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Athletic Injuries > Midterm > Flashcards

Midterm Flashcards

1
Q

Roll Up Injury

MOI, possible injured structures

A

External rotation forced into dorsiflexion from a fall on the ankle from behind
Possible injured structures: deltoid lig, fractured fib, AITFL
- don’t all have to happen and can occur in different order

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2
Q

Healthy Ankle Injury

MOI, injured structures, tests

A

Eversion and external rotation (most commonly in hockey skate or ski boot)
Injured structures: fracture of fibula with no injury to deltoid lig.
Tests: squeeze test and external rotation (both indirect)

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3
Q

High Ankle Sprain

MOI types, injured structures, signs, tests

A

MOI:

1) Dorsiflexion and eversion
2) external rotation of foot w/ internal rotation of leg
3) Postulated to be external rotation and hyperdorsiflexion

Injured structures: AITFL and interosseous membrane

Signs: minimal swelling (noncapsular), toe to heel ambulation, negative ant. drawer and talar tilt, empty end feel in dorsiflexion

Tests: squeeze test, external rotation, length of pain on interosseous

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4
Q

Lower Leg Tendinitis/Paratenonitis

Signs/symptoms, treatment

A

Signs: pain/crepitation of acute onset, red and hot, ankle movement makes it worse, positive STTT

Treatment: POLICE, address training issues, gradual return

TOO MUCH TOO SOON

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5
Q

Retrocalcaneal Bursitis

A 
Inflammation of bursa between tendon and calcaneus 
Usually chronic 
Structural irritants
Pain above insertion of Achilles tendon 
Pain with squeeze from side
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6
Q

Achilles Bursitis

A

Easy to correct
Pain with palpation on posterior aspect of heel
Shoes too tight/excessive friction

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7
Q

Achilles Tendinosis

What is it?, Causes, predisposing factors,

A

Chronic pathological changes brought on my repetitive micro trauma
Inflammatory cells are absent + rice crispies
Changes in collagen fiber structure (disarray + fewer nuclei) and vascularity (neovascularization)

Can be brought on by neglect of tendinitis and worsens with little recovery time

Predisposing facts: years of running, excessive pronation, training in cold climate, improper footwear

Remodel w/ alfredson’s painful heel drops (eccentric)

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8
Q

Stages of Tendinopathies

A

Stage 1 - no pain prior, pain until warm during, after pain goes away with rest

Stage 2 - pain in AM, pain during, pain after

Stage 3 - slight pain before, pain limits activity, no inflammatory mediators but wider b/c it is fraying

Stage 4 - pain even at rest, unable to exercise, may rupture if untreated

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9
Q

Achilles Rupture

A

More common in males in 30-40s
Sports that require rapid change in direction
Reports snap/pop + pain rapidly subsides
Pain 1-2 inches above insertion
Can do double leg heel raise but not single
Divot on palpation
Unable to plantar flex
No pain on stretch because it is completely torn
Positive thompson test
Immobilize w/ 2 cm heel lift for 8 weeks with exercise below neutral for week 2-4

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10
Q 
Compartment Syndrome
(2 types, 4 Ps)
A

Traumatic/Acute: due to direct trauma, can result in devastating injury and is a medical emergency

Exertional/Chronic: starts following increase FITT, usualyl worsens during running/jumping, cease with rest

Pain (out of proportion)
Paresthesia
Paralysis (late finding)
Pulse (lack of)

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11
Q

How to evaluate compartment syndrome?

A

Test strength 10x - looking for weaker, slower, more painful
Stretch muscle - muscles working anaerobically will have pain on stretch
Palpate - firm is bad
Skin colour - pale turn red, dark turn darker

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12
Q

Anterior Compartment of Leg

pain, strength, stretch, nerve, sensory area

A 
Pain: lateral tibia
Strength test: dorsiflexion
Stretch: plantar flexion
Nerve: deep peroneal
Sensory area: b/w 1st and 2nd toes
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13
Q

Lateral Compartment of Leg

A 
Pain: lateral malleolus
Strength test: eversion/plantar flexion 
Stretch: inversion/dorsiflexion 
Nerve: superficial peroneal 
Sensory area: dorsum of foot not near toes
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14
Q

Deep Posterior Compartment of Leg

A 
Pain: lower 1/3 postero-medial tibia
Strength test: inversion/plantar flexion
Stretch: eversion/dorsiflexion
Nerve: tibial
Sensory area: plantar foot (not heel)
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15
Q

Treatment for Compartment Syndrome

A

Slow warm up before activity
Icing after
Stretch before and after
Modify the activity that causes it

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16
Q

What causes Medial Tibial Traction Periostitis (MTTP)

(AKA Medial Tibial Stress Syndrome) - true shin splints

A

Causes by over pronation (due to weak muscles, fatigue, or shoe) and training errors - both cause athlete to modify weight acceptance
Caused by soleus and flexor digitorum longus b/c they eccentrically limit pronation

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17
Q

MTTP - Signs and Treatment

A

Signs: pain on medial tibia that improves with warm up and is worse after, rough/rice crispies over medial tibial margin, minimal STTT signs (can’t produce as much force as running)

Treatment: POLICE, stretch, strengthen to prevent overpronation, correct training errors

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18
Q

Tibial Stress Fractures

cause, presentation, treatment

A

Can be caused by repetitive impact but also if there is muscular imbalance pulling on bone (decreases bone density)

Proximal and anterior stress fractures in the tibia are more resistant to treatment - “anterior is awful”

Presentation: cavus (no shock absorption) or planus (pronated foot - no absorption), gradual onset by exercise, pain all the time and at night

Treatment: decrease weight bearing, pneumatic brace , address training errors, slow return, train in water instead

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19
Q

Which types of muscles are most at risk for strain?

A

Two joint muscles (gastrocs, rectus femoris, hamstrings) and muscles with more fast twitch fibers

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20
Q

Why does a muscle strain occur?

A

Forcible stretch of a passive or active muscle
The stretch must be past the resting length to cause damage
Commonly an eccentric contraction that causes it

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21
Q

Gastroc Strain

A 
Sudden onset
Medial head more susceptible
AKA tennis leg 
Sports with quick starts and stop 
Foot planted and extension of knee
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22
Q

Soleus Strain

A 
Slow onset
Usually lateral 
Calf is tight 
Common in severe pronators
Worse with walking and jogging than sprinting
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23
Q

Signs and symptoms of strain

A

Bruising, swelling, redness

Maybe palpable defect near MT junction

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24
Q

How to test for soleus vs gastroc strain?

A

Bent knee = soleus

Straight knee = gastrocs

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25
Q

How to treat a strain?

A

Same as other acute and subacute but use concentric and eccentric actions (alfredson’s)

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26
Q

Order of assessment

A

3 questions: life or limb, area stable, how to exit?
Subjective/History: MOI, pain, sounds, prior injury, continue?
Objective:
- clear above and below
- tests (ant. drawer, external rotation, squeeze)
- palpate important structures (ottawa ankle/knee rules)
- on sideline: AROM, PROM, resisted

*if there is a fracture - no more tests

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27
Q

What grade means it is not safe to remove athlete from field weight bearing?

A

Anything above grade 1
Grade 1 - weight bearing
Grade 2-3 - non weight bearing

even if it is grade 1 if the athlete does not feel comfortable - remove non weight bearing - better safe than sorry

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28
Q

What pain characteristics should you ask about in the clinical assessment?

A

Sharp = nerve
Localized and deep = bone
Dull and achy = muscle

Does it change? am/pm/sleep/activity

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29
Q

Why is it important if the joint is locking?

A

think about meniscus in the knee

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30
Q

Why is it important if the area feels like it is going to give way?

A

grade 3 injury

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31
Q

Difference between pain and discomfort

A

Pain changes the way you perform an activity, discomfort doesn’t

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32
Q

What is the sideline testing progression for the “minor injury”?

A

Straight - angle - cut - accelerate/decelerate - explosive - jump/kick/spin/strike

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33
Q

Aside from the formal rehab what must the athlete be working on for return to sport?

A

Maintaining their conditioning

Let the athlete know what they can do, not just what they can’t

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34
Q

What do you need to think about for sport specific skill progression?

A

speed, coordination, proprioception, cadence, quality, etc.

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35
Q

What are the three articulating surfaces in the knee?

A

1) Medial and 2) lateral tibiofemoral and 3) patellofemoral

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36
Q

Takes place between the bottom of the femur and the top of the menisci?

A

knee flexion and extension

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37
Q

Takes place between the bottom of the menisci and the tibia?

A

rotation/twisting

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38
Q

When does rotation of the knee occur and why? What is the difference between foot planted and femur fixed?

A

During the last few degrees of extension because the medial femoral condyle is larger than the lateral

Foot planted = femur rotates medially
Femur fixed = tibia rotates laterally

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39
Q

What muscle unlocks the knee?

A

Popliteus contracts to externally rotated the femur

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40
Q

Is the knee more stable in flexion or extension?

A

extension - poor bony fit in flexion

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41
Q

What muscles are the dynamic stabilizers of the knee?

A

hamstrings, quads, IT band, gastrocs

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42
Q

Is the MCL capsular or non capsular?

A

Capsular - slow capsular effusion

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43
Q

Is the ACL intracapsular or extracapsular?

A

Intracapsular - fast swelling (hemarthrosis)

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44
Q

Is the PCL intracapsular or extracapsular?

A

extracapsular

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45
Q

is the LCL capsular or extracapsular?

A

extracapsular

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46
Q

The lateral aspect of the knee is mainly support by___

A

Muscles

Biceps femoris
IT band
Popliteus tendon
Capsular ligaments
Lateral collateral ligament
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47
Q

Lateral knee injuries occur due to a ___. Isolated LCL tears are common/uncommon

A

varus force

Isolated LCL tears are uncommon

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48
Q

Characteristics of the LCL

A

lateral epicondyle of femur to fibular head
extracapsular - minimal swelling
primary STATIC restraint to varus force
Takes load at 25-30 degrees because muscles change angle of pull

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49
Q

The medial aspect of the knee is supported by?

A

MCL is primary stabilizer (at 25-30 degrees)
ACL/PCL
Muscles - medial hamstrings, medial gastroc, quads
boney structure

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50
Q

Characteristics of the MCL

A

capsular - slow swelling
connects directly to MCL - likely injured together
Medial femoral epicondyle to tibia
has superficial and deep components

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51
Q

With a knee injury that has damaged the MCL, medial meniscus, what else is likely to be injured?

A

ACL

then PCL

52
Q

Structure of the ACL

A

goes from anterior tibia to lateral femoral condyle
has 3 bands - two of which are major: anteromedial (controls forward and back) and posterolateral (medial rotation)
primary restraint for anterior tibial translation (greatest at 30 degrees)

53
Q

Which cruciate ligament is stronger?

A

PCL

54
Q

What does the ACL do?

A

restrict posterior translation of femur during weight bearing
restrict anterior translation of tibia during non-weight bearing

55
Q

The anteromedial band of the ACL tighten in __

the posterolateral band of the ACL tightens in __

A

flexion

extension

56
Q

Structure of the PCL

A

medial condyle of femur to posterior tibia

has anterolateral and posteromedial bands (opposite to ACL)

57
Q

What does the PCL do?

A

restrict anterior translation of femur during weight bearing

restrict posterior translation of the tibia during non weight bearing

58
Q

The anterolateral band of the PCL tightens in___

The posteromedial band of the PCL tightens in __

A

flexion

extension

59
Q

General ligament principles:
Lateral rotation makes the __ tight
Medial rotation makes the __ tight

A

lateral rotation - collateral

medial rotation - cruciate

60
Q

What is the purpose of the menisci?

A

distribute nutrients on compression
stabilize knee by increasing concavity
Shock absorption (greatest at 90 degrees knee flexion)

61
Q

Characteristics of the medial meniscus?

A

C shaped
greater radius of curvature
tight connection with MCL and capsule
Poor mobility

62
Q

Characteristics of the lateral meniscus?

A

O shaped
smaller radius of curvature
Attached loosely to capsule
Increased mobility

63
Q

Each meniscus has three zones, what are they and what is the implication?

A

red-red - heals well
red-white
white-white

64
Q

What are the Ottawa Knee Rules?

What should you be suspicious of?

A

Xray when one of the following is present:
Age greater than 55 or less than 18
Tender over fibular head or patella
Inability to flex to 90 degrees (swelling/fracture)
Inability to walk 4 steps

Be suspicious of: MVA, young patients who could have avulsed a bone, clinically loose people

65
Q

Important questions to ask people with knee injuries?

A

MOI - foot planted or not, contact or non contact, pop/crack
were you able to continue? If not, how did you get of the field?
Locking or giving way since?

66
Q

MCL injury MOI

A

valgus force with or without external rotation

can occur in isolation

67
Q

LCL injury MOI

A

less common but more complicated

varus with or without hyperextension

68
Q

What is something done differently with knee injuries during the acute stage?

A

instead of restricting ROM, we want to maintain gentle flexion/extension and dynamic stabilizers (quads/hams)

69
Q

ACL injury MOI

A

occurs with contact or non contact
during cutting or single leg landing
1) deceleration/internal rotation
2) quads active - anterior tibia translation (main mechanism)
3) valgus after MCL
can occur in isolation or with other structures
NOT through hyperextension (protected in notch)

MAY SEE LATERAL JOINT LINE BRUISE - DO NOT CONFUSE WITH LCL

70
Q

Why are there more ACL injuries in females than males?

A

1) anatomical - smaller intracondylar notch, wider pelvis, ligament laxity
2) hormonal - estrogen (not well proven)
3) neuromuscular - increased quad activation between 10 and 30 degrees, activate quads before hams, cut and land differently

71
Q

Knees should be bent on landing because __

A

the line of pull in flexion is more backwards vs in standing it is vertical

72
Q

Findings on an ACL injury

A 
Restricted movement in extension
Lateral joint tenderness (bone bruise - do not mistake for LCL)
Positive lachmans (better because in 20-30 flexion when ligaments are loose and hamstrings don't contribute as much) and anterior drawer (90 degrees)
73
Q

During grade 3 ACL injuries what do we do in the acute stage?

A

prepare for surgery
POLICE
maintain quads/hams strength - required for surgery

74
Q

PCL Injury MOI

A

Sports or MVA (dashboard injury)
commonly due to hyperflexion
valgus after MCL and ACL
varus after LCL and ACL

75
Q

Presentation of PCL injury

A

pop in posterior knee
poorly defined pain in back of knee
minimal swelling - extracapsular
posterior drawer test and sag test positive

76
Q

With ACL injury we want to strengthen __

With PCL injury we want to strengthen __

A

ACL - strengthen hamstrings

PCL - strengthen quads

77
Q

Acute meniscal injuries usually occur in (young/old) adults through combination of flexion, compression and rotation. In full flexion they accept __% of the laod

A

usually young adults

85% of load at 90 degrees

78
Q

Medial meniscus is __x more likely to be injured and MOI is?

A

5x more likely

MOI - internal femoral rotation and possible varus

79
Q

Lateral meniscus MOI

A

hyper flexion or external rotation

80
Q

Presentation of meniscus injuries

A

pain on squatting
restricted ROM - locking
quicker swelling if lateral (red-red)
medial meniscus has less swelling
positive mcmurrays (heel is pointed to side we are testing)
distraction test should have no pain (pulling surfaces apart)

81
Q

Factors indicating surgery for meniscus

A

locked knee
severe twisting
positive mcmurrays - pretty bad

82
Q

With ankle injuries in acute stage we __ ROM and with knee injuries we ___ ROM

A

ankle - restrict

knee - maintain

83
Q

Patella subluxation or dislocation MOI

A 
moves out of groove laterally
MOI: 
tibia ER and femur IR
foot planted 
lateral/varus force
knee usually in extension
84
Q

Predisposing factors for patellar instability

A

patella alta (high riding)
shallow LFC or flat patella
mechanical dysfunction with excessive femoral internal rotation
lax bodies

85
Q

Symptoms/Signs of Patellar Dislocation

A 
knee pop out
pain until reduced
fast swelling - hemarthrosis
loss of knee function if still dislocated
tender of MEDIAL border
positive lateral apprehension
86
Q

What injury has similar presentation to patellar dislocation?

A

ACL - because of the fast swelling and loss of knee function
to tell them apart: ACL will hurt on lateral joint bruise and Patella has pain medially

87
Q

To relocate patella:

A

slightly flex hip and slowly extend the knee

If it does not, do NOT force it because there be other injured structures - send for xray

88
Q

How to treat someone who has dislocated their patella?

A

PROTECT
POLICE
maintain ROM
strengthen associated structures

89
Q

Why should we be cautious of the painful then suddenly not painful injury?

A

grade 3

90
Q

What should you do on the primary survey?

A

U responsiveness (alert, verbal, pain, unresponsive)
Airway
breathing
circulation
spinal injury, deformation, bleeding, shock (if any of these activate EAP and go)
if not then secondary assessment

91
Q

Why do we clear above and below when doing onfield assessment?

A

to rule out injuries to other areas and assess athlete’s tolerance to handling

92
Q

Palpate the knee for:

A

ottawa knee rules (patella and fibular head)

MCL, LCL, hamstrings, ITB, joint lines

93
Q

Knee tests:

A 
patellar apprehension
lachmans
anterior and posterior drawer
mcmurrays (meniscus)
valgus/varus stress (MCL and LCL)
94
Q

Hamstring strains are the most common and have high reoccurrence, what muscle is usually injured ?

A

biceps femoris
active in terminal swing to initial stance
often injured in terminal swing before heel strike (eccentric)

95
Q

Intrinsic and extrinsic factors contributing to hamstring strain are:

A

intrinsic: age (over 23), previous injury, strength (quads more than hams), flexibility, lumbopelvic stability
extrinsic: warm up, fatigue (muscles absorb less and change in coordination), training (increase in FITT)

96
Q

Symptoms and signs for hamstring strain

A

sudden onset
spasm (grade 1) or tear (grade 2-3)
difficulty moving
pain near head of biceps (MT junction)

Bruising
positive STTT
palpable gap

97
Q

Grade 1 strain

A

slight tightness
4-5/5 strength
fewer than 20% torn

98
Q

Grade 2 strain

A

pop or tearing sensation
can’t extend knee
2-3/5 strength
70-80% torn

99
Q

Grade 3 strain

A

pop or tearing
can’t extend knee
0-1/5 strength
more than 80% torn

100
Q

Quadriceps Strain MOI

A

sudden forceful contraction of hip and knee
most common in rectus femoris (2 joint)
unlike hamstrings the tear is near distal MT junction, if they are proximal they are harder to rehab (bull-eye lesion)

similar presentation to hamstring train

101
Q

For strains it is important to ___

A

compression because it prevents blood from localizing

102
Q

During the remodelling stage of strains it is important to work____

A

eccentrically and concentrically

103
Q 
Thigh contusion (AKA \_\_\_)
MOI
A

AKA charlie horse
usually result of impact to relaxed thigh
intra or intermuscular

104
Q

Signs and Symptoms of thigh contusion

A 
may be able to continue
sudden decrease of ROM following
bruising
STTT contraction
may have palpable mass (do NOT massage out)
105
Q

How to test for inter vs intramuscular contusion

A

prone knee bend

if knee bend is less than 90 degrees after 24-48 hours it is most likely intramuscular

106
Q

Grade 1 quad contusion (mild)

A

greater than 90 degrees flexion
may not remember
sore after
minimal strength lost

107
Q

Grade 2 quad contusion (moderate)

A

45 to 90 degrees flexion
tender to touch but finishes game
loss of strength to pain

108
Q

Grade 3 quad contusion (severe)

A

less than 45 degrees flexion
rapid onset - may not finish game
functional loss of strength

109
Q

Key points with quad contusions

A

risk to rebleed in first 7-10 days
hands OFF (nothing until after 48 hours to promote lymphatic drainage)
no aggressive stretch past pain

110
Q

How to treat a quad contusion in first 24 hours?

A

passively and painlessly flex knee to 120 degrees and wrap
ice
crutches
every couple hours unwrap and pump to prevent blood clot

111
Q

How to treat quad contusion after 24 hours?

A

idealize ROM
idealize quad girth and firmness
regain mobility
donut pad for return to sport

112
Q

Myositis Ossificans (types)

A

Periosteal - connected to bone
Heterotopic - within muscle belly

osteoblasts replace fibroblasts and form bone
stops at 6-7 weeks w/ bone reabsorption
muscles can’t function properly

113
Q

Risk factors leading to myositis ossificans from contusion

A

didn’t control bleeding aggressively enough
too vigorous therapy: massage, heat, stretch
knee flexion less than 45 degrees 2-3 days post

114
Q

Symptoms of myositis ossificans

A

increasing morning pain, activity pain, night pain
Loss in ROM
woody on palpation

115
Q

Acute compartment syndrome of the thigh

What is the normal pressure, what can it get to?

A

normal 20 mmHg

can get to 80-100 mmHg

116
Q

What muscles can be affected with hip and groin strains?

A

iliopsoas
rectus femoris
adductors (gracilis, pectineus, longus, brevis and magnus)

117
Q

Adductors are usually ___

Iliopsoas is usually ___

A

acute

chronic

118
Q

Adductor strain

MOI and signs

A 
sudden change of direction
acute and well localized - belly of adductor longus
pain with resisted adduction 
pain of passive hip abduction 
bruising
119
Q

Treatment of adductor strain

A

control bleeding and swelling in first 48

after 48 - focus on muscular imbalances, concentric and eccentric, rapid change of direction, exercise progression

120
Q

Groin Strain - Hip Flexor MOI

A

forced extension and/or excessive contraction of flexors
can be:
rectus femoris (acute)- tenderness 8-10 cm below ASIS
iliopsoas (chronic) - repetitive hip flexion, poorly localized deep pain

121
Q

How to tell the difference between rectus femoris and iliopsoas for groin strain?

A

rectus - pain with flexed knee stretch, pain with active knee extension, positive elys (ipsilateral) and two joint with bent knee

iliopsoas - pain with hip flexion stretch (straight knee), pain with resisted hip flexion with extended knee, positive thomas (contralateral) test and two joint straight knee

122
Q

How to treat a groin strain?

A

POLICE
concentric and eccentric
address muscular imbalances
wrap with hip spica

123
Q

Groin Strain - Abduction, extension and external rotation MOI

A

combination of previous two (adductor and groin strain)
largely due to eccentric movement
common in hockey (skating)
pain on resisted flexion, adduction and internal rotation

look at: muscle imbalances, shooting style, flex of equipment

124
Q

Hip Pointer injury MOI

A

iliac crest contusion and abdominal contusion
disabling - crushing of soft tissue between hard objects
common with improper equipment/placement
immediate pain, decline in hip function, check pain through pelvic ring - pelvic crest can be fractured

125
Q

Female genital injuries

A

straddle fall most common
labial/vulvar contusion, perineal tearing, vaginal laceration
contusion can cause hematomas that we must apply pressure to so it doesn’t form a mass

126
Q

Male genital injuries

A

Most common due to blunt trauma
can be:
- testicular/scrotal contusion (immediate excruciating that improves w/ cremasteric muscle spasm)

-testicular torsion (testicle rotates on spermatacord) - due to forceful cremasteric contraction - medical emergency
unilateral pain and testicle may not be vertical anymore

Athletic Injuries (3 decks)

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