PC Gen Sports Flashcards
1
Q
Muscles that originate from the AIIS
A
direct head of the rectus femoris (femoral n)
2
Q
Treatment of AIIS avulsion fx
A
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
3
Q
Indication for operative tx of sports hernia
A
Failed extensive nonop tx
-> pelvic floor repair (hernia operatoin) vs adductor recession
4
Q
Osteitis pubis
A
inflammation of the pubic symphysis caused by repetitive trauma
common in soccer, hockey, football, running
5
Q
Site of compression in piriformis syndrome
A
Anterior to the piriformis muscle or posterior to obturator internus/gemelli complex
6
Q
Test to reproduce symptoms of piriformis syndrome
A
Flexion, adduction and internal rotation of the hip
7
Q
3 types of snapping hips (coxa saltans)
A
- 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”
8
Q
Treatment painful external snapping hip failed nonop tx
A
Excision of greater trochanter bursa with z-plasty of IT band
9
Q
Treatment painful internal snapping hip failed nonop tx
A
Release of iliopsoas tendon
10
Q
Best test to confirm diagnosis of internal snapping hip
A
Ultrasound
11
Q
Population with highest incidence of hip labral tears
A
acetabular dysplasia
12
Q
Most common location for hip labral tears
A
anterosuperior labrum
13
Q
Provocative test for anterior labral tears
A
FABER –> EAdIR
14
Q
Provocative test for posteroir labral tears
A
FAdIR –> EAbER
15
Q
Best test to assess for hip labral tear
A
MRI arthrogram
16
Q
First line treatment for hip labral tears
A
Nonop –> rest, NSAIDs, PT, steroid injections
No long term f/u
17
Q
Indications for surgical repair of hip labral tears
A
Failed nonop tx & tear at chondrolabral junction (if not amenable to repair, debride it)
18
Q
False profile XR (utility and positioning of beam)
A
- to assess anterior coverage of the femoral head
- - standing position at an angl eof 65 deg btw pelvis and film
19
Q
Alpha angle on radiographs
A
- 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
20
Q
Normal alpha angle
A
< 42
21
Q
Contraindication to open surgical hip dislocation for FAI
A
** Gold standard **
age > 55, morbid obesity, advanced joint disease
22
Q
Time to return to sports in adolescent athlete after surgical hip dislocation for FAI
A
7 months
23
Q
Complications of arthroscopic surgery for hip FAI
A
Most common complication = chondral injury
- traction related pudendal nerve injury
- dislocation
- femoral neck fx
- heterotopic ossification (more open surgery)
- persistent Cam or Pincer lesion
24
Q
Most common reason for revision surgery for FAI
A
Residual FAI
25
Contraindications for hip arthroscopy
- - advanced DJD
- - hip akylosis
- - joint contracture
- - severe osteoporotic bone
- - significant protrusio
26
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
27
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
28
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
29
Postop protocol for hip scope
NWB for one week then progressive WB
| Return to full activity w/in 3 mos
30
Structure at risk of anterolateral portal in hip scope
Superior gluteal nerve
31
Structure at risk of posterolateral portal in hip scope
Sciatic nerve --- increased risk with ER of hip
32
Structure at risk of anterior portal in hip scope
Lateral femoral cutaneous nerve
Femoral neurovascular bundle
Ascending branch of the lateral femoral circumflex artery
33
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
34
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
35
Most common location of hamstring injuries
Myotendinous junction
36
Mechanism of injury hamstring tear
Hip flexion and knee extension
Myotendinous junction (most common) --- sprinter
Avulsion off ischial tuberosity --- water skier
37
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
38
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
39
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
40
Most commonly affected compartment for exercise induced compartment syndrome
Anterior leg compartment (70%)
41
How to measure pressures for exercise inducedcompartment syndrome:
3 pressures measures
- - resting pressure
- - immediate post-exercise pressure
- - continuous post-exercise pressure for 30 min
42
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
43
Cause of shin splints
Traction periostitis
Most commonly posteromedial --> traction periostitis of tibialis posterior & soleus
44
Female athlete triad
- - amenorrhea
- - eating disorder
- - osteoporosis
45
Most sensitive & specific test to assess for femoral neck stress fx
MRI
46
Indication for nonop treatment of femoral neck stress fx
Compression sided stress fx with fatigue line < 50% femoral neck width
47
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
48
Most common location of tibial stress fx
Anterior (tension) sided fx
49
Treatment of tibial stress fx
Nonop --- activity restriction with protected weight bearing
50
Indication for operative tx of tibial stress fx
If "dreaded black line" is present --- especially if violates anterior cortex --> IMN
51
Most common cause of sports related death
Traumatic brain injury
52
Risk factors for concussion
- - sports with player-to-player contact
- - Prior concussion
- - Female
- - Age < 18 yrs
- - Mood disorders, learning disorders, h/o migraines
53
Most commonly used tool to assess for concussion
SCAT5
54
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
```
55
Graduated return to play protocol for concussion
1. Symptom-limited activitiy
2. Light aerobic exercises
3. Sport-specific exercises
4. Non-contact training drills
5. Full contact practice
6. Return to play
Each step should take 24 hrs; takes at least 1 wk to complete
56
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
57
Indication for MRI with stinger
bilateral symptoms (r/o c-spine pathology like herniated disc)
58
Cause of heat cramps
hyponatremia
painful contractions of large muscle groups due to decreased hydration & decreased serum sodium/chloride
59
Defintition of heat stroke
- - hyperthermia
- - tachycadia/tachypnea
- - CNS dysfunction
- - anhidrosis
- - body temp above 40.5C
60
Treatment of heat stroke
Rapid reduction in core body temperature and IV hydration
61
Isotonic
Force remains constant through range of motion
eg. Biceps curls
62
Isometric
Constant muscle length that is proporitonal ot exertional load
eg. Pushing against and immovable object
63
Concentric muscle contraction
Shortened muscle nd tension that is proportional to the exertional load
eg. Biceps curl with elbow flexing
64
Eccentric muscle contraction
Force remains constant as muscle lengthens --- most effectient method of strengthening a muscle
Biceps curl with elbow extending
65
Isokinetic
Muscle contracts at a constant velocity through varied resistance
Requires special machines (eg. Cybex)
66
Open chain exercises
Distal end moves freely
eg. Seated leg extensions & curls
67
Closed chain exercises
Distal end of extremity is fixed
eg. Squats with planted foot
68
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"
69
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
70
Periodization
strength and conditioning term for planned variation in intensity and duration of a specific workout over a predefined duration of time
71
Changes seen in adolescens with weight training
gains in strength largely due to improved neuromuscular activation and coordination rather than muscle hypertrophy
72
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
73
Mechanism of healing for muscle tears
Mediated by myofibroblasts
-- TGF-beta stimulates differentiaiton and proliferation of myofibroblasts
74
Iontophoresis
use of electrical current to drive charged molecules of medicine through the skin into deep tissues
75
Most common cause of sudden death in young athletes
cardiac pathology
- - syncope
- - hypertrophic cardiomyopathy
- - CAD
- - commotio cordis
- - long QT syndrome
76
Best screening tool for identifying cardiovascular problems in high school athletes
History & physical
77
Most common cause of sudden cardiac death
hypertrophic cardiomyopathy
78
After mono -- timing to return to sports
No contact sports for at least 3-5 wks --- until splenomegaly is resolved
79
Workup in female athlete wit hh/o amenorrhea and stress fx
DEXA scan
80
Side effects of anabolic steroids
- - HTN
- - liver tumors
- - Increased LDL
- - Decreased HDL
81
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
82
Effect of glucagon on skeletal muscle
catabolic effect
83
Side effects of creatine
Cramps, increased muscle injury, renal insufficiency (rare)
84
Mechanism of injury for hip pointer (iliac crest contusion)
"direct trauma or crushing
-- hematoma occurs in area around iliac wing"
85
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)]"
86
Muscles that originate from the ASIS
sartorius & tensor fascia lata
87
Treatment of ASIS avulsion fx
"Nonop --> rest, protected WB with crutches, early ROM and stretching
RARE --> ORIF ----> if displaed >3cm or symptomatic nonunion"
88
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"
