Sports Injuries:

Question 1

What are the benefits of warming up before activity?

Answer 1

• increased HR and blood pressure
• Blood flow to muscles increases temperature and reduces stiffness
• increased ventilation
• neural pathways are primed
• Hormone secreted e.g glucagon.

Question 2

What are some examples of apophyseal injuries?

Answer 2

Acute avulsion and chronic apophysitis.

Question 3

What is an acute avulsion?

Answer 3

Tendon pulls on apophysis and a bone fragment separates from the rest of the bone on sudden forceful contraction.

Treated with rest, protective weight bearing, early ROM and stretching.

Question 4

What is chronic apophysitis?

Answer 4

Repeated microtrauma to the apophysis causing inflammation and enlargement.

Diagnosed with radiographs and MRI

treated with conservative management.

Question 5

What is an anterior dislocation of the shoulder? What is it caused by?

Answer 5

Most common type of shoulder dislocation. Caused by the arm being positioned in an excessive amount of abduction and external rotation.

Question 6

What are some possible associated injuries with an anterior shoulder dislocation? (4)

Answer 6

• Axillary nerve injury characterised by loss of sensation over the deltoid
• Hill-Sachs deformity with cortical depression in the humeral head.
• Greater tuberosity fracture
• Bony bankart lesions

Question 7

How do you manage an anterior shoulder dislocation?

Answer 7

Analgesia with intra articular injection with procedural sedation and closed reduction, then immobilisation.

Question 8

How are posterior dislocations commonly caused?

Answer 8

Typically caused by seizures or electrocution, but can occur through trauma (a direct blow to the anterior shoulder or force through a flexed adducted arm)

Question 9

What is a Hill-Sachs lesion

Answer 9

Posterolateral humeral head compression fracture.

Question 10

What is a bankart lesion?

Answer 10

humeral head rips through anterior bony glenoid rim or anterior labrum.

Question 11

What are the 3 Rs of fracture management?

Answer 11

Reduction - relocation of fracture/dislocation with analgesia and muscle relaxants.

Restriction - immobilisation allowing soft tissue recovery

rehabilitation - physiotherapy.

Question 12

What is Lateral epicondylitis? What is it caused by, how do you diagnose?

Answer 12

aka “tennis elbow” is overuse of the common extensor origin. The most common overuse syndrome in the elbow.

repeated microtrauma leads to inflammation. From repetitive wrist extension, gripping, lifting.

Pain over ECRB origin. Resisted wrist/finger extension and passive flexion of wrist on pronation. Mill’s Test.

Can also have radial tunnel syndrome present

Question 13

What is medial epicondylitis? What is it caused by and how do you diagnose?

Answer 13

Aka Golfer’s elbow. inflammation at origin from overuse of flexor and pronator muscles.

caused by repetitive wrist flexion and forearm pronation, gripping and heavy lifting.

Pain 1cm distal or medial to the medial epicondyle. Pain evoked by resisted flexion of wrist and pronation, usually accompanied by a weakness of hand grip. Golfer’s elbow test.

Can also have ulnar neuritis

Question 14

How do you treat elbow epicondylitis?

Answer 14

Conservative treatment first.

Then extracorporeal shockwaves, corticosteroids and surgery.

Question 15

What are meniscal injuries and how are they caused? how can you diagnose and manage?

Answer 15

Injuries can range from a meniscus strain to a partial or full meniscus tear. Characterised by swelling and localised pain with mechanical symptoms.

meniscus can tear suddenly with acute trauma, or wear down gradually and tear over time.

MRI to diagnose.

Management is conservative or surgical with removal or transplant.

Question 16

What are ACL injuries, What are their characteristics and how are they diagnosed?

Answer 16

Anterior cruciate ligament injury is typified by a sudden, painful, audible pop noise.

The patient is typically unable to return to the ongoing sporting activity, and presents with joint instability, and rapid development of an effusion (haemarthrosis)

tenderness at lateral femoral condyle, lateral tibial plateau
positive anterior drawer test.

A positive Lachman’s test is most accurate right after the injury and the pivot shift test is more useful in sub-acute or chronic cases.

Higher incidence in females.

Question 17

What is a common history for PCL injury, How can you diagnose?

Answer 17

history of hyperextension mechanism or a blow to anterior aspect of knee; difficulty descending stairs or running down hills.

increase in posterior translation compared with the contralateral knee in the posterior drawer test; posterior sag of the tibia on the femur (posterior sag sign); positive quadriceps active test

Usually occurs with other ligament injuries.

Question 18

Characteristics of medial collateral ligament injuries.

Answer 18

• Medial collateral ligament injury occurs when excessive valgus stresses or external rotation forces are placed on the knee joint.
• The most common symptom is medial-sided knee pain above or below the joint line. Patients are usually able to walk. Swelling occurs later.
• Most common ligament injury, often occurs with ACL tear.

Question 19

What are some common characteristics of Lateral collateral Ligament injury?

Answer 19

• isolated injury to LCL rate, often occurs with PLC.
• Caused by varus stress or direct blow.
  -swelling occurs later.

Question 20

What is medial tibial stress syndrome?

Answer 20

• lay term is shin splints. Pain is worse following exercise
• represents exertional lower leg pain centred on the posteromedial tibial border and being diffuse/linear (greater than 5 cm) rather than focal.
• common in runners, can lead to stress fractures.
• Treated with conservative methods NSAIDs and physio.

Question 21

What is exertional compartment syndrome?

Answer 21

reversible ischaemia, usually in the anterior compartment.

Characterised by burning/aching pain with exertion that is relieved by rest.

Treatment: avoid activity that caused pain, use of NSAIDs

Question 22

What are varus and valgus?

Answer 22

Varus = feet more towards midline, knees move laterally

Varus = feet away from midlines, knees move medially.