

A

Origin:
- Long head - supraglenoid rim
- Short head - coracoid process
Insertion:
- Radial tuberosity
Innervation:
- Musculocutaneous nerve
Action:
- Elbow flexion, forearm supination, shoulder flexion

129
Q

Origin, insertion, innervation, and action of brachialis

A

Origin:
- distal anterior humerus
Insertion:
- ulnar tuberocity and coronoid process
Innervation:
- musculocutaneous nerve
Action:
- elbow flexion

130
Q

Origin, insertion, innervation, and action of coracobrachialis

A

Origin:
- coracoid process
Insertion:
- medial humerus opposite deltoid tuberosity
Innervation:
- musculocutaneous nerve
Action:
- shoulder flexion

131
Q

Origin, insertion, innervation and action of brachioradialis

A

Origin:
- lateral supercondylar ridge of humerus
Insertion:
- lateral aspect of radial style I’d process
Innervation:
- radial nerve
Action:
- elbow flexion, especially with forearm in neutral position

132
Q

Label the muscle

A

Triceps brachii

133
Q

Label the muscle

A

Anconeus

134
Q

Label the anatomy

A

A - wrist extensors
B - lateral epicondyle
C - common extensor tendon

135
Q

Label the anatomy

A

A - wrist flexors
B - common flexor tendon
C - medial epicondyle

136
Q

Arm arteries from top to bottom

A

Subclavian
Axillary
Brachial
Radial
Ulnar
Palmar arches

137
Q

Palpitations of the elbow

A

Olecronan process
Olecronan fossa
Lateral epicondyle
- common extensor tendon
Wrist extensor
Medial epicondyle
- common flexor tendon
Wrist flexors
Pulse

138
Q

Common acute injuries in the elbow

A

Fractures:
- humerus
- radius: radial head
- ulna: Olecronan process
- medial epiphyseal plate

139
Q

Supracondylar fractures

A

Humerus fractures:
- most common in children/adolescents
- fall on flexed elbow or hyper extension mechanism
Deformity present if displaced, often missed on initial evaluation if non-displaced

140
Q

Ulnar fracture

A
  • coronoid process fracture
  • may be associated with posterior elbow dislocation
141
Q

Radial fractures classifications

A
  • radial head fracture
    Type I: nondisplaced
    Type II: fracture with displacement, depression or angulation
    Type III: comminuted fracture of head (3 or more pieces)
    Type IV: comminuted fracture associated with elbow dislocation
142
Q

Elbow sprain

A
  • ligament injury
  • usually from forced hyperextension or varus/valgus force
  • athlete may hear “click” or “ pop” along with sharp pain at time of injury
  • pain relieved by flexing elbow
  • may also involve avulsion fracture
143
Q

Elbow dislocation

A
  • uncommon, but serious
  • ulna/radius displaced
  • always accompanied by MCL sprain
  • immobilize and refer to a physician
144
Q

Directions of elbow dislocation

A

Posterior
Posterolateral
Posteromedial
Lateral
Medial or divergent

145
Q

Posterior elbow dislocation

A
  • typically results from hyperextension, trochlea levered over coronoid process
  • most common direction is posterolateral
  • involved injustice or most ligament structures
  • may present with subsequent myositis ossifications
146
Q

Elbow dislocation and nerves

A

Potential for injury to brachial artery and medial/ulnar nerve

147
Q

Olecranon bursitis

A
  • typically due to direct trauma
  • immediate swelling, pain, reduced ROM
  • usually easily treated with rest and compression
  • if persists, may be aspirated - risk of infection
148
Q

Common chronic injuries of elbow

A

Tendinopathy, epicondylitis

149
Q

Tendinopathy

A
  • triceps Tendinopathy
  • lateral epicondylitis = tennis elbow
  • medial epicondylitis = golfers elbow
150
Q

Epicondylitis

A
  • local tenderness over epicondyle
  • pain when using involved muscle and in resistive exercises
  • swelling, pan, redness
151
Q

Little league elbow

A
  • lesions resulting from excessive throwing in young athletes (valgus stress)
  • tendonitis/tendinosis
  • medial humeral growth plate
  • avulsion fracture
152
Q

Tommy john surgery

A
  • ulnar collateral ligament reconstruction
153
Q

Issues to consider with tommy john surgery

A
  • conservative treatment plan
  • fail that, then do surgery
  • only if they want to continue baseball then do surgery
  • 9 month - a year for recovery
  • factors that lead up to surgery aren’t addressed
  • likelihood of it breaking down again
154
Q

Movements of wrist

A

Flexion/ extension
Radial/ulnar deviation

155
Q

Movements of fingers

A

Metacarpals:
Flexion/ extension
Abduction/adduction
Proximal/distal phalanges:
Flexion/extension
Thumb:
Opposition/reposition

156
Q

Label the bones

A

A - 4 proximal carpals (scaphoid)
B - radius
C - ulna
D - 4 distal carpals
E - 5 metacarpals
F - 14 phalanges

157
Q

Label the dorsal ligaments of the wrist

A

A - dorsal inter carpal ligament
B - dorsal radiocarpal ligament

158
Q

Label the palmar ligaments of the wrist

A

A - v-deltoid ligaments
B - lunotriquentral ligament
C - UCL and ulnocarpal meniscus homologue
D - ulnolunate ligament
E - radioscapholunate ligament
F - radiolunate ligament
G - scapholuntate ligament
H - radial collateral ligament
I - radioscaphocapitate ligament

159
Q

Carpal tunnel

A

Created by arched carpal bones and carpal ligament

All wrist flexor tendon run through the tunnel

160
Q

Label the carpal tunnel

A

A - ulnar artery
B - median nerve
C - transverse carpal ligament

161
Q

Ligaments in the finger

A

Collateral ligaments

162
Q

Palpitations of hand

A

Approach as if a fracture
- radial style I’d process
- ulnar style I’d process
- scaphoid: anatomic snuffbox
- metacarpals
- phalanges

163
Q

Common acute injuries in hand

A

Fractures:
- colles fracture
- scaphoid fracture
- metacarpals bones
- phalanges
Subungual hematoma
- from crush injury
Sprains and dislocations:
- skiers thumb
- mallet finger
- boutonnière deformity
- jersey finger

164
Q

Management of subungual hematoma

A
  • sterilize
  • use heated paper clip
  • drain blood to relieve pressure
  • pad and protect
165
Q

Management of finger dislocations

A
  • hyperextension or shearing mechanism
  • PIP most common
  • in DIP or MCP dont let athletes reduce - watch digital nerve and vessels
  • MD reduces with nerve block and may require surgery if instability persists
166
Q

Common chronic injuries

A
  • carpal tunnel syndrome
  • de quervains disease
  • ulnar neuropathy
167
Q

Ulnar neuropathy symptoms

A
  • numbness and tingling
  • pain on the outside or middle of the forearm
    Ulnar nerve:
  • may become compressed due to swelling of surrounding muscles and connective tissues
  • its ability to transmit messages to the muscles of the forearm may be significantly reduced
168
Q

Special tests for wrist, hand, and fingers

A
  • active/passive/ resistive ROM
  • valgus stress
  • varus stress
  • finklestein test
  • phalen’s test
  • tinel’s test
169
Q

Finkelstein’s test

A
  • tuck thumb under fingers by making a fist
  • ulnar deviate wrist
  • positive test increased pain all over radial styloid process and length of extensor pollicis breves and abductor pollicis longus
  • implication of dequervians syndrome
170
Q

Phalen’s test

A
  • examiner applies overpressure during passive wrist flexion and holds for 1 min
  • positive test tingling in distribution of median nerve
  • implications median nerve compression
171
Q

Tinels test

A
  • examiner taps nerve over wrist
  • positive test tingling distribution of median nerve
  • implications median nerve compression
172
Q

Functional anatomy of ankle: bone stability

A
  • tibia (medial malleolus)
  • fibula (lateral malleolus)
  • talus - main weight bearing bone
173
Q

Label the ankle

A

A - subtalar joint
B - calcaneus

174
Q

Label the ankle

A

A - tibia
B - fibula
C - talus
D - talocrural joint

175
Q

Functional anatomy of ankle: articulations

A
  • talocrural joint (hinge - plantar/dorsi)
  • subtalar joint (gliding - inversion/eversion)
176
Q

Movements of ankle

A

Dorsi flexion 20 degrees
Plantar flexion 30-50
Eversion 0-35
Inversion 0-35
Pronation 15-30
Supination 45-60

177
Q

Label the ligaments and name their function

A

A - posterior talofibular
B - calcaneofibular
C - anterior talofibular

Resist inversion

178
Q

Label the ligaments and name their function

A

Deltoid, resist eversion

179
Q

Functional anatomy of the ankle: muscles

A
  • weakest aspect of ankle stability
  • 3 peroneal muscles: longus, breves, tertius
  • these resist inversion
180
Q

Inversion ankle sprain mechanism

A
  • most common
  • sports with running, jumping, landing
  • fibula causes a longer lever arm on lateral side of ankle
  • vertical load on uneven surfaces
  • tight Achilles’ tendon
  • weak peroneal muscles
181
Q

Ethology of inversion ankle sprain

A
  • combo of plantar and excessive supination when foot contacts the ground
  • common changing directions quickly
  • fast injury mechanism— muscles cannot contract to control the excessive supination
  • ligaments become the only absorbers
  • ATFL is primary lateral stabilizer and is most commonly damaged
  • CFL can be damages
  • PTFL injured in severe injuries
182
Q

Label the ligaments

A

A - deltoid
B - calcaneofibular ligament
C - posterior talofibular ligament
- sitar posterior tibiofibular ligament

183
Q

Signs and symptoms of inversion ankle sprain

A

First:
- pain and swelling anterolateral aspect of lateral malleolus
- point tenderness over ATFL, no laxity with stress test
Second:
- tearing or popping felt on lateral side
- pain and swelling on anterolateral and inferior aspects of lateral malleolus
- painful palpitation over ATFL and CFL: may be tender over PTFL and deltoid ligament
- positive anterior drawers and Tamar tilt
Third:
- tearing and popping sensation felt on lateral aspect
- diffuse swelling
- painful or no pain
- positive drawer and tilt

184
Q

Eversion/medial ankle sprain mechanism

A
  • rare
  • strong deltoid ligament
  • may be associated with avulsion fracture
  • lateral malleolus can fracture
  • deltoid ligament can avulsion the medial malleolus
  • distal tibiofibular joint can be disrupted
185
Q

Grades of ankle sprains

A

Grade I - mild
- a stretch of the involved ligament
GRade II - moderate
- a partial tear of the ligament with part of the ligament remaining intact
- joint suffers minimal instability
Grade II - severe
- a complete tear of the involved ligament
- ligament may separate completely from the bone and the joint will lose stability

186
Q

High ankle sprain (syndesmotic)

A
  • damage to ligaments holding tibia and fibula together
  • more common than eversion ankle sprains
  • most debilitation of any sprains in the foot and ankle
187
Q

High ankle sprain mechanism

A
  • dorsifelxion and pronation most common
  • foot is planted fixed on the ground with internal rotation of the tibia
  • fibula separated from the tibia disrupting the distal tibiofibular ligament
  • cutting and pivoting sports
  • longer to heal than lower ankle sprain — 6-8 weeks
188
Q

Observation of ankle

A
  • postural deviations
  • valgum or varum
  • difficulty walking
  • deformities, asymmetries, or swelling
  • skin condition
  • pain
  • ROM
189
Q

Palpitation of bony anatomy in ankle

A
  • fibular head and shaft
  • lateral malleolus
  • tibial plateau
  • tibial shaft
  • medial malleolus
  • Tamar dome
  • calcaneus
190
Q

Palpitation of soft tissue anatomy in ankle

A
  • peroneus longus, brevis, tertius
  • flexor digitorum longus
  • flexor hallucis
  • tibialis posterior
  • tibialis anterior
  • extensor hallucis longus
  • extensor digitorum longus
  • gastrocnemius
  • soleus
  • Achilles’ tendon
191
Q

Fracture test of ankle

A

Potts compression (squeeze test)
Percussion or bump test (malleolus fracture)

192
Q

Joint stability test of ankle

A

Anterior drawer test
- determine damage to anterior talofibular ligament primarily
Tamar tilt test
- ATFL, CFL, PTFL
- determine extent of inversion or eversion injury
Kleiger’s test (external rotation)
- to determine the extent of damage to the deltoid ligament
- syndesmosis

193
Q

Other special tests for the ankle

A

Thompson’s test:
- detects Achilles’ tendon rupture
- positive is no movement in the foot
Syndesmotic sprain
- squeeze tibia and fibula together
- positive if pain
Tap test (tinels test)
- possible tarsal tunnel syndrome
Mortons test
- Morton’s neuroma
- squeeze metatarsals together
- positive if pain

194
Q

Movements of the hip

A

Flexion/extension
Abduction/adduction
Internal/external rotation

195
Q

Joints of the hip

A

A - sacroiliac joint
B - iliofemoral joint
C - L5/S1 joint

196
Q

Muscles of the hip flexors

A

A - psoas minor
B - illiacus
C - psoas major

197
Q

Label the muscles and what movement they produce

A

A - pectineus
B - adductor longus
C - gracilis
D - adductor brevis
E - adductor magnus

198
Q

Label the muscles

A

A - gluteus Maximus
B - illiotibial tract
C - gluteus medius

199
Q

Label the muscles of the posterior thigh

A

Left to right:
Bicep femoral
Semitendinosus
Semimembranosus

200
Q

Label the ligaments

A

A - pubofemoral ligament
B - iliofemoral ligament (superior and inferior bands)
C - iliofemoral ligament
D - ischiofemoral ligament

201
Q

Palpitation of the hip

A

Supine:
- anterior superior iliac spine
- iliac crest
- quads
- groin (muscles, lymph swelling, femoral pulse)
Prone:
- hamstrings
- ischial tuberosity
- posterior superior iliac spine
Side:
- gluteus Maximus
- greater trocanter

202
Q

Acute injuries of hip

A

Fractures:
- femur, pelvis
Immature hip:
- epiphyseal plate fractures
- slipped femoral head
Dislocation
Strained
Contusions

203
Q

Hip larval tear

A
  • hip labrum — fibrous ring of cartilage around hip socket
  • deep groin pain
204
Q

Stress fracture of hip

A
  • neck of femur
  • deep tenderness of anterior hip
205
Q

Osteitis pubis

A
  • repetitive running/jumping, shearing movements
  • inflammation and gradual onset of localized pain around pubis symphysis
206
Q

Sport hernia

A
  • strain or tear of any soft tissue in lower abdomen or groin area
  • severe pain in groin
207
Q

Piriformis syndrome

A
  • tight piriformis irritates sciatic nerve
  • overactive hip flexors and weak gluteals
  • may include gluteal and radiating pain from sciatic compression
208
Q

Illiotibial band syndrome

A
  • repetitive running
  • tenderness on lateral knee; weak hip adductors
  • treatment — rices, assessment, gradual RTA
209
Q

Label the anterior compartment muscles

A

A - extensor digitorum longus
B - tibialis anterior
C - extensor hallucis longus

210
Q

Deep posterior compartment artery and nerve

A

Posterior tibial artery
Tibial nerve

211
Q

Lateral compartment artery and nerve

A

Peroneal artery
Superficial peroneal nerve

212
Q

Tendond of the lower limb

A

Posterior tibial tendon
Quadriceps tendon
Achilles’ tendon

213
Q

Common injuries of lower leg

A

Stress fractures
Strains
Sprains
Tendinopathy

214
Q

Strain and sprains of leg

A

Muscle spasm:
- check fluid and electrolyte intake
- Achilles’ tendon strain: forceful contractions
- rupture tear of muscle resulting in palpable mass
- sprained ankle

215
Q

Achilles tendinopathy

A
  • common in distance runners
  • thickening surrounding tissue
  • tenderness with palpitation, pain with activity, swelling, creputation, stiffness especially with dorsiflexion
216
Q

Exertional compartment syndrome

A
  • exercised induced pain and swelling that is relieved by rest
  • increased tissue pressure
  • compromised muscles, nerves, blood vessels within the space and signal to compartment
  • anterior and deep posterior most common
  • can result in neurological disability
217
Q

Shin splints

A

S/S:
- pain on border of tibia
- increases with weight bearing or pressure
Leading to:
- periostitis
- stress fracture
- anterior compartment syndrome
- stress fracture
Prevention:
- check shoes and arches
- check training load and playing surfaces
- chec flexibility/strength or lower leg muscles

218
Q

Bone stress injury

A

Load applied to the bone exceeds bone’s ability to manage this load
- bone is unable to remodel to remodel sufficiently and a stress reaction develops
- often Rene in running and jumping activities

219
Q

5th metatarsal fracture

A
  • styloid process
  • common area for injury
220
Q

Sand toe

A

Hyper planter flexion of big toe
Commonly seen in beach volleyball

221
Q

Turf toe

A

Excessive upward bending of MTP joint
Repeated motions of running or jumping

222
Q

Plantar fasciitis

A
  • chronic inflammation of plantar fascia
  • pain with initial weight bearing
  • point tenderness at clacaneal portion
223
Q

Mortons neuroma

A
  • pinched/squeezed nerve that passes between metatarsals
  • affect the ball of foot
  • feels like standing on a pebble in your shoe
224
Q

Foot conditions

A
  • bunion (hallux valgus)
  • corn
  • ingrown toenail
  • hammer toe
225
Q

Label the toe deformities

A

A - hammer toe
B - claw toe
C - mallet toe

226
Q

Typical tissue healing time frames

A
227
Q

Movements at the knee

A

Flexion/extension
Internal/external rotation when knee is flexed

228
Q

Joints of the knee

A

Patellofemoral
Tibiofibular
Tibiofemoral

229
Q

Name a test that can be used to detect a bicep rupture

A

Ludington test

230
Q

Avascular necrosis

A

Death of a bone tissue due to lack of blood supply

231
Q

What is the main structural cause of medial epicondylitis

A

Damage to tendons that bend the wrist toward the palm

232
Q

What anatomical structures and hormonal differences of female athletes put them more at risk of ACL injuries than male athletes?

A

-ligament laxity from hormonal fluctuations in the menstral cycle

233
Q

Which group of athletes are most prone to athletic pubalgia?

A

Men under the age of 40

234
Q

What population is more at risk for suffering heat stroke?

A
  • people 65 years of age or older
  • infant and children up to 4 years of age

-people who are overweight

  • people who are on medications
  • people who are working in hot environments
235
Q

What is a test you can use to diagnose patellofemoral pain syndrome?

A

Patellar grind test

236
Q

What is the main muscle where shin splints occur?

A

Tibialis anterior

SPSC 3276 Injuries (2 decks)

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