Sport Related Injuries

Question 1

Prevention: General Principles

5

Answer 1

1. Stretch prior to activity: shouldn’t hurt
2. Warm up prior to activity: break a sweat
3. Make sure you’re in good enough shape to participate
4. Ease back into activity
5. Don’t play through the pain

Question 2

What are the kinds of injuries that can happen to the shoulder?
3

Answer 2

Overuse: fatigued tendons and muscles

Subacute: fatigued tendons and muscles that now slowly begin to tear/wear out: pain is increasing

Acute: Fell, threw too hard, swung to hard, now your shoulder hurts

Question 3

Describe overuse injuries? 1

Subacute? 2

Acute? 4

Answer 3

Overuse:
1. fatigued tendons and muscles

Subacute:

1. fatigued tendons and muscles that now slowly begin to tear/wear out:
2. pain is increasing

Acute:

1. Fell,
2. threw too hard,
3. swung to hard,
4. now your shoulder hurts

Question 4

Overuse Injuries of the shoulder are? 2

Answer 4

1. Tendonitis

2. Tendonopathy: sick tendon

Question 5

Describe tendonitis? 3

Tendinopathy? 2

Answer 5

Tendonitis:

1. irritation/inflammation of a tendon
2. Pain down the side of the shoulder with overhead and behind the back activity
3. Nighttime pain

Tendonopathy: “sick” tendon

1. Similar pain complaints
2. Pain may have been evident for a longer period of time

Question 6

Sports injury shoulder tx? 5

Answer 6

Treatment

1. Make sure that’s all it is: xrays and MRI
2. Non-steroidal anti-inflammatories
3. Ice
4. Physical Therapy
5. Corticosteroid injection

Question 7

Describe subacute injury of the shoulder.

1. Progression of what?
2. Describe the pain?

Answer 7

1. Progression of an overuse injury

2. Had occasional pain before, now it hurts worse and more frequently

Question 8

Subacute shoulder injury

1. Dx? 2
2. Tx if unremarkable? 4

Answer 8

1. • Xrays for the bones
   • MRI for the soft tissues
2. If unremarkable
   - Non-steroidal anti-inflammatories
   - Ice
   - Physical Therapy
   - +/- Corticosteroid injection

Question 9

Acute shoulder injury dx? 2

tx?

Answer 9

1. Xray and MRI

2. Treatment depends on the findings

Question 10

Shoulder:
In general the work up for overuse, subacute, and acute shoulder pain is the same
1. What are a must?

2. MRI Indications? 3

Know what you are dealing with before treating it

Answer 10

1. Radiographs
2. • Drop arm sign,
   • external rotation lag sign,
   • dislocation

Question 11

Concerning injuries: Shoulder injuries that you should be more worried about? 2

Answer 11

1. Pain does not improve with conservative management
2. Positive findings on xray
3. Positive findings on MRI (found something wrong)

Question 12

Concerning injuries: Shoulder

1. Positive findings on xray? 2
2. Positive findings on MRI (found something wrong)? 3

Answer 12

1. Fracture
2. Arthritis
3. Rotator cuff tear
4. Labral tear
5. Biceps tendon tear

Question 13

Shoulder

Whats next if conservative tx doesn’t work? 3

Answer 13

1. Shoulder arthroscopy
2. “Clean up the shoulder”
3. Repair torn tendons

Question 14

Recovery
Worst case scenario is cuff repair
1. Healing phase is how long?
2. When does it start?
3. Time in full time sling and part time sling?
4. Rehab?
5. Strengthening?
6. Typically takes how long?

Answer 14

1. 6 weeks: Healing phase
2. Typically start therapy at 3 weeks
3. Full time sling 3 weeks/part time 3 weeks
4. 6 weeks: Rehab
5. 6 weeks: Strengthening
6. Typically 3-4 months…start resuming previous activities…SLOWLY

Question 15

1. What kind of joint is the knee?

2. There are 3 seperate compartments: What are they?

Answer 15

1. A diarthroidal joint: a hinge joint
2. 3 separate comparments
   - Patellofemoral
   - Medial
   - Lateral

Question 16

Two main types of cartilage in the knee? Describe them?

Answer 16

1. Articular cartilage: a thin lining of resilient connective tissue that serves as padding and an ultra low friction surface
2. Meniscal cartilage: serve to deepen the contact of the femur on the tibia, provide stability, distribute force

Question 17

1. Joint reaction force in the knee is about __ times body weight when walking
2. This is absorbed by the what? 2

Answer 17

1. 3
2. • menisci
   • articular cartilage

Question 18

4 main ligaments in the knee?

Answer 18

1. Anterior Cruciate Ligament (ACL)
2. Posterior Cruciate Ligament (PCL)
3. Medial Collateral Ligament (MCL)
4. Lateral Collateral Ligament (LCL)

Question 19

The Knee
Problems of the knee?
5

Answer 19

1. Tendonitis
2. Meniscal tears
3. Ligament injuries
4. Cartilage injuries
5. Arthritis

Question 20

Mechanism of injury of a meniscus tear?

4

Answer 20

1. Twisting
2. Turning
3. Deep knee bends
4. Pivoting

Question 21

Meniscal Tear Symptoms? 5

Answer 21

1. Focal pain, typically intermittent
2. Swelling
3. Nightime pain
4. Pain with activity
5. Catching/locking

Question 22

Meniscal Tears
Tx options?
3

Answer 22

1. Physical Therapy
2. Injections
3. Arthroscopic surgery

Question 23

Arthroscopic surgery

1. What is it?
2. Better by when?

Answer 23

1. remove/fix the tear

2. 80-90% better by 6-8 weeks

Question 24

Ligament injuries
ACL
1. Fix in who?
2. Age restriction?
3. CI in who?

PCL

1. Fix when?
2. CI?

MCL

1. Tx?
2. Weight bearing?

LCL

1. Tx?
2. Fix if what?

Answer 24

ACL

1. Fix in active, physical individual
2. NO real age restriction
3. Contraindicated if significant arthritis

PCL

1. Fix when symptomatic
2. Contraindicated if significant arthritis

MCL

1. Brace for six weeks
2. Weight bearing as tolerated

LCL

1. Brace
2. Fix if part of a complex of lateral injuries

Question 25

Cartilage injury 1. When do we generally find out the level of severity? 2. Variety of treatments dependent on the severity? 2

Answer 25

1. Typically unclear of severity until the time of arthroscopy 2. Variety of treatments dependent on the severity - “smooth down” - Microfracture

Question 26

1. When would we do a cartilage transplant? 2. An attempt to prevent what? 3. Not useful in who?

Answer 26

1. Treatment for smaller, focal cartilage defects 2. An attempt to prevent the progression to osteoarthritis 3. Not useful in degenerative arthritis

Question 27

Knee injuries Meniscus tear with mild/mod arthritis 1. How common? 2. Meniscus tear is the __________ problem 3. Treatment based on what? 4. If symptoms are improving? 5. If not or worsening, then consider?

Answer 27

1. Rather common 2. “mechanical” 3. 6 weeks of observation 4. monitor 5. viscosupplemenation

Question 28

1. What is Viscosupplementation? 2. Maximum benefits can be seen up to when from the last injection? 3. In general, the beneficial effects last for what time period? 4. CI?

Answer 28

1. It is a solution of hyaluronan. - Hyaluronan is the lubricant and shock absorber in joints. 2. 12 weeks 3. 6 months to a year 4. No contraindication to a repeat injection series

Question 29

1. Osteoarthritis reduces the body’s ability to produce what? 2. Without it, the patient experiences what?

Answer 29

1. hyaluronan. | 2. the pain of OA as the joint wears out.

Question 30

Lateral and Medial Epicondylitis Treatment consists of ? 5

Answer 30

1. Rest: take some time off! 2. Ice 3. Compression 4. Elevation 5. Anti-inflammatories

Question 31

Lateral and Medial Epicondylitis For recalcitrant cases? 2

Answer 31

1. Consider corticosteroid injection 2. Platelet rich plasma injection Most of the time these go away. Some require surgery

Question 32

1. What is Platelet Rich Plasma? 2. Extracted from? 3. Delivered and works how?

Answer 32

1. High concentration of functionally viable platelets and their associated growth factors 2. Extracted from a small amount of patients blood: 9-18cc 3. Delivered arthroscopically/open and placed directly into the tear site to stimulate a reparative healing response for soft tissue and bone repair

Question 33

Applications for PDGF 1. Direct liquid form injections of concentrated platelets for what? 2. Clot form applications with extended growth factor release for what?

Answer 33

1. the various tendonitis problems | 2. cuff repairs, etc…