Sport's Medicine Flashcards
Specific Injuries based on anatomic site
- Shoulder? 4
- Elbow? 2
- Knee? 4
- Foot and Ankle sprains? 1
- Shoulder
- Rotator cuff disease
- Degeneration
- Instability
- Biceps and SLAP Lesions - Elbow
- Medial pain issues
- Lateral pain Issues - Knee
- ACL
- Meniscal Injuries
- Articular Cartilage
- Anterior Knee pain - Foot and Ankle
- sprains
Who’s at risk for rotator cuff injuries? 2
- Trauma
- Repetitive overuse
- What kind of population sufferes from degenerative tenon?
- Describe the process?
- Many sports played competitively into 60’s, 70’s and 80’s
2.
- Tendons undergo normal aging and degeneration
- Sport further stress on tendon complex
Describe whats going on in the pictures below?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/636/q_image_thumb.png?1468333407)
- Supraspinatus- No sign of white, which is good. no fat
- More white streaks, pretty substantial tear in a younger individual. fatty white streaks
- Probably not reconstructable and have to start thinking replacable.
What is our goal for nonoperative treatment?
What are these? 6
- Reduce Inflammation
2.
- Time
- Activity shutdown
- NSAID’s
- Subacromial injection
- Modalities
- PT: ROM and Strength
Supraspinatus exercise?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/638/a_image_thumb.png?1468333185)
Infra/Teres Strengthening?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/640/a_image_thumb.png?1468333229)
Subscapularis Strengthening?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/644/a_image_thumb.png?1468333262)
What is the surgical option for a Full thickness rotato cuff tear?
3
- Open Repair
- Mini-Open Repair
- Arthroscopic Repair
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/649/a_image_thumb.png?1468333468)
Describe the Open Repair for RC
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/651/a_image_thumb.png?1468333598)
Describe Mini-Open Repair for RC?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/653/a_image_thumb.png?1468333633)
Describe the Arthroscopic repair for RC?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/667/a_image_thumb.png?1468333666)
Post-op Course for RC surgery?
6
- Sling for 6 weeks
- Rehab for 3 mos
- Golf 4 to 5 mos
- Tennis 6 mos
- Swimming 7 to 8 mos
- Full recovery 1 year
Shoulder Arthritis:
1. Early/Moderate Tx? 5
- Severe? 1
1.
- Activity Modification
- NSAIDS
- Steroid Injections
- PT
- Arthroscopy
2. Shoulder Replacement
What is going on in the following pictures?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/670/q_image_thumb.png?1468333921)
Osteophyte off the humerus itself. They almost always wear out posteriorly. This is best treated with a replacement.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/670/a_image_thumb.png?1468333904)
TSR results
- Failure rate?
- Advantages? 2
- 3% failure
2.
- Predictable pain relief
- Excellent function
What is often a sign of shoulder instability?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/674/a_image_thumb.png?1468334097)
Treatment of 1st Dislocation
- Have to determine what?
- Tx Options? 3
- Whats your biggest issue with stability?
- Anterior vs. Posterior
2.
- Reduction: X-ray
- Immediate: ER Brace
- Surgical
3. Labral tear
Instability Treatment
Open Repair
- Pros? 3
- Cons? 2
- Pro’s:
- Higher success rate
- Better in ligamentously lax
- Glenoid reconstruciton possible - Con’s:
- Risk of over tightening
- Painful post-op
What does neer test?
Biceps Disease
Neer: Outlet Impingement
What contributes to bicep dz?
3
- Acromion shape and slope
- AC joint enlargement
- Cuff and biceps problems
Biceps Degeneration/Tendonitis
How would you treat the following:
- Isolated?
- W/ Rotator Cuff Tendonitis?
- W/ Rotator Cuff Tear?
- Non-Operative Management: if failure then surgical tx
- Non-Operative Management: if failure then surgical Tx
- Surgical Tx
What tests would we do for Bicep pathology?
4
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/680/a_image_thumb.png?1468334636)
Tests for Subscap?
2
Stomach compression test
Lift off test
Diagnostic Imaging: for shoulder path?
2
- MRI:
Moderate accuracy for biceps disease: Gadolinium recommended
- Up to 97% assoc. with RCT
2. Ultrasound- Injection guide
Non-operative Management: Bicep injury
Spontaneous Rupture treated how?
4
Spontaneous Rupture
Treated non-operatively
Non-operative Management
- Rest
- NSAIDS
- Physical Therapy- Rotator cuff strengthening
- Injections- Intra-articular
Surgical Indications:
Tenotomy or Tenodesis
5
- Subluxation or dislocation of biceps
- > 25 % tear
- Significant inflammation, atrophy, hypertrophy
- Routine during TSR and HHR (esp. fracture/stiffness)
- Irreparable rotator cuff tear
Tenotomy 3 vs. Tenodesis 2?
OUr indications?
Evolving with new techniques
- Tenotomy:
- Elderly, cosmesis less of concern
- Easier rehab
- Revision - Tenodesis:
- less than 50 years,
- cosmesis/strength IS a concern
SLAP means what?
Superior Labral tear from Anterior to Posterior
What is Obriens test for?
Labral Tear
318 PATIENTS, 56 WITH POSITIVE TEST POSITIVES CONFIRMED SURGICALLY
SENS - 100%
SPEC - 98%
AC JOINT
What is the crank test?
For labral tear
![](https://s3.amazonaws.com/brainscape-prod/system/cm/370/789/690/a_image_thumb.png?1468335022)
SLAP Lesion Non-operative management
4
- Non-operative Management
- Rest
- NSAIDS
- Physical Therapy X 3 mos
- Throwing Program
SLAP lesions PT includes?
3
- Rotator cuff strengthening- Instability
- Scapula strengthening
- Posterior Capsular Stretching- Internal Impingement
Slap Repairs: Indications
5
- Young patient (<40)
- Mechanical symptoms
- Associated Instability
- Associated internal impingement
- Acute rotator cuff tear