Med Yield Flashcards
What are effective chest compressions?
Compress by 5cm
Allow complete chest recoil
Rate 100-120/ min
Minimise pauses in compressions
Switch out compressors
management of Shockable rhythm (VF, pVT)
Give shock (biphasic 200J, monophasic 360J)
Continue CPR x 2min
Get IV/ IO access
Epinephrine 1mg q3-5 mins
Consider advanced airway + capnography (if CO2 <10, improve CPR)
Amiodarone 300mg bolus then 150mg second dose
Lidocaine 1mg/kg first dose then 0.5mg/kg second dose
management of non shockable rhythm (asystole, PEA)
IV/ IO
Epinephrine 1mg q3-5 mins
Consider advanced airway + capnography
What are the reversible causes or cardiac arrest?
Hypovolemia
Hypoxia
H+ acidosis
Hypo/hyperkalemia
Hypothermia
Tension PNA
Tamponade
Txoins
Thrombosis - pulmonary, coronary
How to manage ROSC
Maintain O2 sats
Treat hypotension
12 lead ECG ?STEMI - if present, coronary reperfusion
How to manage bradycardia w/ a pulse
Maintain airway
Oxygen if needed
Cardiac monitor
BP + sats
IV access
ECG
Assess for signs of decompensation
What are the signs of decompensation?
Hypotension
Altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF
What to do If decompensation signs are present in bradycardia
Atropine 0.5mg bolus, repeat every 3-5mins, max 3mg
If ineffective, dopamine or epinephrine infusion or transcutaneous pacing
Dopamine 2-20mcg/kg/min
Epinephrine 2-10mcg/min
How to manage tachycardia w/ pulse
Maintain airway
Oxygen if needed
Cardiac monitor
BP + sats
Assess for signs of decompensation
What to do If decompensation signs are present in tachycardia
Consider sedation
IV access + 12 lead ECG
Narrow complex:
If regular = adenosine 6mg IV rapid push, 2nd dose 12mg
If irregular:
Vagal manoeuvres
BB or CCB
If wide QRS (>0.12s):
Adenosine if regular + monomorphic
Antiarrhythmic infusion
Amiodarone 150mg over 10 mins then 1mg/ min for 6 hrs
Procainamide 20-50mg/min until arrhythmia suppressed, hypotension ensures, QRS duration increases >50% or max dose 17mg/kg given
What is the grading of hypothermia?
Systemic cold injury
Mild - 32-35 degrees
Mod - 30-32
Severe - <30
What ix are needed in hospital following a drowning
CXR - localised, perihilar or diffuse pulmonary edema
ABG, lytes, Cr, ECG, continuous core temp monitoring
RF for szs
Fam hx
Cerebrovascular dz
Brain tumors
Alcohol or substance use
Prev head injury
Malformations of cortical development
Infections
Commonly associated conditions w/ szs
Personality disorders
Haem disorders - sickle cell, antiphospholipid syndrome
Learning disabiities
Migraines
Mood disorders
Systemic autoimmune conditions - SLE
Ix for szs
Lytes, glucose, ex lytes, kidney + liver function, ammonia, CBC
UA
Blood + urine toxicology
CT or MRI brain
EEG - may need to do sleep deprived
ECG
Consider spinal tap to r/o infection + raised ICP
What sports pose a risk to the athlete, if they had epilepsy, and what sports pose a risk to others if the athlete has epilepsy?
Risk to self:
rodeo, ski jumping, freestyle skiing, surfing, climbing, diving, Alpine skiing, archery, canoeing, karate, cycling, fencing, gymnastics, hockey, swimming, shooting
Risk to others:
Aviation, motor sports
RTP in szs based on low vs high of sports
For low risk sports:
Single provoked seizure = okay to return
Single unprovoked seizure = okay to return once neuro cleared
For high risk sports:
Single provoked seizure = okay to return once neuro cleared
Single unprovoked seizure = 1 yr sz free
In motor sports or aviation, no RTP
What ix are needed in anaphylaxis
Not needed
ABG if ongoing resp distress
Tryptase levels to confirm - must be drawn within 3 hrs of sx onset, must be placed on ice, rarely elevated in food induced anaphylaxis
Consider ECG
RF for post concussion syndrome
4 or more initial sx >1 wk
Prior concussion + sx >1 wk
Sx of drowsiness, nausea, reduced consciousness >1 wk
Sensitivity to light + noise >1 wk
Amnesia associated w/ sx >1wk in males
How does the direction of the blow change the structure likely to be damaged in a nasal bone #?
Blow to inferior nose more likely to injure cartilagenous septum + nasal tip
Lateral blow more likely to # nasal bone, can cause fracture displacement + septal dislocation
Direct blows can lead to nasal obstruction
Low vs high velocity trauma causes what pattern of nasal fracture?
Low velocity trauma causes simple fracture pattern
High velocity trauma causes complex comminuted # and associated injuries to face, head, C spine
Other forms of dental injury other than # + management
Extrusion (tooth moved out of socket) - dentist within 24hrs unless tooth cannot be repositioned, in which case immediate dentist
Intrusion (tooth moved inward) - dentist within 3 hrs
Lateral luxation (tooth moved laterally) - dentist within 24hrs unless tooth cannot be repositioned, in which case immediate dentist
Avulsion - dentist immediately
Complications of dental trauma
Mandibular condyle #s (anterior open bite, malocclusion, limited mandibular opening)
Monitoring in AS
Monitor with BASDAI score (fatigue, spinal pain, joint pain/ swelling, areas of tenderness, duration of morning stiffness) - rated 0-10 then divided by 5. Score >4 = suboptimal treatment
Complications of AS
Fusion of vertebrae leading to restrictive lung disease
Aortitis or aortic insufficiency
Hip arthritis
Increased risk of achilles tendinopathy
RF for AS
Positive fam hx of SpA or HLA-B27
Reactive arthritis triggered by chlamydia or certain enteric infections
Pathophysiology of Spondylosis
Discs undergo desiccation when they age, lose compressibility + bulge causing loss of disc height
Osteophytes form
Ligamentum flavum undergoes hypertrophy
Changes cause narrowing of neural foramen
Pathophysiology of disc herniation
Annular fibers around nucleus pulposus degenerate
Nucleus pulposus can herniate through fibers (usually due to mechanical force)
Herniated disc impacts + compresses nerve root
Where do nerve roots exit compared to their numbered pedicles?
Nerve roots exit above their corresponding pedicle (i.e. C6 nerve root exits between C5 + C6)
Types of scoliosis
Neuromuscular
Congenital
Idiopathic
Tanner stages
Stage 1: no pubic hair, no breast tissue palpable, testicular volume <4ml
Stage 2: downy hair, breast bud palpable under areola, testicular volume 4-8ml
Stage 3: scant terminal hair, breast tissue palpable outside areola, testicular volume 9-12ml
Stage 4: terminal hair that fills entire triangle overlying pubic region, areola elevated above contour of breast, testicular volume 15-20ml
Stage 5: terminal hair extending beyond inguinal crease, areola hyperpigmentation + papillae development, nipple protrusion, testicular volume >20ml or >4.5cm long
DDx for scoliosis
Leg length discrepancy
Postural abnormalities
What is Atlantoaxial Instability?
Increased motion at joint between 1st + 2nd vertebrae
Can e congenital, inflammatory, traumatic or infections that weaken structures leading to it
Sx of Atlantoaxial Instability
Usually asymptomatic
Can present after injury w/ gait changes, progressive weakness, fatigue, neck pain
RF for Atlantoaxial Instability
Downs
RA
JIA
Dwarfism
Marfan’s syndrome
Ix for Atlantoaxial Instability
Lateral cervical XR w/ flexion + extension views
Physical for Atlantoaxial Instability
Hyperreflexia
Sensory changes
Weakness
Gait disturbance
DDx for Atlantoaxial Instability
Neck sprain
Cervical disc herniation
Vertebral #
Management of Atlantoaxial Instability + what sports would someone not be allowed to do
Restrict from contact sports if symptomatic
If asymptomatic, may be restricted from butterfly stroke, diving, high jump, squat lifts, gymnastics, skiing
Avoid blind ET intubation - use flexible bronchoscope
Can consider atlantoaxial fusion if progressive sx or myelopathy
Most common rotator cuff tears
Supraspinatus + infraspinatus
What is the action of the pectoralis?
Adductor
Internal rotation
Flexor of humerus
RF for Pec Major tendon rupture
Males 20-40 years old
Weightlifting
Steroid use
CTD
Diabetes
MOI Pec Major tendon rupture
Usually complete avulsion of pec tendon at humeral insertion
Downward portion of bench press with shoulder in last 30 degrees of extension against heavy resistance.
Sx of Pec Major tendon rupture
Pain and weakness of shoulder
Will often feel a pop
Physical for Pec Major tendon rupture
Swelling and significant bruising of chest wall and upper arm
Asymmetric pec muscle
Loss of axillary contour - asymmetric muscle outline (retracted medially)
Shoulder ROM limited d/t pain
Dropped nipple sign
Weakness in adduction and internal rotation
Ix for Pec Major tendon rupture
XR to r/o # - soft tissue swelling + loss of pec major shadow seen
MRI w/ dedicated sequence gold standard
US can be helpful in meantime
Management of Pec Major tendon rupture
NSAIDs, ice, sling
Refer to ortho urgently
Partial tears, sternoclavicular tears, muscle belly tears - usually non surgical
Shoulder ROM once tolerated
Strengthening from 6wks post injury
Unrestricted activity 2-3mo after injury
Complete tears = surgical
Acute repair within 3 wks optimal
DDx for Pec Major tendon rupture
Long head bicep subluxation
Proximal humerus #
Rotator cuff tear
Classification of clavicle #s
1 = # of middle ⅓
2 = # of distal ⅓
3 = fracture of proximal ⅓
What is PIN compression syndrome + what causes it?
Posterior interosseous nerve syndrome
PIN is deep branch of radial nerve
Overuse pronation + supination, trauma (Monteggia or radial head #), inflammatory dz, lipoma/ neuroma/ ganglion
RF for PIN compression syndrome
Manual labourers, body builders, racquet sports
Males
Sx of PIN compression syndrome
Painful spontaneous weakness of extensor muscles
Fatigue during finger extension, elbow supination, wrist extension
Dull, aching pain 5-10cm distal to lateral epicondyle
Physical for PIN compression syndrome
Tenderness on palpation of proximal radius
Sensation normal
Weakness in wrist extension in ulnar deviation but okay in radial deviation
Weak extension of MCP joints
3rd + 4th digits most affected (“rock on” sign)
Ix for PIN compression syndrome
XRs + US
EMG studies
DDx for PIN compression syndrome
Radial nerve palsy
C7 radiculopathy
Lateral epicondylitis
Management of PIN compression syndrome + time frame for recovery
Conservative - rest, NSAIDs, immobilization, steroid shot
Surgery in refractory cases
Activity modification recommendations + home exercises
ROM
Strengthening
Time frame for recovery
3-4mo usually
MOI Elbow dislocation
Wrestling, gymnastics, football, falls, MVA
Conditions commonly associated w/ Elbow dislocation
Radial #, epicondyle avulsion #, coronoid process #
Physical for Elbow dislocation
Visual deformity normally seen
Prominent olecranon = posterior
Long extended forearm = anterior
Ix for Elbow dislocation
AP + lateral XR
Management of Elbow dislocation (sideline + in hosp)
On field reduction
Supine pt, forearm traction, humeral counter traction, anterior force on olecranon, forearm supination
Full passive ROM indicates successful reduction
Post reduction XRs + neurovascular exam
Sling x3 days
If unable to reduce immediately
Immobilize in posterior splint in 90 degrees flexion in pronation
FU XRs 1 + 2 wks after injury
May need surgery if recurrent instability
Time frame for recovery
1-3mo
What is little leaguer’s elbow?
(medial apophysitis)
Catch all phrase for elbow pain in young athlete but traditionally:
Valgus stress lesion of medial epicondylar physis
On a continuum w/ avulsion # of medial epicondyle
RF for medial apophysitis
Pitchers
Number of pitches
Management of medial apophysitis
4-6 wks rest w/ ROM + stretching
NSAIDs + ice
Pitch count
What is Nurse maids elbow?
Traumatic subluxation of radial head by sudden forcible traction on pronated hand or wrist w/ elbow extended
MOI + RF nurse maids elbow
MOI
Child suddenly pulling away or dropping to ground with hand held
Pulling child up or swinging by hand
RF
Kids <4y/o
Sx of nurse maids elbow
Immediate pain
Child not using affected limb
Physical for nurse maids elbow
Arm held in pronated + partially flexed position
Tenderness over radial head
Supination limited
Management of nurse maids elbow
Reduction:
Flexion-supination
Thumb over radial head
Rotate arm into full supination
Flex elbow to 90 degrees
Hyperpronation
Pronate forearm further as elbow is moved into full extension
If function not normal in 15mins, repeat reduction or get XRs
MOI + associated sports for UCL elbow injury
Repetitive valgus overload (overhead throwing sports (baseball, cricket, softball, football quarterback), racquet sports, contact sports, gymnastics, volleyball (spiking + serving))
Acute trauma (extreme valgus stress)
RF for UCL elbow injury
High velocity throwing or overhead activity sports
Contact sports
Sx of UCL elbow injury
Acute: sudden pain, audible pop
Chronic: persistent, insidious medial elbow pain
Physical for UCL elbow injury
Tenderness along sublime tubercle
Valgus stress test positive
Ix for UCL elbow injury
XRs - joint widening
MRI or MRA
Management of UCL elbow injury
Acute
NSAIDs, rest, ice
High grade partial tears + complete ruptures = surgery (if throwing athlete)
Activity modification recommendations + home exercises
ROM
Wrist flexor + extensor strengthening
Restricted throwing + valgus stress x6 wks
Prevention of UCL elbow injury
Throwing athletes should have 3-4mo rest every year
Conditions associated with scapholunate ligament injury
intra-articular distal radius and other carpal fractures
Levels of scapholunate ligament injury
Occult instability - XR negative, wrist pain usually only w/ mechanical loading
Dynamic instability - will be evident on stress XRs
SL dissociation - SL widening seen on XR
SL advanced collapse (SLAC)
MOI lunate dislocation
FOOSH
high energy injury that occurs when wrist is in extension and ulnar deviation.
RF for lunate dislocation
Chronic crutch walkers
Gymnasts, football, collision sports
Sx of lunate dislocation
Dorsal wrist pain
Decreased grip strength
Decreased ROM
May have carpal tunnel symptoms (25%)
Physical for lunate dislocation
Wrist effusion in acute injuries
Tenderness to palpation of lunate + radial aspect of wrist
May have positive median nerve compression tests, as lunate can dislocate into the carpal tunnel
Finger extension test positive - hold wrist in flexion, test active finger extension against resistance - pain over lunaate
Kleinman shear stress test positive (lunotriguetral instability) - wrist in neutral position, examiner’s contralateral thumb over dorsal lunate while ipsilateral thumb loads the pisotriquetral joint with a dorsally directed force - pain = positive
Ix for lunate dislocation
X-rays: PA, oblique, and lateral wrist inc clenched fist view
Gap >3mm / increased gap compared to contralateral side
CT for ligament injuries
Arthroscopy is gold standard
DDx for lunate dislocation
Scaphoid fracture
Colles fracture
Scaphoid impaction syndrome
Dorsal wrist ganglion cyst
Other carpal bone injury
Complications of lunate dislocation
AVN
median nerve palsy
compartment syndrome and long term issues.
Management of lunate dislocation
Urgent reduction and surgery needed then prolonged immobilization
Partial tears can be treated conservatively w/ splinting
Refer to ortho/ plastics emergently
Zones of flexor tendons in hand
Zone 1: distal to FDP insertion (FDP tendon only)
Zone 2: proximal A2 pulley to FDS insertion (no man’s land - poorer outcomes)
Zone 3: distal carpal tunnel to proximal A2 pulley (contains lumbricals)
Zone 4: carpal tunnel (contains flexors + median nerve)
Zone 5: Proximal to carpal tunnel (different repairs if muscle belly involved)
Zones of extensor tendons in hand
Zone 1: DIPJ (mallet injury)
Zone 2: middle phalanx (can involve central slip insertion)
Zone 3: PIPJ (Boutonierre deformity)
Zone 4: Proximal phalanx (can involve central slip + lateral bands)
Zone 5: MCPJ (can involve sagittal band + joint capsule)
Zone 6: metacarpals (distal to junctura (tendon can retract))
Zone 7: wrist joint (involvement of extensor retinaculum)
Zone 8: distal ⅓ of forearm (can involve musculotendinous junction)
Zone 9: proximal ⅔ of forearm (can involve muscle belly)
What is IP collateral ligament strain + degrees of severity
Injury to a collateral ligament at the interphalangeal (IP) joint of the finger, usually the proximal interphalangeal (PIP) joint:
1st degree: pain but no laxity
2nd degree: pain and laxity but firm end point when ligament is stressed
3rd degree: pain and loss of firm end point when ligament is stressed
MOI + RF IP collateral ligament strain
MOI
axial loading with radial or ulnar stress applied to the finger, usually while extended
RF
Ball handling, collision, and contact sports: football, basketball, volleyball, wrestling
Prior injury or dislocation of the PIP joint
Sx of IP collateral ligament strain
Finger struck by player or ball during play
Axial trauma causing forced ulnar or radial deviation
Usually presents acutely but may become chronic
Physical for IP collateral ligament strain
Pain and swelling over radial or ulnar aspects of PIP joint
Decreased range of motion (ROM) secondary to pain and edema
Assess function of flexor and extensor tendons by isolating MCP, PIP, and distal interphalangeal (DIP) joints separately to rule out tendon injury.
Loss of active ROM may be due to either pain or volar plate/central slip injury, so digital block may be necessary to test ROM
DDx for IP collateral ligament strain
Phalangeal fracture
IP dislocation
Central slip injury
Volar plate injury
Management of IP collateral ligament strain
Buddy tape for 3 wks
Surgery if:
Displaced intra-articular
Large avulsion #
Instability w/ active ROM
Tissue interpoisition limiting ROM
FU 1-2 wks to r/a
What is Climbers finger + how is it managed?
Flexor tendon pulley rupture (especially A2 and A4)
Manage with splints or surgical pulley reconstruction
What does dysplasia, subluxation, dislocation, teratologic dislocation + unstable hip mean in relation to the hip
Dysplasia refers to an acetabulum that is shallow or underdeveloped.
Subluxation refers to a femoral head that is not centered within the acetabulum.
Dislocation refers to a femoral head that is completely out of the acetabulum.
Teratologic dislocation refers to a femoral head that is in a fixed dislocated position usually associated with a genetic, developmental, or neuromuscular disorder.
An unstable hip refers to a femoral head that can be subluxed or dislocated on physical examination.
RF for DDH
Firstborn
Breech presentation
Oligohydramnios
Underlying ligamentous laxity
Swaddling
Caucasians
Females
Family history
Conditions commonly associated w/ DDH
Torticollis
Metatarsus adductus
Physical for DDH
Barlow (Adduction and internal rotation of hip, palpable clunk is positive sign as hip dislocates)
Ortolani (Abduction and external rotation of hip with examiner’s middle finger over greater trochanter, palpable clunk is positive sign produced by reduction of dislocated hip)
Ix + screening for DDH
US best
Screen at 4-6 wks if RF present or clunk on exam
Management of DDH
Pavlik harness for week 3 - 6mo
Hip spica cast for 6-18mo (change cast q6wks)
Surgery if closed reduction fails or excessive abduction present
Complications of DDH
Failed reduction
Osteonecrosis of femoral head
Hip labral pathology
OA
Types of FAI
Cam type: malformation of the femoral head resulting in neck widening and asphericity
Pincer type: malformation of the acetabulum that results in over-coverage of the anterosuperior acetabular wall and abnormal retroversion of the acetabulum
Mixed type: most common type, combination of cam and pincer lesions
Distal femur # types
Supracondylar: Zone is from the femoral condyles to the junction of the metaphysis and femoral shaft.
Intracondylar.
Condylar.
MOI, hx + sx for ischial tuberosity avulsion #
intense athletic activity, such as sprinting, or with excessive passive lengthening of the hamstring muscles, as often occurs during cheerleading or gymnastics.
The patient may experience a popping sensation at the time of injury and typically presents with severe posterior thigh or gluteal pain and complains of difficulty walking.
Types of pelvic # + direction of force
Lateral compression - rami #, iliac wing #, sacral #, coccygeal #
Anterior posterior compression - symphisis diastasis #, open book #, 2x ipsilateral ischiopubic rami #,
Avulsion # e.g. ischial tuberosity
What ix for ?pelvic #
CT
FAST
Management of pelvic #
Immobilize w/ pelvic binder
Low grade: protected wt bearing, bed rest, NSAIDs, XRs after 2-5 days
High grade: surgery
Complications of pelvic #
Vascular injury leading to blood loss
Closed head injuries
Visceral injury (bladder and urethral, small bowel, diaphragm)
Nerve injury
Deep venous thrombosis
Atelectasis/pneumonia
Musculoskeletal back pain
Sexual dysfunction
Malunion/nonunion of pelvic fracture
Structures that make up the Posterolateral Corner (static vs dynamic)
Static structures:
Lateral cruciate ligament (LCL)
Popliteus tendon (PT)
Popliteus ligament
Lateral capsule
Arcuate ligament (variable)
Fabellofibular ligament and fibula (variable)
Dynamic structures:
Biceps femoris
Popliteus muscle
Iliotibial (IT) tract
Lateral head of gastrocnemius
What are the 3 primary stabilizers of the lateral knee found in the PLC?
Fibular collateral ligament (FCL). It serves as the primary varus stabilizer of the knee in late knee flexion.
Popliteus tendon. This structure resists external rotation of the knee.
Popliteofibular ligament (PFL). This ligament acts like a sling to hold the popliteus muscle/tendon complex down against the posterior lateral portion of the tibia. It is a varus stabilizer of the knee in extension.
injuries associated w/ PLC injury
ACL or PCL injuries
Knee dislocation
Fibular nerve injury
Popliteal artery injury
In elderly, can be associated w/ tibial plateau #
MOI PLC injury
Falls, land on fully extended lower extremity. Knee then “fails” in varus, hyperextended position then buckles
Knee hyperextension
Varus blow to flexed knee
RF for PLC injury
Female gender
Sports competition (vs. practice)
Contact sports
American football
Prior knee or ankle injury
Physical for PLC injury
Grading of PLC injuries is done in full knee extension and then with 30 degrees of knee flexion; this can be affected by presence of effusion or pain.
Place a varus stress with knee in extension; if opens up over 4 mm compared to opposite side, impacts the PCL tear
Then test at 30 degrees and compare to other side. If point of care ultrasound (POCUS) is available, it adds accuracy to exam
Must have a neuro (fibular nerve) exam, specifically ankle dorsiflexion + great toe extension
Must have a vascular exam; “two-second” capillary refill and palpitation of posterior tibialis, dorsalis pedis pulse
External rotation recurvatum test (if positive, think PLC + ACL)
Patient is in supine position; the examiner stabilizes the femur by pushing downward in the quadriceps area just proximal to the patella. With the other hand, the examiner grasps the patient’s great toe and lifts. A measurement is taken from the heel of the raised leg and the table. The opposite leg is also tested, and any difference over a centimeter indicates a positive test
Dial test
Patient is in prone position. The examiner grabs the patient’s forefoot while allowing their heels to touch. The knees are flexed 30 degrees, then externally rotated by the examiner. The knees are then flexed 90 degrees, and the same test is done. If there is >10 degrees difference with the other knee at either position, result is a positive test. If the difference is at 30 degrees of flexion, it implicates the PLC. If the difference is 90 degrees of flexion, it implicates both the PLC and the PCL
DDx for PLC injury
ACL tear
PCL tear
Knee dislocation
Tibial plateau fracture
Growth plate injury
Bone contusion
Lateral meniscus tear
IT band subluxation at knee
Fibular nerve injury
Vascular injury to geniculate artery system
Grading + treatment of PLC injury
Grade 1 = 0-5mm lateral opening
Hinge brace x4-5 wks, crutches, allow knee flexion
Grade 2 = 5-10mm lateral opening
Knee immobilizer, non wt bearing x3 wks then treat as grade 1
Grade 3 = >10mm lateral opening
Knee immobilizer, non wt bearing, refer to ortho for surgery
Complications of PLC injury
Fibular nerve injury
Vascular injury
Physical injury
Multiple ligament injury
If ACL or PCL is repaired and PLC injury is missed, early arthritis and graft failure occur.
Ottawa knee rules
XR if any of the following:
55 yr of age or older.
Isolated tenderness over patella.
Tenderness over head of fibula.
Inability to flex knee to 90 degrees.
Inability to bear weight at time of injury + in ED
Ix for PLC injury
XR: AP, lateral, sunrise, varus stress views if injury is chronic
look for arcuate sign, an avulsion fracture for the fibular head associated with PLC injury and ACL injury
Look for Segond fracture, avulsion fracture from lateral tibial plateau associated with ACL injury
MRI
What is a patella sleeve #?
Cartilage of the inferior pole of the patella is pulled off, often with a small avulsed bone fragment. This occurs with a vigorous contraction of the quadriceps muscle group when the knee is in a flexed position
Occur usually between 8-12 y/o
Types of patella # + MOI
Transverse - usually displaced (usually from strong quadriceps contraction (partial fall, jumping sports) or direct trauma)
Stellate - usually comminuted + nondisplaced (usually from high impact direct trauma)
Longitudinal (usually d/t trauma or dislocation of patella)
Stress # - weightlifters + gymnasts
Hx + sx of patella #
Activity (partial fall, exertional strain, etc.)
Trauma (object, direction, force)
Subluxation or dislocation
Popping or snapping
Locking or joint instability
Loss of range of motion (ROM)
Difficulty weight-bearing
Speed and extent of swelling
Characterization of pain
Physical for patella #
Tenderness to palpation
Pain with passive motion of the patella.
Limited range of active leg extension owing to disruption of soft tissues.
Palpable step-off defect
Effusion or soft tissue swelling
Distal neurovascular status
Investigations for patella #
XR: AP, lateral, sunrise
CT for ?occult #
MRI for patella sleeve + osteochondral #
DDx for patella #
Bipartite patella: usually bilateral and not associated with point tenderness, with rounded edges at the superior and lateral corners of the patellae
Patella dislocation
Proximal tibia or distal femur #
ACL tears
In peds:
Sinding-Larsen-Johansson syndrome: Overuse injury of the inferior pole of the patella typically occurring between 10 and 14 yr of age may be misdiagnosed as a patellar fracture.
Management of patella # (acute, non op vs surgical, indications for each, rehab after)
Acute
Aspiration of hemarthrosis + injection of LA
Icem elevation
NSAIDs
Immobilization (usually in slight flexion)
Non operative treatment
If:
Displacement of <3 mm in any plane or <2 mm at the articular surface
Full range with active knee extension as compared to the contralateral side
Compressive dressings and aspiration of hemarthrosis (if present) before cast application may help to control edema and discomfort.
Immobilization in full extension in a locked knee brace with early weight-bearing as tolerated for initial 2 to 3 wk
Early active ROM with hinged knee brace with progression in flexion after 2 to 3 wk
Weekly radiographs should be obtained to evaluate for possible fracture displacement and appropriate healing
Progressive ROM and strengthening are used until the patient can perform a straight-leg raise against gravity without extension lag
Surgery
If:
Displacement of >2 mm of articular step-off or >3 mm in any plane of fracture separation
Disruption of extensor mechanism is indicated by lack of full extension against gravity.
ORIF
Long leg cast x3-6 wks post op
Wt bearing as tolerated in cast or locked brace: reduces quadriceps contraction and fragment distraction
Isometric exercises and straight-leg raises: started within days of cast application or surgical fixation
ROM exercises such as continuous passive motion may be started immediately after stable internal fixation
Active flexion and passive extension are performed until the fracture is healed and then progress with resistance exercises
Resistance exercises: Several months of resistance exercises may be required to achieve full strength and ROM.
RTP after patella #
Return to play when bony healing is demonstrated on AP, lateral, and merchant radiographs; complete and painless ROM are achieved; 90% of quadriceps strength is achieved; and balance and proprioception are restored
Usually 3-6mo
Complications of patella #
Patellofemoral arthritis
A slight decrease in flexion
Painful hardware: common complication; managed by removal after fracture union (minimum 6 mo) or tendon healing (minimum 3 mo).
Infection
AVN
Loss of fixation
Describe the blood supply to the meniscus
The peripheral 1/3 zone (red-red) has good vascular supply
Central third zone (red-white) has limited vascular supply
Inner third zone (white) is avascular
What is a Tibial plafond #
Distal tibia #
MOI + sx of Tibial plafond #
MOI
Usually high impact axial force that drives talus into plafond
Hx
Ankle pain
Management of Tibial plafond #
Surgery
What is the nerve supply, muscles involved and muscle action for the anterior compartment?
Deep peroneal
Muscles: Tibialis anterior, EHL, Extensor digitorum longus
Muscle action: DF ankle + toe extension
What is the nerve supply, muscles involved and muscle action for the lateral compartment?
Superficial peroneal
Muscles: Peroneus longus, brevis, tertius
Muscle action: PF + eversion
What is the nerve supply, muscles involved and muscle action for the deep posterior compartment?
Posterior tibial
Muscles: Tibialis posterior, soleus, flexor hallucis longus, flexor digitorum longus and popliteus muscles
Muscle action: PF ankle, inversion + toe flexion
What is the nerve supply, muscles involved and muscle action for the superficial posterior compartment?
Sural
Muscles: Gastrocnemius
Muscle action: PF ankle
Classification of strains
Mild strain (1st degree): stretch type injury with few muscle fibers injured, causing only minor swelling/pain and minimal loss of strength/motion
Moderate strain (2nd degree): partial tear with strength loss and functional limitations due to more extensive muscle injury
Severe strain (3rd degree): extensive or complete tear across whole muscle with disabling loss of muscle function
What is Kohler’s?
Pediatric osteochondrosis of tarsal navicular that causes necrosis
Who gets Kohler’s?
Children 2-7 y/o
Boys more common
Sx of Kohler’s
Insidious onset midfoot pain
Limp
Aggravated by activity
Repetitive microtrauma
Physical for Kohler’s
Localised edema, warmth around tarsal navicular
Tenderness medial midfoot
DDx for Kohler’s
Osteochondritis dissecans
What do you see on XR for Kohler’s
XRs (AP, lateral, oblique)
Navicular sclerosis
Diminished size or flattening of navicular
Management of Kohler’s
Ice, NSAIDs, immobilization x2-3mo
Refer to ortho if sx not improved w/ this
What is it called when adults get navicular osteonecrosis?
Mueller Weiss disease
Causes of posterior ankle impingement syndrome
Repeated hyperplantar flexion
Os trigonum syndrome (congenital accessory bone that becomes inflamed, particular w/ repetitive plantar flexion)
Talar compression syndrome
Prominent bone (medial malleoli process, posterior process of calcaneus)
Causes of anterior ankle impingement syndrome
Repetitive hyperdorsiflexion (kicking a ball)
Tibial or talar osteophytes impinge soft tissue
RF for posterior ankle impingement syndrome
acute or recurrent hyperplantar flexion (ballet on pointe), recurrent ankle sprains, or ankle instability.
Athletes: ballet dancers (“en pointe” and “demi pointe”), cheerleaders, running downhill (forced plantar flexion)
Poor shoe wear without appropriate support
Overuse injury is more common than traumatic injury
RF for anterior ankle impingement syndrome
sports requiring recurrent forceful dorsiflexion of the ankle, recurrent ankle sprains (supination and plantar flexion) and/or chronic ankle instability, and acute ankle sprains/fractures.
Athletes: soccer players, gymnasts, basketball players, football players, high jumpers, running uphill
Sx of anterior ankle impingement syndrome
pain w/ dorsiflexion (uphill running/walking)
Pain with kicking a soccer ball, especially a dead ball
Popping or snapping sensation of isolated soft tissue lesions
Subjective feeling of limited range of motion or blocking on dorsiflexion
Sx of posterior ankle impingement syndrome
Pain is difficult to localize, typically anterior to the Achilles tendon.
Pain described as consistent, sharp, dull and/or radiating
Prior history of inversion (supination) and plantar flexion injury
Posterior ankle pain exacerbated by either plantar flexion (compression of soft tissues or bony prominence) or dorsiflexion (stretching of the posterior capsule and ligaments)
Physical of anterior ankle impingement syndrome
Tenderness to palpation over the anterior, anterolateral, or anteromedial ankle (most important clinical finding)
Pain in the anterior aspect of the ankle with either forced plantar flexion or dorsiflexion
Possible palpable mass with tenderness to palpation
Physical of posterior ankle impingement syndrome
Tenderness to palpation in the posterior aspect of ankle, typically anterior to and not involving the Achilles tendon
Possible palpable soft tissue thickening with tenderness to palpation
Positive plantar flexion test: pain in posterior ankle with plantar flexion (pathognomonic)
Reproducible pain with pressure over posteromedial aspect of the ankle during passive inversion and plantar flexion
Ix for ankle impingement syndrome
XRs - wt bearing ankle XR (AP, lateral, oblique)
MRI
DDx for anterior ankle impingement syndrome
Lateral ankle ligament sprain
Synovial thickening/synovitis
Loose/intra-articular bodies, avulsion fragments
Chondral or osteochondral lesions of anterior tibial plafond or talar dome
Osteoid osteoma of the talus
Ganglion cyst
Osteoarthritis
DDx for posterior ankle impingement syndrome
Deltoid ligament sprain
Posterior tibial tendonitis/tenosynovitis
Flexor hallucis tendonitis/tenosynovitis
Achilles tendonitis/tenosynovitis
Peroneal tendonitis/tenosynovitis
Retrocalcaneal bursitis
Haglund deformity
Tarsal coalition
Thickening of posteromedial ankle capsule
Tarsal tunnel syndrome
Osteochondral lesions of talar dome (medial)
Shepherd fracture (acute fracture of the posterolateral process of the talus)
Ganglion cyst
Osteoarthritis
Management inc PT exercises + when to refer to surgeon for ankle impingement syndrome
Relative rest, avoid provoking activities
Ice
NSAIDs
Steroid shot +/- LA
Shoe modifications, heel lifts, orthotics
PT
Range of motion exercises, proprioceptive (balance) training, and strengthening exercises to improve ankle stability
Address core/gluteal weakness.
Modalities: electrotherapy, transcutaneous electrical nerve stimulation (TENS) unit, deloading taping, soft tissue massage
Refer to surgeon if 6mo failed conservative therapy
Surgical excision of os trigonum or other debridement
Prevention of ankle impingement syndrome
Good technique w/ ballet - “forcing turnout” can predispose to this
Preventing recurrent ankle sprains
Early exercise protocol for acute ankle sprain
Proper rehabilitation, including ankle strengthening, range of motion, and proprioception
Proper footwear/orthotics
What is Sever’s dz?
Apophysitis at insertion of achilles tendon into calcaneus in teens
Overuse syndrome
RF for Sever’s dz
Occurs during growth spurts (9-12 y/o)
Males more common
Common in repetitive running + jumping
Hard surface running
Sx of Sever’s dz
Heel pain worse w/ activity
Can be uni or bilateral
Physical for Sever’s dz
No swelling or ecchymosis
Pain w/ single heel rise test (Sever sign)
Tenderness with medial and lateral compression of the calcaneus (heel squeeze test)
Tenderness at Achilles insertion on heel
DDx for Sever’s dz
Nerve entrapment (plantar)
Neuroma (plantar)
Plantar fasciitis (plantar)
Heel pad syndrome (plantar)
Calcaneal stress fracture (plantar)
Peroneal tendinopathy (midfoot/lateral)
Sinus tarsi syndrome (midfoot/lateral)
Tarsal tunnel syndrome (midfoot/medial)
Achilles tendinopathy (posterior)
Haglund deformity (posterior)
Management + time frame for recovery of Sever’s dz
Rest, reduce activity
Ice, NSAIDs
Heel lifts
Stretching calf muscles
Strengthen ankle plantar flexors once pain free
Persistent pain may require 3-4 wk immobilization
Correct any biomechanical abnormalities
Time frame for recovery
6-12mo, sometimes sx persist up to 2 yrs
What is Haglund’s deformity?
Prominence of posterior superior calcaneal tuberosity
What is Haglund’s disease?
Retrocalcaneal bursitis, insertional Achilles tendinitis, and pre-Achilles (superficial) bursitis. These occur due to compression of the distal Achilles tendon and the surrounding soft tissues.
RF for Haglund’s disease
Common in hockey players, sports w/ shoes w/ stiff/ closed heels
Tight Achilles tendon
Ix for Haglund’s disease
Bilateral foot XRs
Management of Haglund’s disease
Open heel shoes
Ice, NSAIDs
Soft tissue massage
Achilles stretching
Orthotics, heel pads
Immobilisation boot
Can refer for surgery
Types + characteristics of sesamoid injury/ dysfunction
Stress fractures:
Most common sesamoid pathology
More common in athletes than in general population
Sesamoiditis:
General term that encompasses multiple conditions including osteonecrosis, chondromalacia, or inflammatory changes
Usually involves the medial (tibial) sesamoid
Acute fracture:
Typically caused by forced dorsiflexion
Often, a transverse fracture line is seen on imaging with sharp edges
RF for sesamoid injury
Repetitive, forceful dorsiflexion, or loading (pushing off) of the MTP joint
At-risk sports include dancing (especially ballet), running, gymnastics, volleyball, basketball, high-impact aerobics, and soccer
Asymmetrical sesamoids
Overpronation
Playing on artificial turf
Wearing shoes without adequate forefoot support (i.e., high heels)
Sx of sesamoid injury
Gradual onset of pain on the plantar surface of the 1st hallux
Pain with dorsiflexion or weight-bearing
Unilateral symptoms are typical.
Pain typically is located at the medial sesamoid.
Acute fracture usually occurs with a history of hyperextension injury of the big toe
Physical for sesamoid injury
Tenderness with direct palpation of the sesamoids ± swelling or ecchymosis
Pain with resisted plantarflexion of the 1st hallux
Pain with passive dorsiflexion of the 1st MTP
Pain with “pushing off” while walking or running
Decreased range of motion and/or strength of the 1st MTP
Ix for sesamoid injury
XR (AP, lateral, medial + lateral oblique (wt bearing)
Axial view of 1st MTP in dorsiflexion
CT or SPECT best for #
Management of sesamoiditis or stress #
Sesamoiditis or stress fracture/nonunion:
Initially, conservative therapy is recommended for at least 4 to 6 wk
Relative rest with immobilization by offloading the 1st MTP complex with orthotics or rocker sole shoes (forefoot unloader shoe), a dancer’s pad, or metatarsal bar; taping the great toe in plantarflexion may be considered for severe symptoms
Ice
NSAIDs
Rarely, injections with corticosteroids can be considered
Avoid wearing high-heeled shoes
Long-term treatment includes:
Correction of any mechanical abnormalities with the use of taping, orthotics, or a stiff-soled shoe to limit dorsiflexion of the 1st MTP joint.
Eliminating or minimizing the stressing activity
Surgery, usually to excise the sesamoid, to treat prolonged symptoms despite several months of conservative management
Management of acute sesamoid #
Non–weight-bearing immobilization with a short leg cast/ankle foot orthosis (AFO) for 6 to 8 wk, followed by protected weight-bearing in cast/AFO for 4 to 6 additional weeks
Open reduction and internal fixation or percutaneous fixation are surgical options
Complications of sesamoid injury
Nonunion of fractures
Development of stress fractures or avascular necrosis in untreated sesamoiditis
RF for tibialis posterior tendon rupture
More common in older adults
MOI of tibialis posterior tendon rupture
The mechanism is typically an eversion ankle injury instead of the more common inversion ankle injury.
Sx of tibialis posterior tendon rupture
Pain
Medial ankle bruising and swelling
Physical for tibialis posterior tendon rupture
Antalgic gait
Asymmetric pes planus (more severe on affected side)
Loss of normal alignment of the heels when standing on toes (normal is calcaneal varus alignment)
Weakness with resisted inversion
Medial ankle bruising and swelling
Ix for tibialis posterior tendon rupture
US to confirm dx
Complications of tibialis posterior tendon rupture
Can lead to severe arch collapse
Management of tibialis posterior tendon rupture
Refer to ortho for surgery
RF for tibialis posterior tendinopathy
Recent increase or change in training or type of activity
Surgical or accidental trauma to the foot
60% of cases in patients >50 yr of age associated with hypertension (HTN), diabetes, and obesity; no association of these factors with younger patients
Severe pronation of the foot with planovalgus foot deformity
Association with rheumatoid arthritis and seronegative inflammatory disease
Prior exposure to steroids; local injection reported as a possible cause of rupture
Sx of tibialis posterior tendinopathy
Pain along the length of the posterior tibialis tendon, particularly near the medial malleolus
May relate to a recent change in activity frequency, type, and intensity
Medial arch pain
Occasional radiation of pain into the medial calf area
Symptoms usually worsen with prolonged or strenuous activity, especially activities with a strong push-off motion.
Initially painful but normal heel raise progressing to gait changes and inability to toe-raise
Physical for tibialis posterior tendinopathy
Tender posterior tibialis tendon, especially posterior to the medial malleolus
Medial ankle and possible foot swelling
Flattened longitudinal arch compared with unaffected foot
Increased hindfoot valgus and “too many toes sign,” where more toes are seen laterally when viewing the patient from behind (late finding)
Single-limb heel-rise test: Patient stands on affected foot and attempts to rise up on the ball of the foot while the other foot is off the ground. With tendinopathy, patients will be able to raise the affected heel, although with pain. Repetitive heel raises may show some weakness and pain in the tendon with persistent valgus hindfoot position through the toe raise.
Tendon strength testing: foot plantarflexed and everted, then resist patients attempt to invert the foot (Avoid dorsiflexion because anterior tibialis may help to invert the foot.)
Management of tibialis posterior tendinopathy
Stage 1 + 2
Unloading: over-the-counter (OTC) or custom orthotics for medial arch support; relative rest (cross-training—pool running or swimming as tolerated). It is preferred to use an orthosis with ankle stirrup support and medial longitudinal arch support
Reloading: controlled reloading with focused concentric or eccentric exercises, transition to weight-support training (treadmill in pool) and weaning from unloading braces or orthotics.
3-4mo therapy needed
If fixed hindfoot deformity present = need surgery
What is Freiberg’s dz?
Osteonecrosis of superior portion of metatarsal head
Commonly in teens
Sx of Freiberg’s dz
Dull, aching pain over metatarsal head
May have reduced ROM
Pain worse w/ activity + wt bearing
Physical for Freiberg’s dz
Tenderness over metatarsal head
Ix for Freiberg’s dz
XR - joint space widening then flattening + collapse
Bone scan
Management of Freiberg’s dz
Restrict wt bearing
Rest
Heals in 6-12 wks
Surgery if failed conservative therapy
How to measure rating of perceived exertion?
Subjectively rate how hard you’re working using Borg scale, where six is no effort and 20 is maximal exertion.
How to measure maximum heart rate?
208 - (0.7 x age)
What is a MET
Metabolic equivalent
MET is defined as the energy cost of sitting idly and is equivalent to caloric consumption of 1 calorie/kg/hour
Describe mitral valve prolapse
Most common congenital valve disorder
Affects 5% population
Most people asymptomatic
When would you be concerned re SCD in people with mitral valve prolapse?
Low risk of SCD unless hx of syncope, ventricular arrhythmias, family hx of SCD, chest pain during exertion or mod-severe mitral regurg
Describe congenital long QT syndrome
Inherited autosomal dominant
Abnormalities in K+ or Na+ channels
Adrenergic surges provoke arrhythmia
What sport can commonly cause SCD in pts with congenital long QT syndrome?
Swimming d/t adrenergic surge associated w/ diving into cold water
Sx of congenital long QT syndrome
Palpitations, dizziness, syncope
How to manage congenital long QT syndrome in athletes
Avoid sports w/ adrenergic surge (swimming, sprinting, basketball, soccer, football, hockey)
Rx w/ BB
Describe presentation + dx of myocarditis
Febrile illness w/ coryza prodrome, CP, palpitations
Raised troponin, non specific ECG changes (ST + T wave abnormalities)
Management of myocarditis in athlete
No strenuous exertion or sports for 6mo
Describe WPW
Accessory conduction pathway between atria and ventricles
Predisposes pt to re-entrant supra-ventricular tachycardia - can switch to VFib
Describe ECG changes for WPW
Short PR interval
Delta wave (slurred upstroke of QRS)
How to treat WPW + when to RTP
Radiofrequency ablation of accessory pathway
3mo post op
Describe Brugada syndrome
Genetic disorder causing sodium ion channel dysfunction
Higher incidence in Asians
Describe ECG changes in Brugada syndrome
ST elevations in V1-3
Inverted T waves
Gradually descending ST wave
Management of Brugada syndrome
High risk of VFib so no sports
Implantable defib
RTP for atrial flutter
If no flutter in 3mo can RTP
If co-existing structural heart defects, okay to do low risk sports
If ablation or surgery + no heart defects, RPT 2-4 wks
What is Marfans syndrome?
Autosomal dominant collagen disorder
What are the cardinal features of Marfans?
Aortic root aneurysm + dislocated lenses
What are the stigmata of Marfans syndrome?
Thumb sign - entire distal phalanx extends beyond ulnar border of palm when thumb fully extended
Wrist sign - grasp wrist + thumb covers entire nail of 5th finger
Pectus carinatum or excavatum
Hindfoot valgus with forefoot abduction
Pes planus
++ Tall
Severe myopia
Spontaneous pneumothorax
Striae
Mitral valve prolapse
Aortic regurg
Dissection of ascending aorta
Scoliosis or kyphosis
Reduced elbow extension
Arachnodactyly
High arched palate
Long, narrow head
Span to height >1.05 (arm span>height)
What are the sports restrictions for Marfans?
Athletes can participate in low to moderate dynamic sports unless they have severe mitral regurg, aortic root dilatation or aortic dissection
Should not participate in wt lifting or contact sports
Complications of Marfans
Aortic dissection or aortic rupture
Aortic valvular insufficiency owing to aortic root dilatation
Mitral valve insufficiency, often associated with myxomatous change
Bacterial endocarditis
Spontaneous pneumothorax
Retinal detachment
Sx of measles
Acute, viral, resp illness
Prodrome of fever + malaise
Cough, coryza, conjunctivitis
Koplik spots on buccal mucosa then generalised maculopapular rash
Infectivity period in measles and + complications
Infectivity
Contagious 4 days before + after onset of rash
Incubation 1-3 wks
Complications - encephalitis
Infectivity, sx + complications of mumps
Infectivity
Viral infection involving parotid gland
Sx 2-3 wks after exposure
Sx
Swollen, painful parotid glands, fever, HA, weakness, fatigue, myalgias
Complications
Orchitis, pancreatitis, oopheritis, mumps encephalitis, hearing loss
Cause + transmission of Zika, + sx
Transmitted by aedes mosquito (same as dengue fever)
Can be transmitted via sex - wait 8 wks (female) or 6mo for men (lasts longer in semen)
Fever, rash, joint pain
Complications + prevention of Zika
Can lead to Guillain-Barre
Causes microcephaly if passed to fetus
Long sleeved clothes, insect repellant w/ deet, don’t go to areas while pregnant, mosquito bed at night, safe sex practices
Causes of traveler’s diarrhea
viral (rotavirus, norovirus), E coli, salmonella, shigella, cryptosporidium, giardia, campylobacter
What are the four most common MRI sequences?
T1 weighted : provides Sharp and atomic detail, good for meniscal pathology, lacks sensitivity to detect soft tissue injury
Proton density, weighted: good for menisci and ligaments
T2 weighted: highly sensitive for soft tissue injury, especially tendons
STIR: highlights access water which can occur due to bone stress, joint fluid and soft tissue pathology. Imaging of choice for subtle fractures.
What are the phases of muscle loading?
Concentric - muscle tensioning + shortening at same time
Isometric - muscles tensioned and contracted but no movement
Eccentric - muscles acting while lengthening to control or slow down muscle
Food sources of vitamin D
Portobello mushrooms, salmon, mackerel, tuna, sardines, egg yolk, liver, dairy
Food sources of B12
Liver, sardines, lamb, salmon, eggs, milk, cheese, nutritional yeast.
Food sources of calcium
Sardines, dairy, tofu, white beans, kale, bok choy, almonds, broccoli
Food sources of magnesium
Spinach, brown rice, macro, dark chocolate, pumpkin seeds, almonds, black beans, avocado, yoghurt
Food sources of potassium
Avocado, spinach, sweet potato, tomato paste, salmon, tuna, dried apricot, white beans, banana
Food sources of iron
Liver, beef, sardines, turkey, lentils, tofu, beans, dark chocolate, spinach, pistachios, quinoa
Food sources of zinc
Oysters, lamb, beef, lentils, chickpeas, cashews, yoghurt, mushrooms, spinach, chicken
Carb strategy day before, after and on match day
Day before: high glycaemic index carbs
Breakfast day of: low glycaemic index carbs
Pre-match: low glycaemic index carbs 3 to 4 hours before match
During match: high glycaemic index drinks or gels
Post match: high glycaemic index food and drink for several hours
Day after: high glycaemic index food and drinks
Pros and cons of casein protein
Slow release protein can increase muscle protein synthesis overnight if taken before bed, protein has been shown to be better and taken regularly
Pros and cons of whey protein
Protein is essential for muscle protein synthesis, unnecessary if sufficient protein is consumed in diet
Pros and cons of Creatine
Improve speed, strength, power and high intensity exercise capacity. Can increase mass which may not be wanted, can possibly increase cramping
Pros and cons of Caffeine
Prolong endurance performance, increase lipid oxidation, increase mental alertness
Side effects like nausea, headache, tremors
Potential nutritional concerns and actions needed for vegan athletes
Low energy intake, low protein intake, low B12, low iron, low calcium, low vitamin D
Educate about risk of nutrition deficiencies, full dietary review, consider B12 supplement, consider creatine supplement, may need labs
Potential nutritional concerns and actions needed for injured athlete
Loss of lean muscle mass, increasing body fat, increased inflammation
Increase protein intake, consider omega-3 supplements, consider collagen supplements if bone, ligament or tendon injury, consider calcium or vitamin D supplements if bone injury, avoid alcohol intake
Potential nutritional concerns and actions needed for travelling athlete
Becoming ill, lack of appropriate food, danger of meat contamination, dangerous drinking tapwater
Promote and sanitisation, plan ahead and take food for flight, stay hydrated on flight
Potential nutritional concerns and actions needed for athlete with allergies
Risk of allergic reaction
Ensure team is aware, label food accurately with allergens, consider referring to allergist for confirmation
Potential nutritional concerns and actions needed for athlete with minor illness
Performance impaired, potential spread illness, reduced appetite, dehydration
Considers zinc, lozenges and vitamin C, consider electrolytes, consider using smoothies if appetite suppressed, increased hand sanitisation for whole team
Describe the pattern of restrictive lung dz, obstructive lung dz + exercise induced bronchoconstriction on PFT values
Obstructive Lung Disease (e.g., asthma, COPD):
FEV₁: Decreased (<80% predicted).
FVC: Normal or mildly reduced.
FEV₁/FVC: Reduced (<0.7).
Restrictive Lung Disease (e.g., pulmonary fibrosis):
FEV₁: Decreased (<80% predicted).
FVC: Decreased (<80% predicted).
FEV₁/FVC: Normal or increased (≥0.7).
A decrease of 10% or more in forced expiratory volume in 1 second (FEV₁) from baseline is diagnostic of EIB.
A ≥12% and 200 mL increase in FEV₁ after bronchodilator administration (e.g., albuterol) supports the diagnosis of bronchoconstriction
