Quiz 4 [CH 13, 14, 15] Flashcards
1
Q
acute injury
A
-caused by trauma
-we can typically refer to a single event when the injury occurred
2
Q
chronic injury
A
-generally results from overuse
-injuries that occur with repetitive dynamics of running, throwing, or jumping
3
Q
diaphysis
A
main shaft of the bone
-middle part of bone
4
Q
epiphysis
A
located at the ends of long bone
-growth areas
5
Q
what are the growth areas of a bone
A
epiphysis
6
Q
articular cartilage
A
covers the ends of bones to provide cushion + protection during movement
7
Q
what 2 bones have articular cartilage + what does it do
A
femur + tibia
-absorbs shock
8
Q
periosteum
A
covers long bones exept at joint surfaces
9
Q
osteoblasts
A
bone forming cells
10
Q
osteoclasts
A
absorb + remove osseus tissue
11
Q
fractures
A
occur as a result of extreme stresses + strains placed on bones
12
Q
how can fractures be classified
A
open or closed
13
Q
open fx
A
bone protruding out of skin
14
Q
closed fx
A
fracture doesn’t penetrate superficial tissue
15
Q
signs + symptoms of fx
A
-obvious deformity
-point tenderness
-swelling
-pain with active + passive ROM
16
Q
transverse fracture
A
occurs in a straight line
17
Q
see image of each type of fx (ch13 ppt, slide 6)
A
18
Q
linear fracture
A
bone splits along its length
-caused by shear forces
19
Q
what forces cause linear fracture
A
shear forces
20
Q
oblique fracture
A
occurs when 1 end receives sudden torsion/twisting, + the other end is fixed/stabilized
-nondisplaced: stays in place
-displaced: bone broken in 2
21
Q
spiral fractures
A
has an “s” shaped separation
22
Q
greenstick fracture
A
complete breaks in bones that have no completely ossified
23
Q
greenstick fx occurs in what population
A
-occurs more often in children
-because they have a lot of collagen in their bones
-collagen keeps the bone springy, making the bone harder to fully break
24
Q
comminuted fracture
A
consists of 3 or more fragments at the fracture site
-bone breaks into a bunch of different pieces
-needs a lot of force to occur + compression
25
if you got into a car accident + knees went into dash in front of you, what fracture most likely would occur
comminuted
26
what can long bones be stressed by
-tension
-compression
-bending
-torsion
-shear
27
in most cases, what must happen to the fractured bone for an extended period
the fx bone must be immobilized for an extended period
28
how long will long bones be immobilized after fx
4-6 weeks
29
how long will small bones be immobilized after fx
3-4 weeks
30
what is one of the most common fx that results from physical activity
stress fractures
31
common sites for stress fx
weight bearing bones of leg or foot
32
how do stress fx occur
repetitive forces transmitted through the bones produce irriation of the periosteum
33
do stress fx show up on x-ray
can be difficult to diagnose
-might not show up on x-ray
34
treatment for stress fx
stop activity for at least 14 days + slowly progress back to activity
35
dislocation
occurs when at least 1 bone in a joint is forced completely out of its normal alignment + must be manually or surgically reduced
36
subluxation
occurs when bone partially comes out of its normal articulation but then goes right back into place
37
what do both dislocation + subluxation likely result in
rupture of stabilizing ligaments + tendons surrouding the joint
38
what should first time dislocation be wary of
fx
39
2 common sites for dislocations/subluxations
-shoulder
-knee
40
difference between dislocation + subluxation
-dislocation won't reset on its own
-subluxation does reset on its own, automatically
41
what 3 joints are the hardest to put back into place + require imaging
-ankles
-elbows
-hips
42
sprain
involves damage to a ligament that provides support to a joint
43
ligament
tough inelastic band that connects 1 bone to another
44
grading system for ligament sprains
-grade 1
-grade 2
-grade 3
45
grade 1 ligament sprain
some stretching with minimal instability of the joint
-mild to moderate pain with localized swelling
46
grade 2 ligament sprain
some tearing + separation of ligament fibers with moderate instability
-moderate to severe pain
-also called "partial tear"
47
grade 3 ligament sprain
total tearing of the ligament which leads to instability
-severe pain
-joint becomes stiff
48
does pain go away faster in grade 2 or grade 3 sprains
goes away faster in grade 3 because in grade 2, pain receptors are still sending signals since partially holding on
49
contusion
aka bruise
-mechanism of injury that involves an impact from some external object that causes soft tissue to be compressed against hard bone
50
myositis ossificans
-if the same muscle is bruised repeatedly, small calcium deposits can accumulate in the injured area
-can significantly impair movement
51
what 2 muscles are most vulnerable for myositis ossificans
-quadriceps
-biceps brachii
52
muslce strain
if a muscle is overstretched or forced to contract against high loads, separation or tearing of the muscle fibers occur
53
grading system for muscle strains
-grade 1
-grade 2
-grade 3
54
grade 1 muscle strain
few muscle fibers have been stretched/torn
-some tenderness + pain on active motion
-full ROM usually possible
55
grade 2 muscle strain
several muscle fibers have been torn + active contraction is extremely painful
-possible swelling + discoloration
56
grade 3 muscle strain
complete rupture of a muscle
-signficant impairment
-loss of ROM
-pain initially but dies down due to nerve fiber separation
57
guarding
following injury, the muscles that surround the injured area contract to in effect splint the area + minimize pain by limiting movement
58
cramps
extremely painful involuntary contractions that most commonly occur in the calf, abdomen, or hamstrings
59
what 3 muscles do cramps most often occur in
-calf
-abdomen
-hamstrings
60
soreness
pain caused by overexertion in exercise
61
acute-onset soreness
occurs during + immediately after exercise
62
delayed-onset soreness (DOMS)
occurs 24-48 hours post exercise
63
nerve injuries usually involve ____ or ____
compression or tension
64
responses produced by nerve injuries
-diminished sense of feeling
-increased sense of feeling
-numbness, prickling, or tingling
65
neuropraxia
sudden nerve pinch or stretch can produce both a sharp shooting pain that radiates down a limb + muscle weakness
-called a stinger
66
what can serious injuries involving the crushing of a nerve cause
lifelong disability such as paraplegia
67
most common overuse/chronic injuries involve a ____
tendon
68
tendinitis
inflammation of the tendon
-general inflammatory response
-only been around 6 weeks or less
69
tendinosis
microtears + degeneration of the tendon
-repetitive overuse continues + the inflamed/irritated tendon fails to heal, the tendon begins to degenerate
-has been around for a longer period of time, usually minimum 6 weeks
-doesn't necessarily have continuous inflammatory response but rather repetitive damage
70
tenosynovitis
inflammation of a tendon + its synovial sheath
-when inflammation occurs, tendons adhere to synovial sheath + cause pain
71
what does the synovial sheath usually do
reduces friction for movement
72
where does tenosynovitis most commonly occur
in the long flexor tendons of the fingers
73
bursae
pieces of synovial membrane that contain a small amount of fluid
-lubricate + cushion joints for fluid motion
-basically water baloons in your body that provide shock absorption
74
bursitis
due to repetitive movement or direct trauma, large amounts of synovial fluid are produced
75
is bursitis chronic or acute
can be both chronic + acute
76
is bursitis an inflammatory condition
yes
77
are there more bursae or articular cartilage in the body
bursae
78
osteoarthritis
wearing down of hyaline cartilage
-can be worn down enough, exposing, eroding, + polishing the underlying bone
79
osteoarthritis most often affects what joints
weight bearing joints
-knees
-hips
-lumbar spine
80
is osteoarthritis common in athletes
no because younger populations
-more common in professional athletes like NFL + MBA because older in professional career
81
myofascial trigger points
area of tenderness in a tight band of muscle
-palpation of trigger points produces pain
82
what causes development of myofascial trigger points
develops due to mechanical stress
-static postural position that produces constant tension in the muscle
83
what are 3 places were myofascial trigger points typically occur
-neck
-upper back
-lower back
84
importance of healing process following injury
any interference with the healing process during a rehab program is likely to slow return to full activity
85
is it possible to speed up healing process
-you can't necessarily speed up the process physiologically
-however, you can create an environment conducive to the healing process
86
3 phases of the healing process
1. inflammation
2. proliferation
3. maturation
87
healing process- inflammation
when it is uncomfortable + often results in swelling, the inflammatory process is crucial for removing damaged cells + beginning tissue repair
-first 48-72 hours
88
healing process- proliferation
in the proliferation phase, collagen is formed + granulation occurs (laying down new CT + tiny blood vessels)
-next 6 weeks
89
healing process- maturation/remodelling
finally the maturation/remodelling stage, which may last up to 2 years, allows new collagen to be synthesized + results in the formation of scar tissue
-next 2 years
90
timeline of healing process
-inflammation- first 48-72 hours
-proliferation- following 6 weeks
-maturation/remodelling- 2 years
91
how many bones in the foot
26 bones
92
how many tarsal bones in the foot
7
93
how many metatarsal bones in the foot
5
94
how many phalangeal bones in the foot
14
95
*be able to identify tarsal bones + arches of the foot on both a skeleton + outside of foot (ch 14 powerpoint slides 2 + 3)*
96
tarsal bones (7)
-talus
-calcaneus
-navicular
-cuboid
-3 cuneiforms (medial, intermediate, lateral)
97
arches of the foot
-medial longitudinal
-metatarsal
-transverse
-lateral longitudinal
98
medial longitudinal arch
along the medial border of calcaneus, extending to the distal head of the first metatarsal
-spring ligament is the main support
99
what is the main support of the medial longitudinal arch
spring ligament
100
plantar fascia
thick white band of fibrous tissue extended the entire bottom of the foot
101
medial movements of foot
-adduction
-supination
102
what muscles produce medial movements of foot (adduction/supination)
muscles passing behind + in front of medial malleolus
-posterior tibialis
103
lateral movements of foot
-abduction
-pronation
104
what muscles produce lateral movements of foot (abduction/pronation)
muscles passing behind + in front of lateral malleolus
-peroneal muscles
105
plantar muscles of foot cause what movement
toe flexion
106
dorsal muscles of foot cause what movement
toe extension
107
how can many injuries to the foot be prevented
by using an orthotic device to correct biomechanical problems
108
what should be performed routinely by athletes in sports that place a great deal of stress + strain on the feet
strenthening, stretching, + mobility exercises
109
majority of foot skin conditions are ____
preventable
-proper hygiene
-washing/drying feet following activity
-changing to clean socks
110
assessment of the foot- history
-how did the injury occur?
-did it occur suddenly or come on slowly?
-what type of pain is there?
-on what type of surface has the athlete been training on?
-is this the first time your foot has been injured?
111
what is sharp pain indicative of
soft tissue injury or fx
112
single most important predictor of injury
if athlete has had injury before
113
if you take a good history...
you should be able to narrow down to top 5 diagnoses at most
114
assessment of the foot- observation
-athlete favoring a foot
-ability to bear weight
-swelling, discoloration
-wear patterns on inside of shoe
115
*know wear patterns (ch 14 ppt slide 7)*
116
assessment of the foot- palpation
-check bony structures first for deformities or areas of point tenderness
-the dorsal pedal pulse should be palpated to check for normal circulation
117
retrocalcaneal bursitis
bursa between achilles tendon + calcaneus becomes irritated by constantly rubbing or pressure from the heel of a shoe
118
signs of retrocalcaneal bursitis
-swelling
-warmth
-redness
-TTP at the calcaneus
119
care for retrocalcaneal bursitis
donut shaped pad to disperse pressure created by heel counter
120
heel bruise
caused by direct blow to heel (acute or chronic)
-often caused by cleats
121
signs of heel bruise
-severe pain at the heel
-unable to tolerate stress of weight bearing
122
care for heel bruise
-cryotherapy initially
-heel cup for protection
-athlete will be out for a while since they cannot weight bear
123
plantar fasciitis
caused by leg legnth discrepancies, inflexibility of the medial longitudinal arch, calf tightness, or shoes without arch support
124
signs of plantar fasciitis
-pain along plantar aspect of foot
-pain in morning after waking up
-pain intensifies when dorsiflexed
125
why is there severe pain in mornings for patients with plantar fasciitis
because we sleep slightly plantarflexed
126
care for plantar fasciitis
-stretching of gastroc, soleus, + achilles tendon
-night splint to gently stretch the plantar fascia
127
fractures of metatarsals
caused by direct force (stepped on) or twisting/tortional stress
128
what is the most common metatarsal fx
Jones fx
-neck of the 5th metatarsal
129
signs of metatarsal fx
-swelling + pain
-point tender
-needs x-ray to diagnose
130
care for metatarsal fx
-POLICE- protect, optimal load, ice, compress, elevate
-short leg walking cast for 3-6 weeks
-potentially surgery if displacement fx
131
Jones fx
fracture of the neck of the 5th metatarsal caused by inversion or high-velocity rotational forces
-athlete complains of sharp pain on lateral foot + hearing a "pop"
-poor blood supply, could result in nonunion
132
care for Jones fx (displaced + nondisplaced)
-nondisplaced- non-weight bearing case for 6-8 weeks
-displaced- surgery
133
second metatarsal fx
also called March fx (named in 1855 due to Prussian soldiers on long marches)
-pain + point tenderness
-overuse injury
-modified rest + non-weight bearing
134
longitudinal arch strain
caused by subjecting foot to unaccustomed stresses when coming in contact with hard playing surfaces
135
signs of longitudinal arch strain
pain only when running below the medial malleolus + posterior tibialis tendon
136
care for longitudinal arch strain
-POLICE
-arch taping
-reduction of weight bearing
137
metatarsal (transverse) arch strain
caused by:
-hypermobility
-fatigue
-poor posture
-excessive weight
-improperly fitted shoes
138
signs of metatarsal (transverse) arch strain
pain in metatarsal region
139
care for metatarsal (transverse) arch strain
apply pad to elevate depressed metatarsal heads
140
fx + dislocation of the toes- cause
kicking an object, stubbing toe, or direct blow to the toes
141
fx + dislocation of the toes- signs
-swelling + discoloration
-pain weight bearing
142
fx + dislocation of the toes- care
-involving 1 or more toes, cast for 3-4 weeks
-reduction of dislocated toe performed easily by physician without anesthesia
143
bunions (hallux valgus)- cause
painful deformity of the head of the first metatarsal (big toe)
-occurs from wearing shoes that are pointed + too narrow
144
bunions (hallux valgus)- signs
-tenderness
-swelling
-enlargement
145
bunions (hallux valgus)- care
-shoe selection plays important role in treatment
-night splints to correct position of the great toe
146
what sport do we see bunions the most in
soccer
147
Morton's neuroma
mass occurring in the plantar nerve, aka neuroma
148
where is Morton's neuroma most common
between 3rd + 4th metatarsals
149
signs of Morton's neuroma
-severe intermittent pain radiating from the distal MT heads to the tips of the toes
-pain relieved when not weight bearing
-burning numbness
150
Morton's neuroma- care
tear drop shaped pad is placed between the 2 MT heads to have the toes spread apart while weight bearing
151
turf toe
hyperextension injury resulting in sprain of the great toe from overuse or trauma
152
turf toe- care
-flat insoles that have thin sheets of steel under the forefoot
-taping the toe to prevent further dorsiflexion
153
if an athlete has less severe turf toe, can they play
yes, continue to play
154
if an athlete has more severe turf toe, can they continue to play
no- out for 3-4 weeks
155
ingrown toenail
nail growing into soft tissue resulting in inflammation + infection
156
ingrown toenail- signs
-swelling
-heat
-aching
157
how can ingrown toenail be prevented
by trimming nails properly + straight across
158
subungual hematoma (blood under toenail)
-blood can accumulate as a result of toe being stepped on or dropping an object on the toe
-area under toenail appears bluish-purple color
159
our ankles provide us with ____ information
proprioceptive
160
prevention of lower-leg + ankle injuries- stretching
-achilles tendon
-gastroc
-soleus
161
prevention of lower-leg + ankle injuries- strengthening
ex: 4-way ankle
162
prevention of lower-leg + ankle injuries- neuromuscular control
-relies on CNS to interpret proprioceptive information + then to control individual muscles + joints to move properly
-ex: balance exercises
163
prevention of lower-leg + ankle injuries- footwear + tape
-shoes worn for activity intended
-protection
164
what 3 bones make up the ankle
-tibia
-fibula
-talus
165
*be able to identify tibia, fibula, talus (ch15 ppt slide 4)*
166
talocrural joint
aka ankle
-tibia, fibula, talus
167
movements of talocrural joint
-plantarflexion
-dorsiflexion
168
subtalar joint
talus + calcaneus
169
movements of subtalar joint
-inversion
-eversion
170
*be able to identify ligaments (ch15 ppt slide 5)*
171
lateral ligaments of ankle/lower leg
-ATFL
-CFL
-PTFL
172
medial ligaments of ankle/lower leg
deltoid ligaments
173
most ankle sprains occur due to what movement
inversion
-thus, lateral ligaments are injured
174
majority of ankle sprains occurs to what ligaments
lateral ligaments
-ATFL
-CFL
-PTFL
175
an eversion ankle sprain would tear what ligaments
deltoid ligaments (medial)
176
compartments of muscle
-anterior
-lateral
-superficial posterior
-deep posterior
177
most common place for compartment syndrome
anterior cmopartment
178
assessment of ankle joint- history
-what trauma or mechanism occurred?
-did you hear a sound- snap, crackle, pop?
-prior history of injury?
179
assessment of ankle joint- observation
-obvious deformity
-discoloration
-swelling
-obvious pain
-ROM
180
assessment of ankle joint- palpation
start with key bony landmarks then progress to ligaments + muscles
181
bump test
rules out fx for ankle joint
182
anterior drawer test
tests ligament stability in plantarflexion/dorsiflexion directions
183
talar tilt test
tests ligament stability for inversion/eversion directions
184
assessment of ankle joint- functional examination
if the athlete has difficulty performing the following activities, they aren't ready for RTP:
-walk on toes
-walk on heels
-hop on affected foot
-stop + start running
-change of direction
185
inversion/eversion ankle sprains are more common
inversion
186
inversion sprains- what ligament is the weakest + most commonly sprained ligament
ATFL
187
why are eversion sprains less common than inversion
due to bony + ligamentous anatomy
188
do inversion/eversion sprains take longer to heal
eversion
189
high ankle sprain
anterior + posterior tibiofibular ligaments involved
-injury most often occurs in forced dorsiflexion + ER of the foot
-extremely hard to treat + can take months
190
ankle sprains- signs
-swelling
-tender to palpation
-may have inability to bear weight
-pain
-joint stiffness
191
ankle sprains- care
-POLICE
-returning to activity should be a gradual progression of functional activities
192
ankle fractures
caused by several mechanisms:
-direct blow
-inversion/eversion
193
ankle fx- signs
-immediate swelling
-point tenderness
-athlete apprehensive when bearing weight
194
ankle fx- care
-refer for x-ray
-immobilization
195
assessment of lower leg- history
-how long has it been hurting?
-where is the pain or discomfort?
-any numbness or tingling?
-feeling of warmth?
196
numbness/tingling in the lower leg directly relates to ____
compartment syndrome
197
what emergency do we worry most about in the lower leg
compartment syndrome
198
assessment of lower leg- obesrvation
-postural deviations
-walking difficulty
-obvious deformities
199
assessment of lower leg- palpation
-musculature in the 4 compartments
-tibia
-fibula
200
bump test
test for fx of lower leg
201
squeeze test
test for fx in lower leg
202
thompson test
used to determine rupture of the achilles tendon
203
achilles tendon ruptures are usually which grade
grade 3
204
achilles tendon ruptures are commonly seen in what sport
gymnastics
205
what bone of lower leg carries most of your weight
tibia
-big weight bearing bone
206
what is the most commonly fractured long bone in body
tibia
207
tibial + fibular fractures
usually the result of direct trauma to the area or of indirect trauma such as rotation + compression
208
tibial + fibular fractures- signs
-immediate pain
-swelling
-possible deformity (open or closed)
209
tibial + fibular fractures- care
splint to immobilize + immediate referral to hospital
210
shin splints (medial tibial stress syndrome)
stress reaction of the distal 2/3 tibia
211
shin splints (medial tibial stress syndrome)- signs
-initially may only hurt after an intense workout
-as it worsens, may have pain throughout normal daily activities
-can progress to stress fx
212
shin splints (medial tibial stress syndrome)- care
-modification of activity
-correction of foot mechanics
-stretching program
-referral to physician for bone scan
213
if shin splints are left untreated, what can occur
can become stress fx
214
compartment syndrome
increased pressure in 1 of the 4 compartments of the lower leg which causes pressure on the muscular + neurovascular structures of the leg
-if you get too much pressure on the neurovascular strecture, acts like a tourniquet + cuts off blood supply
215
can compartment syndrome cause loss of a limb
yes
216
compartment syndrome- what compartments are commonly involved
-anterior
-deep posterior
217
3 types of compartment syndrome
-acute
-acute exertional
-chronic
218
acute compartment syndrome
-medial emergency
-direct blow
219
acute exertional compartment syndrome
occurs without any trauma
220
chronic compartment syndrome
usually occurs during running + jumping
-worse after activity
221
compartment syndrome- signs
-deep aching pain due to compression
-tightness
-swelling
-reduced circulation
222
compartment syndrome- care
-immediate first aid
-compression wrap should NOT be used due to compression already causing pain
-measurement of intercompartmental pressure by physician confirms diagnosis
-surgery to release pressure (fasciotomy)
223
describe swelling in compartment syndrome
one calf would be bigger than the other
224
describe reduced circulation in compartment syndrome
dorsal pedal pulse would be different on one of the sides
225
tendinitis
inflammatory condition occurring from repetitive stress placed on the tendon such as running or jumping
-general pain + stiffness
-tendon may be warm + painful
-can take increased amounts of time to resolve
-NSAIDs may help
225
what basic emergency care is counter-productive for compartment syndrome
compression wrap
226
227
achilles tendinitis or rupture- which sounds like a gun shot
rupture
228
achilles tendinitis or rupture- which requires surgical repair
rupture
229
what population is achilles rupture most common in
males above age 30
230
time difference for tendinitis vs tendinosis
-tendinitis is first 6 weeks
-tendinosis is fter first 6 weeks
