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Sports Injuries > Midterm 1 > Flashcards

Midterm 1 Flashcards

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1
Q

What are the three stages of healing

A
  1. Inflammation
  2. Repair
  3. Remodeling
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2
Q

Inflammation stage of healing

A
  • Generic response to tissue threat
  • Often exaggerated and quickly reversible
  • Acute inflammation involves biochemical mediators
  • Presents clinically using SHARP symptoms
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3
Q

What are the SHARP symptoms

A

Swelling
Heat
Altered function
Redness
Pain

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4
Q

What are the 3 biochemical mediators involved in inflammation and what do they cause

A

MEDIATORS:
- Histamine
- Prostaglandin
- Bradykinin
CAUSES:
- vasodilation
- increased permeability
-increased sensitivity of nerve endings (acute hyperalgesia)

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5
Q

What is edema

A

Fluid leaks from vessels into tissues

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6
Q

What is a hematoma

A

collection of blood that has escaped vessels

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7
Q

Hemarthrosis

A

bleeding into joint cavity

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8
Q

Joint effusion

A

Synovial membrane creates excess synovial fluid

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9
Q

What occurs during the repair or proliferative stage of healing

A
  • Macrophages clean through phagocytosis
  • Fibroblasts build temporary foundation by creating and laying collagen (limited structural integraty)
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10
Q

What occurs during the remodeling or maturation stage of healing

A
  • No net gain in collagen
  • Synthesis of new high quality, well organized collagen balances breakdown of original foundation
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11
Q

when does the remodeling phase start and how long does it last

A

starts 3 weeks post injury and lasts up to 2 years

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12
Q

When dos the repair stage begin and how long does it last

A

Starts 2 days post injury and can last up to 3 weeks

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13
Q

How long does the inflammation stage last

A

72 hours

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13
Q

how does the repair stage present clinically

A
  • better than inflammation
  • pain, swelling etc. should disappear by end
  • heat and redness mostly done
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13
Q

What is the funnel progression when assessing a pateint

A

History
Observation
ROM
Resistance
Special Tests
Palpation

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14
Q

How does the remodeling stage present clinically

A

Able to introduce progressively more challenging/ sport specific skills as musculature becomes stronger and develops more endurance

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14
Q

Assessing injury: History

A
  • Introduction to patient and listen to injury story
  • Inquire about clinical presentation (consequences of injury, signs and symptoms, functional impact)
  • learn about person (general health, previous history, current physical activity demands)
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14
Q

Assessing injury: Observation

A
  • Consent
  • Qualitative and bilateral to compare
    LOOKING FOR:
  • swelling
  • deformity
  • discoloration
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15
Q

Assessing Injury: ROM

A

LOOK FOR:
- Limited
- Excessive (damage to ligaments, capsuls etc.)
- Pain
THEN INTERPRET

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16
Q

Reasonable values for ROM in Knee

A

Flexion: 140
Extension: 0
Medial Rotation: 30
Lateral rotation: 40

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16
Q

Reasonable values for hip ROM

A

Flexion: 120
Extension: 30
Medial Rotation: 45
Lateral rotation: 45

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17
Q

Reasonable values for ankle ROM

A

Dorsiflexion: 20
Plantarflexion: 50
Inversion: 20
Eversion: 20

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18
Q

Reasonable values for Shoulder ROM

A

Flexion: 180
Abduction: 180
Medial rotation: 70
Lateral rotation: 90

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19
Q

Assessing injury: resistance

A

THROUGH MANUAL STREGTH TEST GRADING
0. can’t contract at all
1. flicker of contraction, can’t create motion
2. moves but can’t over come gravity
3. can overcome gravity, can’t handle additional force
4. Able to meet additional resistance
5. Strength = to uninvolved side

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20
Q

Assessing injuries: Special tests and palpation

A
  • Use index of suspicion (IOS) list
  • reproduce mechanism of injury
  • reproduce symptoms
  • no test is perfect (may have to do multiple different ones)
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21
Q

Grades of ligament tears

A
  1. Tearing of only a few ligament fibers
  2. More severe partial tearing of the ligament
  3. Complete tear of the ligament
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22
Q

When is pain most likely to show up?

A
  1. injured muscle contracts
  2. injured tissue is pulled apart
  3. injured joint surface is compressed
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23
Q

What does PEACE refer to when discussing care for soft tissue injuries

A

Protect
Elevate
Avoid
Compress
Elevate

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24
Q

Plantar Fasciopathy

A
  • Plantar heel pain ( where fascia anchors)
  • Localized pain that sometimes spreads
  • Pain in the morning or while running
  • insidious onset
  • Usually prevalent in runners or old fat sedentary people
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25
Q

Windlass Mechanism

A
  • Great stretch on plantar aponeurosis caused by impact with plantarflexion
  • Stretch causes bounce back to supination
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26
Q

Potential factors causing plantar fasciopathy

A
  • Excessive pronation
  • BMI >30kg/m^2
  • Plantar flexor tightness
  • limited Dorsiflexion
27
Q

MTSS

A

MEDIAL TIBIAL STRESS SYNDROM
- Insidious onset
- exercise-induced lower leg pain
- distal posteromedial tibial border
- pain extends more than 5cm

28
Q

What should you watch out for in MTSS indicating compartment syndromes

A
  • Cramping, burning, pressure
  • Neurological Symptoms (pins and needles, numbness)
  • Signs or symptoms of vascular disfunction (discoloration, bad capillary refill)
  • increased pressure in compartment affects blood and nerve supply to that compartment
29
Q

What are the two competing MTSS hypotheses

A

Periostitis
- Stemming from local soft tissue tensile loading
Bone Stress
- Response related to impact loading and bony integrity

30
Q

Periostitis

A

Flexor digitorum longus and soleus attaches where MTSS pain originates. At this point the deep crural fascia is pulled on creating a tensile load leading to pain
- Functions such as plantar flexion, eccentric load during dorsiflexion, toe flexion, supination and pronation

31
Q

Bone stress MTSS hypothesis

A

Loading on bone causes posterior bending which compresses the tibial cortex causing pain

32
Q

Bone density in athletes with MTSS

A

23% lower than matched athletes
- May normalize as symptoms improve

33
Q

Physiology of bone stress injury

A
  • Remodeling by osteoblasts and osteoclasts
  • Edema, structural fatigue and microfracture possible
34
Q

Achilles Tendinopathy

A
  • caused by repetitive impact (jumping or running sports)
  • insidious onset
  • thickened, swollen paratenon
  • morning stiffness
35
Q

Why is achilles vulnerable

A
  • Twisting structure of the tendon
  • Region of hypovascularity (slow healing)
  • High tensile loading (up to 10x body weight
36
Q

Reactive tendinopathy

A
  • Acute
  • Proteoglycans (hyperexcited state) and bound water - not truely inflammatory
37
Q

Tendon disrepair and degeneration

A

Chronic (tendinosis)
- CAS and stiffness

38
Q

Windlass test in WB

A

Used to asses MTSS or Turf Toe
- Put weight on injured leg
- manually ex toe

39
Q

Thompson Test

A

Used to asses Achilles rupture
- Squeeze gastrocnemius muscle belly
- foot should planterflex

40
Q

One leg hop variations

A

Assess power and strength in injured vs uninjured
DISTANCE
- Single hop
- triple hop
- crossover (triple jump alternating side of line) - more commonly used in soccer players
TIMED
- 6 meter timed hop test

41
Q

Bracing for lower limb injuries

A
  • Involves semi-rigid hinge brace for 6 weeks
  • 0.3 RR of recurrent sprains
  • 0.69 RR of first time sprains
42
Q

Rocker bottom Shoe

A
  • Used for high ankle sprain, 2nd and 3rd degree ankle sprain, turf toe, fracture
  • Allows role through gait
43
Q

Plantar fasciopathy treatment

A

Night sock that prevents morning stiffness of fascia (Strasberg)

44
Q

Alfredson Eccentric Heal Drop Protocol

A
  • Used for Achilles tendinopathy
  • Eccentric load to whatever you can tolerate
  • 3 x15 2 times a day
  • 180 heel drops per day
  • maybe don’t need to do that many
45
Q

Preventative measures to injuries when starting running

A
  • Change the training surface
  • Reduce training speed, duration, frequency
  • increase volume of rest
  • try graded running program
46
Q

MOI components of a knee injury

A
  • Contact or non-contact activities
  • hyperflexion or hyperextension
  • rotational stress
  • valgus collapse
  • trunk control
  • foot and ankle
47
Q

How does swelling rate indicate injury in knee

A

Slow swell - meniscus (increased synovial fluid acting like a splint 24 hours)
Fast swell - ACL, PCL (hemarthrosis ligament damage with blood supply, 1-4 hours)
No affusion - MCL

48
Q

Whip test

A
  • Allows you small amounts of synovial fluid
  • palm sweeps up medial side of leg and then sweeps down lateral side
49
Q

ACL injury risk in female and male athletes

A
  • 1 in 29 female
  • 1 in 50 male
    RR= 1.5
50
Q

Risk of injury based on family history and primary ACL injury

A

RR= 2.53

51
Q

Patellar tendinopathy

A
  • Pain on apex of patella
  • Absorbs eccentric energy
  • Tendon heals slowly
52
Q

Anterior knee pain

A
  • 20 to 30% of the population
  • Extension and energy absorption aggravate it
  • Crepitus sound/sensation
  • knee buckle due t decrease quad reflex activity
53
Q

Patellofemoral Pain syndrome

A
  • Pain distribution: deep under patella, margins of patella, mostly lateral side
  • Caused by compression and shear beyond tolerance
  • possible explanations include patellar mal-alignment or training overload
  • quad pulls patella laterally and lateral condyle sticks out more increasing shear force (especially in valgus position)
  • deep squat increases compression
54
Q

What percent of athletes have patellar tendinopathy

A

18%
- more in court sports

55
Q

Possible risk factors for patellar tendinopathy

A
  • Flexibility in the quads, ham/ hip ex, plantarflexors
  • jumping/training volume
56
Q

What is the name of the special test for the menisci

A

McMurry

57
Q

What is the name of the special test for the ACL

A

Lachman

58
Q

What is the name of the special test for the PCL

A

Posterior Drawer

59
Q

What is the name of the special test for the MCL

A

Valgus stress test

60
Q

What is the name of the special test for LCL

A

Varus stress test

61
Q

What mechanisms should you check when assessing anterior knee pain

A
  • trunk and pelvis
  • quads
  • valgus/varus
  • arch of foot
  • internal rotation steaming from hip
62
Q

Acute knee injury prevention programs

A

Plyometrics
Feedback on landing technique
Agility
Balance
Strength

63
Q

ACL IRR with injury prevention programs

A

0.47

64
Q

Knee injury IRR with injury prevention programs

A

0.73

65
Q

Female soccer lower extremity injury IRR with injury prevention programs

A

0.73

66
Q

What are the goals of knee injury prevention programs

A
  • Control/limit valgus knee position and hip internal rotation
  • Address asymmetry in limb mechanics
  • Increased knee flexion and avoid full extension
  • improved trunk contol
67
Q

Patellar tendon strap

A
  • may reduce pain on single leg squat
  • pressure on painful part of tendon
  • pressure changes direction of force
68
Q

Taping for patellofemoral pain

A
  • Can reduce pain for some athletes
  • addresses laterally located patella
  • may impact position to reduce pain
69
Q

Exercise protocols for AKP recovery

A
  • Eccentric stress (controlled tensile load strengthens tendon) - heal elevated and max flexion
  • Moderate to heavy, slow resistance protocols (6-8 seconds under tension 50-90% of 1RM)
70
Q

What muscle groups should be considered for training in AKP

A

Hip abductors, hip external rotators and knee extenders
- for some athletes foot target exercises

Sports Injuries (2 decks)

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