injury scenario Flashcards
valgus
decreased lateral joint angle (knock-kneed)
varus
increased lateral joint angle (bow-legged)
strain
stretching or tearing of a tendon or muscle
acute 1st degree treatment
POLICE
2-3 days decreased activity
sprain
stretching or tearing of a ligament
acute 2nd degree treatment
POLICE
2-3 weeks decreased activity
3rd degree
POLICE
2-3 months decreased activity
surgery often required
Ankle- observation
swelling
position of ankle
ankle fracture test- fibular fractures
squeeze test
tap test
ankle ligament stress tests
-anterior posterior drawer test
-posterior drawer test
-anterior talofibular ligament (ATFL) slight plantar flexion
-calncaneofubular ligament (CFL) neutral
- deltoid ligament (anterior fibres slight PF and Ev. Middle fibres neutral and Ev.)
-AITFL: WB dorsiflexion
ext rot test
squeeze test
Ankle palpation
-ATFL
-CFL
-PTFL
-deltoid ligament
-anterior inferior tibiofibular ligament
What are the 2 possible ankle injuries?
inversion sprain
eversion sprain
Ankle inversion sprain
Hx, Ax, Tx
Hx: roll ankle plantar surface of foot facing medial, ankle in PF position, more common than eversion
Ax: pain and laxity w ATFL, CFL, PTFL, anterior drawer pos, posterior drawer pos, restricted ROM (esp PF and INV), weak restricted eversion
Tx: Deal w suspected fracture first, POLICE, ligament frictions, ROM, strengthening, balance/proprioception, running progression, sports specific exercise, gradual RTP
Eversion sprain
Hx, Ax, Tx
HX: Roll ankle, plantar surface of foot facing lateral, usually with ankle in neutral
position
AX: Pain and laxity with one or both Deltoid ligament tests, positive Anterior drawer test, restricted ROM especially into EV., weak resisted INV.
TX: Deal with suspected fracture first, POLICE, ligament frictions, ROM, strengthening, balance/proprioception, running progression, sport specific exercise, gradual RTP
Ankle tape jobs
ankle inversion sprain
ankle eversion sprain
Foot observations (4)
-foot posture
(pes cavus vs. pes planus)
-footwear
-1/3 squat test (arch suppport)
-twist test (arch support)
Foot AROM/PROM (6)
PF
DF
INV
EVER
Toe flexion
Toe extension
Foot length testing
gastocnemius
soleus
flexor hallucis longus
Foot palpation
medial calcaneal tubercle
general calcaneus
plantar fascia
dorsal pedal pulse
What are the 2 possible foot injuries?
plantar fasciitis (chronic grad onset)
fat pad syndrome (chronic grad onset)
Plantar fasciitis
Hx, Ax, Tx
Hx: gradual onset, progressive heel pain, nontraumatic, unilateral, pain worse in morning
Ax: Either pes cavus or planus, loss of control of arch through arch support testing on injured side, possible tightness in Gastroc, Soleus and FHL, pain over Medial Calcaneal Tubercle, occasionally pain into entire plantar fascia
Tx: POLICE, correct biomechanics, foot strengthening, night splint, tape jobs
Fat pad syndrome
Hx, Ax, Tx
Hx: gradual onset
Ax: pain in general calcaneus, often more pain w weight-bearing DF
Tx: rest, heel cup, supportive footwear, fat pad tape job, address biomechanics
2 ankle tape jobs
Low dye arch
Fat pad
Posterior lower leg assessment
gait pattern
foot biomechanics
Posterior lower leg
AROM/PROM
plantar flexion
dorsiflexion
inversion
eversion
Posterior lower leg: strength testing
plantar flexion
- gastrocs
- soleus
dorsiflexion
inversion
eversion
posterior lower leg: 1 special test
thompson’s test
posterior lower leg palpation
- achilles tendon
- muscle belly
- gastrocs
-soleus
What are the 3 possible posterior lower leg injuries?
achilles tendon rupture (acute)
achilles tendinopathy (chronics)
calf strain (acute)
achilles tendon rupture
Hx, Ax, Tx
Hx: push off acute injury with feeling of being kicked in the heel or hit in the calf
Ax: NO active PF, NO movement w thompson’s test, excessive DF, can’t do single leg PF, swelling/bruising
Tx: POLICE, hospital, surgial/non-surgical repair
Achilles tendinopathy
Hx: chronic gradual onset, over training, biomechanical issues, achilles pain worse in morning
Ax: Pain w active PF, no weakness, mild pain w passive DF, tenderness on palpation 2-6cm above calcaneous
Tx: biomechanical correction of feet, assess footwear, eccentric loading program!!!!!, tape
Calf strain
Hx, Ax, Tx
Hx: acute injury, can occur either in gastroc or soleus musculotendinous junction, mid belly or high on medial/lateral heads of gastroc, result of forceful push, feels like being hit in the calf
Ax: TOP over injury site, pain and weakness w active PF, possible pain w passive DF, possible swelling
Tx: POLICE, heel lifts to unload calf, NO stretching for first 1-2 weeks depending on severity
isometric –> concentric –> eccentric exercise,
taping
Anterior lower leg observation
gait
lower extremity biomech: tibial torsion
Anterior lower leg AROM/PROM, strength testing
PF/DF
INV/EVER
Toe flex/Ext
Anterior lower leg special tests (2)
- gastroc soleus length test
- tuning fork
Anterior lower leg palpation (3)
- dorsal pedal pulse
- anterior compartment
- tibia
What are the 3 possible anterior lower leg injuries?
acute anterior compartment syndrome (acute)
chronic anterior compartment syndrome (chronic)
medial tibial stress syndrome (chronic)
Acute anterior compartment syndrome
Hx, Ax, Tx
Hx: impact from external force, object or other player, numbness in foot, pain and
tightness in front of leg, loss of sensation 1st inter-webbed space, progressively
worsening symptoms, not relieved with rest
AX: decreased dorsal pedal pulse, TOP and tightness with palpation anterior
compartment, weakness DF, no improvement in symptoms with rest
TX: Medical EMERGENCY, send to ER
Chronic anterior compartment syndrome
Hx, Ax, Tx
HX: Chronic, comes on every time athlete exercises lower extremity, numbness,
possible weakness (drop foot), feeling of tightness in anterior leg
AX: Weakness with resisted DF, decreased dorsal pedal pulse, tightness and pain with palpation anterior compartment, improves almost immediately with rest
TX: POLIE (no C!), Biomechanical corrections, assess footwear, stretch tight structures, compartmental pressure testing requested by DR; also might request XRAY to rule out stress fracture
Medial tibial stress syndrome
Hx, Ax, Tx
HX: Chronic, overuse, court sports, TOP over distal 1/3 tibia, pain increases with
exercise and lingers post activity
AX: Poor biomechanics, footwear?, possible weakness with resisted inversion, pain
along medial aspect of tibia usually 2-3cm sore spot
TX: correct biomechanics, assess footwear, ice cups, alternative workouts (decreased pounding), strengthening exercises (Tib post, balance exercises, towel scrunches), low
dye tape job to correct foot biomechanics
Knee: observation
gait
Knee: squat assessment
depth
quality
Knee AROM/PROM
KF/KE
Knee strength testing (2)
KF (hamstrings)
KE (quads)
Knee: 6 ligament stress tests
- posterior sag
- posterior drawer
- lachman’s test
- anterior drawer
- valgus stress test
- in full ext (deep fibers)
- at 30 deg flexion (superficial fibers) - varus stress test
- in full ext
- at 30 deg flexion
Knee: 6 special tests
- Intracapsular swelling tests
- patellar compression
- swipe test - McMurray’s test for meniscus
- Apley’s compression test for meniscus
- Lateral patellar glide for apprehension
- Patellar grind test
- VMO contraction
Knee: 6 places to palpate
- medial joint line (medial meniscus)
- Lateral joint line (Lateral Meniscus)
- MCL
- LCL
- Medial Retinaculum
- Underside of Patella
What are the 7 possible knee injuries?
ACL sprain
PCL sprain
MCL prain
LCL sprain
Meniscus tear
Patellar dislocation/subluxation
Patellofemoral pain syndrome (chonic)
Anterior cruciate ligament sprain
Hx, Ax, Tx
HX: Impact by another player from the lateral side, folded back over other player with a
twisting motion, athlete will report a “pop”. Might also be a non-contact ACL where
athlete goes to cut and knee buckles into valgus and hears a “pop”, sometimes reports
pain, sometimes reports no pain, always reports instability.
AX: Laxity, or laxity and pain with anterior drawer and Lachman, positive swipe test,
positive patellar compression test for swelling, restricted KF/KE
TX: POLICE, thorough medical exam, strengthening specific to hamstrings, bracing, possible surgery if ACL ruptured
Posterior cruciate ligament sprain
Hx, Ax, Tx
HX: Impact with dashboard in car accident, falling on another athlete, tibia translating
posteriorly on femur, fixed rotation, direct impact, may report “pop”
AX: Positive posterior sag, laxity with posterior drawer test, positive intracapsular
swelling tests, possible limitation into KF/KE
TX: Same as ACL, NO surgery, strengthen quadriceps
Medial collateral ligament sprain
Hx, Ax, Tx
HX: Lateral impact from side, athlete might report a “pop”, valgus force applied to knee
AX: Generalized swelling in observation, laxity with either one of or both Valgus stress
tests, limited ROM KF/KE, TOP over MCL
TX: Avoid valgus forces during daily activities, restore ROM, DTFM, brace, surgery very rare
Lateral collateral ligament sprain
Hx, Ax, Tx
HX: Impact from medial side, athlete might report a “pop”, varus force applied, often from a fall, not a very common injury
AX: Generalized swelling, laxity with either one of or both Varus stress tests, limited ROM KF/KE, TOP over LCL
TX: Same as MCL, avoid varus stress
Meniscus tears
Hx, Ax, Tx
HX: Usually planted foot with a rotary force, athlete twists with foot planted, clicking, popping, locking, knee can feel unstable
AX: positive Apley’s and McMurray’s tests, IR stresses lateral meniscus, ER stresses medial meniscus, positive intra-capsular swelling tests, TOP along either medial or lateral joint line depending on which meniscus is damaged
TX: POLICE, AROM, open-chain strengthening exercises, possible surgery
Patellar dislocation/subluxation
Hx, Ax, Tx
HX:
Dislocation – kneecap completely comes out of groove
Subluxation – patellae slipped out of groove, came out partly.
Patellae dislocates almost exclusively laterally, can be from impact, or non-contact, generally valgus orientation, extremely painful
AX: Limited ROM KF/KE, weakness KE, swelling, positive lateral apprehension test, TOP over medial retinaculum
TX: If dislocated immobilize and treat like a fracture, don’t move athlete, call 911. If occurred in past, start to strengthen quadriceps, use a brace, restore squat pattern
Patellofemoral Pain Syndrome (PFPS)
Hx, Ax, Tx
HX: Chronic injury, repetitive KF/KE, common in running and running sports, pain behind knee cap, pain worse when sitting with knee bent or when exercising, has been getting progressively worse
AX: poor squat pattern, generally VMO contraction test positive (inhibited), positive patellofemoral grind test, TOP to dorsal patellae
TX: Rest, ice, biomechanical correction, squat pattern education, patellar taping or strap, stretch and strengthen quads, hip flexors, hip abductors
Hip: observation
squat assessment
Hip: AROM/PROM
(hip and knee)
Knee AROM/PROM
a. KF/KE
Hip AROM/PROM
a. Hip Flexion (HF)
b. Hip Extension (HEXT)
c. Hip ABDuction (HABD)
d. Hip ADDuction (HADD)
e. Hip Internal Rotation (HIR)
f. Hip External Rotation (HER)
Hip: strength
(knee and hip)
Knee Strength
a. KE/KF
Hip Strength
a. HF
b. HEXT
c. HABD
d. HADD
e. HIR
f. HER
Hip: 5 special tests
Ober’s Test: ITB tension
Noble’s compression test: ITB friction
Straight leg raise: hamstring length
Quadriceps length test
Measure circumference of quadriceps
Hip: 3 places to palpate
-Over quadriceps muscles
-Over hamstring muscles
-Over iliotibial band/lateral femoral epicondyle
What are the 4 possible hip injuries?
Iliotibial band friction syndrome (chronic gradual)
Hamstring strain (acute)
Quadriceps strain (acute)
Quadriceps contusion (acute)
Iliotibial band friction syndrome
Hx, Ax, Tx
HX: Gradual onset, increasing symptoms with activity, pain is on lateral side of knee,
pain worse with going down stairs, change in training habits
AX: Positive Ober’s length test, positive Noble’s compression test, potentially weak hip abductors, poor squat mechanics, TOP over ITB (sometimes)
TX:POLIE (No C!), Correct biomechanics, hip strengthening if weak, can provide stretches for tight structures, rolling on ITB
Hamstring strain
Hx, Ax, Tx
HX: Acute injury, specific incident, generally quick acceleration, might report poor warm-up, most often injured in deceleration phase of sprint, athlete reports a sharp pain in back of leg
AX: Weak and painful KF, decreased length on straight leg raise on injured side, TOP to hamstring muscles
TX: POLICE, stretch after 2 weeks, restore movement, start with very easy hamstring strengthening, progress to dynamic hamstring length, incorporate eccentric
strengthening
Quadriceps Strain
Hx, Ax, Tx
HX: Acute injury, specific incident, landing from a jump, or acceleration, athlete reports
a sharp pain in front of leg
AX: Weak and painful KE, limited and painful quadriceps length test, depending on
which quadriceps is injured might also have pain with hip flexion (if rectus femoris is
involved), TOP over quadriceps
TX: POLICE, quadriceps strengthening, quadriceps stretching after 2 weeks
Quadriceps contusion
Hx, Ax, Tx
HX: Acute injury, another player or object impacted into leg, loss in ROM, quadriceps
feeling very swollen
AX: Strong but painful KE, limited quadriceps stretch test, visible bruising or swelling, increased quadriceps circumference compared to uninjured side, tender over area where was impacted
TX: Remove from activity, immediately ice while quadriceps stretched to comfort, apply
gentle compression, NO HEAT, NO DEEP TISSUE MASSAGE
Shoulder: 2 observations
- shoulder posture
- supporting shoulder
-step deformity
-elevated shoulder
-protracted shoulder - scapulohumeral rhythm
Shoulder: AROM/PROM, strength
flexion
extension
abduction
adduction
ext rotation
int rotation
Shoulder: 12 special tests
- Apley’s scratch test
- Wall pushup
- Hawkin’s Kennedy Impingement test
- Neer’s impingement
- Empty can test
- Speeds test
- Yergason’s test
- Cross arm test
- Depression of acromion
- Apprehension test
- Sulcus sign
- Anterior –> posterior glide
Shoulder: 2 places to palpate
- Palpation of Supraspinatus Tendon
- Palpation of Biceps Tendon
Shoulder Impingement syndrome
Hx, Ax, Tx
HX: Chronic activity, overuse of shoulder, generally overhead activities (throwing,
swimming), can involve a number of structures (most common Supraspinatus tendon,
or bursa), pain with certain movements of arm, worse with activity
AX: Painful arc (motion in ABD from 90-120°), Pain with apley’s scratch test, possible
winging with Wall push-up, positive Hawkin’s Kennedy test for pain, pain with Neer’s
impingement test, Positive Empty Can test for pain, TOP to Supraspinatus
TX: Correct shoulder biomechanics, closed chain scapular control, improve
scapulohumeral rhythm, avoid overhead activities, rotator cuff strengthening (no
overhead rotation), sport specific mechanics
Bicipital tendinopathy
Hx, Ax, Tx
HX: Overuse, chronic, overhead activities, common in throwing sports, pain when raises
arm forwards
AX: Pain with active flexion above 90°, pain with Speed’s test and Yergason’s test, pain
on palpation to Biceps tendon, might see scapulohumeral dysfunction, might see
weakness with wall push-up
TX: Treat biomechanics, modify aggravating activities
Shoulder Sprain/Separation (Acromioclavicular Joint Sprain)
Hx, Ax, Tx
HX: Traumatic, acute injury, fall on point of shoulder, hit by another player, fall on
arm/hand at side of body, common in contact sports
AX: Limited ROM in all directions with pain, limited strength in all directions with pain,
pain with cross arm test, pain and laxity with acromial depression
TX: Ice, sling can help with pain, restore ROM, pendulum exercises, pad around ACJ for
return to sport, ACJ tape job, can refer to DR. for X-rays if suspect clavicular fracture
Shoulder Subluxation/Dislocation
Hx, Ax, Tx
HX: Acute injury, generally trauma, athlete will report feeling of “shoulder popping out”,
shoulder might feel unstable, athlete might tell you shoulder is out, fall on outstretched
hand (FOOSH) injury
AX: posture of athlete presentation (slumped forward), if athlete tells you shoulder is
out don’t continue to assess –> hospital, limited mobility into end range all movements,
positive apprehension test, perhaps positive one of Sulcus sign, and/or
Anterior –> Posterior glide
TX:
Subluxation= POLICE, strengthening program for rotator cuff, scapular stabilization
Dislocation= Treat as a fracture, immobilize in position of presentation, seek
immediate medical attention, ICE, keep athlete comfortable, if out of sling, can start
with pendulum exercises and progress as per subluxation
Elbow: Observation
-Scapulohumeral rhythm
-Hand posture
-Carrying angle
Elbow: AROM/PROM
- Elbow Flexion
- Elbow Extension
- Wrist Flexion
- Wrist Extension
- Pronation
- Supination
Elbow: Strength testing
- Elbow Flexion
- Elbow Extension
- Wrist Flexion
- Wrist Extension
- Pronation
- Supination
- Grip Strength
Elbow: 2 ligament Stress test
Varus stress test
Valgus stress test
Elbow: 2 special tests
Wrist extensor stretch test
Wrist flexor stretch test
Elbow: 3 places to palpate
- common extensor origin
- common flexor origin
- olecranon
What are the 4 elbow injuries?
Olecranon bursitis
Lateral Epicondylagia (Tennis Elbow)
Medial Epicondylalgia (Golfer’s Elbow)
Collateral Ligament Sprain
Olecranon bursitis
Hx, Ax, Tx
HX: Acute or repeated trauma, fall on point of elbow pain on point of elbow, pain with
pressure over elbow, swelling on elbow
AX: Visible swelling, TOP over olecranon, boggy feeling on palpation of olecranon
TX: POLIE (No C!), protective padding for sport, alleviate aggravating factors
Lateral Epicondylalgia (Tennis Elbow)
Hx, Ax, Tx
HX: Chronic, pain with gripping, pain worse when using arm, pain over lateral
epicondyle, can also come from minor trauma, pain with certain wrist movements
AX: Pain with active wrist extension, decreased wrist flexion PROM with pain, pain with
resisted supination, decreased grip strength that elicits pain, pain with stretch test of
wrist extensors, TOP over CEO, assess scapulohumeral rhythm
TX: correct shoulder biomechanics, stretch wrist extensors, gentle strengthening
isometric to concentrically, eccentric wrist extensor program, supination strength,
compression band
Medial Epicondylalgia (Golfer’s Elbow)
Hx, Ax, Tx
HX: Chronic, pain with gripping, worse when using arm, pain over medial epicondyle,
pain with wrist flexion
AX: Pain and weakness with active wrist flexion, pain with gripping, worse when using
arm, pain with resisted pronation, pain with stretch of wrist flexors, TOP over CFO, assess
scapulohumeral rhythm
TX: Correct shoulder biomechanics, stretch wrist flexors, gentle strengthening
isometric to concentrically, eccentric wrist flexor program, compression band
Collateral Ligament Sprain
Hx, Ax, Tx
HX: Trauma to elbow, another athlete landing on elbow, acute pain in medial or lateral
side of elbow
AX: Limited elbow flexion or extension, visible swelling, laxity and pain with either
radial or ulnar collateral ligament stress test
TX: POLICE, support elbow, restore ROM, begin strengthening, gradually increase
loading through ligament.
The hand: 2 observations
- thenar eminence
- hand posture
The hand: AROM/PROM
a. Wrist Flexion
b. Wrist Extension
c. Radial deviation
d. Ulnar deviation
e. Finger flexion
f. Finger extension
g. Thumb movements
- Extension
- Flexion
- ABDuction
- ADDuction
- Opposition
The hand: strength tests
AROM/PROM plussss grip strength!!!!!
The hand: 3 ligament stress tests
a. Ulnar collateral ligament of thumb –> Valgus stress at 0° and 30° of MCP jt
flexion
b. Radial collateral ligament of thumb
c. Ulnar and radial collateral ligaments of interphalangeal (IP) joints
The hand: 5 special tests
a. Phalen’s Test – Carpal tunnel
b. Tinel’s Tap Test – Carpal tunnel
c. Derkan’s Test – Carpal tunnel
c. Scaphoid compression test
d. Pinch Test – Ulnar collateral ligament
The hand: 4 places to palpate
a. Anatomical snuff box
b. Ulnar collateral ligament of thumb
c. Radial collateral ligament of thumb
d. Ulnar and radial collateral ligaments of interphalangeal (IP) joints
Carpal Tunnel Syndrome
Hx, Ax, Tx
HX: Can be acute or chronic/repetitive trauma, pain or numbness/tingling in median
nerve distribution, might report hand feeling clumsy, worse with direct pressure or
when using hand
AX: Possible atrophy of thenar eminence, decreased grip strength, positive Phalen’s
test, positive Tinel’s tap test, positive Derkan’s test
TX: Rest, ice, brace to maintain neutral wrist (no compression!), very gentle ROM and
strength exercises, correct any loading issues, correct upper body extremity mechanics
Scaphoid Fractures
Hx, Ax, Tx
HX: Fall on an outstretched hand (FOOSH), need to be cautious as is frequently
confused for a wrist sprain, lots of pain in wrist on radial side, pain with movement
AX: Decreased ROM in all directions, especially painful into radial deviation, weakness
with thumb movements, positive scaphoid compression test, positive pain with palpation of anatomical snuff box
TX: Send for medical attention with DR and Xray, immobilize, ice, once out of cast or
possible surgery start to restore ROM
Thumb Hyperextension (Skier’s Thumb)
Hx, Ax, Tx
HX: Fall on hand with thumb being forced backwards, trying to tackle another player
and thumb getting jammed back or stuck in jersey, common with sports involving a ball
and catching
AX: Swelling visible around MCP joint of thumb, limited AROM/PROM into extension and ABD, positive pinch test, laxity and pain with ulnar collateral ligament stress test of 1st MCP, possible damage to radial collateral ligament depending on direction of fall
TX: POLICE, ROM and strengthening, (Thumb extension, abduction, with and without
resistance), tape job, splint
Collateral Ligament Sprain of the Fingers (Jammed Finger)
Hx, Ax, Tx
HX: Common in ball sports, player will report jamming end of finger, might also be a
valgus or varus force, finger is generally quite swollen, there is limited mobility
AX: Visible swelling around injured finger, limited AROM/PROM into Flex/Ext, pain and
laxity with either UCL or RCL of injured finger and joint
TX: Ice bucket, splint finger, self massage, gentle ROM, gentle strengthening, DTFM to
injured ligament, buddy tape for return to sport
achilles tendinopathy what type of program?
eccentric loading program
