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year 2 > HSS final > Flashcards

HSS final Flashcards

1
Q

muscle strain mechanism of injury

A

most common in two joint muscles when they are max elongated during quick powerful contractions and quick eccentric contractions (eg hamstrings decelerating leg)

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2
Q

grades of muscle strain: severity, presentation and common length of recovery
I
II
III

A

grade I- minimal damage to single muscle (>5%), generally 2-3 weeks recovery
minimal loss of strength and motion

grade II- more extensive but not completely ruptured
generally 2-3 months before a complete return to athletics
significant loss of strength and motion. These injuries may require

Grade III: Complete rupture of a muscle or tendon
These can present with a palpable defect in the muscle or tendon
generally need surgery

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3
Q

what is most important in R.I.C.E.?

A

ice most important to slow cell metabolism and stop 2 edema

2 edema => losing proteins

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4
Q

general rehab principles

A
  1. rice
  2. protection
  3. AROM
  4. flexibility => lengthen motion
  5. strengthening
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5
Q

myositis ossificans

A

heterotropic ossification (bone growth) in muscle after injury to muscle, usually from direct blow in contact sports

most common in thigh and quads

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6
Q

4 common overuse injuries

A
  1. patella tendinitis
  2. PFPS
  3. ITB syndrome
  4. plantar fascitis
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7
Q

7 treatment progressions for overuse injuries

A
  1. determine cause during eval
  2. activity modification
  3. NSAIDs
  4. therapeutic modalities
  5. flexibility
  6. strength
  7. return to sport
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8
Q

ACL injury- who is it most common in? why?

A

most common in women > men because wider pelvis => increased flexion and tibial torsion

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9
Q

ACL anatomy

2 bands and when they are taut

A
  1. anteromedial - taut in flexion

2. posterolateral- taut in extension

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10
Q

ACL function (4)

A
  1. mechanoreceptors for proprioception
  2. prevents forward translation of tib on femur
  3. checks IR
  4. checks hyperextension
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11
Q

ACL biomechanics during…
active knee ext (OKC)
tibial rotation

A

active knee extension (60-0): increased anterior translation

tibial rotation: ACL stress increases as tibal rotation increases

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12
Q

ACL mechanism of injury (3)

A
  1. hyperextension
  2. varus/ valgus force
  3. rotation
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13
Q

unhappy triad of knee injury**

A

ACL
MCL
medial meniscus

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14
Q

laxity vs. instability

A

instability is pts subjective complaint

laxity- measurable

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15
Q

functional progression (of all knees) (6)

A
  1. quad control
  2. ROM
  3. normalize gait
  4. ascend stairs
  5. descend stairs
  6. running => return to sport
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16
Q

when are muscles the strongest?

how does this affect our stair rehab?

A
  1. muscles are strongest when slightly stretched
  2. going up stairs everything is slightly stretched (hips, knees gluts all bent/ stretched) so easier than going down stairs which is all quads
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17
Q

PCL anatomy

2 bands and when they are taut

A
  1. anterolateral band (bulk) - taut in flexion

2. posteromedial band - taut in extension

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18
Q

PCL function (3)

A
  1. prevents posterior tib displacement on femur
  2. resists ER
  3. resists valgus/varus
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19
Q

PCL biomechanics
strength vs. ACL
what puts force on PCL

A
  1. 2x strength of ACL

2. loading the hamstring at 12-100 degrees (walking)

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20
Q

PCL mechanism of injury (3)

A
  1. A/P force on flexed knee (w/ or w/o rotation)
  2. rotatry force with valgu/ varus
  3. hyperextension
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21
Q

ACL rehab OKC vs. CKC

A

no stress on ACL during CKC squat

**no OKC resisted for 3m p/o

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22
Q

PCL rehab
most important to work on
what to absolutely not ever work on***

A
  1. focus on QUAD strengthening

2. no strengthening at deep flexion angles and NO OKC hamstrings

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23
Q

early WB status p/o
ACL repair
PCL repair

A

ACL: >50% PWBAT => no crutches

PCL: TTWB/PWB up to 6 weeks

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24
Q

MCL anatomy

3 bands

A
  1. superficial
  2. deep
  3. posterior oblique
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25
Q

MCL function (2)

A
  1. primary restrain to valgus force (lat -> medial)

2. restraint to ER

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26
Q

MCL mechanism of injury (2)

A
  1. valgus or varus force

2. rotation force with fixed leg

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27
Q

MCL biomechanics

when is it taut

A
  1. taut throughout ROM but increases as knee approached full extension
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28
Q

meniscus anatomy
medial
lateral
vascularity

A

medial- oval or C shape, larger than lateral
lateral- circular or O shape, greater mobility

vascularity- outer 1/3 from capsule and synovial attachements

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29
Q

meniscus function (4)

A
  1. to distribute weight bearing loads
  2. increase joint congruency (increase stability)
  3. limit abnormal motions
  4. improve articular nourishment
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30
Q

meniscus biomechanics
moves with ….
in extension
in flexion

A
  1. moves with tibia, pushed by femur
  2. extension => ant and medial
  3. flexion => post and lateral
31
Q

meniscus mechanism of injury (2)

A
  1. rotation with foot planted in ground

2. degenerative lesion

32
Q

rehab following meniscal repair (surgery)
protective phase
RTS

A
  1. 4-6 weeks = protection phase:
    limit ROM < 90
    WBAT w/ brace locked in extension
  2. RTP - 4 months
33
Q

Patellofemoral
purposes of patella (2)
articular surfaces
contact area

A
  1. patella protects and increases movement arm for quad tendon
  2. posterior fact divided into 7 articular surfaces
  3. contact area- starts at 15deg flexion and moves proximally w/ increased flexion
34
Q

factors affecting patella alignment (7)

A
  1. increased Q angle
  2. patella alta
  3. excessive pronation
  4. tight lateral structures
  5. decreased flexibility
  6. VMO insufficiency
  7. proximal weakness/ imbalance
35
Q

PFPS (dx/ presentation/ causes) 4

A
  1. excessive lateral tracking
  2. excessive compressive forces “chondromalacia” = everything is tight
  3. patella tendinitis
  4. fat pad irritation (dances with lots of hyper extension)
36
Q

compartment syndrome
def
where we usually see it

A

def: increased pressue w/i fixed osseofascial compartment causing compression of muscular and neurovascular structures

can occur in any compartment but most often seen in lower leg

37
Q

acute compartment syndrome
common cause
how do it present?
does anything increase pain?

how is it confirmed
treatment

A
  • *considered a medical emergency
    1. from direct trauma/ fracture
    2. presents with pain, tightness and swelling
    3. decreased pedal pulses/ sensory changes
    4. pain with passive stretch

confirm dx by intercompartmental pressure measurements

relieved by emergency fasciotomy

38
Q

chronic compartment syndrome
symptoms
most common compartments (2)
treatment

A

activity related symptoms

most common compartments:
anterior
deep posterior

low success with conservative treatment => surgery

39
Q

acute exertional compartment syndrome
when does it occur
etiology

A

occurs during intense, repetitive exercise, most frequently long distance runners… repetitive muscle contraction or acute trauma causes muscles to swell

etiology: tissues can’t expand to alleviate pressure, nerves and BV compressed => ischemia (pain) and sensory disturbances

increase P => decrease venous flow => increased capillary leakage => decreased arterial flow

40
Q

poor biomechanics that can lead to compartment syndrome (4)

A
  1. overstriding
  2. increased heel strike
  3. increased pronation
  4. weak hip or core muscles causing increased ground reaction forces
41
Q

clinical presentation of compartment syndrome (5)

A
  1. aching, burning or cramping in affected compartment
  2. tightness
  3. numbness or tingling
  4. weakness
  5. foot drop in severe cases
42
Q

pain pattern of compartment syndrome (3)

dx - how and normal and abnormal #s

A
  1. several minutes to come on
  2. progressively worsens
  3. stops 15-30 minutes after cessation of exercise

dx:
use needle catheter to measure pressure in compartment immediately after intense exercise

normal 0-10mm Hg
dx: > 35mm Hg post exercise

43
Q

conservative management of compartment syndrome (5)

A
  1. activity modification => cross training
  2. deep soft tissue massage
  3. myofascial release
  4. new shoes/ orthodics
  5. work on gait deficiencies
44
Q

achilles tendon rupture
who is affected most? age/ gender
cause

A
  1. males > females
  2. age > 35

from sudden acceleration or deceleration

45
Q 
achilles tendon rupture
 conservative treatment (3) vs. surgical options (3)
A

conservative treatment:
long immobilization- case 4-6 weeks
higher re-injury rate
100% strength return unlikely

surgical options:
primary repair
percutaneous repair
reconstruction

46
Q 
achilles tendon rupture rehab
 overview (3)
 what don't we do?
 main focus (2)
A
  1. protect repair
  2. active ROM
  3. gradual strengthening/ avoid high loads

** don’t stretch** focus on gait and strength*

47
Q

ankle sprains

most common ligament sprains and how we do it

A

anterior talo-fibular ligament

sprained by PF then inversion

48
Q

ankle sprains mechanism of injury
lateral sprain
medial sprain
synedsmosis

A

lateral: PF/ inversion/ ER
medial: PF/ eversion/ valgus stress
syndesmosis: fixed foot with tib IR/ high valgus force

49
Q

how much DF do we need for normal gait?

A

10 degrees

50
Q

plantar fascitis
common pt population
pain presentation (2)
what increases pain?

some causes (5)

A

common in middle aged women and young male runners- very common w/ obesity

presents with pain in proximal arch and heel
pain with toe/ forefoot DF

WB increases tension
running increases WB 2x

some causes:
leg length discrepancy
pes cavas 
excessive pronation of subtalar joint
increased flexibility of longitudinal arch
gastroc/ soleus tightness
51
Q

turf toe- what is it?

treatment (3)

A
  1. hyperextension of MTP of great toe

treatment:
activity modification
flat insoles - to help with push off
taping

52
Q

general RTP guidelines

A
  1. full ROM
  2. flexibility meets demands of sport
  3. lack of apprehension w/ sport specific movements
  4. quality of movements
  5. muscle strength >85-90% unaffected limb
53
Q

SAID principle

A

Specific
Adaptation to
Imposed
Demands

that which is used developes, that which is not used wastes away

54
Q 
what do i need to walk?
  muscle control
  mobility
     hip
     knee
     ankle
A

neuromuscular quad control to do straight leg raise w/o quad lag**

mobility:
hip
flex 20 deg
ext 20 deg

knee
0-60

ankle
DF -10 deg
PF - 20-30 deg

55
Q

arthrogenic muscle inhibition
when it happens/ why
describe 5 steps of cycle

A

happens after injury, as a protective mechanism quad shuts down

  1. knee injury => (2) effusion => (3) quad inhibition => (4) loss of knee extension => (5) antalgic gait => knee effusion etc
56
Q

3 basic quad re-training modalities/ exercise

A

e-stim (NMES and russian)

quad sets
SLR
terminal knee ext

57
Q

knee ROM needed to ride a stationary bike
short-crank
full crank

A

short crank: 85-90

full crank: 110-115

58
Q 
when can i walk up steps
  muscle control (2)
  mobility
     hip
     knee
     ankle
A

need concentric quad strength (double leg squat) and ability to stand on one leg

mobility
hip
flex 30-40
ext 5

knee
0-100

ankle
DF -20

59
Q

common compensations for not using quads on stairs (2)

A

use railing

lean back/ trunk tilt

60
Q 
when can i walk down steps
  muscle strength needed (2)
  ROM
    hip
    knee
    ankle
A

eccentric quad control (on knee press) and ability to stand on one leg

ROM
hip
flex 60-65
ext 5

knee
0-100

ankle
DF- 25 deg

61
Q

when can i do leg press?
ROM
progression from 2 legs -> 1 leg (weight guidelines)

A

need full ext -> 100 deg flex

“rule of 60” progress from 2 legs -> 1 leg use 60% of wt

62
Q

Open chain vs. closed chain exercises

closed chain kinetics have… (4)

A
  1. decreased posterior shear forces
  2. decreased tibiofemoral shear
  3. decreased patellofemoral stress
  4. decreased patellofemoral contact stress per unit at 0-53 degree of flexion
    (increased patellofemoral contact stress 53-90 degrees)
63
Q

OKC safe zone post op
ACL
PCL

A

ACL: 90-30 deg knee flexion

PCL: 0-60 deg knee flexion
same as both ACL/PCL CKC

64
Q

CKC safe zone post op
ACL
PCL

A

ACL safe zone: 0-60 deg knee flexion

PCL safe zone: 0-60 deg knee flexion

(same as OKC PCL p/o)

65
Q

when can i use an elliptical?

A

6 inch step-up with controlled alignment (starting on 8 inch step up)

66
Q

the 4 local core stabilizing muscles

A
  1. transverse abdominals
  2. pelvic floor muscles
  3. diaphragm
  4. multifids
67
Q 
function of core
 interesting notes from a study
A

provide stable base in preparation or anticipation of trunk and extremity movements => feed forward

studies show people with low back pain activate core after movement

68
Q

6 global movers of the spine

A
  1. rectus abdominus
  2. external obliques
  3. psoas muscls
  4. latissimus
  5. spinal extensors
  6. QL
69
Q

pelvic neutral (whats aligned)

A

both ASIS with pubic symphysis (while lying supine)

70
Q

how to cue pt to get into neutral spine

4 steps/ things to activate (do)

A
  1. pelvic floor activation (“muscles to stop peeing”)
  2. transverse abdominus (tighten to put on tight pants)
  3. diaphragmatic breathing w/ emphasis on expanding rib cage and back
  4. activate multifids (bulge lateral to spinous processes)
71
Q

correct activation of core muscles for hip extension (4)

A
  1. transverse abs (and pelvic floor)
  2. multifids
  3. glutes
  4. hamstrings
    in there is an injury in glutes u will see hamstrings bulge then move
72
Q

postural progression of exercises (6)

A
  1. lying down
  2. quadruped
  3. seated
  4. half kneel
  5. kneel
  6. standing
73
Q

stages of motor control (4)

A
  1. mobility
  2. stability
  3. controlled mobility
  4. skill
74
Q 
aquatic therapy - what % of bdy wt is eliminated when water is up to...
 pubic symphysis
 umbilicus
 xyphoid
 C7
A

pubic symphysis - 40% bdy wt is supported
umbilicus - 50% bdy wt
xyphoid - 60% bdy wt
C7 - 90% bdy wt

year 2 (24 decks)

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