Sports Flashcards
Discuss the presentation and management of an ACL tear
Mechanism:
- non-contact pivot injury
Presentation:
- “pop” with immediate pain and hemarthrosis
- avoidance of extension
- Lachman positive (may have initial difficulty due to swelling)
X-ray:
- Deep sulcus sign with impaction of anterior portion of lateral femoral condyle
MRI:
- disruption of the ACL
Treatment:
- physical therapy used for majority if non-active and stable
- ACL reconstruction
Discuss the presentation and management of meniscal injuries
Location:
- medial tears more common than lateral tears (unless acute with ACL tear than it is lateral)
Mechanism:
- repetitive injury
- Acute twisting injury
Classification:
- red-red zone is periphery (outer third)
- red-white zone is middle third
- white-white zone is inner third (a vascular)
Pattern:
- bucket handle
- vertical
- parrot beak (oblique)
Presentation:
- pain localizing to medial or lateral side with PwP along medial or lateral joint line
- Locking and clicking
- delayed swelling
- McMurray: ER and varus for medial and IR and valgus for lateral
MRI
- double PCL or double anterior horn sign
Treatment:
- rest, NSAIDs, physis
- Partial meniscetomy when in white-white
- Meniscal repair if have good vascular supply
Differentiate between Cam and Pincer impingement
Cam: - present in young male athletes and is a change to the anterolateral femoral head - characteristics: - decreased head to neck ratio - aspherical femoral head - decreased femoral offset - femoral neck retroversion Pincer: - present in active middle aged women and have anteriorsuperior acetabular changes - characteristics: - anterosuperior acetabular rim overcoverage - acetabular retroversion - acetabular protrusio - coxa profounda
Discuss the presentation and management of FAI
Presentation:
- activity related hip or groin pain relieved with flexion
- difficulty sitting
- mechanical clicking or popping
- limited hip flexion <90 degrees
- anterior impingement test (flexion, adduction, internal rotation) leads to pain
X-ray:
- Pistol grip deformity: Cam impingement
- Crossover sign: acetabular retroversion
- alpha angle: on frog leg lateral first line connect centre of femoral head and centre of femoral neck and second is from centre of femoral head to anterolateral head-neck junction where prominence begins: >42 have offset, >50-55 have Cam
- lateral centre-edge angle: vertical line from Center of femoral head and other to lateral portion of acetabulum: >40
- Acetabular index: from triradiate cartilage horizontal and from triradiate to superior portion of lateral acetabulum
Treatment:
- Activity modification and PT with minimal symptoms and no mechanical symptoms
- Arthroscopic osteoplasty
- PAO
- hip arthroplasty
Discuss the presentation and management of OCD
Is an articular cartilage and subchondral bone defect Mechanism (correspond to Clanton 1-4): - softening of the overlying articular cartilage with intact articular surface - early articular cartilage separation - partial detachment of lesion - osteochondral separation with loose bodies Presentation; - vague activity related pain - mechanical symptoms - localized tenderness - Wilson’s test: paint with IR and extension of knee, relieved with ER Investigations: - X-ray - MRI Treatment: - restricted weightbearing and bracing - subcondral drilling - fixation
Discuss the presentation and management of snapping hip
Types:
- External snapping hip: IT band sliding over GT
- Internal snapping hip (most common): iliopsoas sliding over femoral head
- Intra-articular: loose body or labral tear
Presentation:
- snapping sensation that can be painless or painful
- external: apply pressure to GT with hip flexion to stop, Ober
- internal: reproduce when move from flexed and ER to extended and IR
Treatment:
- acute require activity modification, PT, injection
- excision of bursa or release of iliopsoas tendon
Discuss the presentation of a disruption of the extensor mechanism
Mechanism:
- tensile overload with resisted knee extension
- quadriceps more common than patella (especially in older adults)
Presentation:
- sudden knee extension with “pop” and pain afterwards
- PwP and defect
- disruption of extension
X-ray:
- patella Alta or Baja (measured on lateral with longitudinal length of patella compared to patellar tendon which should be = 1)
Management:
- primary repair or reconstruction
Discuss the presentation and management of a hip labral tear
Mechanism: - FAI - hip dysplasia - trauma - capsular laxity - joint degeneration Presentation: - mechanical hip pain and snapping - locking - anterior tear: pain from fully flexed, ER, and abducted to extension, IR, and adduction - posterior tear: pain from flexed, adducted and IR to abduction, ER, and extension Investigations: - MRI arthropgram Treatment: - rest, NSAIDs, PT, injection - arthroscopic labral debridement
Discuss the presentation and management of MCL injuries
Mechanism: - valgus stress to the knee - terrible triad: MCL, ACL and medial meniscus injury Presentation: - “pop” - medial joint line pain and PwP - valgus stress test positive Treatment: - mainly nonoperative unless associated injury - bracing for grade 2-3 injuries
Discuss the presentation and management of rotator cuff tears
Mechanism:
- chronic degenerative tear: SIT muscles
- chronic impingement
- acute avulsion: subscapularis in younger patients, SIT in those >40
Presentation:
- insidious onset of pain which increases with overhead activities
- night pain
- loss of active ROM, good passive ROM
- Supraspinatus: painful arc, drop arm test, Jobe
- Infraspinatus: ER resistance
- Teres minor: ER resistance
- Subscapularis: lift off
Investigations:
- US
Treatment:
- PT, NSAIDs, injection first line for most tears
- subacromial decompression
- rotator cuff repair
What are the risk factors for adhesive capsulitis
- Diabetes
- Thyroid
- Dupurtren’s
- Artherosclerotic
- Cervical disc disease
Discuss the presentation and management of adhesive capsulitis (frozen shoulder)
Have loss of active and passive ROM
Mechanism:
- inflammatory process leading to fibroblastic proliferation in joint capsule leading to thickening, fibrosis and adherence
- result in mechanical block in motion
Stages:
- freezing: gradual onset of diffuse pain over 6w - 9m
- frozen: decreased ROM affective ADL for 4-9mon
- thawing: gradual return to motion over 5-26mon
Investigations:
- x-ray to rule out arthritis
Treatment:
- physical therapy, NSAIDs, injection
- manipulation under anaesthesia if fail to improve
Discuss the presentation and management of a SLAP lesion
Superior Labrum from Anterior to Posterior tear Mechanism: - repetitive overhead activities - fall on outstretched hand Presentation: - deep shoulder pain with mechanical symptoms - O’Brien test: resisted adduction,90 extension and pronation Investigations: - MRI Treatment: - physical therapy, NSAIDs - arthroscopic debridement
Discuss the presentation and management of AC joint injuries
Mechanism:
- Direct impact on shoulder
Presentation:
- pain
Classification:
- Type 1: pain, no instability require sling
- Type 2: increase in CC distance by <25%, sling
- Type 3: increase in CC distance by 25-100%, sling
- Type 4: superior displacement and skin tenting with posterior displacement, surgery
- Type 5: increase in CC distance >100%, surgery
- Type 6: inferior dislocation
Discuss the presentation and management of subacromial impingement
Mechanism:
- mix of extrinsic compression between numeral head and acromion/coracoacromial ligament/acromioclavicular joint and instrinsic degeneration of supraspinatus
Presentation:
- insidious onset of pain that is worse with overhead activities
- night pain
- Neer positive
- Painful arc
X-ray:
- type III hooked acromion
- proximal migration of humerus with rotator cuff arthropathy
Treatment:
- NSAIDs, PT, injection
- decompression/acromioplasty when failed for >4-6 months
