Lower Extremity Sports Injuries Flashcards
1
Q
What are 9 specific injuries to the pelvis, hip and thigh?
A
- pelvic apophysitis
- pelvic avulsion fractures
- snapping hip syndrome
- femoral stress fracture
- femoral acetabular impingement/labral tears
- muscle strains
traumatic hip dislocation - slipped capital femoral epiphysis
- Legg-Calve Perthes disease
2
Q
What is the weakest point in the muscle-tendon unit of a growing athlete?
A
pelvic apophyses
3
Q
Why do pelvic apophyses tend to occur?
A
bone growth exceeds the ability of the muscle tissue to sufficiently lengthen and stretch, thus increasing tensile forces which leads to microtrauma and progressive weakness and inflammation
4
Q
What the 3 most common sites for pelvic apophysitis?
A
- ASIS
- AIIS
- ischial tuberosity
5
Q
ASIS apophysitis occurs because what 2 muscles are pulling?
A
- Sartorius
- TFL
6
Q
AIIS apophysitis occurs because what muscle is pulling?
A
rectus femoris
7
Q
Between what ages do both the ASIS and AIIS apophyses ossify?
A
14-16
8
Q
Ischial tuberosity apophysitis occurs because what muscle group is pulling?
A
hamstrings
9
Q
Between what ages does the ischial tuberosity ossify?
A
21-25
10
Q
What are 3 other less common apophysitis sites?
A
- lesser trochanter
- greater trochanter
- iliac crest
11
Q
What are the symptoms of pelvic apophysitis?
A
well-localized, dull pain with activity at the involved location
12
Q
What can be done to reproduce the athleteās symptoms?
A
tensioning of the muscle
13
Q
What is the treatment for pelvic apophysitis?
A
rest, WBAT as long as there is no antalgic gait.
Once pain is controlled focus on muscle flexibility, ROM, and strengthening of the lumbopelvic and LE musculature
14
Q
Return to sport following pelvic apophysitis is dependent upon symptoms and may take up to _ weeks
A
6
15
Q
When do pelvic avulsion fractures tend to occur?
A
with the progression of an unmanaged apophysitis in the pelvis
16
Q
What ages do pelvic avulsion fractures tend to occur the most?
A
adolescents ages 14-25 years
17
Q
What are the signs and symptoms of a pelvic avulsion fracture?
A
- sudden āpopā
- tenderness and swelling
- painful WB resulting in antalgic gait
- associated bruising
18
Q
What determines the treatment of pelvic avulsion fractures?
A
the degree of widening and displacement of the apophysis:
- less than 2 cm = conservative
- greater than 2 cm = surgical ORIF
19
Q
Describe conservative treatment for pelvic avulsion fractures
A
relative rest from activity for 3 weeks followed by focus on regaining ROM, short course of muscle strengthening, followed by return to sport activities around 6-8 weeks
20
Q
What is snapping hip syndrome characterized by?
A
audible and/or palpable āpoppingā of the hip caused by tendons moving over bony prominences
21
Q
In what type of athletes is snapping hip syndrome most frequently found?
A
- performing artists
- distance runners
- hurdlers
22
Q
What are the 2 classifications of snapping hip?
A
- external
- internal
23
Q
What causes external snapping hip syndrome?
A
the friction of the IT band and/or anterior aspect of the glute max passing over the greater trochanter
24
Q
What are 2 other pathologies that may occur with repetitive external snapping?
A
- trochanteric bursitis
- damage to the glute med
25
What are the characteristics of external snapping hip syndrome?
- lateral hip pain and tenderness around greater trochanter
| - snapping with a description of "hip dislocation"
26
True or False
True external snapping hip syndrome does not contribute to altered athletic performance
True
27
What causes internal snapping hip syndrome?
the iliposoas tendon chronically subluxes from lateral to medial while the hip is brought from a flexed, abducted, and ER position into extension with IR
28
What are the characteristics of internal snapping hip syndrome?
Deep, often painful and audible clunking sensation in the anterior groin
- May also report achiness in posterior buttock/SI region
29
What can help aid in the diagnosis of internal snapping hip syndrome?
direct pressure over the iliopsoas decreases snapping
30
What is the treatment of both external and internal snapping hip syndrome?
- soft tissue techniques and stretches
| - exercises to improve trunk control, stability, and LE positioning
31
What are the 2 varieties of femoral stress fractures?
- compression stress along the medial aspect of the femoral neck
- tensioning along the lateral side
32
In what type of athlete do femoral stress fractures tend to occur?
long distance runners (females 4x more than males)
33
What causes femoral acetabular impingement (FAI)?
Abutment and approximation of the femoral head or neck with the acetabular ring
34
What are the 2 types of lesions FAI can result from?
- Cam lesion
| - pincer lesion
35
What are Cam lesions a result of?
abnormally shaped femoral head repeatedly impinging on the acetabulum
36
Cam lesions result in lesions to what aspect of the acetabulum?
anterior superior
37
What are pincer lesions a result of?
excessive coverage of the acetabular rim, resulting in abutment of the femoral head and neck when the hip is flexed
38
Pincer lesions result in lesions to what aspect of the acetabulum?
posterior inferior
39
Cam lesions are more common in _____ whereas pincer lesions are more common in _____.
males
mature females
40
What are the main complaints in patients with FAI?
Deep hip and groin pain in the shape of a āCā that is aggravated with long periods of sitting as well as athletic activity
41
How is anterior hip impingement tested for?
hip flexion and IR
42
How is posteroinferior hip impingement tested for?
hip extension and ER
43
True or False
Labral tears most often need surgical repair
True
44
What exercises should be avoided in the early phases of labral repair rehab?
anterior hip
- SLR
- situps
- lunges
45
A torn labral early in life often times leads to earlier what in adults?
THA
46
Why are muscle strains not common in young athletes?
Because they tend to incur more apophyseal avulsion injuries instead
47
What are the 3 most common muscle strains to the hip and thigh?
- adductor
- flexor
- hamstring
48
What are the 3 classifications of muscle strains?
1) minimal muscle damage
2) moderate amount of microtears
3) complete muscle rupture
49
Describe the conservative treatment of muscle strains (1 and 2)
PRICE (protection, rest, ice, compression, elevation)
- avoid muscle stretching
- pain free ROM activities to the associated joint segments
- eccentric muscle training
50
True or False
Corticosteroid injections are used as a treatment intervention in the adolescent athlete with a muscle strain
False
51
In what direction do the majority of hip dislocations occur?
posterior
52
What is the protocol for traumatic hip disloctions?
splinting and prompt transport to a medical facility
53
How long after hip dislocation will an athlete be NWB?
6 weeks
54
How long after hip dislocation can an athlete begin hip mobility and strengthening?
12 weeks
55
What is Slipped capital femoral epiphysis (SCFE)?
Posterior slippage of the proximal epiphysis
56
In what patient population is SCFE most common?
boys around the age of 11 with a high BMI
57
What are the symptoms of SCFE?
insidious pain that was gradual in onset to the groin, thigh, or medial knee that increases with physical activity
58
What are 2 clinical signs that are indicative of SCFE?
- resting LE in extension, adduction, and ER
| - significant limp
59
What is the treatment of SCFE?
surgery
60
How long is a child NWB following SCFE repair surgery?
8-12 weeks
61
What is the PT intervention strategy for SCFE?
maximize ROM, muscle strength and endurance, balance, and proprioception
62
What is Legg-Calve-Perthes disease?
Idiopathic osteonecrosis of the capital epiphysis of the femoral head presenting in males 4 to 8 years old
63
What are the clinical signs and symptoms of Legg-Calve-Perthes disease?
- insidious onset of limp usually without any associated pain
- limitations in hip IR and abduction
64
What are the primary goals of LCP treatment?
- maintenance of hip mobility
- decreased pain with WB
- containment of femoral epiphysis within acetabulum
65
What is the major difference between treatment approaches for SCFE and LCP?
```
SCFE = surgery
Legg-Calve-Perthes = conservative
```
66
Describe the typical protocol following ACL repair
- open-chain knee extension within 40-90 degrees for the first 8-10 weeks
- progression to jogging and B jumping around 3-4 months
- Return to sport 6-12 months
67
Describe the 3 grades of MCL sprains
1) pain with stress testing without associated joint laxity
2) pain with stress testing with increased joint excursion; presence of distinct end point
3) complete ligament disruption with excessive excursion; no distinct end point
68
A return to sport can be expected to occur _-_ weeks following a grade 1 MCL sprain, _-_ weeks following grade 2, and _-_ weeks in grade 3
1-3
4-6
9-12
69
Most meniscal injuries in children younger than age 10 occur in the setting of a congenital malformation known as what?
discoid meniscus
70
Do discoid menisci tend to occur most commonly in the medial or lateral menisci?
lateral
71
Describe the rehab process following repair of the meniscus in a child
- NWB or PWB for 4-6 weeks with the use of a hinged brace to limited knee ROM to 0-90 degrees
- address deficits in strength, coordination, and limb control
- return to sport 3-4 months post-op
72
What is an OCD lesion of the knee?
a condition in which damage to the subchondral bone causes secondary damage to the overlying articular cartilage
73
What is the most commonly affected site within the knee?
lateral aspect of the medial femoral condyle
74
What is the major complaint of a knee OCD lesion?
anterior knee pain
75
Describe conservative treatment for a stable OCD lesion
NWB with the knee immobilized for 6-8 weeks
Return to sport around 3 months
76
Return to sport is expected at _-_ months following surgery to repair an unstable OCD lesion
6-9
77
What are 3 differentials for an OCD lesion?
- patellofemoral pain
- chondromalacia
- plica syndrome
78
What are most acute patellar dislocations and associated osteochondral fractures caused by?
planting or twisting maneuvers
79
Describe treatment if there is no osteochondral damage noted
immobilization for 4 weeks followed by progressive ROM and rehab
80
Where do osteochondral fractures typically occur with an acute patella dislocation?
medial patella facet and/or lateral femoral condyle
81
Describe treatment if there is no osteochondral damage noted
Surgery followed by a period of protective WB (dependent upon damage) and a return to sport within 4-6 months
82
What are 5 commonly encountered diagnoses that cuase anterior knee pain due to overuse?
- patellofemoral pain syndrome
- Osgood-Schlatter disease
- Sinding-Larsen-Johansson disease
- inflamed synovial plica
- patella tendinopathy
83
What is the most common cause of all knee overuse injuries?
patellofemoral pain syndrome
84
What causes patellofemoral pain syndrome?
biomechanical alterations in LE function resulting in abnormal stress across the patellofemoral joint and tissue overload
85
What is the main complaint of PFPS?
Dull ache from underneath or around the patella that increases with squatting, stairs, running, and prolonged sitting
86
What is the major proximal factor that may contributes to PFPS that should be part of the focus of treatment?
glute med and max strength and neuromuscular control during CKC
87
What are 2 distal factors that may contribute to PFPS that should be part of the focus of treatment?
- excessive foot pronation
| - limited ankle dorsiflexion
88
Where does Osgood-Schlatter disease represent injury at?
tibial tubercle
89
Where does Sinding-Larsen-Johansson disease represent injury at?
inferior pole of the patella
90
What is the focus of treatment for both Osgood-Schlatter and Sinding-Larsen-Johansson disease?
- rest
- NSAIDs
- normalizing LE flexibility (esp quads and hamstrings)
- strengthing of quads, adductors, and ERs
91
In what patient population does patellar tendinopathy develop?
Older adolescents with fused growth plates
92
What is patellar tendinopathy aka?
jumper's knee
93
Describe treatment for patellar tendinopathy
- rest
- eccentric strengthening
- stretching of quads and hamstrings
94
What are plicae?
bands of tissue in the synovial lining of the knee that arise from remnants of embryologic knee development
95
When does a plica become symptomatic?
when it rubs across the medial femoral condyle
96
What plica is most commonly symptomatic?
medial
97
What is the plica usually felt as?
A painful, taught band, running from the medial patella to the medial femoral condyle
98
Describe treatment for plica syndrome
- activity modification
- inflammation control
- flexibility restoration
- pain free strengthening
- dynamic limb control
99
What is the generic term to describe pain to the lower leg?
shin splints
100
What are 3 differential diagnoses for lower leg pain?
- medial tibial stress syndrome
- tibial stress fracture
- compartment syndrome
101
What is medial tibial stress syndrome characterized by?
pain and inflammation along the anteromedial plane of the distal to central 1/3 of the tibia with running and jumping activities
102
What causes medial tibial stress syndrome?
high, repetitive loads and rapid foot pronation
103
What are 7 contributing factors to MTSS?
- decreased hip IR ROM
- excessive PF ROM
- excessive midfoot mobility
- poor shock attenuation
- rapid changes in exercise intensity
- weakness or imbalance about the lower leg
- high BMI
104
What is the suggested treatment for MTSS?
- active rest (low impact activities)
- ice
- compression/taping
- NSAIDs
- flexibility and strengthening of lower leg musculature (focus on gastrocsoleus complex)
105
How long is the return to sport following MTSS?
6-8 weeks
106
What causes tibial stress fractures?
repetitive bony overload and the inability to meet the demands of the levels of force
107
What are 5 contributing factors to tibial stress fractures?
- improper training regimens
- poor bone health
- high BMI
- abnormally high or low arches
- excessive foot pronation
108
What running characteristics lead to a high incidence of tibial stress fractures?
- high vertical loading rates
- heel striking at ground contact
- increased step length
- decreased cadence
- high tibial acceleration
109
What are the signs and symptoms of tibial stress fractures?
localized, acute, and sharp pain on the tibial surface along with palpable thickening usually along the central to upper 1/3 of the tibia
110
What is the treatment option for acute compartment syndrome?
fasciotomy
111
In what patient population is chronic exertional compartment syndrome or exercise-induced compartment syndrome common in?
long distance runners
112
Why does exercise induced compartment syndrome occur?
Because the containing fascia is unable to expand, thereby constricting blood flow resulting in ischemia
113
What compartments of the leg are most commonly affected by compartment syndrome?
anterior and lateral
114
What are the signs and symptoms in an athlete with chronic exertional compartment syndrome (CECS)?
aching pain, tightness, and squeezing sensations about the lower leg in the distribution of the affected compartment
115
What is the treatment for CECS?
alteration of running mechanics along with pain relief strategies
116
The ankle is the most common site for athletic injuries, accounting for __-__% of all musculoskeletal injuries
20-30
117
What motions occur at the talocrural joint?
DF and PF
118
What motions occur at the subtalar joint?
inversion and eversion
119
Ankle supination is a combination of what motions?
PF, inversion, and adduction
120
Ankle pronation is a combination of what motions?
DF, eversion, and abduction
121
85% of ankle pathology is due to what?
acute ankle sprain (lateral most often)
122
What is a high ankle sprain aka?
syndesmotic sprain
123
What causes a high ankle sprain?
forced eversion and ER of the ankle causing widening of the distal tib-fib joint
124
What are the signs and symptoms of an ankle sprain?
- patient reports a distinct injury with a sudden "pop"
- unable to continue activity
- pain, swelling, and ecchymosis throughout the ankle and into the foot and toes
- limited and painful WB
125
What is treatment for an ankle sprain?
PRICE (protection, rest, ice, compression, and elevation)
- a few days of rest and immobilization due to pain
- early joint mobility and weight bearing has been shown to be more favorable for functional return (begin DF and PF movements first followed by inversion and eversion movements)
126
When do ankle fractures in sports tend to occur?
with deceleration or rotational forces about a fixed foot
127
In children under 12 years with an immature skeletal system, a physeal fracture of the distal fibula is highly probable with what type of injury?
lateral ankle sprain
128
What are the signs of a ankle fracture?
pain on palpation over the physeal growth plate (1 finger width above distal portion of lateral malleolus)
Ottawa Ankle Rules
- bone tenderness at posterior edge or tip of lateral malleolus
- bone tenderness at posterior edge or tip of medial malleolus
- inability to bear weight both immediately and in ER
129
What is the treatment for an ankle fracture?
cast immobilization for 3 weeks followed by rehab similar to that of a lateral ankle sprain
130
Ottawa ankle rules have been shown to be sensitive in detecting fractures to the foot in children over 5 years of age, what are they?
- bone tenderness at posterior edge or tip of lateral malleolus
- bone tenderness at posterior edge or tip of medial malleolus
- inability to bear weight both immediately and in ER
131
What is a triplane fracture?
an ankle fracture that occurs in older children ages 15-17 in 3 planes (coronal, sagittal, and transverse) due to partially closed growth plates
132
What is a Tillaux fracture?
a Salter-Harris type III fracture of the unfused anterolateral segment of the distal tibia epiphysis caused by avulsion of the epiphyseal segment of the AFTL
133
Where is pain experienced in a Tillaux fracture?
anterior lateral aspect of the foot
134
What is the treatment protocol following a triplane of Tillaux fracture?
- NWB for 3-4 weeks
- short leg cast for 3-4 weeks
- PT to restore normal strength and mobility
135
When should you suspect a osteochondral fracture of the talar dome?
when there is persisten pain following a sprain with continued edema and intermittent clicking or locking
136
What are the treatment methods of an osteochondral fracture of the talar dome?
- conservative:
casting and orthotic intervention
- surgery to remove loose body
137
Ankle _____ can be the source of anterior, antereolateral, or posterior ankle pain
impingement
138
What causes ankle impingement?
the formation of an osteophyte on the distal tibia due to abnormal ankle mechanics
139
What are the symptoms of ankle impingement?
Pain between the fibula and the lateral talus, within the sinus tarsi, or AFTL
140
What is the treatment of ankle impingement?
- rest
- NSAIDs
- bracing
- joint mobilization
- possible arthroscopic debridement
141
What 2 overuse foot injures are often more frequent in the skeletally mature athlete?
tendonitis and plantar fasciitis
142
In the skeletally immature athlete, atraumatic pain along the posterior calcaneus is likely due to what?
Sever's Disease
143
Describe what Sever's disease is
a traction apophysitis of the calcaneus at the site of the attachment of the Achilles tendon, plantar fascia, and intrinsic muscles of the foot
144
What are the symptoms of Sever's disease?
- pain along the heel that increase during sports such as soccer, gymnastics, and basketball with repetitive running and jumping (pain is usually bilateral)
- muscles length restrictions to triceps surae muscle complex
- excessive foot pronation
- possible swelling
145
What is the treatment for Sever's disease?
- pain control modalities
- continuation of sports activities if tolerable
- restore flexibility and length to impaired musculature
- strengthening of calf and foot muscles
- gel heel lift to unload Achilles
146
What is Iselin's disease?
A traction apophysitis to the proximal fifth metatarsal (insertion of peroneus brevis muscle)
147
What are the symptoms of Iselin's disease?
- pain and swelling over the proximal 5th metatarsal
- pain with WB
- pain with resisted eversion
148
What is the treatment for Iselin's disease?
Rest and flexibility activities to the evertors and PFs
149
A Lisfranc injury is an injury to what joint?
Tarsometatarsal joint
150
What causes a Lisfranc injury in sports?
a low-energy axial load on a plantarflexed foot with the knee anchored on the ground
151
What are the symptoms of a Lisfranc injury?
- pain on the dorsum of the foot
- forefoot edema and bruising along the plantar arch
- weightbearing is painful and increases when asked to stand on tiptoes
- tenderness upon palpation along the tarsometatarsal joints
- gapping between the hallux and 2nd toe
152
How are Lisfranc injuries treated?
conservatively with the athlete immobilized with a CAM walking boot for 6-10 weeks and allowed to WB according to pain tolerance
153
How long does complete recovery take in a Lisfranc injury?
4 months, and some may not be able to return to sport
154
What is tarsal coalition?
a congenital malformation where two or more tarsal bones are fused
155
What are the symptoms of tarsal coalition?
- restricted midfoot mobility
- pain with cutting, pivoting, running
- history of recurrent, chronic ankle sprains
156
What is the treatment for tarsal coalition?
directed at controlling foot motion to decrease stresses about the fusing joints
157
What is an os navicular secundum?
a congenital formation of a small ossicle next to the navicular or within the tibialis posterior tendon
158
What metatarsal is the most commonly fractured in children?
5th
159
What are the Ottawa foot rules?
- bone tenderness at the base of the 5th metatarsal
- bone tenderness at the navicular
- inability to bear weight both immediately an in ER
160
What is a Jones fracture?
a fracture of the proximal diaphysis of the fifth metatarsal
161
What is turf toe?
Hyperextension injury to the first MTP, resulting in damage to the plantar capsuloligamentous structures
162
What are the symptoms of turf toe?
pain along the plantar surface of the toe along with possible bruising and swelling
- pain is replicated with active or passive great tow extension
163
What is the treatment for turf toe?
PRICE
| - early mobility is key to avoid hallux rigidus
