Sports Injuries (26) :(

Question 1

Manual muscle testing: what are the levels of brake testing?

Answer 1

0/5- no muscle contraction
1/5- muscle contraction without any movement
2/5- movement with gravity eliminated
3/5- movement against gravity
4/5- movement against moderate resistance
5/5- movement against maximal pressure

Question 2

Ligaments vs tendons?

Answer 2

Ligaments- bone to bone

Tendons- muscle to bone

Question 3

Sprain vs strain?

Answer 3

STrain- Tendon/muscle

Sprain- ligament

Question 4

What happens during a cervical strain and what are the signs/symptoms?

Answer 4

Sudden turn of the head, forced flexion, extension or rotation of the cervical muscles
S/sx- localized pain and tenderness, restricted motion, reluctance to move the neck in any direction

Question 5

How do you manage a cervical strain?

Answer 5

RICE and cervical collar (ice in beginning, heat after 72 hrs- inflammation process has ended)
Follow up with ROM, isometrics, isotonic strengthening program, cryotherapy, medication

Question 6

What is an isometric exercise?

Answer 6

Contractions of a group of muscles where the affected joint doesn’t move- helps build muscle strength

Question 7

What is an isotonic strengthening system?

Answer 7

Exercises that help maintain muscle tone

Question 8

What happens during a cervical sprain (whiplash) and what are the s/sx?

Answer 8

Similar to a strain but more violent; a snapping of the head and neck occurs, compromising the ligaments over the midline of the spine
S/sx- similar to cervical strain but last longer; pain usually starts the day after the trauma from muscle spasm

Question 9

How do you manage a cervical sprain?

Answer 9

Treat for a cervical fx until spinal cord trauma is ruled out
RICE for first 48-72 hrs, bedrest if needed, pain meds, NSAIDs, mechanical traction

Question 10

What is a cervical disc injury and what are the s/sx?

Answer 10

Herniation from extruded disc fragment or disc degeneration

S/sx- neck pain, some restricted ROM, radiating pain and numbness/tingling in upper extremity and weakness

Question 11

How to treat a cervical disc injury?

Answer 11

Rest and immobilization, traction or surgery

Question 12

What test is used to diagnose a cervical disc injury?

Answer 12

Spurlings- tilt head to one side 10-15 degrees and apply pressure straight down, repeat for other side; positive= reproduction of symptoms

Question 13

What is brachial plexus neuropraxia (burner/stinger) and what are s/sx?

Answer 13

Stretching or compression of the brachial plexus (network of nerve fibers for the upper arm beginning in the root of the neck
S/sx- burning sensation, numbness/tingling, pain from shoulder to hand, loss of fxn for several minutes; doesn’t last longer than a few days
*More common in football players who turn their head to the side as they tackle

Question 14

Management for brachial plexus neuropraxia?

Answer 14

Strengthening and stretching, padding neck to limit impact during mvmt; can resume normal activity once s/sx have disappeared

Question 15

Signs of a concussion?

Answer 15

Brief periods of diminished consciousness or unconsciousness that lasts seconds or minutes, Glasgow of 13-15, post-traumatic amnesia for less than 24 hrs, no signs of subdural or epidural hematoma (must rule out), negative CT or MRI

Question 16

Management of concussion?

Answer 16

Remove athletes from competition if LOC (assume cervical spine injury if LOC), allow for return to baseline before returning to play gradually
*After the 1st concussion, chances of a 2nd one are 3-6 times greater

Question 17

How to determine retrograde vs anterograde amnesia after a concussion?

Answer 17

Retrograde- ask a series of questions starting at the time of the injury, with each question going farther back in time (positive= can’t remember events before injury)
Anterograde- give the pt a list of 3 unrelated things to memorize with them immediately repeating it and then q5 min (positive= can’t remember, possible intracranial bleed)

Question 18

How to test analytical skills after a concussion?

Answer 18

Count back from 100 by 7’s

Question 19

Romberg test vs tandem walk?

Answer 19

Romberg- pt stands with feet shoulder width apart, shuts eyes and extends arms out to sides 90 degrees, tilt head back and lift one foot off the ground while keeping balance; if done, then have pt touch the index finger to the nose (lack of balance indicates cerebellar dysfunction)
Tandem walk- have pt straddle a straight line- walk heal to toe for about 10 yds, then return to start by walking backwards (lack of balance indicates cerebral or inner ear dysfunction)

Question 20

Occurrence of a clavicle fx, s/sx and management?

Answer 20

Occur primarily in middle 3rd- greenstick fx (only one end of bone broken) often occurs in young pts
S/sx- arm supported, head turned towards arm with chin tilted away, obvious deformity, pain/swelling/deformity on palpation
Management- closed reduction, sling, immobilization with brace fro 6-8 wks, isometrics after brace removed
*If the posterior portion is broken, you need a surgical consult to make sure the lung hasn’t been punctured
*Loss of clavicle length wont impede movement of the arm- the shoulder joint is responsible for mvmt of the arm

Question 21

What is an acromioclavicular sprain and what are the grades?

Answer 21

Result of a direct blow (from any direction), upward force from humerus
Grade 1- point tenderness and pain with movement; no disruption of AC joint
Grade 2- tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM
Grade 3- rupture of AC and CC (coracoclavicular) ligament
Grade 4- posterior dislocation of clavicle
Grade 5- loss of AC and CC ligaments; tearing of deltoid and trapezius attachments; gross deformity, severe pain, decreased ROM
Grade 6- displacement of clavicle behind the CC ligament
* 1-2= no deformity, tenderness

Question 22

Tests for acromioclavicular sprain and management?

Answer 22

AC compression- extend arm straight out, raise to 90 degrees, adduct 45 degrees, bend at elbow, bring hand to shoulder, push on elbow so arm is pushed over the shoulder
O’Brien’s- extend arm straight out, raise to 90 degrees, adduct 10-15 degrees, press down on the arm with humerus internally rotated and then externally
Management- ice, stabilize, aggressive rehab
1-3= nonoperative, 3-4 days to 2 wks of immobilization
4-6= surgical
If pt is a teen/adult and the bones aren’t touching, need a surgical consult

Question 23

What is glenohumeral subluxation/dislocation? Anterior vs posterior?

Answer 23

Incomplete or partial dislocation of the glenohumeral joint
Anterior- front force on shoulder, forced abduction, external rotation
Posterior- forced abduction and internal rotation (like falling on an extended and internally rotated shoulder

Question 24

S/sx off glenohumeral subluxation/dislocation?

Answer 24

Anterior- flattened deltoid, prominent humeral head in axilla, arm carried slightly away and out, moderate pain and disability
Posterior- severe pain and disability, arm carried in and closer to body, prominent acromion and coracoid process, limited ability to rotate arm out and elevate

Question 25

Special tests for glenohumeral subluxation/dislocation?

Answer 25

Jobe’s Apprehension- lay supine, flex elbow to 90 degrees, bring arm out 90 degrees and apply downward pressure to externally rotate glenohumeral joint; positive= apprehension of pain, pain= poss posterior impingement of rotator cuff
Jobe’s Relocation- position arm as in apprehension test, then place downward pressure just below the armpit; positive= pain or apprehension reduced

Question 26

Management of glenohumeral subluxation/dislocation?

Answer 26

RICE, reduction by a doctor and immobilization for 3 wks, isometrics while in sling, resistance exercises
*If pt is an athlete and is this is not the 1st dislocation, consider an MRI

Question 27

Complications of dislocations?

Answer 27

Bankart lesion- permanent anterior defect of labrum
Hill Sachs lesion- caused by compression of cancellous bone (spongy, porous) against anterior glenoid rim creating a divot in the humeral head
SLAP lesion- defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum
Brachial nerves and vessels may be compromised
Rotator cuff injuries
Bicipital tendon subluxation and transverse ligament rupture

Question 28

What is shoulder impingement syndrome?

Answer 28

AKA swimmer’s shoulder or thrower’s shoulder
Mechanical compression of supraspinatus tendon, subacromial bursa and long head of biceps tendon due to decreased space under coracoacromial arch (tendons of the rotator cuff become impinged as they pass thru the shoulder joint in the narrow subacromial space)
Exacerbating factors- laxity and inflammation, postural malalignments (kyphosis, rounded shoulders)

Question 29

S/Sx of shoulder impingement syndrome? Tests?

Answer 29

Diffuse pain, pain on palpation of subacromial space, decreased strength of external rotators compared to internal rotators, tightness in both posterior and inferior capsule, positive impingement and empty can tests

Question 30

Tests for shoulder impingement syndrome?

Answer 30

Empty Can test- extend arm straight out to the side 90 degrees and internally rotate like you are emptying a can of pop, apply downward pressure on the lower arm; positive= significant pain or weakness
Hawkin’s/Whistle Stop- keeping one hand on the shoulder, raise the arm straight up to 90 degrees, bend elbow in to 90 degrees, holding onto the wrist push down to internally rotate the humerus; positive= pain
Neer’s- keeping one hand on the shoulder, passively pronate the arm and raise straight up as high as possible; positive= any pain

Question 31

What are the Neer’s Stages of Shoulder Injury?

Answer 31

1- result of supraspinatus or biceps tendon injury presenting with point tenderness, pain with abduction and resisted supination with external rotation; edema, thickening of rotator cuff and bursa (occurs in athletes less than 25 yo)
2- permanent thickening and fibrosis of supraspinatus and biceps tendon; presenting with aching during activity that worsens at night; may have restricted motion
3- hx of shoulder problems and pain, tendon defect or possible muscle tear and permanent scar tissue and thickening of rotator cuff
4- infraspinatus and supraspinatus wasting, pain during abduction, tendon defect greater than 3/8”, limited active and full passive ROM, clavicle degeneration
*See attachment for more explanation

Question 32

Rotator cuff tear? What test is used to diagnose?

Answer 32

Tear in the tendons around the shoulder joint, partial vs full thickness tears; very common, usually occurs in those who use the same repetitive arm movements
Full thickness tears usually occur in athletes over 40 with a long hx
Test- empty can

Question 33

Stages of rotator cuff tear? Management?

Answer 33

1- edema and Inflammation, or early stage impingement characterized by pain with certain positions and motions; overhead motions may be restricted
2- fibrosis and tendonitis characterized by marked loss of motion, pain, weakness, inflammation and tendon involvement; actively lifting the arm overhead may be difficult; joint noise, grinding “crepitus” and a feeling of catching when raising the arm over head may be present
3- bony spurs and tendon ruptures with significant weakness, degenerative changes, decrease or absence of active motion, significant or absence of pain depending on the severity of the damage
Management- pain meds, NSAIDs and u/s for inflammation; strengthen lower extremity and trunk to reduce stress on shoulder, restore approp. mechanics and strengthen rotator cuff to restore space around humeral head; worse cases may need immobilization, rest and possible surgery

Question 34

Shoulder bursitis etiology, s/sx and management?

Answer 34

Chronic inflammation due to trauma or overuse; fibrosis occurs and fluid builds up, resulting in chronic inflammation
S/sx- pain with motion, tenderness during palpation in subacromial space; positive impingement tests
Management- cold, u/s, NSAIDs for pain and inflammation; maintain full ROM to lower chances of contractures and adhesions forming

Question 35

Adhesive capsulitis etiology, s/sx and management?

Answer 35

Contracted and thickened joint capsule with little synovial fluid; chronic inflammation with contracted inelastic rotator cuff muscles; usually affects more females in their 40’s and diabetics
S/sx- generalized pain with active and passive motion, leading to movement resistance
Management- aggressive joint mobilization and stretching of tight muscles; can use steroid injections to help with inflammation; electric stimulation for pain and u/s for deep heating; can take a year or more to resolve

Question 36

Thoracic Outlet Syndrome etiology and s/sx?

Answer 36

Compression of brachial plexus, subclavian artery and vein due to: decreased space between clavicle and 1st rib, scalene compression, compression by pec minor and presence of cervical rib
S/sx- numbness/tingling, pain, sensation of cold, impaired circulation, muscle weakness, muscle atrophy, radial nerve palsy

Question 37

Tests for Thoracic Outlet Syndrome? Management?

Answer 37

Allen’s test- find the radial pulse in the arm being tested, abduct arm to 90 degrees with elbow flexed (L shape), have pt turn their head to the opposite side of arm being tested; positive= diminished or absent radial pulse
Management- correct anatomical condition thru stretching (pec minor and scalene) and strengthening (trapezius, rhomboids, serratus anterior, erector spinae)

Question 38

Bicep tendonitis etiology, s/sx?

Answer 38

Repetitive overhead athlete-ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath
S/sx- tenderness over bicipital groove, swelling, crepitus due to inflammation

Question 39

Tests for bicep tendonitis? Management?

Answer 39

Speed’s test- bring arm straight up with had supinated; push down on lower arm while pt resists; positive= pain
*May have sudden jerking motion of arm when stop pushing on it
Yeargason’s- position arm like you are going to shake someone’s hand, stabilize elbow by holding the inside, grip the forearm with the other hand, keeping the elbow straight, bring the forearm backwards; positive= pain or snapping in bicipital groove
Management- rest, ice, u/s for inflammation, NSAIDs, gradual strengthening and stretching

Question 40

Olecranon bursitis?

Answer 40

AKA baker’s elbow, student’s elbow, elbow bump
Elbow bursa becomes irritated or inflamed, causing pain and limiting mvmt
S/sx- pain, swelling (spontaneous, not warm), point tenderness
Management- in acute condition, lasts for less than 1 hr; chronic conditions need superficial therapy, usually compression; aspiration may be needed if swelling doesn’t resolve

Question 41

Ulnar collateral ligament injury etiology, s/sx?

Answer 41

Repetitive stress damages the ulnar collateral ligament; may result in ulnar nerve inflammation or wrist flexor tendonitis
S/sx- pain along medial aspect of elbow, tenderness over ligament, associated paresthesia, positive Tinel’s, pain with valgus stress test; x-ray may show hypertrophy of humeral condyle, calcification within UCL, loose bodies in posterior compartment

Question 42

Tests and management for ulnar collateral ligament injury?

Answer 42

Valgus stress- fixate the humerus and externally rotate it, palpate the ulnar collateral ligament, hold proximal wrist joint with other hand, flex elbow to 30 degrees, apply abduction or valgus force (see video)
Varus stress- fixate humerus and place in external rotation with one hand, palpate radial collateral ligament, flex elbow to 30 degrees, hold wrist joint with other hand, apply adduction or varus force (see video)
Tinel’s test- lightly tap over nerve to elicit a pins and needles feeling
Management- RICE, NSAIDs, strengthening and analysis of throwing motion; might need surgery

Question 43

Lateral epicondylitis?

Answer 43

AKA tennis elbow
Inflammation of the tendons that join the forearm muscle on the outside of the elbow; damage occurs from repetitive motion and overuse
S/sx- pain in area after activity, pain worsens and pain in wrist and hand develop, elbow has decreased ROM, pain with passive wrist extension
Management- RICE, NSAIDs, ROM exercises, deep friction massage, avoid pronation motions, mobilization and stretching, mechanics training, counter force or neoprene sleeve

Question 44

Medial epicondylitis?

Answer 44

AKA golfer’s elbow
Inflammation of the tendons that attach your forearm muscles to the inside of the bone at your elbow; damage occurs from repetitive motion and overuse
S/sx- pain with forceful flexion or extension, point tenderness, mild swelling, passive mvmt of wrist seldom elicits pain
Management- sling, rest, cryotherapy, heat thru u/s, NSAIDs, brace below elbow to reduce stressing; may need splinting and complete rest for 7-10 days if severe enough

Question 45

Carpal tunnel tests and management?

Answer 45

Tinel’s- rest arm supine on table, tap wrist, then tap index finger up to elbow; positive= tingling in thumb, index finger, middle finger and lateral half of ring finger
Phalen’s- bring hands together but with tops of hands touching, touch wrists to chest for 1 min; positive= tingling in thumb, index finger, middle finger and lateral half of ring finger

Question 46

DeQuervain’s tenosynovitis etiology, s/sx?

Answer 46

AKA radial styloid tenosynovitis
Tendons around the base of the thumb are irritated or constricted from constant wrist movement; swelling of tendons and tendon sheath can cause pain and tenderness
S/sx- aching pain, mvmt of wrist increases pain, point tenderness and weakness during thumb extension and abduction. painful snapping and catching of tendons during mvmt

Question 47

Test and management for DeQuervain’s?

Answer 47

Finkelstein’s test- rest arm so wrist is at edge of trtmt table with thumb up; have pt move only wrist down’ positive = pain at tip of styloid process
Management- immobilization ,rest, anti-inflammatories, cold, maintain ROM with joint mobilization

Question 48

Scaphoid fracture?

Answer 48

From falling on an outstretched arm
S/sx- Swelling, severe point tenderness, scaphoid pain from radial flexion
Management- ice, splint, x-ray, cast for 6 wks, followed by strengthening exercises; protect for 3 mos.

Question 49

Mallet finger?

Answer 49

Blow from a thrown ball that strikes the tip of the finger, jamming and avulsing the extensor tendon; rupture of extensor tendon
S/sx- pain at distal interphalangeal joint, athlete unable to extend finger, point tenderness
Management- RICE for pain and swelling, splinted in extension position for 6 wks (must start over if it fails to be extended even once)

Question 50

Boutonniere deformity?

Answer 50

Rupture of extensor tendon of second knuckle below finger tip
S/sx- severe pain and inability to extend DIP joint; swelling, point tenderness, obvious deformity
Management- cold, splinted in extension position fro 6 wks (must start over if it fails to be extended even once)

Question 51

Gamekeeper’s thumb?

Answer 51

Torn ulnar collateral ligament
S/sx- pain over UCL with a weak and painful pinch, tenderness and swelling over medial aspect of thumb
Management- x-ray, splint for protection

Question 52

Metacarpal fracture?

Answer 52

Metacarpals- 5 long bones in the hand
S/sx- pain, swelling, may appear to be an angular or rotational deformity
Management- RICE and pain meds, x-ray, reduction of deformity, splinting
Boxer’s fx- 5th metacarpal neck fx

Question 53

Bennett’s fracture?

Answer 53

Injury to the base of the thumb joint usually caused by a hard impact or trauma such as punching something hard or falling onto the hand with the thumb sticking out to the side or backwards
S/sx- pain and swelling over base of thumb
Management- referred to surgeon

Question 54

Low back muscle sprain?

Answer 54

Usually caused by straining with some type of rotation
S/sx- pain diffuse or local and with active or passive flexion; no neuro involvement
Management- RICE for spasm, graduated strengthening and stretching, NSAIDs, may need complete bedrest

Question 55

Sciatica etiology and s/sx?

Answer 55

Nerve root compression from intervertebral disk protrusion, structural irregularities within the intervertebral foramina or tightness of the piriformis muscle
S/sx- can comes abruptly or gradually, sharp shooting pain, numbness/tingling; sensitive to palpation while straight leg raises intensify pain

Question 56

Tests and management for sciatica?

Answer 56

Straight leg raise- lay in supine position without a pillow; starting on unaffected leg, raise leg at hip joint while keeping knee fully extended until pain occurs
Tension sign- while pt is supine, grasp heel and thigh with hands, flex hip and knee to 90 degrees, then extend knee as far as possible while palpating the tibial portion of the sciatic nerve it passes behind the popliteal space
Slump test- have pt sit straight with hands behind back, have pt slump forward at thoracic and lumbar spine (keeping chin and head straight); apply pressure to 1 shoulder with one hand and have pt tilt chin to chest, then apply pressure to back of head and have pt extend knee on affected side; while maintaining the position, bend foot toward body (active dorsiflexion of ankle); positive= unable to extend knee due to pain or pain while slightly flexing the knee while dorsiflexing ankle
Management- rest, treat cause of inflammation, traction for disc extrusion, NSAIDs

Question 57

Spondylolysis/ Spondylolisthesis etiology and s/sx?

Answer 57

Spondylolysis- degeneration of vertebrae from congenital weakness (stress fracture results)
Spondylolisthesis- slipping of 1 vertebrae above or below another; usually assoc. with a spondylolysis
S/sx- spondylolysis begins unilaterally; pain and persistent aching, low back stiffness with increased pain after activity, frequent need to change position, full ROM with some hesitation for flexion, localized tenderness, step off deformity may be present

Question 58

Test for spondylolysis/spondylolisthesis? Management?

Answer 58

Single leg stance- pt stands on 1 leg and leans backwards; positive = pain
unilateral fracture= pain when opposite leg raised
bilateral fractures= pain with either leg being raised
Management- bracing and occasionally bedrest to help reduce pain, *exercises to control or stabilize segments, trunk and core strengthening, braces during high level activities, vigorous activities may need to be limited (increased chance of lumbar strain and sprain)

Question 59

Sacroiliac joint dysfunction etiology, s/sx?

Answer 59

Twisting with both feet on ground, stumbles forward, falls backward, steps too far down, heavy landings on 1 leg, bends forward with knees locked during lifting
Causes irritation and stretching of sacrotuberous or sacrospinous ligaments and possible anterior or posterior rotation of innominate bones
With pelvic rotation, hypermobility is the norm; however, during the healing process, hypermobility may result and allow the joint to dislocate
S/sx- pain in low back and legs or inflammation of joints, pelvic asymmetry, leg length deformity, blocked normal mvmt during trunk flexion, pain after 45 degrees during straight leg raise, increased pain during side bending moving toward the painful side, sit to stand will cause pain (sitting comfortable)

Question 60

Tests for sacroiliac joint dysfunction and management?

Answer 60

SI compression- have pt lay prone, place pressure down and in toward spine; positive= pain in buttocks or joint
SI distraction- have pt lay prone, cross hands, place pressure down and out on both hips with palms for 30 sec; positive= pain in buttocks or joint
Management- bracing for acute sprain, strengthening exercises; joint must be mobilized to correct positioning

Question 61

Myositis ossificans traumatica?

Answer 61

Formation of ectopic bone after repeated blunt trauma (disruption of muscle fibers, capillaries, fibrous connective tissue and periosteum; gradual deposit of calcium and bone formation
S/sx- x-ray shows calcium deposit 2-6wks after injury, pain, weakness, swelling, decreased ROM, tissue tension and point tenderness
Management- conservative trtmt; after 1 yr, if too painful and restricts motion, it may require surgical removal (remove too early and it may come back)

Question 62

Trochanteric bursitis?

Answer 62

Inflammation at the site where the gluteus medius ties into the IT band
S/sx- lateral hip pain that may radiate down the leg, palpation reveals tenderness over lateral aspect of greater trochanter
Management- RICE, NSAIDs, ROM including hip abductors and external rotators, avoid inclined surfaces,

Question 63

Legg Calve-Perthes disease?

Answer 63

Avascular necrosis of femoral head in kids 4-10; articular cartilage becomes necrotic and flattens
S/sx- pain in groin can be referred to the abdomen or knee, limping
Management- bedrest to help with synovitis, brace to avoid direct weight bearing; with early trtmt, head may ossify and revascularize
Complication- if not treated early, will result in ill shaping and osteoarthritis in later life

Question 64

Slipped capital femoral epiphysis?

Answer 64

Found mostly in boys 10-17 who are tall and thin or obese for their age; may be related to growth hormones; 25% of cases are seen in both hips
S/sx- pain in groin that comes on over weeks or months, hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp
Management- with minor slippage, rest and NWB, can prevent further slippage; surgery for major displacement

Question 65

Snapping hip phenomena?

Answer 65

Habitual movement predisposes muscles around hip to become imbalanced (lateral rotation and flexion); common in young female dancers, gymnasts, hurdlers; related to structurally narrowing pelvis, increased hip abduction and limited lateral hip rotation
S/sx- pain with balancing on 1 leg, possible inflammation
Management- cryotherapy and u/s to stretch musculature and strengthen weak musculature in hip

Question 66

Medial vs Lateral Collateral Ligament Sprain?

Answer 66

Medial- from severe blow or outward twist; can do valgus stress test
S/Sx- little or no joint effusion, some stiffness, pretty much normal ROM (grade 1)
Lateral- from varus force, generally with tibia internally rotated
S/sx- pain/tenderness, swelling and effusion, joint lax with varus test, can cause issues with peroneal nerve

Question 67

MCL Sprain Grades?

Answer 67

1- little fiber tearing or stretching, little or no joint effusion, some stiffness, pretty much normal ROM, pain along lateral aspect of knee
Management- RICE, crutches, exercise
2- partial tear, no gross instability, slight swelling, mod to severe joint tightness, pain along medial aspect of knee
Management- RICE, crutches, brace, exercise
3- complete tear, no medial stability, min to mod swelling, immediate pain and ache, loss of ROM
Management- RICE, poss OR, brace, ROM
*LCL management follows MCL management

Question 68

Anterior vs Posterior Cruciate Ligament?

Answer 68

Anterior- tibia externally rotates with valgus (outward) force at knee
S/sx- severe pain, disability, swelling
Tests- Anterior Drawer, Lachman’s
Management- RICE, OR (longer rehab after)
Posterior- fall on bent knee
S/sx- pop in back of knee, tenderness, slight swelling
Tests- Posterior Drawer, Godfrey’s
Management- RICE, rehab, OR?

Question 69

Meniscal Lesions?

Answer 69

Most commonly from rotary force with knee flexed or extended
S/sx- slow swelling, loss of ROM, locking and giving way of knee, pain with squatting
Special test- McMurray
Management- OR, rehab

Question 70

Osgood-Schlatter vs Larsen-Johansson Disease?

Answer 70

Osgood- childhood repetitive injury that causes a lump at the tibial tubercule (apophysitis)
Larson- patellar tendonitis
S/sx- swelling, hemorrhaging, pain
Management- reduce stressful activity, poss cast

Question 71

What tests can be used to determine patella dislocation?

Answer 71

Apprehension and patellar glide

Question 72

Inversion ankle sprain?

Answer 72

Grade 1- mild pain and disability, no major change to weight bearing, point tenderness, no laxity; stretching of ATF
Tests- Anterior Drawer, Talar Tilt
Management- RICE, rehab
Grade 2- feel/hear a pop/snap mod pain with difficulty weight bearing, tenderness, edema; possible tearing of ATF and CF
Positive tests
Management- RICE, rule out fx, crutches 5-10 days, protective immobilization with ROM, rehab
Grade 3- severe swelling, pain, hemarthrosis, unable to bear weight; damages all ankle ligaments, relatively uncommon
Positive tests
Management- RICE, x-ray, cast, crutches after cast removal, isometrics, ROM, may need surgery

Question 73

Eversion ankle sprain?

Answer 73

Uncommon due to bony protection and ligament strength
S/sx- severe pain, unable to bear weight, pain with abduction and adduction
Management- RICE, x-ray, no weight bearing initially, NSAIDs; same as inversion

Question 74

Syndesmotic sprain?

Answer 74

Injury to distal tibiofemoral joint (anterior/posterior tibiofibular ligaments); torn with increased external rotation or dorsiflexion (foot forced up and externally rotated)
S/sx- severe pain, loss of function
Tests- Kleiger’s; need to manipulate under x-ray or won’t show up
Management- same as other sprains but longer trtmt time

Question 75

Achilles tendon rupture?

Answer 75

Caused from sudden stop and go motions, forceful plantar flexion with knee moving into full extension (more common in athletes)
S/sx- sudden pop in back of heel, immediate pain that subsides, swelling, decreased ROM
Test- Thompson
Management- surgery for serious injuries; RICE, NSAIDs, NWB cast for 6 wks, walking cast 2 wks, rehab

Question 76

Medial tibial stress syndrome?

Answer 76

Pain in anterior portion of shin caused by repeated microtrauma (runners) or weak muscles, bad shoes, training errors
S/sx- 4 grades of pain: pain after activity, pain before and after activity not affecting performance, pain before/during/after activity affecting performance, pain so severe performance is impossible

Question 77

Main things to know for sports injuries?

Answer 77

Tests and corresponding injuries

Grades of sprains

Question 78

Sternoclavicular sprain grades?

Answer 78

1- pain and slight disability
2- pain, subluxation with deformity, swelling, point tenderness, decreased ROM
3- gross deformity (dislocation), pain, swelling, decreased ROM

Question 79

Compartment Syndrome pressure differences?

Answer 79

Greater than 30 mmHg compromise muscle micro blood flow
Upper extremity- greater than 65 mmHg in forearm- stops blood flow
Lower Extremity- 55 mmHg in calf- stops blood flow
*Know order of symptoms and causes