Lectures 1-4 Flashcards
What is Malfeasance?
Legal Consideration
Individual commits an act that is not his responsibility to perform
Misfeasance
Legal Consideration
Individual commits act that is his responsibility to perform, but uses wrong procedure, or does the procedure wrong
Nonfeasance
Legal Consideration
Fail to perform an act that was your responsibility.
Gross Negligence
Legal
Total disregard of other’s safety
What is EAP
Emergency Action Plan
A very important aspect of sport EAP (home and visting field)
Knowing where the AED machine is
What is Documentation used for?
Protect yourself in case of legal action
H-SOAPIE
What it stands for
History, Subjective, Objective, Analysis, Plan, Interventions, Evaluation
SOIE
What does it stand for
Clinical Charting Follow-ups
Subjective, Objective, Interventions, Evaluation
What is laxity?
Looseness of a limb or muscle
What is Elastic Deformation
Tissue returns to normal state after the stress is removed
Plastic Deformation
Tissue is unable to return to normal state once the stress is removed (permanently deformed) -> structural injury
Yield Point
Stress needed to go from elastic to plastic deformation of a tissue
Rupture Point
Complete failure of tissue
Describe Shear force
forces opposite each other, causing tissue to slide over adjoining surface in parallel fashion
ACL and PCL sprains, brain injuries
Describe torsion
Twisting mechanism causing rotation along the fixed point
torsion fracture
Acute vs. Chronic Injury
Sudden onset, single traumatic event
VS.
Gradual Onset, repetitive stress
Acute Injuries
Contusion
1st, 2nd, and 3rd degree
1st - superficial tissue damage
2nd - increased pain due to increase in area and depth of damage
3rd - severe compression resulting in severe pain
Compression of soft tissue due to direct blow
Sprain
1st, 2nd, and 3rd degree
1st - mild overstretching and mild pain
2nd - partial disruption of ligament, moderate pain
3rd - complete disruption, hard pop, rapid swelling
Injury to ligament or capsule structure
Strain
1st, 2nd, and 3rd degree
1st - microtearing, mild pain and tenderness
2nd - partial tearing, immediate localized pain
3rd - complete tear, palpable defect
Stretching or tearing
Neuralgia
pain along the path of a nerve. Compression or chronic inflammation
Neuroma
Thickening of nerve due to chronic irritation or inflammation
Inert Vs. Contractile Tissue
Ligaments, fasciaes, aponeurosis
vs.
Muscle
Fracture Types
TOSSGAFIC
Transverse, Oblique, Spiral, Stress, Greenstick, Avulsion, Fissure, Impacted, Comminuted
Comminuted Fracture
Multiple fragments of shattering of the bone at site of injury
Avulsion Fracture
Pulling away of a piece of bone secondary to tensioning of an attaching ligament, tendon, or muscle
Fissure Fracture
Fracture line not extending through the thickness of the bone
Greenstick Fracture
Incomplete fracture through the bone, mot common in youth
Describe Specificity
Ability of a test to correctly identify people without the disease
False positive: no disease found and test is positive
Describe Sensitivity
ability of a test to identify patients with a certain disorder
What numbers should look like for
Positive likelihood VS. negative likelihood ratios
Numbers should be greater than 10
VS
Numbers less than 1
How many muscles touch the scapula?
17 = 17 ways something can go wrong
what seperates the scapula from the clavicle?
the AC joint
AC Sprain (seperated shoulder)
Describe it
MOI - FOOSH
S/S - keynote deformation, pain on AC, decreased hz add
SP - AC cross-over
Tape - AC tape
GH Sprain
MOI - forceful abd, or hz abd with or without extension
Common, poor stability at the shoulder (shoulder favours mobility)
GH Sprain
MOI - forceful abd, or hz abd with or without extension
Common, poor stability at the shoulder (shoulder favours mobility)
GH Acute Dislocation
MOI:
- Anterior - abd, ext rot, ext
- Posterior - Flex, int rot, and post force
- Inferior - hyperabduction and inferior force
What is the most common GH doslocation?
Location
Anterior
What does posterior GH dislocation look like?
Head of humerus is completely behind the scapula. Looks flat from the front.
Hill-Sachs Lesion
Posterior aspect of humeral head’s cartilage suffers small defect because of impact on glenoid fossa as humeral dislocates.
Not a common injury because posterior dislocation is not that common
Usual location of chronic dislocation, and symptoms
Anterior dislocation
Dead arm syndrome
(pain, swelling the first few times)
How to prevent re-injury after first acute dislocation?
Immobilize arm in external rotation
What is a test that detects impingement but does not tell you what structure is injured?
Hawkins-Kennedy
What is a test that detects impingement but does not tell you what structure is injured?
Subacromial
Hawkins-Kennedy
What causes tendinitis, bursitis, or impingement in the shoulder?
Overuse injury - usually overhead motion
Throwing, swimming
Number of seconds that is considered too long for blood flow to return to the fingers?
Past 4 sec
Impingement Syndrome (posterior)
Tightness of posterior capsule
Pinching os supraspinatus (or infraspinatus) between humerus and glenoid rim
Biceps Tendonitis
MOI - overhead movements that involve excessive elbow flexion such as pitching, javelin throwing
S/S - pain in bicipital groove with int and ext rot
SP- Speed’s test
Clavicular fracture
S/S
S/S - shoulder and upper extremity appear much lower than the non-injured side
can be life threatening if posterior displacement
Scapular Fracture
S/S, RULE OUT
S/S- painful abd, individual will want to stay with arm abducted
Rule out - associated rib fracture and pneumothorax
What is considered a full body experience that you wouldn’t expect?
Pitching
What should pitchers make it a habit to do after every game?
Ice shoulder
4 joints of the shoulder
○ Acromioclavicular
○ Sternoclavicular
○ Glenohumeral
Scapulothoracic
Ligaments of the AC joints
Acromioclavicular and coracoclavicular
What conditions at the shoulder can be life threatening?
Spinal cord injuries and heart attacks
What are the tests Cozen, Maudsley, and Mill for?
Sensitivity and Specificity
Cozen and Maudsley (good sensitivity) Mill for specificity
What is the avg carrying angle?
greater in females
10-15 degrees
Contusion
MOI - direct blow to muscle
Upper arm
Tackler’s Exostosis
similar to myositis ossificans
ectopic boen formation on antero-lateral aspect of the humerus, not infiltrating the muscle tissue
MOI - repeated direct blows
Olecranon bursitis
MOI, Tape
MOI - fall on elbow, direct blow
Tape - donut pad
Ligamentous injnury
MCL, LCL
MOI - direct blow outside of elbow (valgus)
MOI - direct blow to inside of elbow (varus)
Elbow Subluxation (radioulnar)
MOI, S/S
MOI - longitudinal traction of extended and pronated forearm (getting swung by the arms)
S/S - inability to perform pronation/supination
Elbow subluxation is most common in who?
Adolescents
Evulsion Fracture
fracture where tendon or ligament is pulling on the bone
Evulsion Fracture
fracture where tendon or ligament is pulling on the bone
Where is a tendon usually stronger?
Near a growth plate
Biceps Brachii rupture usually occur where
97% are proximal
Biceps brachii rupture MOI
sudden eccentric load, weight lifting
Medial Epicondylitis
MOI - repeated stress on wrist flexors
Golfer’s elbow. Or with involvement of the growth plate - little league
Little league elbow
What is it
Avulsion of the medial epicondyle due to repeated tensile stress from wrist flexors and valgus stress
Lateral Epicondylitis
Tennis elbow
MOI - repeated stress (eccentric) on common tendon of wrist extensors
SP: Lat epicondylitis test
Gamekeeper’s thumb
Sprain of the thumb ulnar (medial) collateral ligament
MOI - forceful abd and ext
Tape - thumb taping
Interphalangeal collateral ligament sprain
MOI - excessive varus/valgus stress and hyperextension
Tape - buddy tape
Dislocation of the metacarpals and phalanges
MCP = rare MOI - hyperextension or shearing force causes ant capsule to tear
Most common disloction spot is at the proximal interphalangeal joint
What is the weakest finger?
Ring finger because it does not have the flexor digitorum
Scaphoid Fracture
MOI - FOOSH
S/S - pain with palpation of anatomical snuffbox
What fracture accounts for 60-70% of all carpal bone injuries in general population?
Scaphoid Fracture
Monteggia’s Fracture
Fracture of proximal third of the ulna with an associated dislocation of the radial head
Galeazzi’s Fracture
Distal radius with associated dislocation or subluxation of the distal radioulnar joint
Colles’ Fracture
Distal metaphysis of the radius, with displacement of the distal fragment dorsally
Smith’s Fracture
distal radius with displacement of the distal fragment towards the palmar aspect
Lunate Fracture/ Kienbock’s Disease
Fracture of lunate bone that can present with minimal pain because of the amount of cartilage surrounding it.
MOI - FOOSH
Hard to diagnose
Bennett’s Fracture
Articular fracture of proximal end of first metacarpal
MOI - axial compression
Avascular necrosis description
dark area showing that the bone is dying
tx - reattachment of the bone
Boxer’s Fracture
distal epiphysis of 4th or 5th metacarpal
MOI - punch (poor technique or against very hard surface)
Phalangeal fracture
MOI - direct blow or hyperextension
What does the Rectus Femoris corss?
The hip joint
Hip Pointer
What is it
Contusion of the iliac crest (looks bruised)
MOI - blunt trauma to the iliac crest
Tape - donut pad
Quad Contusion
Bruising of quad muscle
Myositis Ossificans
Abnormal ossification (bone formation) within quad muscle tissue
S/S - palpable mass within muscle tissue
How cna you prevent myositis ossificans/.
no massage, heat, stretching 72 hours post injury to quads
Greater trochanteric bursitis
Between greater trochanter and gluteus maximus
s/s burning, aching pain over posterior to tip of g trochanter
Iliopsoas bursitis
Inflammation in the joint due to degeneration can cause the bursitis
s/s - pain medial and anterior to the joint, not easily palpated
Ischial Bursitis
What causes it
Direct fall on ischium, prolonged sitting, especially with leg crossed
Hip Flexor Strain
MOI, Tape
MOI - overuse, quick hip flexion or sudden stretch
Tape - hip spica
What is the trendelenburg test?
Assessment of capacity of gluteus medius to stabilize pelvis
One leg, look for contralateral drop of pelvis
Avulsion Fracture
Rapid sudden acceleration or deceleration (strong muscle contraction)
Femoral Fracture
MOI - tremendous impact forces
Potentially life threatening
Femoral Fracture s/s
Displaced vs. Non-displaced
severe pain, swelling, shortened limb deformity
vs.
pain on palpation, muscle weakness and spasms
Stress Fracture
Common locations, risk factors
- Pubis, femoral neck
- sudden increase in training load, change in running surface, improper footwear
Pelvis Fracture
Sacrum, pelvis ring, iliac crest
What should be treated as a spinal injury even though it is located in the hip?
Pelvis fracture
Why is the hamstring the most strained muscle of the body?
Biarticular, and sustains lots of eccentric forces
Eccentric Force
A force that does not pass through the centre of gravity of the body on which it acts or through a point at which the body is fixed.
If not treated appropriately, what condition can a quads contusion develop into?
Myositis Ossificans
What restricts posterior displacement of tibia on the femur?
ACL
What type of nerves on the leg once compressed can could lead to neurological deficit in the lower leg?
Superficial nerves
Bursa
What is it
Fluid-filled sac that reduces friction between muscles/tendons and bones
MOI Bursitis
Prepatellar - direct blow (most superficial)
Deep infrapatellar - overuse (quad friction)
Pes anserine - overuse
Semimembranosus - tight hammy
Suprapatellar - secondary to knee inflammation
Subcutaneous infrapatellar - other knee injuries
Tx of Bursitis includes
RICE
Mod of activites
Screw-home mechanism
Screw home mechanism (SHM) of knee joint is a critical mechanism that play an important role in terminal extension of the knee.
PCL Sprain
MOI - fall on knee/hyperflexion
Symptoms will worsen over time
MCL Sprains
get tackled outside the knee while your foot is planted.
Grade 1 and 2 do not involve mensicus
Grade 3 does
Valgus stress
Dynamic knee valgus
caused by the lack of strength and control of your hip and knee muscles. Research has shown that increased dynamic knee valgus increases your risk of ACL injuries and other lower leg injuries
LCL Sprains
Impact to inside of the knee with foot grounded
Grade 3 is where 50% of patients will develop OA
Varus Stress
Which meniscus is bigger the lateral or medial?
Lateral
What type of injury are tears most associated with?
ACL injuries
MOI of meniscal injuries
twisting with compression and flexion or involved with MCL injury
List the meniscus tear types
Vertical longitudinal, vertical radial, oblique, bucket handle, horizontal,
Tx is surgery mainly
Patellofemoral stress syndrome
Also called lateral patellar compression syndrome
possible causes - tight quads, weak quads, weak glutes
s/s - dull, aching pain under knee cap that increases with activity
Chondromalacia
Cartilage degeneration of the knee cap
seen on x-ray and MRIs
Patellar dislocations
lateral dislocation of the knee cap due to imbalance
Patellar Dislocation
immediate treatment - > immobilize send to ER
What is another name for Jumper’s knee?
Patellar Tendinitis
Patellar tendinites
Inflammation of patellar tendoncaused by excessive running and/or jumping
s/s pain after or with activtiy, decreased quad flexibility, pain with end range knee flexion
eccentric quad strengthening
Extensor tendon rupture (quad)
MOI - powerful muscle contraction
S/S - patella can appear higher (superior) compared to the opposite side if the rupture is inferior to the patella
Iliotibial band (ITB) friction syndrome
Tight TFL/ITB causes friction of the ITB on lateral femoral condyle
Plantar Fascitis
Overuse injury that is common in runners
MOI - factors affecting risk: pes cavus or planus, improper footwear, reduced flexibility of plantar muscles and calf, improper running pattern
s/s - pain underneath the foot or medial heel at the first step in the morning
What is the most common injury of all the sports?
Lateral ankle sprain
Lateral Ankle Sprain
MOI - forceful inversion
S/S - swelling around lateral malleolus, point tenderness on ligaments, can’t bear weight on injured side
SP - medial talar tilt/anterior drawer
q
What is the most sprained ligament?
Anterior Talofibular (ATFL)
Anterior drawer tests specifically for ATFL
Medial Ankle Sprain
MOI - forceful eversion
S/S - swelling around medial malleolus
SP - lateral talar tilt
Syndesmosis Sprain
High ankle sprain
MOI - dosiflexion and eversion
s/s - extreme tenderness on distal anterior tibiofibular lig.
Predictors of Ankle Sprains
People with inflexible ankles, more eversion increases risk for inversion sprain
Avulsion Fracture
A piece of bone chipped away with the ligament
Avulsion of deltoid ligament from the medial malleolus
Term
Medial Ankle Sprain
Avulsion of peroneus brevis tendon from the 5th metatarsal
Lateral Ankle Sprain
Gastrocnemius Strain
Stretching of muscular fiber of the calf muscle
MOI - forced dorsiflexion with extended knee or forced knee extension with dorsiflexed ankle
Muscular fatigue resulting in muscle cramps
S/S - decreased strength in plantar flexion, decreased flexibility in dorsiflexion, tenderness on muscle belly
T - strain tape
Achilles Tendinopathy
MOI, Risk Factors
MOI - overuse
Risk Factors - improper footwear, foot misalignment, change in exercise environment
S/S - decreased in plantar flexion, decreased flexibility in dorsiflexion, pain in tendon
Achilles tendon rupture
MOI - muscular contraction while stretching, knee extended
S/S - pop, visible defect in the tendon, inability to do plantar flexion on walk on tip of toes, feeling of being shot in the leg
Most severe acute muscular injury
Achilles tendon rupture
Medial Tibial Stress Syndrome (MTSS)
Shin splints
S/S - pain on the medial side of the tibia, increased with running, trigger points at the insertion of the soleus on the medial tibia
T - shin splint tape with foam compression
Stress Fracture
Often in running and jumping
Risk Factor: increased in mileage, change in surface or shoe
Syndesmosis Sprain
Sprain between the tibia and fibula
Seperation caused by dorsiflexion and eversion
Syndesmosis Sprain
Sprain between the tibia and fibula
Seperation caused by dorsiflexion and eversion
Ottawa ankle rules
When would you send a patient to the emergency room for ankle x-rays?
Pain with palpation of the distal posterior 6 cm of tibia or fibula
Inability to BW for 4 steps
Ottawa ankle rules
Send to emergency room for midfoot x-rays?
Pain with palpation of base of 5th metatarsal or navicular bone
Inability to BW for 4 steps
What does the Ottawa ankle rules not guarantee even if it is positive?
Does not mean there is a fracture
What movements are likely to be limited with a medial ankle sprain?
Eversion
