Ortho/Sports/MSK Flashcards
When do you need to wear eye goggles in sports?
CORRECTED vision worse than 20/40
For any sport with high risk of eye injury (basketball, baseball, hockey, lacrosse, racket sports)
Wrestling is low risk, but no eye goggles available so CANNOT participate!
Heat stroke vs Heat Exhaustion
Heat stroke: T > 40 and mental status changes
- Tx: rapid cooling ideally by immersing the affected individual in ice water until he or she becomes more responsive and core temperature is below 39°C.
Heat exhaustion: T < 40 but elevated, cramping, fatigue, tachycardia
- Tx: stop exercising and drink fluids
Syncope with myoclonic jerks VS. Seizure
Syncope with myoclonic jerks
- unresponsiveness with muscle jerking
- very rapid recovery and return to baseline
- no postictal phase
- may have some FHX leading you to think cardiac (long QT)
- needs cardiac w/u and no sports until then
Seizure
- postictal phase
- recovery less fast
- NOT an absolute contraindication to sports. Some sports swimming, diving, archery, and powerlifting, may pose a higher risk.
How should T1DM pts try to prevent hypoglycemia during exercise?
Lower their pre-exercise insulin dose or decrease their basal infusion of insulin 1 to 2 hours before exercise.
Post-exercise hypoglycemia risk typically peaks about 3 to 4 hours after exercise.
Boy who got “popped hip” with resulting pain at anterior inferior iliac spine with pain on flexion and extension of hip
anterior inferior iliac spine (AIIS) apophyseal avulsion injury
due to pediatric skeletal immaturity
In what sports are concussion rates the highest?
football
boys’ hockey
boys’ lacrosse
girls’ soccer.
Do boys or girls have a higher rate of concussion in high school sports?
GIRLS
Is rate of concussion higher during game or practice?
Game
The rate of concussion is higher during sports competition than during practice. However, because athletes typically spend more time practicing than in competition, the absolute number of concussions is often higher in the practice setting
Do helmets decrease rate of concussion?
NO.
Implementation of rules that limit player-to-player contact during practice and competition appears to be a successful strategy for reducing sports concussion.
Protective headgear, mouthguards, and helmets with increased padding have not proven effective in preventing concussions.
What is an ankle sprain?
Ligamentous injury
The anterior talofibular and calcaneofibular ligaments are the most often sprained.
The initial treatment of ankle sprain is aimed at decreasing swelling, and includes compression, ice, and elevation. Early mobilization of the joint is associated with faster recovery - so you’d recommend stir-up style brace and ROM exercises.
When should you get an XR of ankle?
unable to bear weight on the affected ankle
those with tenderness involving the tip or posterior aspect of the ankle malleoli.
How do you reduce risk of ACL tear?
Neuromuscular training program would reduce her risk
Insidious onset knee pain, tenderness over inferior pole of patella suggests what etiology
Apophysitis involving inferior pole of the patella
Patellofemoral pain syndrome
Chronic anterior knee pain without inciting injury Pain with prolonged sitting instability with running Pain with climbing/descending stairs Can be bilateral
PE: Pain over medial patella, pain with compression, mild swelling
If someone has aortic stenosis with pressure gradient < 20 and normal exercise test, what sports can they participate in?
Mild AS = all sports with annual cards re-eval
Also:
Mod AS= low dynamic and static component
Severe AS = restricted
Back pain causes in children
Most are mechanical - physical therapy
If there is anatomic cause, most likely spondylosis.
- back pain with extension and activity
Non-ossifying Fibroma, Fibrous Dysplasia, Unicameral bone cyst
Non-ossifying Fibroma: small, well-defined radiolucent cortical lesion with a surrounding rim of sclerosis
Nonossifying fibromas larger than 50% of a bone’s diameter carry a risk of pathologic fracture and should be followed every 6 to 12 months with radiographs. Small NOFs resolve spontaneously, and do not require follow-up.
BUT can look like fibrous dysplasia. Fibrous dysplasia lesions, while benign, tend to enlarge with growth and have a significant risk of pathologic fracture.
Unicameral bone cyst: fluid-filled cysts surrounded by a thin rim of bone. They most commonly originate in the proximal humerus or proximal femur. Children with UBCs in locations where a fracture is likely to lead to surgery, such as the femoral neck, should be referred to an orthopaedic surgeon for treatment with either corticosteroid injection or operative management.
General Principles for evaluating bone cyst
Sclerosis of the bone surrounding a radiolucent defect is indicative of a stable, benign lesion.
Bone lesions that expand beyond the cortex, and do not have distinct margins, are concerning for malignancy and warrant referral to oncology or orthopaedic surgery.
How do you treat club foot [congenital talipes equinovarus (TEV)] ?
Immediate referral to Ortho for serial casting.
Ponseti method includes serial casting, surgery to cut the Achilles tendon, and bracing.
How to distinguish club foot from metatarsus adductus?
Infants with metatarsus adductus have normal ankle motion, while those with TEV are fixed in a plantarflexed position (aka can’t dorsiflex).
Casting and splinting may be useful for infants with metatarsus adductus that persists beyond age 6 months, though this condition almost always resolves spontaneously by the age of 3 to 4 years.
What syndrome is associated with vertebral fusions and what imaging studies do you need to recommend?
Klippel-Feil syndrome
- congenital fusions of cervical vertebrae (can lead to neck pain and atlantoaxial instability)
- may be associated with Sprengel deformity - congenital elevation and rotation of the scapula due to failure of scapula to descend to normal position
- can also vertebral fusions at other levels
- may have renal associated abnormalities
- also associated with congenital heart disease and hearing loss
Imaging:
- renal US
- XR of spine to find other fusions
Vertebral Anomaly -> Renal Abnormalities
Intoeing Causes
Metatarsus adductus, internal tibial torsion, and femoral anteversion are normal developmental variants that lead to the appearance of intoeing, and typically do not require treatment.
Acute calf pain and stiff gait after an acute illness most likely due to?
Influenza causing acute myositis
How do you treat Osgood schlatter?
Osgood-Schlatter disease is an apophysitis of the tibial tuberosity
Patellar strap
Strengthening/Stretching exercises
can continue physical activities unless limping or severe activity related pain
Toe-walking
Normal in children < 3 and most will resolve btwn 5-6 years of age (school age). Usually familial
Effects
- may have lower exercise tolerance bc toe walking expends more energy
- may have more ankle sprains/LE pain as adults
PE:
- should have good tone, strength, reflexes
- should be able to stand with heel on ground
- red flag - if unilateral, needs to be evaluated.
could indicate the presence of hemiplegia, developmental dysplasia of the hip, or leg-length discrepancy.
Tx: reassurance. but if does not resolve, can use PT, ankle foot orthoses
Congenital muscular torticollis: cause and treatment
Likely secondary to trauma to the SCM muscle. Prominent cause of positional plagiocephaly.
Head tilted to side of injured muscle. Ear and eye ipsilateral to side of injury appear smaller.
Tx: PT with home exercise program, prone positioning during tummy time
What screening test should children with congenital scoliosis undergo?
Congenital scoliosis - results from 1 or more congenital vertebral malformations.
Renal abnormalities in 1/3 of patients - get a renal US
Imaging to evaluate hip dysplasia
US = 5-6 months XR = > 6 months
unilateral toe walking and limited ROM of hip = dislocation
Reactive arthritis
Often associated with other signs of inflam: uveitis, conjunctivitis, urethritis, rash, etc
associated with prior infection - usually GI or GU
synovial fluid shows leuks but no bacteria
Tx: NSAIDS
Treatment of intoeing
most common cause of intoeing in a child older than 2 years is femoral anteversion. In the prone position, there is increased internal rotation of the hip, greater than 45°. External rotation is generally less than 45°. Generalized ligamentous laxity may be present.
Referral to an orthopedic surgeon for a 5 year old child with femoral anteversion is not necessary
Most of the time this self-corrects and no intervention is necessary.
Mechanisms of injury for knee injuries
ACL = sudden deceleration and pivoting of knee
landing from a jump, twisting with the foot planted, and sudden deceleration.
PCL= direct blow to the anterior knee with the knee flexed
Medial meniscus = twisting motion of the planted leg
patellar subluxation and dislocation = forceful quadriceps contraction during a cutting motion
Medial collateral ligament = medially directed blow to the lateral side of the knee describes a mechanism of injury for a medial collateral ligament tear.
Genu Valgus vs Varum Normal
Birth—2 years: varus (bowing) of the knees
2—4 years: valgus (knock-knee) posture
4—7 years: levels off to 4–7° valgus in males and 5–9° in females
The tibiofemoral angle is formed by the angle between the femur axis and the tibia axis and should be measured by standing plain radiographs >10° is considered abnormal.
What test do you do to identify septic arthritis of the sacroiliac joint?
FABER test
Tests for Knee ligaments/meniscus
McMurray
- int rotation = medial meniscus
- ext rotation = lateral meniscus
Anterior drawer = ACL
Posterior drawer = PCL
Varus = lateral collateral
Valgus = medial collateral
Traumatic Myositis Ossificans
Calcification of a Hematoma within damaged muscle following blunt injury
XR shows soft tissue mass with peripheral bone maturation that is separate from the bone (aka not bony neoplasm)
Does not need addition eval if history and XR findings consistent.
Tx: Physical therapy and immobilization
- enables the tissue to heal and mass to reabsorb
- surgery only after period of 6-12 month following injury
Osteochondritis Dissecans
- fragment of necrotic articular cartilage and underlying subchondral bone gradually separates from the adjacent osteocartilaginous tissue.
- most commonly in medial femoral condyle
- repetitive microtrauma
XR: well demarcated radiolucent area - subchondral fragment may be intact or evidence of separation
According to NCAA, what needs to be tested during routine screening for collegiate athletes?
Sickle Cell Disease - due to risk of sudden death from exertional rhabdomyolysis among those with sickle cell trait.
NOT EKG, or any other labs
Little League Elbow
Medial Humeral Epicondyle Apophysitis
- overuse injury
- prevention is limiting number pitches thrown and gettin rest days
Tx: rest. PT
What performance enhancing drug is associated with insulin resistance?
Growth Hormone
- peripheral edema, insulin resistance, hyperglycemia, cardiomegaly, arthralgias/myalgias
VS
Testos - cardiomyopathy, dec HDL incr LDL, testos effects
Tennis Elbow
Lateral epicondylitis
- reproducible wiht wrist extension and supination
Golf
Medial epicondylitis
