PC Gen Sports Flashcards
Muscles that originate from the AIIS
direct head of the rectus femoris (femoral n)
Treatment of AIIS avulsion fx
Nonop: bed-rest, ice, activity modification
- hip flexed for 2 weeks
- - position lessens stretch of affected muscle and apophysis
- hip flexed for 2 weeks
- follow with guarded weight bearing for 4 week
Indication for operative tx of sports hernia
Failed extensive nonop tx
-> pelvic floor repair (hernia operatoin) vs adductor recession
Osteitis pubis
inflammation of the pubic symphysis caused by repetitive trauma
common in soccer, hockey, football, running
Site of compression in piriformis syndrome
Anterior to the piriformis muscle or posterior to obturator internus/gemelli complex
Test to reproduce symptoms of piriformis syndrome
Flexion, adduction and internal rotation of the hip
3 types of snapping hips (coxa saltans)
- External snapping hip –> IT band sliding over greater troch
- Internal snapping hip –> iliopsoas sliding over femoral head, prominent iliopectineal ridge, exostoses of lesser troch, or ilipsoas bursa
- Intra-articular snapping hip –> loose bodies inthe hip (eg. synovial chondromatosis) or labral tears
“external can be seen from across the room; internal can be heard from across the room”
Treatment painful external snapping hip failed nonop tx
Excision of greater trochanter bursa with z-plasty of IT band
Treatment painful internal snapping hip failed nonop tx
Release of iliopsoas tendon
Best test to confirm diagnosis of internal snapping hip
Ultrasound
Population with highest incidence of hip labral tears
acetabular dysplasia
Most common location for hip labral tears
anterosuperior labrum
Provocative test for anterior labral tears
FABER –> EAdIR
Provocative test for posteroir labral tears
FAdIR –> EAbER
Best test to assess for hip labral tear
MRI arthrogram
First line treatment for hip labral tears
Nonop –> rest, NSAIDs, PT, steroid injections
No long term f/u
Indications for surgical repair of hip labral tears
Failed nonop tx & tear at chondrolabral junction (if not amenable to repair, debride it)
False profile XR (utility and positioning of beam)
- to assess anterior coverage of the femoral head
- - standing position at an angl eof 65 deg btw pelvis and film
Alpha angle on radiographs
- frog leg lateral of the hip
- line 1 = ctr of femoral head to ctr of neck
- line 2 = ctr of femoral head to point along anterolateral neck where prominence begins
Normal alpha angle
< 42
Contraindication to open surgical hip dislocation for FAI
** Gold standard **
age > 55, morbid obesity, advanced joint disease
Time to return to sports in adolescent athlete after surgical hip dislocation for FAI
7 months
Complications of arthroscopic surgery for hip FAI
Most common complication = chondral injury
- traction related pudendal nerve injury
- dislocation
- femoral neck fx
- heterotopic ossification (more open surgery)
- persistent Cam or Pincer lesion
Most common reason for revision surgery for FAI
Residual FAI
Contraindications for hip arthroscopy
- advanced DJD
- hip akylosis
- joint contracture
- severe osteoporotic bone
- significant protrusio
Purpose and location of anterolateral portal in hip arthroscopy
Primary viewing portal; established first
2 cm anterior & 2 cm superior to the anterosuperior border of the greater troch
Purpose and location of posterolateral portal in hip arthroscopy
Posterior access ot the hip joint (never done this)
2 cm posterior to the tip of the greater troch
Purpose and location of anterior portal in hip arthroscopy
Anteroir access to the hip joint
Located at intersection btw superior edge of greater troch and ASIS
Postop protocol for hip scope
NWB for one week then progressive WB
Return to full activity w/in 3 mos
Structure at risk of anterolateral portal in hip scope
Superior gluteal nerve
Structure at risk of posterolateral portal in hip scope
Sciatic nerve — increased risk with ER of hip
Structure at risk of anterior portal in hip scope
Lateral femoral cutaneous nerve
Femoral neurovascular bundle
Ascending branch of the lateral femoral circumflex artery
Pulled groin - aka adductor strain — most common population, mechanism & muscle injured
Soccer/hockey players
Forceful external rotation of abducted leg
Adductor longus most common injured
Treatment of pulled groin
Nonop
Rest, ice, protected WB as needed
Rehab program — gentle stretching, progressing to resistance exercises and core strengthening then gradual return to sports
Most common location of hamstring injuries
Myotendinous junction
Mechanism of injury hamstring tear
Hip flexion and knee extension
Myotendinous junction (most common) — sprinter
Avulsion off ischial tuberosity — water skier
Indications for nonop treatment of hamstring injuries
- Most hamstring injuries
- single tendon, retraction <1-2cm
- rupture at myotendinous junction
rest, ice, NSAIDS, protected WB for 4 wks followed by stretching & strengthening
May return to play with hamstring is 90% contralteral side
Indications for operative tx of hamstring injuries
- proximal avulsion ruptures
- partial avulsion that failed nonop tx for 6 mos (persistent symptoms)
- at least 2 tendons but > 2 cm retraction in young, active pts
Treatment of thigh contusions
Immobilize in 120 degrees flexion using ace wrap or HKB immediately after injury for 24-48 hrs, with frequent use of cold therapy
Most commonly affected compartment for exercise induced compartment syndrome
Anterior leg compartment (70%)
How to measure pressures for exercise inducedcompartment syndrome:
3 pressures measures
- resting pressure
- immediate post-exercise pressure
- continuous post-exercise pressure for 30 min
Diagnostic criteria for exertional compartment syndrome
resting (pre-exercise) pressure > 15 mmHg
immediate (1 minute) post-exercise is >30 mmHg and/or
post-exercise pressure >20mmHg at 5 minutes
post-exercise pressure >15 mmHg at 15 minutes
Cause of shin splints
Traction periostitis
Most commonly posteromedial –> traction periostitis of tibialis posterior & soleus
Female athlete triad
- amenorrhea
- eating disorder
- osteoporosis
Most sensitive & specific test to assess for femoral neck stress fx
MRI
Indication for nonop treatment of femoral neck stress fx
Compression sided stress fx with fatigue line < 50% femoral neck width
Indications for ORIF with percutaneous screw fixation of femoral neck stress fx
- Tension sided stress fxs
- Compression sided stress fxs with fatigue line > 50% femoral neck width
- Progression of compression sided stress fxs
Most common location of tibial stress fx
Anterior (tension) sided fx
Treatment of tibial stress fx
Nonop — activity restriction with protected weight bearing
Indication for operative tx of tibial stress fx
If “dreaded black line” is present — especially if violates anterior cortex –> IMN
Most common cause of sports related death
Traumatic brain injury
Risk factors for concussion
- sports with player-to-player contact
- Prior concussion
- Female
- Age < 18 yrs
- Mood disorders, learning disorders, h/o migraines
Most commonly used tool to assess for concussion
SCAT5
Red flags in pt with concussion
Neck pain or tenderness Double vision Weakness or tingling/burning in the arms or legs Severe or increasing headache Seizure or convusion Loss of consciousness Deteriorating conscious state Vomiting Increasingly restless, agitated or combative
Graduated return to play protocol for concussion
- Symptom-limited activitiy
- Light aerobic exercises
- Sport-specific exercises
- Non-contact training drills
- Full contact practice
- Return to play
Each step should take 24 hrs; takes at least 1 wk to complete
Contraindication to return to play in cervical spine injury in sports
- transient quadriplegia with sever stenosis
- spear tackler’s spine
- ligamentous instability
- upper c-spine abnls (odontoid hypoplastia; os odontoideum)
- Klippel Feil with long fusoin segment or limited motion
Indication for MRI with stinger
bilateral symptoms (r/o c-spine pathology like herniated disc)
Cause of heat cramps
hyponatremia
painful contractions of large muscle groups due to decreased hydration & decreased serum sodium/chloride
Defintition of heat stroke
- hyperthermia
- tachycadia/tachypnea
- CNS dysfunction
- anhidrosis
- body temp above 40.5C
Treatment of heat stroke
Rapid reduction in core body temperature and IV hydration
Isotonic
Force remains constant through range of motion
eg. Biceps curls
Isometric
Constant muscle length that is proporitonal ot exertional load
eg. Pushing against and immovable object
Concentric muscle contraction
Shortened muscle nd tension that is proportional to the exertional load
eg. Biceps curl with elbow flexing
Eccentric muscle contraction
Force remains constant as muscle lengthens — most effectient method of strengthening a muscle
Biceps curl with elbow extending
Isokinetic
Muscle contracts at a constant velocity through varied resistance
Requires special machines (eg. Cybex)
Open chain exercises
Distal end moves freely
eg. Seated leg extensions & curls
Closed chain exercises
Distal end of extremity is fixed
eg. Squats with planted foot
Aerobic exercise
- Energy source
- Muscle type
- Exercise duration
Aerobic:
- oxidative phosphorylation (Krebs cycle); glycogen & fatty acids
- Type I muscle –> slow twitch
- high endurance
–> hight yield ATP; requires O2; “slow red ox muscles”
Anaerobic exercise
- Energy source
- Muscle type
- Exercise duration
Anaerobic:
- ATP-CP
- Type II (A,B) –> fast twitch
- 10 seconds of high intensity
Type IIA –> aerobic & anaerobic
Type IIB –> primariy anaerobic
Periodization
strength and conditioning term for planned variation in intensity and duration of a specific workout over a predefined duration of time
Changes seen in adolescens with weight training
gains in strength largely due to improved neuromuscular activation and coordination rather than muscle hypertrophy
Carbohydrate loading
- gains in strength largely due to improved neuromuscular activation and coordination rather than muscle hypertrophy
- best technique is to actually just maintain a normal diet
Mechanism of healing for muscle tears
Mediated by myofibroblasts
– TGF-beta stimulates differentiaiton and proliferation of myofibroblasts
Iontophoresis
use of electrical current to drive charged molecules of medicine through the skin into deep tissues
Most common cause of sudden death in young athletes
cardiac pathology
- syncope
- hypertrophic cardiomyopathy
- CAD
- commotio cordis
- long QT syndrome
Best screening tool for identifying cardiovascular problems in high school athletes
History & physical
Most common cause of sudden cardiac death
hypertrophic cardiomyopathy
After mono – timing to return to sports
No contact sports for at least 3-5 wks — until splenomegaly is resolved
Workup in female athlete wit hh/o amenorrhea and stress fx
DEXA scan
Side effects of anabolic steroids
- HTN
- liver tumors
- Increased LDL
- Decreased HDL
Human growth hormone mechanicsm
most abundant substance produced by pituitary gland — has direct anabolic effect by accelerating the incorporation of Aas into proteins — works like IGF-1 — increased muscle size but not strength
Effect of glucagon on skeletal muscle
catabolic effect
Side effects of creatine
Cramps, increased muscle injury, renal insufficiency (rare)
Mechanism of injury for hip pointer (iliac crest contusion)
“direct trauma or crushing
– hematoma occurs in area around iliac wing”
Mechanism of injury for ASIS avulsion
”– indirect trauma
- sudden and forceful contraction of the sartorius and TFL
- occurs during hip extension [sprinting (sartorius) or swinging baseball bat] (TFL)]”
Muscles that originate from the ASIS
sartorius & tensor fascia lata
Treatment of ASIS avulsion fx
“Nonop –> rest, protected WB with crutches, early ROM and stretching
RARE –> ORIF —-> if displaed >3cm or symptomatic nonunion”
Mechanism of injury for AIIS avulsion
“typically occurs due to eccentric contraction of the rectus femoris (femoral n.)
as hip extends and knee is flexed
causes avulsion of its anatomic origin off the pelvis”
