Random Shit To Know Flashcards
Kienbock’s Disease
AVN of lunate
Hypothenar hammer syndrome
Post-traumatic (micro or macro) digital ischemia of ulnar artery at Guyon’s canal. Pain over hypothenar eminence and ring finger (maybe small, middle, or index). Paresthesias.
Ulnocarpal impaction syndrome
Has positive ulnar variance (ulna longer than radius) with ulnar wrist pain due to impaction of ulna with carpals.
Elson Test
Special test for boutonnière deformity. Elson test: bend PIP 90 degrees over edge of table and try to extend the MIDDLE phalanx. If weak and the DIP gets rigid this is a positive test (DIP should stay limp)
Preiser’s Disease
AVN of scaphoid
Bennett’s Fracture
Fracture plus dislocation of metacarpal bone at base of thumb. Even though it is a fracture, there should still be a small fragment of the 1st metacarpal that continues to articulate with trapezium.
Pinch Grip Test
Looking to see if you can pinch the tips of thumb and index. Looks at anterior interosseous branch of median nerve. Can get compressed between heads of pronator teres. Innervates FPL, index and long fingers of FDP, pronator quadratus.
Wartenberg’s Sign
Position of abduction in the pinky. The ulnar nerve controls abduction and adduction of the pinky but with abduction the extensor digiti minimi and branch to pinky from EDC also play a part and are controlled by radial nerve. To do this test you have palm on a table and have them extend the fingers then abduct and adduct (they won’t be able to adduct).
Wartenberg Syndrome
Entrapment of superficial branch of radial nerve at posterior border of brachioradialis. Provides sensory input to dorsum of thumb, index, and middle fingers proximal to PIP’s.
Elbow flexion test
Test for ulnar neuropathy. Elbows maximally flexed, forearms maximally supinate, wrist placed in extension. Hold up to 3 minutes.
Froment’s Sign
Test for ulnar nerve palsy. Test for adductor pollicis (innervated by ulnar nerve). If positive the FPL (innervated by median nerve) will substitute and hyper flex IP joint. The patient will make strong pinch between thumb and index finger of flat object, then try to pull it out.
Bunnell-Littler Test
Evaluates source of PIP flexion motion limitation.
Normal = full PIP flexion with MCP extension
Capsular Retriction = no increase in PIP flexion with MCP flexion
Lumbrical Restriction = increased PIP flexion with MCP flexion
Scaphoid Shift Test
Looks at scapholunate instability. Also called Watson’s shift test. Patient rests elbow on table. Place thumb on palmar scaphoid and other fingers around forearm. Other hand puts their hand in ulnar deviation and extension. Move hand passively into radial deviation and flexion while keeping pressure on scaphoid. If you let go of the force abruptly there will be a painful thunk.
Murphy’s Sign
Sign for lunate dislocation. If you have patient make a fist the 3rd metacarpal should be higher than 2nd/4th. If sunken in there may be lunate dislocation.
Arcade of Struthers
Thin aponeurotic band from medial head of triceps to medial intermuscular septum about 6-10 cm proximal to medial epicondyle where ulnar nerve travels.
Time For Fracture to Heal
Minimum of 6 weeks
Speeds and Dynamic Speed’s Test
- Speed’s
- Resisted flexion from 90 flex/ER/supination/elbow extension position - Dynamic Speed’s
- Elbow flexed (90), shoulder flexed (45). Pull arm up towards ceiling against resistance
Yergason’s Test
Arm down by side with elbow at 90 and arm pronated. Supinate the arm against resistance and check for recreation of anterior shoulder pain at long head of biceps.
Bony Bankart
Avulsion fracture of anteroinferior glenoid associated with anterior shoulder dislocation.
Hill-Sachs Deformity
Impaction of posterior/superior/lateral humerus following anterior dislocation (Bankart).
Bristow-Laterjet Procedure
Procedure for anterior shoulder dislocations where they saw off coracoid and screw it to the front of the glenoid as a bumper plate.
Load and Shift Grades and What is Normal
25% anteriorly and 50% posteriorly is normal.
Grade 0 = Normal
Grade 1 = Excessive mobility up to glenoid rim but no subluxation
Grade 2 = Subluxation but spontaneous reduction
Grade 3 = Frank dislocation with locking
Anterior Interosseous Nerve vs Median Nerve
Median nerve travels between the 2 heads of the pronator teres and then gives rise to AIN (the median nerve continues down as well). The median dives between the FDS and FDP.
AIN: FPL, Radial 2 FDP, Pronator quadratus.
Median: Rest of the wrist/finger flexors (except FCU and ulnar FDP); 1st 2 lumbricals; thenar muscles; sensation to median nerve distribution.
Median nerve comes off lateral and medial cords.
Ulnar Nerve Course and Innervation?
Arises from medial cord of brachial plexus. Travels under Arcade of Struthers and then Osborne band.
Innervates: FCU, medial 1/2 FDP, 2 ulnar lumbricals, all 4 hypothenar muscles, all interossei, adductor pollicis. Ulnar nerve sensation.
Radial Nerve Origination and Innervation?
Arises from posterior cord. Divides into superficial and deep branch, deep branch turns into posterior interosseous nerve. Innervates BEAST brachioradialis/Brachialis, extensors, Anconeus, supinator, triceps.
How long to results of corticosteroid injections last?
2-6 weeks.
Cozen’s Test
Resisted wrist extension in 90 flexion, pronation, radial deviation. Sensitive test.
Mill’s Test
Pronate, flex wrist, extend elbow. Don’t flex the fingers though.
Maudsley’s Test
Resist 3rd digit extension in elbow extension position (very sensitive).
When does peel back mechanism occur?
Cocking phase of throwing
Putti-Platt Procedure
Tightening the anterior capsule and subscapularis with subsequent accepted loss of ER to increase stability of shoulder. Not used for baseball players because of the loss of ER.
Fat-Pad Sign
Also called “sail sign”. Describes the elevation of the anterior fat pad. It’s usually concealed in the coronoid fossa. Happens with increased swelling or a fracture (usually condylar in children and radial head in adults).
Capsular Shift
Capsule and ligaments tightened to increase shoulder stability. This has fallen into favor for MDI and will maximize stability but allow full return of ROM.
Volkmann’s Contracture
Acute ischemia to the muscle fibers of the forearm flexors»_space; extensors.They become fibrotic and shortened and leads to contracture. This is caused by obstruction of the brachial artery near the elbow due to improper/poor fitting of cast; supracondylar fractures; crush injuries; and compartment syndromes.
Position on arm: Wrist flexion/pronation, thumb adduction, MCP extension, IP flexion
Runner’s Hematuria Prevention
- Keep a small amount of urine in the bladder before run
- Avoid high doses of NSAID’s (they have blood-thinning effects and can exacerbate problem)
Runner’s Hematuria Management
Usually clears up within hours/days. Regardless, recommend sending to PCP to investigate possibility of serious pathology (kidney stones, cancer, etc.)
Diuresis
Water loss at the kidneys
Wound healing intention?
Primary Intention = when wound edges are approximated (sutures, staples, glute)
Secondary Intention = wound edges cannot be approximated and wound needs to heel from the bottom
Tertiary Intention = combination of both, wound cannot be stitched up immediately but can after awhile
Time delay allowed to close wound to have minimal risk for infection?
4-6 hours so wound edges aren’t too inflamed, colonized, or necrotic.
Management of hypoglycemia?
Mild: management can be treated with absorbed glucose, hard candy, sugared beverage, fruit juice.
Severe: Usually has mental status changes, autonomic changes, and/or collapse. Needs to be treated with subcutaneous/intramuscular injection of glucagon (kits for home administration are available and should be available at athletic events for athletes with DM1).
Athlete Collapses With No Prodromal Symptoms?
Cardiac collapse tends to be instantaneous with no symptoms prior to the collapse. If they have ventricular fibrillation they will hit the ground and no longer talk.
Sickling Collapse vs Heat Collapse
Sickling collapse usually occurs within first 1/2 hour on field and core temperature not greatly elevated.
Salter-Harris Fracture
A growth plate fracture of a long bone.
Type 1: Fracture line runs straight across growth plate
Type 2: Fracture breaks at an angle going through most of the growth plate and the metaphysis
Type 3: Rare. Usually in distal tibia bone. Cuts vertically through epiphysis and then through part of physis (almost like a 90 angle)
Type 4: Vertical/oblique line that goes through metaphysis, physis, and epiphysis.
Type 5: Growth plate damage but no fracture.
1 = Straight
2 = M
3 = E
4 = ME
5 = Crush
How long to place in a sling after a shoulder dislocation?
3 weeks
After injury/surgery, what should total ROM for the throwing shoulder be compared to the other side?
Within 5% of total motion compared to the other side.
Noncontact and contact ACL injury rate for female vs male athletes?
2-6 times higher for noncontact. Equal injury rate for contact.
The risk of subsequent contralateral ACL injury is higher in females vs males also.
Risky body positions during landing to tear ACL?
- Extended knee
- Flat foot
- Offset body position
Risk factors for noncontact ACL injuries?
- Joint laxity
- Intercondylar notch width
- BMI
- Maximal knee flexion during landing
- Initial and maximal knee valgus
Components of ACL injury prevention program that decrease rate of ACL injuries?
Components include:
1. Dynamic stretching
2. Strengthening
3. Functional balance
4. Agility
5. Plyometrics
Lasts more than 10 minutes, 3x/week for at least 8 weeks. Should be continued in-season during warm up.
Risk factors found to predict development of PF pain in asymptomatic female adolescent athletes?
- Knee valgus displacement during box-drop test
- Early sport specialization
Differences in females (compared to males) with regards to cutting/jumping and ACL risk?
- Females (adults/children) have higher knee valgus angles/moments during cutting, landing and squatting
- The increased valgus angles/moments shown to be associated with ACL injury risk
- Females have decreased hip flexion angles and greater knee flexion stiffness during cutting tasks
- Greater hip adduction angles in females and positively related to knee valgus angles
- Females are weaker (normalized to body weight) in hip strength, and quad/hamstring strength.
- Females have different quad, hamstring, and gastroc muscle activation patterns than males.
Muscle strength and knee kinematics?
They are weakly to moderately related. This suggests that strength is not the only factor, other neuromuscular factors may be important
Female structural factors compared to males with regards to ACL?
- Female ACL is smaller in length, cross-section, and volume (even after adjusting for body anthropometry)
- Females have narrower/shallower notches (notch width is good predictor of size in men but not women; notch angle is good predictor of ACL size in women but not men)
- Female ACL is less stiff and fails at a lower load (even after adjustment for anthropometry and ACL size).
Hormones and the females ACL?
Although there is no consensus in the literature, there have been studies correlating menstruation with ACL tears in women. Estrogen and progesterone receptor sites have been reported in human ACL cells. It has been proposed that levels of these hormones may have deleterious effects on the tensile strength of the ACL.
Position the knee usually is in during isolated ACL tears?
ER and valgus. This is counterintuitive because the ACL is only loaded in IR. This mechanism may be related to impingement of the ACL on the lateral wall of the intercondylar notch. A narrow notch would directly contribute to this mechanism.
Kohler Disease?
Idiopathic avascular necrosis of the navicular. Can take 2-3 years to return to normal.
Little league elbow?
Medial epicondyle apophysitis. The medial apophysis is the weakest structure on the medial side of the elbow.
Osteochondrosis vs osteochondritis
Osteochondrosis is a developmental disorder of the bones in children/adolescents where there is a disruption of blood supply to a specific area of bone, resulting in death of bone tissue (AVN is similar and can occur at any age). Osteochondritis is an inflammatory condition that affects the cartilage and bone in a joint, usually develops following injury/trauma.
Where does OCD happen more in the lateral elbow?
Capitellum > radial head
Panner’s Diesase
Osteochondrosis of the capitellum. Different than OCD. Unlike Panner’s, OCD represents a focal lesion in the subchondral bone and is a well-demarcated island of involvement.
NATA Pitch Limitations
9-14 years old limited to 75 pitches per game
600 pitches/season
2000-3000 pitches per year
Preeclampsia
Serious blood pressure condition that occurs during pregnancy. Affects mother an unborn baby. Affects at least 5-8% of all pregnancies. Rapidly progressive condition characterized by high blood pressure and presence of protein in the urine. Swelling, sudden weight gain, headaches, and changes in vision are important symptoms. This is a medical emergency.
Guidelines for bike fitting (with hands placed on brake lever hoods)
Knee Flexion: 25-30 degrees when crank arm is in 6 o’clock position, foot slightly plantarflexed
Patellar Position: Knee over pedal spindle (center of pedal) when in the forward position
Trunk Angle: 25-35 degrees (from horizon)
Shoulder FLexion: 90
Saddle to bar position (Top of middle saddle to top of handlebar): <5 cm
Elbow flexion: 25
Wrist position: Neutral
What is the quadriceps index needed to hop test an athlete following ACL reconstruction? What other criteria?
80%.
Trace or less knee effusion, full knee ROM and no pain with single leg hopping in place.
Findings on x-ray with arthritis?
Severe Arthritis: less than 1-2 mm space and subchondral sclerosis
Moderate Arthritis: More than 1-2 mm space and small cysts present
With Periodization, plometric performance in late offseason/early preseason?
Low to moderate intensity.
Primary and Secondary Assessment During On Field Assessment?
Primary:
- General impression
- Mental status
- Airway (A)
- Breathing (B)
- Circulation (C)
- Bleeding
- Shock
Secondary:
- History
- Vitals
- Head to toe exam
What part of clavicle do most fractures occur?
Middle 1/3
How to manage displaced Clavicular fractures?
Early plate fixation results in improved outcomes compared to nonoperative management.
Return to play after displaced clavicle fracture?
After surgery about 8 weeks for 50% of people and the rest within 12 weeks.
If not operated on, likely 10-12 weeks.
Horizontal muscles versus vertical muscles?
For sprinting you want to focus on posterior chain muscle groups
When pain occurs for stress fracture, shin splints, and compartment syndrome?
Compartment syndrome usually stops quickly after stopping exercise. Stress fractures/shin splints linger after stopping.
Testing equipment needed for compartment syndrome?
Needle manometer
Measures to diagnose compartment syndrome?
Pre-exercise >15 mmHg.
Pressure readings 1 minute post exercise >30 mmHg
Pressure readings 5 minutes post exercise > 20 mmHg
Return to activity/sports after fasciotomy for compartment syndrome?
Once wound is healed, walking and cycling are encouraged. Patients may begin light jog in 2 weeks and resume run training at 6 weeks. Most rehab suggests it will take about 3 months to return to competition.
What to do if you find someone unresponsive?
Check ABC’s. Make a phone call to 911 as soon as possible and attach AED as soon as possible. One round of CPR is acceptable if there is no one to place a call to 911.
Good Samaritan Law
Applies in emergency settings only for when someone acts in good faith when someone is in imminent danger.
What to do if athlete has slightly high blood pressure in pre-participation screen?
This shouldn’t stop the athlete from participating but you do want to take repeat measures over the subsequent days. One measure is not indicative of hypertension.
Fat soluble vitamins
A, D, K, E
Technique to emphasize end-point assessment during ligament assessment?
Perform the load but start in a relaxed (opposite) position. You want to perform the testing usually faster.
Wolff-Parkinson-White Syndrome?
Accessory electrical conduction pathway from atrium to ventricle
When can throwing be performed following SLAP repair?
16 weeks
Best view for Jefferson fracture. What is it?
Open mouth. Burst fracture of posterior elements of C1 from axial load or hyper extension.
Best imaging modality for neurosurgical intervention?
CT Scan
Best imaging modality for LCPD?
MRI
If you find someone unconscious and they wake up, what should you do about their c-spine?
Assess for a stable c-spine in supine while waiting for EMS. The EMS should spine board them, stabilize the c-spine, and go to the ER.
Arcade of Frohse
The arcade is formed by a fibrous band between the two heads of the supinator muscle. The deep branch of the radial nerve passes beneath the arcade.
Osborne’s Ligament
Osborne’s ligament can be classified as the fibrous band bridging the two heads of the FCU (arises from humerus and goes to FCU). Osborne’s ligament forms the roof of the cubital tunnel, an opening between the muscles through which the ulnar nerve passes.
HAGL Lesion
Humeral avulsion of the GH ligament (inferior). Usually occurs with arm being forced into abd/ER position.
ALPSA Lesion
Anterior labroligamentous periosteal sleeve avulsion. The anterior labrum rolls off the glenoid and backwards in a medial and inferior direction (like you’re rolling up a sleeve and going backwards towards the scapula).
Branches from posterior cord?
STAR: Subscapular, thoracidorsal, axillary, radial
Bankart Lesion
Avulsion of the anterior portion of the inferior GH ligament and labrum off the anterior rim of the glenoid.
Best exercises for supraspinatus? Infra and Teres Minor?
Supraspinatus:
1. Prone H ABD c ER
2. Scaption
3. Prone scaption
Greatest EMG: Prone scaption with ER
Infraspinatus:
1. Any ER
Greatest EMG: SL ER
Teres minor:
1. Better activation with ER and extension
Greatest EMG: SL ER
Motions to be careful with after posterior dislocations?
Flexion, IR, and H ADD
Best Surgery For MDI?
Inferior capsular shift
Capsulorraphy vs Capsular Shift
Capsular shift is when the joint capsule is tightened, depending on the location of the laxity. Capsulorraphy can be done with staples or thermal shrinkage.
Os Acromiale
Unfused acromial epiphysis. Usually ossifies from 18-25. This can project into the RTC outlet, decreasing total area, and is thought to be associated with RTC pathology.
RTC Repair Rehab?
Sling for 6 weeks.
Early PROM (full ROM by 8-10 weeks)
Isometrics at 3-4 weeks (isotonics 4-6 weeks)
AAROM at 3-4 weeks (delaying abd for 6-8 weeks)
What clinical tests are most predictive of RTC tear?
Supraspinatus weakness
Weakness in ER
Impingement sign
What to do if the spine is not in a neutral position after neck trauma?
- Try to realign the spine to minimize secondary injury to spinal cord
- Don’t move the neck if any of the following occurs:
- There is increased pain
- Neurologic symptoms occur
- Muscle spasm
- Airway compromise
- It is physically difficult to reposition spine
- Resistance is encountered
- The patient is apprehensive
How often should emergency action plans be rehearsed?
At least annually
During initial assessment, what findings heighten the suspicion of a potentially catastrophic cervical spine injury and require initiation of spine injury management protocol?
- Blunt trauma and unconscious or altered level of consciousness
- Neuro findings/complaints
- Significant midline spine pain with or without palpation
- Obvious spinal column deformity
If doing CPR during neck stabilization procedure, what should you do about rescue breaths?
Jaw thrust instead of head tilt technique.
Removing helmet or shoulder pads for neck injury?
Protective athletic equipment NEEDS to be removed prior to transportation to emergency facility. Needs to be done with at least 3 people present.
How to move supine athlete? Prone?
Supine: 8 person lift
Prone: Need to use log roll PUSH technique (5 people)
Scoop Stretcher
Hinged at both ends to “scoop” the athlete so not needing to do log roll or lift and slide.
Securing head on spine board?
Head is always last part of body to be secured. ONce the head-immobilization device is placed to stabilize the head, tape or straps should be used to secure the head at 2 separate points of contact (chin and forehead)
Face Mask Removal
With 4 attachments, remove the 2 side straps first, folllowed by the top straps (so mask doesn’t rotate down onto throat)
If one score gets stuck keep trying to remove the others and then have a tool to cut the mask.
