Module 8 - Sport-Related Vascular Conditions Flashcards
1
Q
What are the four sport-related vascular conditions in endurance athletes?
A
- Flow limitations in the Iliac Artery
- Adductor Canal Compression / Venous Outflow Syndrome
- Popliteal Artery Entrapment Syndrome
- Chronic Exertional Compartment Syndrome
2
Q
What is FLIA?
A
- Flow limitations in the Iliac Artery
3
Q
What is PAES?
A
- Popliteal Artery Entrapment Syndrome
4
Q
What is CECS?
A
- Chronic Exertional Compartment Syndrome
5
Q
What are Flow limitations in the Iliac Artery?
A
- Blood flow limitation during exercise
6
Q
What do Flow limitations in the iliac artery consist of?
A
- Functional Stenosis
- Structural Stenosis
7
Q
What is Functional Stenosis?
A
- Artery is compressed
- Kinked by a combination of surrounding tissue & anatomical/biomechanical position
8
Q
What is Structural Stenosis?
A
- The artery wall itself undergoes maladaptive changes (endofibrosis)
9
Q
How do the symptoms of Flow limitations in the Iliac Artery change over time?
A
- Begins non-specific
- Progressive months - years
10
Q
Why are the initial symptoms of Flow limitations in the iliac artery difficult to detect?
A
Difficult to differentiate from:
- Normal Exertional Discomfort
- Common Musculoskeletal injuries
- Overuse
- Overtraining
11
Q
What are the non-specific symptoms of flow limitations in the iliac artery?
A
- Pain
- Burning
- Powerlessness
12
Q
What are the symptoms of FLIA?
A
- Ischemia
- Hypoxia
- Claudication
13
Q
What is Claudication?
A
- pain in your thigh, calf, or buttocks that happens when you walk
14
Q
What is the progression that occurs with FLIA?
A
- Functional to structural stenosis
- Worsening symptoms
- Earlier onset
- Slower Recovery
15
Q
What are some risk factors for FLIA?
A
- cycling
- extreme body position
- long training hours
- high demand for O2 delivery
16
Q
How do you assess FLIA?
A
- Questionnaire
- Exclusionary tests
- Functional Assessment
- Maximal Ramp Exercise Test
17
Q
What is an Ankle-Brachial PRessure Index?
A
- Blood pressure at ankle(s) will be reduced if flow is limited
- Comparing both legs to each other, and to arm
18
Q
What is the specialist clinical evaluation of FLIA?
A
- Echo-Doppler Ultrasound Imaging
19
Q
What is echo-doppler ultrasound imaging?
A
- imaging at rest, after exercise and with muscle contraction
- observe artery diameter, course, possible kink
- compare bilaterally
20
Q
What does echo-doppler ultrasound imaging view?
A
- Arterial kink
- excessive length (tortuosity)
- endofibrosis / stenosis
21
Q
What causes maladaptive endofibrosis?
A
- Artery thickens to resist turbulent flow
22
Q
What are some bike and body positions that can reduce the risk of FLIA?
A
- Upright handlebar, closer to body
- Forward Saddle
- Shorter Cranks
- Rearward Cleat Position
- Flat Shoes
23
Q
What are some biomechanical techniques used to reduce the risk of FLIA?
A
- Reduce active pulling on the upstroke
- Push down harder
24
Q
How does reducing active pulling on the upstroke of cycling reduce the risk of FLIA?
A
- Decrease Psoas recruitment
- Increase Glutes Recruitment
25
What training modifications can you make to reduce the risk of FLIA?
Decrease
- Intensity
- Volume
- Volume of Intensity
- Symptoms
26
What should training zones account for?
- Symptoms
27
What exercises can be done to reduce the risk of FLIA?
- Core, hips & lumbar stabilization
- Must be individualized
28
What symptoms of FLIA might need surgical management?
- Arterial kink
- Excessive Length (tortuosity)
- Endofibrosis / stenosis (narrowing)
29
What is the surgical management of a lengthened iliac artery?
- Surgical shortening
30
What is the surgical management of an artery that is predisposed to kink?
- artery excised from surrounding tissues
31
Describe Adductor Canal Compression / Venous Outflow Syndrome
- Superficial Femoral aa. & vv. compression
- Hypertrophied Quad & Adductor mm.
32
What are the symptoms of Adductor Canal Compression / Venous Outflow Syndrome?
- Ischemia
- Hypoxia
- Claudication
- Swelling
- Heaviness
- Paraesthesia
33
What is the management of adductor canal compression/venous outflow syndrome?
- Surgical Release
34
What happens during a 60-sec isometric contraction?
- blood volume pushed out
- During relaxation, blood volume flow back in
35
What is NIRS reoxygenation sensitive to?
- Severity of arterial flow limitations
36
Why might there be back flow of deoxygenated blood? How can it be identified?
Why
- Upstream outflow limitation
How Identified
- Near-infrared spectrometry
37
What can NIRS identify? what can it not?
Can
- back-flow of deoxygenated blood
Can Not
- upstream limitation location
38
What is adductor canal compression / venous outflow syndrome?
- Mechanical compression of microvasculature
39
Describe the mechanical compression of microvasculature that occurs with adductor canal compression / venous outflow syndrome
- Local compression from hypertrophied muscle
- 'Up-stream' venous compression
40
What occurs with the mechanical compression of microvasculature that occurs with adductor canal compression/venous outflow syndrome?
- 'backflow' of deoxygenated (venous) blood volume on muscle relax
41
Describe Popliteal Artery Entrapment Syndrome
- Compression of Artery, Vein, Nerve
42
What are the types of popliteal artery entrapment syndrome?
- Structural
- Functional
43
What subtypes of popliteal artery entrapment syndrome are there?
- I-VI & F
44
When is structural popliteal artery entrapment syndrome most common?
- males > 40
45
When is functional popliteal artery entrapment syndrome most common?
- Females < 40
46
What are the symptoms of popliteal artery entrapment syndrome?
- Claudication
- Swelling
- Fullness
- Paraesthesia
47
What is the diagnosis of popliteal artery entrapment syndrome?
- Provocative testing
- Duplex Ultrasound Imaging
- MR angiography, CT scan
48
What are provocative testing diagnostics of popliteal artery entrapment syndrome?
- exercise
- calf raises
49
What does duplex ultrasound imaging test for?
- Peak systolic velocity
50
What can MR angiography, CT scan result in when testing for Popliteal Artery Entrapment Syndrome?
- High False Positives
51
What are some potential injuries that could present like popliteal artery entrapment syndrome?
- Tibial Fracture
- Compartment Syndrome
- Bursitis
- Nerve Entrapment
- Referred Pain Sciatica
- Muscle Strain
52
What are some complications with Popliteal Artery Entrapment Syndrome?
- Thrombosis (clot blocking vein)
- Embolism (detached piece of thromboembolus)
53
What are some management techniques for popliteal artery entrapment syndrome?
- Soft tissue treatment
- Botox Injections
- Surgical decompression (fasciotomy, myotomy)
- Vascular repair, re-routing, bypass
54
What is Chronic Exertional Compartment Syndrome ?
- Compression of Fascial Compartments
- Muscle, Artery, Vein, Nerve
55
What is Chronic Exertional Compartment Syndrome caused by?
- Mechanical pressure
56
What are the symptoms of Chronic Exertional Compartment Syndrome?
- Claudication
- Paraesthesia
- Fullness
- Weakness
- Swelling
- Hernia
- Hypoxia
- Ischemia
- Nervous Sensory Disruption
57
Describe the onset and recovery of chronic exertional compartment syndrome
To Start
- Gradual onset during training
- Rapid Recovery
Over time
- Faster onset
- Slower recovery
58
Does chronic exertional compartment syndrome impact one side more than the other?
Sometimes but:
- commonly bilateral
59
What is an important sign of chronic exertional compartment syndrome progression?
- Earlier onset and slower recovery
60
What is used to diagnose chronic exertional compartment syndrome?
- Needle manometry pressure testing
- NIRS muscle oxygenation
61
What is the management technique used to treat chronic exertional compartment syndrome?
- Manual Therapies (not very effective)
- Surgery - Fasciotomy
- Training modification / reduction
- Forefoot running
62
What is Acute Compartment Syndrome?
- Severe Tissue Ischemia
63
What is is the usual cause of acute compartment syndrome?
- Often Direct Trauma
64
What are the symptoms of Acute Compartment Syndrome?
- Paresthesia
- Weakness
- Paralysis
- Pain "out of proportion to injury"
65
What is the treatment for acute compartment syndrome?
Surgical
- Fasciotomy
