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YEAR 1 MED > Sports injuries > Flashcards

Sports injuries Flashcards

1
Q

What are the menisci of the knee?

A
  • two semicircular fibrocartilage structures that lie between the femoral and tibial articular surfaces
  • they act as shock absorbers and are prone to injuries caused by the large forces crossing the knee
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2
Q

Basic anatomy of the knee diagram…

A
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3
Q

Knee anatomy cross-section…

A
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4
Q

Which meniscus (lateral or medial) is more commonly injured and why?

A
  • the medial meniscus is more commonly injured because it is fixed, in comparison to the more mobile lateral meniscus
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5
Q

What are the 2 types of meniscal tears?

A
  • Traumatic: injury usually occurs after landing or twisting witht he knee flexed (can be associated with ACL tear)
  • Degenerative tears: occur in older population through abnormal cartilage (may occur with very little injury)
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6
Q

Bucket-handle meniscal tear…

A
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7
Q

Why is it clinically important to establish how peripheral (close to outer boundary) a meniscal tear is?

A
  • very peripheral tears occur through vascular tissue and usually repair well
  • meniscal tears further away from the blood supply (ie. further into the knee) cannot heal
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8
Q

Meniscal cyst diagram…

A
  • meniscal cyst results from synovial fluid being pumped into the meniscal tear
  • (a valve effect means the fluid in the cyst cannot drain back into the knee)
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9
Q

What injury usually causes a meniscal tear, and what are the clinical features of a meniscal tear?

A
  • Type of injury: during a tackle, twisting or changing direction
  • Symptoms: locked knee, effusion, joint line tenderness
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10
Q

How is diagnosis of meniscal tears made?

A
  • usually just on history and examination (special tests for meniscal tears are not very reliable)
  • MRI: confirms diagnosis but knee arthroscopy is most accurate way to confirm diagnosis
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11
Q

What is the management for meniscal tears?

A
  • Conservative: RICE, physio
  • Surgical: arthroscopy (meniscal repair if able to, partial meniscectomy removes damaged portion only and reduces risk of OA in future)
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12
Q

What is the role of the ACL and what is the mechanism of injury of an ACL tear?

A
  • ACL prevents anterior translation of the tibia (also restrains rotation)
  • Mechanism of injury: twisting or valgus strain pattern (common in football and skiing)
  • note: associated injuries to the MCL and meniscus are common
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13
Q

Mechanism of injury in anterior cruciate ligament (ACL) rupture…

A
  • knee is usually extended or slightly flexed with the foot fixed
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14
Q

What is the unhappy triad?

A
  • ACL injury
  • MCL injury
  • meniscal injury
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15
Q

What are the symptoms of an ACL rupture/tear?

A
  • Struggle to weight-bear
  • Instability of knee (‘giving way’) but no pain
  • struggle to change direction at speed
  • effusion sometimes
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16
Q

What is the difference between onset of injury between meniscal tears and ACL tears, and why?

A
  • ACL tears: swelling usually occurs within minutes to hours
  • Meniscal tears: swelling usually occurs over 24 hours
  • (this is because the ACL is more vascular than the menisci)
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17
Q

How is diagnosis of an ACL tear made and how is diagnosis confirmed?

A
  • Anterior drawer test (Lachman test is +ve)
  • diagnosis made clinically and confirmed with arthroscopy and MRI
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18
Q

What is the management for an ACL tear?

A
  • Conservative: RICE and physio
  • Surgical: ACL reconstruction by arthroscopy if knee is unstable (tendon graft)
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19
Q

What is the role of the PCL?

A
  • PCL is the primary restraint to posterior movement of the tibia on the femur
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20
Q

What is the aetiology of a PCL tear?

A
  • PCL injuries require a lot of force (usually from RTAs, dashboard injury)
  • PCL can also rupture when knee is forcibly hyperextended
  • Check neurovascular status of leg and foot as potential knee dislocation which is bad!)
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21
Q

Mechanism of injury in posterior cruciate ligament (PCL) injuries…

A
22
Q

What are the clinical features of a PCL injury?

A
  • unable to weight-bear
  • positive posterior sag and positive posterior drawer test
  • look for associated ligamentous injuries
23
Q

What investigation should be done for suspected PCL injury?

A
  • MRI
24
Q

What is the management for PCL injuries?

A
  • Conservative: rehabilitation
  • Surgical: reconstruction
25
Q

Which collateral ligament injury is more common (medial or lateral)?

A
  • Medial (MCL) are more common, commonly associated with ACL injuries too
26
Q

Mechanism of injury in collateral ligament tears…

A
27
Q

What are the clinical features of collateral ligament injuries?

A
  • pain and possible instability
  • MCL: tenderness over attachment of MCL and opening up of joint on valgus stress is present
  • LCL: easily palpable as a cord-like structure, area is tender, opening up of joint on varus stress is present
28
Q

What is the management for collateral ligament tears?

A
  • Conservative: physio and bracing for 6 weeks if bad
  • Surgical: only if chronic unstable injuries
29
Q

Anatomical features that prevent lateral dislocation of the patella…

A
30
Q

What are the 2 types of patella dislocation and what is the aetiology?

A
  • Habitual: usually young women with ligamentous laxity and a hypoplastic trochlea
  • Traumatic: usually during sports with knee slightly flexed with side impact
31
Q

What are the clinical features of a patella dislocation?

A
  • very painful, tenderness over medial side of knee and an effusion
  • patella usually spontaneously reduces if knee has been extended (if not then will be laterally displaced)
32
Q

What is the patellar apprehension test?

A
  • forced lateral displacement of the patella produces anxiety and resistance in patients with a history of lateral patellar instability
33
Q

What is the management for a patella dislocation?

A
  • Conservative: reduction, mobilisation encouraged, physio
  • Surgical: osteochondral fractures should be repaired or removed arthroscopically, recurrent dislocations may require surgical realignment, repair of medial patellofemoral ligament is carried out where physio has failed
34
Q

What is the aetiology of shoulder dislocations?

A
  • The shoulder joint has very little stability
  • The joint has sacrificed stability for movement
35
Q

What is the pathology of a shoulder dislocation?

A
  • Dislocation can be anterior (95%) or posterior (5%)
  • Anterior dislocation: occurs when arm is forced back in a ball-throwing position of external rotation and abduction
  • Posterior dislocation: occur with high-energy trauma, epileptic seizures, and electrocutions
36
Q

What is a Bankart lesion?

A
  • Glenoid labrum tear = Bankart lesion
  • (predisposing to further dislocations)
37
Q

What is a Hill-Sachs lesion?

A
  • Recurrent dislocations cause a Hill-Sachs lesion due to impaction of the glenoid on the posterior part of the humeral head
38
Q

What are the clinical features of a shoulder dislocation?

A
  • patient usually sports player (rugby)
  • lots of pain, shoulder usually being held by other arm
  • Examination findings: loss of normal contour, palpable glenoid, complete loss of movement
  • (posterior: arm held in fixed internal rotation)
39
Q

Abnormal shoulder contour in anterior dislocation of the humerus…

A
40
Q

What investigations should be done for suspected shoulder dislocations?

A
  • Confirm anterior dislocation with x-ray (always performed to exclude fracture)
  • Posterior dislcoation often missed (AP x-ray appears normal), should be suspcected if arm in fixed internal rotation
41
Q

Posterior dislocation of shoulder: AP X-ray showing light bulb sign…

A
42
Q

Posterior dislocation of shoulder: CT scan (axial view)…

A
  • there is posterior subluxation of the head with impaction of the head from the glenoid rim
43
Q

What is the management for a shoulder dislocation?

A
  • Conservative: reduction with adequate analgesia, then joint is rested in collar and cuff, then physio
  • (check axillary nerve is functioning before and after any intervention)
  • Surgical: posterior dislocation may require open reduction with general anaesthesia
44
Q

Elderly people when they dislocate their shoulder don’t usually get a Bankart lesion, what happens instead?

A
  • rotator cuff usually tears instead
45
Q

What is the aetiology of an ankle sprain?

A
  • commonly found on the sports field
  • mechanism of injury is inversion or eversion with damage to the lateral ligament and medial ligament respectively
46
Q

What is the pathology of a lateral ligament sprain and what is the pathology of a medial ligament sprain?

A
  • Lateral ligament sprain: varus tilt of talus, anterior talofibular and calcaneofibular ligaments are torn
  • Medial ligament sprain: valgus tilt of talus, deltoid ligament complex is torn
47
Q

Lateral ligament sprain/rupture diagram…

A
48
Q

What are the clinical features of an ankle sprain?

A
  • pain, ‘feels something go’, swelling occurs immediately
  • tenderness over the medial or lateral aspect of the ankle
49
Q

When would an x-ray be done in suspected ankle sprain?

A
  • x-ray only done if there is bony tenderness (malleoli) and inability to bear weight (Ottawa ankle rules)
50
Q

What is the management for an ankle sprain?

A
  • Conservative: analgesia, RICE, physio
51
Q

A patient comes in after an injury at the gym whilst bicep curling, on his upper arm their is a ‘pop eye’ sign, what is the diagnosis?

A
  • proximal biceps tendon rupture

YEAR 1 MED (49 decks)

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