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KIN 424 - Medical Aspects of Sport > Module 8 - Sport-Related Vascular Conditions > Flashcards

Module 8 - Sport-Related Vascular Conditions Flashcards

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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
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2
Q

What is FLIA?

A
  • Flow limitations in the Iliac Artery
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3
Q

What is PAES?

A
  • Popliteal Artery Entrapment Syndrome
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4
Q

What is CECS?

A
  • Chronic Exertional Compartment Syndrome
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5
Q

What are Flow limitations in the Iliac Artery?

A
  • Blood flow limitation during exercise
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6
Q

What do Flow limitations in the iliac artery consist of?

A
  • Functional Stenosis
  • Structural Stenosis
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7
Q

What is Functional Stenosis?

A
  • Artery is compressed
  • Kinked by a combination of surrounding tissue & anatomical/biomechanical position
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8
Q

What is Structural Stenosis?

A
  • The artery wall itself undergoes maladaptive changes (endofibrosis)
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9
Q

How do the symptoms of Flow limitations in the Iliac Artery change over time?

A
  • Begins non-specific
  • Progressive months - years
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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

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11
Q

What are the non-specific symptoms of flow limitations in the iliac artery?

A
  • Pain
  • Burning
  • Powerlessness
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12
Q

What are the symptoms of FLIA?

A
  • Ischemia
  • Hypoxia
  • Claudication
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13
Q

What is Claudication?

A
  • pain in your thigh, calf, or buttocks that happens when you walk
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14
Q

What is the progression that occurs with FLIA?

A
  • Functional to structural stenosis
  • Worsening symptoms
  • Earlier onset
  • Slower Recovery
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15
Q

What are some risk factors for FLIA?

A
  • cycling
  • extreme body position
  • long training hours
  • high demand for O2 delivery
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16
Q

How do you assess FLIA?

A
  • Questionnaire
  • Exclusionary tests
  • Functional Assessment
  • Maximal Ramp Exercise Test
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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
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18
Q

What is the specialist clinical evaluation of FLIA?

A
  • Echo-Doppler Ultrasound Imaging
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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
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20
Q

What does echo-doppler ultrasound imaging view?

A
  • Arterial kink
  • excessive length (tortuosity)
  • endofibrosis / stenosis
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21
Q

What causes maladaptive endofibrosis?

A
  • Artery thickens to resist turbulent flow
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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
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23
Q

What are some biomechanical techniques used to reduce the risk of FLIA?

A
  • Reduce active pulling on the upstroke
  • Push down harder
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24
Q

How does reducing active pulling on the upstroke of cycling reduce the risk of FLIA?

A
  • Decrease Psoas recruitment
  • Increase Glutes Recruitment
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25
Q

What training modifications can you make to reduce the risk of FLIA?

A

Decrease
- Intensity
- Volume
- Volume of Intensity
- Symptoms

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26
Q

What should training zones account for?

A
  • Symptoms
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27
Q

What exercises can be done to reduce the risk of FLIA?

A
  • Core, hips & lumbar stabilization
  • Must be individualized
28
Q

What symptoms of FLIA might need surgical management?

A
  • Arterial kink
  • Excessive Length (tortuosity)
  • Endofibrosis / stenosis (narrowing)
29
Q

What is the surgical management of a lengthened iliac artery?

A
  • Surgical shortening
30
Q

What is the surgical management of an artery that is predisposed to kink?

A
  • artery excised from surrounding tissues
31
Q

Describe Adductor Canal Compression / Venous Outflow Syndrome

A
  • Superficial Femoral aa. & vv. compression
  • Hypertrophied Quad & Adductor mm.
32
Q

What are the symptoms of Adductor Canal Compression / Venous Outflow Syndrome?

A
  • Ischemia
  • Hypoxia
  • Claudication
  • Swelling
  • Heaviness
  • Paraesthesia
33
Q

What is the management of adductor canal compression/venous outflow syndrome?

A
  • Surgical Release
34
Q

What happens during a 60-sec isometric contraction?

A
  • blood volume pushed out
  • During relaxation, blood volume flow back in
35
Q

What is NIRS reoxygenation sensitive to?

A
  • Severity of arterial flow limitations
36
Q

Why might there be back flow of deoxygenated blood? How can it be identified?

A

Why
- Upstream outflow limitation
How Identified
- Near-infrared spectrometry

37
Q

What can NIRS identify? what can it not?

A

Can
- back-flow of deoxygenated blood
Can Not
- upstream limitation location

38
Q

What is adductor canal compression / venous outflow syndrome?

A
  • Mechanical compression of microvasculature
39
Q

Describe the mechanical compression of microvasculature that occurs with adductor canal compression / venous outflow syndrome

A
  • Local compression from hypertrophied muscle
  • ‘Up-stream’ venous compression
40
Q

What occurs with the mechanical compression of microvasculature that occurs with adductor canal compression/venous outflow syndrome?

A
  • ‘backflow’ of deoxygenated (venous) blood volume on muscle relax
41
Q

Describe Popliteal Artery Entrapment Syndrome

A
  • Compression of Artery, Vein, Nerve
42
Q

What are the types of popliteal artery entrapment syndrome?

A
  • Structural
  • Functional
43
Q

What subtypes of popliteal artery entrapment syndrome are there?

A
  • I-VI & F
44
Q

When is structural popliteal artery entrapment syndrome most common?

A
  • males > 40
45
Q

When is functional popliteal artery entrapment syndrome most common?

A
  • Females < 40
46
Q

What are the symptoms of popliteal artery entrapment syndrome?

A
  • Claudication
  • Swelling
  • Fullness
  • Paraesthesia
47
Q

What is the diagnosis of popliteal artery entrapment syndrome?

A
  • Provocative testing
  • Duplex Ultrasound Imaging
  • MR angiography, CT scan
48
Q

What are provocative testing diagnostics of popliteal artery entrapment syndrome?

A
  • exercise
  • calf raises
49
Q

What does duplex ultrasound imaging test for?

A
  • Peak systolic velocity
50
Q

What can MR angiography, CT scan result in when testing for Popliteal Artery Entrapment Syndrome?

A
  • High False Positives
51
Q

What are some potential injuries that could present like popliteal artery entrapment syndrome?

A
  • Tibial Fracture
  • Compartment Syndrome
  • Bursitis
  • Nerve Entrapment
  • Referred Pain Sciatica
  • Muscle Strain
52
Q

What are some complications with Popliteal Artery Entrapment Syndrome?

A
  • Thrombosis (clot blocking vein)
  • Embolism (detached piece of thromboembolus)
53
Q

What are some management techniques for popliteal artery entrapment syndrome?

A
  • Soft tissue treatment
  • Botox Injections
  • Surgical decompression (fasciotomy, myotomy)
  • Vascular repair, re-routing, bypass
54
Q

What is Chronic Exertional Compartment Syndrome ?

A
  • Compression of Fascial Compartments
  • Muscle, Artery, Vein, Nerve
55
Q

What is Chronic Exertional Compartment Syndrome caused by?

A
  • Mechanical pressure
56
Q

What are the symptoms of Chronic Exertional Compartment Syndrome?

A
  • Claudication
  • Paraesthesia
  • Fullness
  • Weakness
  • Swelling
  • Hernia
  • Hypoxia
  • Ischemia
  • Nervous Sensory Disruption
57
Q

Describe the onset and recovery of chronic exertional compartment syndrome

A

To Start
- Gradual onset during training
- Rapid Recovery
Over time
- Faster onset
- Slower recovery

58
Q

Does chronic exertional compartment syndrome impact one side more than the other?

A

Sometimes but:
- commonly bilateral

59
Q

What is an important sign of chronic exertional compartment syndrome progression?

A
  • Earlier onset and slower recovery
60
Q

What is used to diagnose chronic exertional compartment syndrome?

A
  • Needle manometry pressure testing
  • NIRS muscle oxygenation
61
Q

What is the management technique used to treat chronic exertional compartment syndrome?

A
  • Manual Therapies (not very effective)
  • Surgery - Fasciotomy
  • Training modification / reduction
  • Forefoot running
62
Q

What is Acute Compartment Syndrome?

A
  • Severe Tissue Ischemia
63
Q

What is is the usual cause of acute compartment syndrome?

A
  • Often Direct Trauma
64
Q

What are the symptoms of Acute Compartment Syndrome?

A
  • Paresthesia
  • Weakness
  • Paralysis
  • Pain “out of proportion to injury”
65
Q

What is the treatment for acute compartment syndrome?

A

Surgical
- Fasciotomy

KIN 424 - Medical Aspects of Sport (11 decks)

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