Readings quiz 2 Flashcards
1
Q
Most common nerve entrap at shld
A
Suprascapular n. entrap
2
Q
Most common nerve entrap at shld CAUSES
A
Volley, tennis, Wlift, OH and throwing mvt
Hypertrophic spinogleno lig
3
Q
Most common nerve entrap at shld: entrap locations & ms affected
A
Suprascap notch: SST, IST
Spinoglenoid notch: IST
4
Q
Most common nerve entrap at shld: dx
A
s/s
EMG
5
Q
Most common nerve entrap at shld: S/S
A
Pain: - poor localis, deep - post/lat shld - TOP suprascap notch Wasting IST/SST Shld weakness abd/er
6
Q
Most common nerve entrap at shld: tx
A
avoid mvt STR: scap, RC (later) Flexib/STT Cx/Tx tx Chx as needed
7
Q
LH biceps rupture happens with young pop?
A
Nope middle/aged = td degenration at prox portion
8
Q
LH biceps ts rupture: S/S?
A
No pain
+/- bruise
STR +/- limited (regained 6w-3m
9
Q
LH biceps ts rupture: cxh indicated
A
Max power & str needed for sports,
Within 1 week of injury
10
Q
Pec major tear: where
A
insertion humerus
ms-td jucntion
ms belly
11
Q
Pec major tear: MOI
A
heavy bench press
12
Q
Pec major tear: s/s
A
pain medial upper arm/lat chest (rip/popping at moi)
weak shld add/ir/flex
deformity
TOP
13
Q
Pec major tear: tx
A
Dx: US, MRI
Chx: 2 mp of injury
PT: no pec major exs x6-8w
14
Q
Finger joint sprain: MOI
A
sideways forces
15
Q
Finger joint sprain: should be treated like lig injury
A
NO
Assess: collat and dors/palm capsule
If no adequate tx: intrinsitc and extrinsic ms and joint tightness and s/s
16
Q
Finger joint sprain: tx
A
protection
Optim loading
17
Q
Finger joint sprain: PIP often linked with ? Tx?
A
Disloc (jammed finger
Reduction
Buddy tapping
18
Q
Hip pointer: MOI?
A
Blow/contact with
- protective equip
- contact with ground
- contact with another player
- contact sport
- poor slinding technique
- diving in volleyball
19
Q
Hip pointer: severe patho?
A
external oblique aponeuro torn from iliac crest
avulsion fx apophysis
Periosteum (under) blood accumulation
20
Q
Hip pointer s/s?
A
Pain with trunk rots/trunk flex - hip mvr - breathing/coughing Gait affected Bruising +/-
21
Q
Hip pointer: tx?
A
crutches
MD: xrays, meds (nsaids, ms relax, analgesics)
Ice, modailities
Gentle rom
Elastic bandage
Rehab: STT, STR/stretch, core, propriocetion
Protection: hip pads,/foam for RTS
22
Q
Avulsion fx in LE: pop
A
children/ados (bones tensile strength
23
Q
Avulsion fx in LE: cmmon areas
A
Ischial tub (hm, add mag) ASIS (sart) AIIS (rec fem) Iliac crest (ext obl ms) Symph pubis (add)
24
Q
Avulsion fx in LE: MOI
A
Excessive passive lengthening
Bone fail to accomodate the applic of the tensile force
25
Avulsion fx in LE: ischial tub
| MOI?
flex of hip with hm ecc contraction
26
Avulsion fx in LE: ischial tub tx
< 2cm conservative (8-12w rest), treat grade 3 ms tear, grad RTS
>2cm ORIF
27
Avulsion fx in LE:ASIS/AIIS, MOI?
ext hip while rectus fem/sartorius ms contract eccentric
28
Avulsion fx in LE: ASIS/AIIS tx
no dispalcement: treat as grade 3 ms tear + grad RTS
| Displaced/severe separation: chx
29
ITBFS MOI & patho?
Overuse
Compressive loads on ITB on lat condyle of the knee
Rich innervated/vasc layer of fat & connective tissue compressed
Dynamic knee valgus (hipp add/ir)
Pelv
ic drop (hip abd/er weak)
30
ITBFS S/S?
```
Pain
- stairs, walking, running, cycling
- antalgic gait, limping
- long training, downhill, cambered surface
- rep knee flex/ext
Tigth: ITB, TFL, VL
Weak hip abd, er
TOP above lat condyle
Nobles compression tests (ITB syndrome test) +ve
```
31
ITBFS tx?
```
Activ modif, biomec correction
STR exs hip abd/er
STT/stretch (glutes, TFL)
Not foam roll distal itb
Tx for pain releif (tape, dry needling, modal..)
```
32
Whats the behavioral regulation?
The behavioral regulation consists of the individual’s thermal sensation and comfort. It is the conscious effort to change the thermal discomfort (for example, putting on a sweater when you are cold and removing it when you are warm).
33
Whats the physiologic regulation?
The physiologic regulation is variable depending if exposed to a hot or a cold environment.
34
Shivering starts at ?? degrees and stops at ?
Start: 34.4-36°
Stops: 29-31°
35
T/F
| Shivering increases the temp to 7-9 times more than the resting metabolic rate.
F
| 5-6 times
36
T /F
The ineffect
ive sweating mechanism will also contribute to ineffective
body water loss which may lead to dehydration and predispose to heat illnesse
T
37
Dehydration in a cold evironement?
- evaporation of sweat
- increased heat loss via breathing caused by the dryness of cold-air
- increased fluid loss via cold-induced diuresis (vasoconstriction at the level of the skin brings more blood volume to the core organs including the kidneys which will increase the urine output and fluid loss).
38
how to replace sweat loss with fluids
Sporting event of less than 1.5 hour duration: water
| • Sporting event of more than 1.5 hour duration: glucose-electrolyte drink to improve endurance and prevent hypoglycemia
39
A heat rash is due to ?
It is caused by the inflammation of sweat glands and blockage of sweat ducts (thus making the affected area unable to sweat). This blockage can be caused by dead skin cells or bacteria.
40
T/F
Heat edema is a condition generally seen during the late stages of cold acclimatization while the blood volume is initially expanding to meet the new thermoregulation needs.
F
is a condition generally seen during the early stages of heat acclimatization while the plasma volume is initially expanding to meet the new thermoregulation needs.
41
Where is heat edema
mild edema in hands, feet and ankles
42
Where ms cramps are frequently happening
calves, feet, abdomen
43
What would be the cause of ms cramps
that dehydration as well as sodium and other electrolytes depletion contribute to the problem. There are also possibly some alterations in spinal neural activity in fatigue state in susceptible individuals
44
Management of ms cramps
Management of muscle cramps
o Rest in cool area
o Stretch the cramping muscle
o Proper hydration; ideally sport drinks
45
exs-assoc collapse: what
suddenly develop signs and symptoms of hypotension when they stop exercising abruptly. The blood pools in the veins of the legs due to the sudden stop of the pumping action of the muscles involved in venous return and lead to the collapse.
46
exs assoc collapse severe?
a collapse before the finish line suggests a serious medical cause of collapse.
47
exs assoc collapse RTS?
RTS (return to sport)
• Ensure no remaining symptoms present
• Ensure proper hydration
• Avoid physical activity for a period of 12 to 24 hours.
48
Biological adaptation to heat
• Earlier and greater sweating response (this is the most important biological adaptation)
* Increase in blood volume
* Increase in stroke volume
* Decrease in heart rate at a given activity level
* Sodium conservation in the body
49
Avg time for heat acclim? And de-acclim process?
require approximately 1 week for physically fit individuals and 2 weeks for the average individuals. The heat acclimatisation benefits will last approximately one week after the person leaves the hot environment and will then decay progressively (75% will be lost after 3 weeks). Thus, one or two days of cold weather will not interfere with the acclimatisation process.
50
Heat acclim, How many hours/day?
To achieve the biological adaptations, it will require a minimum of heat exposure of 2 hours/day (could be broken down initially but the total time should remain 2 hours per day) combined with cardiovascular physical exercises (the progressive physical activity needs to be done during the heat exposure time).
51
Frostbite is a precursor of frostnip
F
| The opposite
52
Whats frostbite?
Frostbite consists in the freezing of the body tissue. The water in and between the body’s cells freezes and swells (water expands upon freezing). The swelling and the ice crystals formed damage or destroy the cells around. Blot clots may also occur.
53
Skin damage with frostnip?
No skin damage is involved
54
what affected in superficial frostbite?
In superficial frostbites, only the skin and
| subcutaneous tissue are affected, thus the blisters formed will be clear
55
whats affected in deep frostbites
deep frostbite, skin and subcutaneous tissue will be affected as well as potentially vessels,
muscles and bones.
The deep frostbites will lead to hemorrhagic blisters.
56
Deep frostbites management
Re-warm the area in warm water (37-40° C) for 20-30 min (until it appears red and feels warm), cover with loose dry sterile dressing, separate fingers and toes with sterile cotton gauze, send for advanced care (for severe frostbites, re-warming should be accomplished within 24 hours).
57
Whats second freezing?
More injuries and more vascular damage will be caused if the frozen body part is thawed and frozen again (second freezing).
58
Atlitude illness rarely occurs below?
2000m
59
Incidence & severity of atlitude influenced by
speed of ascent
altitude reached
length of stay
60
Acute mountain sickness: what, s/s?
is defined as the presence of a headache in a non-acclimatised person who has recently arrived at an altitude above 2500 m and has one or more symptoms of AMS.
```
Here is a list of the hallmark symptoms of AMS.
o Mild to severe headache
• Throbbing
• Occipital or temporal regions
• Worse at night or on awakening
Other symptoms include
o Difficulty sleeping, insomnia
o Nausea, vomiting and loss of appetite
o Coughing and/or tightness in the chest
o Irregular breathing or SOB
o ↓ urine output
o Weakness, fatigue
o Cyanosis (nail bed, around mouth)
o Balance problems (ataxia)
```
61
Onset and duration of acute mount sickness
The onset generally occurs after 6 to 10 hours of exposure and the symptoms subside within 3 to 7 days.
62
Management of Acute mount. sickness
Management of AMS
o Take vital signs on a regular basis
o Stop ascending and rest with light activity (allow up to 2 days of acclimatisation)
• Mild AMS will resolve on its own but person should avoid further ascent until symptoms are resolved.
o If signs and symptoms persist, descent to lower altitude
• Descending 500-1000 m generally provides quick relief of symptoms
63
Whats high-altitude cerebral edema (HACE)?
It consists of an accumulation of fluid between the brain and the skull possibly due to a combination of the followings: sustained cerebral vasodilation, increase capillary permeability and inability to compensate for excess cerebral edema.
64
Onset of HACE
The onset occurs generally between 2 to 5 days after arrival at altitude above 2750 m.
65
S/S of HACE
Here is a list of the hallmark symptoms of HACE:
o Altered level of consciousness
o Ataxia
o Drowsiness
o Stupor
o Irrational behavior progressing to coma
The person will also demonstrate mild to moderate symptoms of AMS.
66
Management of HACE
Management of HACE
o Take vital signs on a regular basis
o Immediate descend is necessary; prepare for evacuation
o High flow of supplemental O2 with NRB mask
o Obtain more advanced care
67
whats high altitude pulmonary edema
HAPE is a form of noncardiogenic pulmonary edema associated with pulmonary hypertension and elevated capillary pressure. It causes the greatest number of fatalities of altitude illnesses.
68
whats onset of HAPE
The onset occurs generally between 1 to 3 days after arriving at a given altitude (rarely occur after 4 days at a given altitude).
69
Dx of HAPE
```
The diagnosis of HAPE requires
o At least 2 or more symptoms
• Dyspnea at rest
• Cough
• Weakness
• ↓ exertion performance
• Chest tightness or congestion
o At least 2 signs
• Crackles or wheezing
• Central cyanosis
• Tachypnea (late finding)
• Tachycardia (late finding)
```
70
Management of HAPE
```
Management of HAPE
• Take vital signs on a regular basis
• Rest and supplemental O2 with NRB mask
• Descend 500-1000 m; prepare for evacuation as needed
• Obtain more advanced care as needed
```
71
Prevention of High altitude illnesses
Prevention of high-altitude illnesses
• Perform minimal activity in the first 24 hours at altitude
• Avoid heavy exertion for the first 3 days
• Drink up to 4L of fluid/ day (keep urine color light)
• Avoid sleeping pills, alcohol, or any other respiratory depressants
• If doing a high-altitude hiking trip:
o Plan the trip in stages
o No more than 600m/ day
o Take a rest every 600-1200m
o Descend to sleep
o Observe partners for signs and symptoms of altitude illnesses
• Note that the level of fitness does not accelerate altitude acclimatisation.
72
Herpes simplex virus is common in which sports
Herpes simplex virus (HSV) is commonly seen in wrestling and rugby
73
HSV
- incubation period
- s/s
incubation period is 5-10 days. Lesions commonly affect the skin of the head/face, the lips and the eyes (e.g. conjunctivitis, eye lid infection). Infected athletes can also develop systemic symptoms such as fever and malaise.
74
HSV
- management
- recurrence
-Management of HSV consists in the intake of antiviral oral medications (e.g. acyclovir).
-sport participation is restricted when the athlete is infected (No sport until lesions have healed
• Scabs have dried
• No vesicles, ulcers or drainage
Covering active lesions with taping is considered unacceptable by NCAA
rules )
-Recurrence can occur because the virus stays in the body for the rest of their lives.
75
molluscum contagiosum is what? which sports?
Molluscum contagiosum is a virus that presents as white or skin colored papules (3-5 mm diameter). They are more commonly seen in swimmers, gymnasts and wrestlers.
76
Mollusc. contag
- S/S
- transmission
They affect more commonly the hands, forearms and face. Transmission is though skin-to-skin contact.
77
Mollusc contag
- tx
- RTS
Treatment is recommended because it does speed up the recovery process and limits transmission to others. However, it is a self-limiting condition, but recovery may take many months or years if untreated. Treatment include liquid nitrogen or curettage. Lesions should be covered when playing sports.
78
Warts
- what
- where
Warts are in the category of viral infection. The two hallmark features of warts are that they do not retain normal fingerprints and you can see black dots in the lesions (which are capillaries). They are commonly seen in hands and feet.
79
Warts
- infectivity
- transmission
- Their infectivity level is low
| - transmission is via skin-to-skin contact or through environment (swimming pool, decks, showers, etc).
80
Warts
- tx
- RTS
Treatment consists in liquid nitrogen application. Ideally, the lesions should be treated before RTS and they should be covered until completely resolved.
81
Impetigo
- which sports
- infectivity
As per other skin infections, impetigo is common in contact sports; e.g. wrestling, football, judo. It is highly contagious, and transmission is via skin-to-skin contact.
82
Impetigo bullous type
The bullous type consists in multiple fluid-filled vesicles like blister-like lesions that eventually collapse in their centre and present as honey-crusted lesions. The centre portion of the lesions will reveal erythematous plaques draining serous fluid if the crust is removed.
83
Impetigo non bullous type
The non-bullous type presents with small vesicles with erythematous bases and honey-crusted lesions that also drain fluid.
84
Tx impetigo
Depending on the extent of the lesions, treatment consist in the application of a topical antibacterial cream (e.g. Bactroban) or oral antibiotics (if cream is not effective or if lesions are extensive).
85
RTS impetigo
According to the NCAA guidelines, antibiotics should be taken for at least 72 hours before RTS and the athlete must be free of new lesions for the last 48 hours. Then, lesions need to be covered with bio-occlusive dressing (it provides a barrier to virus and bacteria).
86
Folliculitis
| - what?
Folliculitis consists in the infection of the upper portion of hair follicle & surrounding areas.
87
Furunculosis
| - what?
Furunculosis consists in the infection of the deeper hair follicle cavity and lesions contains pus.
88
Folliculitis/furunculosis where?
| tx?
areas of increased sweating and friction (for e.g. buttock, belt line and axilla).
Treatment consists in taking antibiotic cream or oral medication depending on the extent of the infection.
89
3 types of tinea
– Athlete’s foot (a.k.a. tinea pedis)
– Jock itch (a.k.a. tinea cruris)
– Ring worm (characterized by ring shape lesions on the skin)
90
tinea tx
application of an antifungal cream 2-3 X/ day over 2-4 weeks (e.g. clotrimazole, miconazole, ketoconazole) or oral medications for more extensive lesions.
the area can be kept dry with drying powder as needed.
91
tinea RTS
Sport participation is restricted. NCAA guidelines require 72 hours of treatment before RTS, then coverage of lesions with bio-occlusive dressing (same idea as dressing described for impetigo). Preventive measures include regular changes of socks, shorts & underwear, foot powders and regular shower facilities cleaning / sport equipment cleaning.
92
Oncomycosis
| - which sport
- swimming
93
Scabies
- what
- transmission
- Scabies consists of mites that burrow into the epidermis.
| - Transmission is via skin-to-skin contact.
94
Scabies
| - where?
Typical locations affected include axillary skin folds, fingers and toes web spaces, flexor surface of the wrist, extensor surface of the elbow and knee, periumbellicus, genitalia, buttocks and lateral foot.
95
Hepatitis RTS
Athlete with hepatitis should not participate in physical activity if fever, fatigue or hepatomegaly is/are present. Otherwise, sport participation is not a problem.
96
Mononucleosis
- transmission
- incubation
- illness duration
Mononucleosis is a virus transmitted through close contact especially via the saliva. The incubation period is 30-50 days after exposure and the illness generally last 5 to 15 days.
97
Mono
| - S/S
Symptoms include: flu-like illness, sore throat, malaise, headache, myalgia, nausea, vomiting.
98
T/F
| Mono severity decrease with age
F increase
99
Mono
| Tx and RTS
Treatment is symptom-based and there is no need to isolate the athlete. The athlete should rest from physical activity until acute symptoms have resolved. Contact sports should be avoided while the spleen is enlarged. Thus, the spleen should be assessed by an MD before return to play. The majority of spleen rupture due to mononucleosis generally occurs within 21 days of the onset of the symptoms.
100
Training recommendations for one system involvement
* Generally, the upper respiratory tract is involved and presents as sore throat, runny nose and/or headache but afebrile.
* Can do mild to moderate training (< 80% VO2 max)
* Can increase skill training and decrease anaerobic and aerobic training
101
Training recom for generalized s/s
* Symptoms such as general malaise, excessive fatigue, muscle pain and tenderness, fever, resting HR > 10 beats compared to normal resting HR.
* Avoid physical activity
* Return gradually once systemic symptoms are gone
