Soft Tissue Injuries Flashcards
What is a strain?
Muscle injury resulting in partial or full thickness tear
What is a sprain?
Ligamentous injury resulting in a partial or full thickness tear
What is the most common part of the body that is sprained?
Ankle
True or false: strains can occur anywhere along the muscle, including tendon insertions
True
What is tendinitis? How long does it last for? Treatment?
Acute inflammation of tendon, usually from overuse
- usually resolves in 2-3 days
- RICE and PT
What is tendinopathy?
Chronic inflammation of a tendon that can last for several months
What is the treatment for tendinopathy?
NSAIDs do not work–PT, PRP
True or false: shoulder injuries are common
True
What indicates that laxity is an issue?
If there is pain associated with it
what are the three major extrinsic factors in shoulder joint pain?
Intensity
Duration
Frequency
what is the major intrinsic factor in shoulder pain?
Skeletal immaturity
Where do the long and short heads of the bicep tendon attach to?
Long head = supraglenoid tubercle
Short head = Coracoid process
Which head of the biceps is usually affected?
Long head
What causes the pain with biceps tendonitis?
tendon becomes inflamed in the bicipital groove
What is Yergason’s test?
Supinate arm against resistance to check for bicipital tendonitis
What is Speed’s test?
tests for bicipital tendonitis or superior labral tears
-hold hand fully out and supinated. Pain in the bicipital groove
How reliable is pain in locating the pathology of shoulder pain?
Poor
What are the two muscles that are likely injured with lateral shoulder pain?
Supraspinatus
Infraspinatus
What is the muscle that is likely injured with anterior shoulder pain?
Subscapularis
What are the history bits that are common to shoulder muscle tears?
Pain when rolling onto that side at night
What is the full can test, and what does it assess for?
Supraspinatus
What is the correct way to test the supraspinatus with empty can test?
arms in 45 degree abduction
What is the bear hug test, and what does it assess for?
- Examiner tries to pull the patient’s hand from the shoulder contralateral shoulder
- Positive test = weakness of the subscapularis
What is the external rotation test, and what does it assess for?
elbow at side and flexed to 90. Resisted external rotation weakness = Infraspinatus / teres minor
What is Patte’s test, and what does it assess for?
hornblower’s sign
-external rotation against resistance weakness/pain = infraspinatus / teres minor issue
What are the two tests for subacromial bursitis?
Neer’s test
Hawkin’s test
What is the treatment for subacromial bursitis?
PT
NSAIDs
Ice
What are the primary and secondary causes of subacromial bursitis?
- Primary - overuse
- Secondary - shoulder instability in young athletes
What is the usual cause of olecranon bursitis?
Trauma to the olecranon
What are the s/sx of olecranon bursitis?
boggy, non-tender mass over the olecranon
What is the treatment for olecranon bursitis?
- RICE
- Steroid injection
- Surgery
What is the cause of lateral epicondylitis?
Insidious onset from repetitive supination
What are the s/sx of lateral epicondylitis?
Pain and decreased grip strength with resisted supination
-TTP (tenderness to palpation) near lateral epicondylitis
What is the treatment for lateral epicondylitis?
- RICE
- PT
- Steroid injections
What is the test for lateral epicondylitis?
- Resistance against supination pain
- Extension against resistance
What is the OMM nonsense for lateral epicondylitis?
Anterior/posterior radial head SDs
What are the s/sx of medial epicondylitis?
- TTP over flexor masses
- Pain with resisted pronation
What is mallet finger?
Object striking the finger, creating a forceful flexion of extended DIP, and tearing the extensor digitorum tendon
What are the exam findings of mallet finger?
- TTP over the dorsal aspect of the DIP
- No active extension at the DIP
What is the treatment for mallet finger?
Splint the DIP continuously for 6 weeks
When is referral for mallet finger indicated?
- If avulsion of more than 30%
- If passive extension is not achieved.
what are the three views that should be obtained with any orthopedic complain?
AP
Lateral
Oblique
What is jersey finger?
Forced extension of the DIP during active flexion tears the flexor digitorum profundus
What are the exam findings of Jersey finger?
- TTP
- Inability to flex the DIP joint
What is the treatment for Jersey finger?
Splint and refer to ortho
What is the central slip extensor tendon injury?
PIP joint is forcibly flexed while actively extended, causing central slip rupture and a resulting boutonniere’s deformity
What are the exam findings with central slip extensor tendon injuries?
- TTP at dorsal PIP
- Inability to actively extend
What is the treatment for central slip extensor tendon injuries?
Splint PIP joint in full extension for 6 weeks
What are the two indications for referral to ortho with slip tendon injuries?
- Avulsion of more than 30% of joint
- Full passive extension is not achieved
What is a “jammed” finger?
Forced ulnar or radial deviation of a finger causing partial or complete collateral ligament tears
What joint is usually affected with jammed fingers?
PIP
What are the exam findings of Jammed fingers?
TTP at the collateral ligaments
What is the treatment for jammed fingers?
Stabilize joint and buddy tape weeks
When is referral indicated for jammed fingers?
Unstable joint or child with injury
What is the best way to assess for a jammed finger (rupture collateral ligament)? Why?
Flexion of 30 degrees to remove the stabilization effect of the MCP joint
What is the correct way to buddy tape fingers?
do not leave 5th finger exposed
What is a volar plate injury?
Forced hyperextension of the (usually at the PIP joint) causes a rupture of the volar plate
What are the exam findings of volar plate injuries?
TTP at the volar aspect of the involved joint
What are the two tests that should be done with volar plate injuries?
- Full flexion and extension
- Collateral ligament stability
What is the treatment for volar plate injuries?
Splint 30 degrees of flexion and progressively increase extension for 2-4 weeks
When is referral indicated for volar plate injury?
Avulsion or unstable joint
What is skier’s thumb?
Disruption of the ulnar collateral ligament by forced abduction of the MCP joint (partial/complete tears, with/without avulsion)
What are the exam findings of skier’s thumb? How do you isolate the ulnar collateral ligament?
- TTP over the UCL at MCP joint
- Stress to full flexion to isolate ligament
What is the treatment for Skier’s thumb?
Splinting for 6 weeks
When should Skier’s thumb be referred to ortho? (3)
- Fracture or avulsion fracture
- More than 35 degree of joint opening
- No clear end point
What is a Stener’s lesion?
Complication from Skier’s thumb, where the proximal end of the UCL becomes trapped outside of the adduct aponeurosis
-Presents with joint instability and tender mass
What is the treatment for a Stener’s lesion?
Surgical
Who usually gets trochanteric bursitis?
- Runners
- Over pronators
- ballerinas and figure skaters
What are the s/sx of trochanteric bursitis?
Pain over the lateral hip, with TTP over the greater trochanter
What is the treatment for trochanteric bursitis?
- RICE
- NSAIDs
- Gentle hip stretching
- Steroid injections
What in particular should be stretched with trochanteric bursitis?
IT band
What are the attachments of the IT band?
Gerdy’s tubercle and lateral femoral condyle
What is snapping hip?
acute trochanteric bursitis associated with pain over or just posterior to the trochanter that presents as a snap that appears every time they snap their hip
Who usually gets a snapping hip?
Athletes who repetitively flex and extend their hip
What is the treatment for a snapping hip?
- Topical anti-inflammatory
- IT band rehab
- Injection of trochanteric bursae
what is an internal snapping hip?
- Iliopsoas tendon rubbing over the iliopectineal ligament eminence of the pelvic brim
- Presents as a deep anterior snapping sensation with hip flexion
What is the treatment for an internal snapping hip?
- Stretching
- PT
- bursa injections
What is iliotibial band friction syndrome?
Inflammation of the IT band due to overuse, that classically presents with TTP along the lateral femoral condyle
What is the treatment for iliotibial band friction syndrome?
- Stretching
- Massage
- Foam rollers
What is the thomas test for iliotibial band friction syndrome?
Flex hip and see if contralateral leg externally rotates–indicates a tight iliopsoas
What is the largest and most complicated joint in the body? What type of joint is it?
Knee
Ginglymus
What does the stability of the knee depend on?
- Strength and support of muscle and tendons
- Ligaments connecting the femur and the tibia
what is the motion of the knee?
Screw–external/lateral rotation of the tibia on the femur
What is the purpose of the screw motion of the knee?
Medial femoral condyle is longer than the lateral femoral condyle
Which is stronger: the ACL or the PCL?
PCL
What is the role of the patellar ligament, relative to the quads?
Holds the quad forward
Which knee meniscus is C shaped? Which is O shaped?
C = Medial O = lateral
Which meniscus of the knee is attached to its overlying collateral ligament?
Medial to the MCL
Why is the lateral meniscus of the knee less frequently injured than the medial?
Fibular head protection
Not attached to the LCL
What usually causes ACL injuries?
Valgus stress with acute hyperextension
What are the components of the unhappy triad?
Injury to the MCL, ACL, and the medial meniscus
What is the treatment for the unhappy triad?
Surgical
How is the PCL commonly injured?
Acute hyperflexion–“dashboard knee”
What are grades I - III of PCL tears?
I = mild laxity
II = moderate laxity
III complete tear
What is the treatment for PCL tears?
Operative
What is the treatment for meniscal tears?
Depends on severity of the symptoms–pain control and rehab vs surgery
What is patellofemoral syndrome?
Patellar tracking syndrome of chondromalacia–abnormal tracking through the trochlear groove d/t degeneration in the articular cartilage
what is the treatment for patellofemoral syndrome?
PT
OT
Patellar taping or band
What is Hoffa’s syndrome?
fat pad in the deep infrapatellar space leads to anterior knee pain that is worse with taping
What is osteochondritis dissecans?
Fragmentation of the articular cartilage that may eventually progress to necrosis
What is the treatment for osteochondritis dissecans?
If immature skeleton = avoid running and jumping for 8 months
Mature = skeleton
What is osgood-Schlatter’s syndrome (“apophysitis”)?
- Overuse injury with avulsion of the patellar tendon leading to pain
- Usually seen in adolescents
What is the treatment for osgood-schlatter’s syndrome?
RICE
Isometric stretches
PRP
What is patellar tendonitis? Treatment?
- “Jumper knee”
- Overuse injury that is a risk for OS
- RICE
What is a baker’s cyst?
Posterior popliteal cyst that is a complication of chronic inflammation of the knee
What is the treatment for a Baker’s cyst?
RICE
NSAIDs
Aspiration if necessary
What is housemaid’s knee?
Prepatellar bursitis from kneeling for long periods
What is Clergyman’s knee?
Superficial infrapatellar bursitis that is commonly seen in roofers
What is deep infrapatellar bursitis?
Inflammation between the patellar ligament and the tibia
What is the risk of injection and/or aspiration of bursa?
All connected so increased risk of infection spreading
What ways does the fibular head move?
Anterolateral and posteromedial
What is the treatment for fibular head abnormalities?
Anti-inflammatories
What nerve may be associated with fibular head abnormalities?
Peroneal nerve
What is tibial torsion? How is it treated?
External or internal torsion of the tibia that usually occurs in children. Usually treated with ME
What is the ligament that is on the medial side of the ankle?
Deltoid ligament
What are the ligaments that are on the lateral side of the ankle, from anterior to posterior (3)?
- Anterior tibiotalar
- Calcaneofibular ligament
- Posterior talofibular ligament
Should you evaluate the gait with an ankle injury?
Yes
What is Morton’s toe?
Long second toe
What is the functional test for arch assessment?
Forward squat test–keep heels on the ground
-If arches roll inward = pronation
Which ligament is being assessed for with the anterior drawer test?
Anterior talofibular ligament
Which ligament is being assessed for with the talar tilt test? What does a positive test indicate?
- Calcaneofibular ligament
- Increased motion and/or lack of endpoint
Which ligament is being assessed with the reverse talar tilt?
Deltoid ligament
What is the external rotation test of the ankle, and what does it assess for?
Forceful external rotation of the foot
-If affected side opens more than 15 degrees compared to other, then indicates a high ankle sprain
Where on the leg is the squeeze test performed?
Mid leg
What are the components of the ottawa ankle rules?
TTP over:
- Lateral malleolus
- Medial malleolus
- base of the 5th metatarsal
- navicular
or inability to bear weight
What is the swing test?
Keep plantar aspect of the foot parallel to the ground while passively flexing the knee
-Positive test is when RROM is felt
