Sports Injuries

Question 1

functions of ligaments

Answer 1

read bone-bone

Question 2

functions of tendons

Answer 2

read muscle-bone

Question 3

transition tendinous areas prone to injury

Answer 3

musculotendinous areas

osteotendinous areas

Question 4

common factors of sports injuries

Answer 4

• load to failure (stress fractures, tendons, ligaments)
• unique qualities determine resistance to failure
• adults: ligament/tendon > bone
• children: bone > lig/tendon

Question 5

arrangement and orientation of ligaments and tendons

Answer 5

ligaments: random arrangement, weaving pattern
tendons: organized, parallel; long axis direction

Question 6

what is crimping

Answer 6

• orientation of collagen in resting state

- folded, elongates upon contraction

Question 7

non-linear response of tendons and ligaments

Answer 7

• toe region: crimping
• linear region: crimping unfolds and stretches
• yield/failure: limit to stretching = sports injuries
• stretching and warm up widens regions

Question 8

what is viscoelastic response

Answer 8

• viscous = to be able to resist strain
• elastic = to be able to return to original state
• depends on magnitude, duration, and prior loading
• water: if tendon or ligament is hydrated, there is better viscoelastic response

Question 9

types of viscoelastic response

Answer 9

creep, stress-relaxation, hysteresis

Question 10

what is creep

Answer 10

• time-dependent tissue elongation when subjected to constant stress
• increasing deformation with constant load
• tendons will lengthen slightly, recruit more muscles
• joints will loosen
• “stretching”

Question 11

what is stress-relaxation

Answer 11

• time dependent decrease in applied stress required to maintain a constant elongation/load
• tendons: stress will decrease with time
• ligaments: joints will loosen

Question 12

what is hysteresis

Answer 12

• energy lost within tissue between loading and unloading

- subsequent use of the same force results in greater deformation

Question 13

types of joints

Answer 13

• fibrous/synarthrodial: connected by ligament, no movement
• cartilaginous/synchrodroses: has limited movement
• synovial/diarthroses: free movement, housed by capsule

Question 14

types of synovial joints

Answer 14

read

Question 15

dislocations vs subluxations

Answer 15

• dislocation: when articulating surfaces have lost total contact with each other
• subluxation: still partial articulating contact
• joint congruence: total articulation between 2 surfaces
• loss on congruity: surfaces don’t match each other

Question 16

most common shoulder dislocation type

Answer 16

anterior

Question 17

pe of shoulder dislocations

Answer 17

• fullness of deltoid is lost
• acromion becomes prominent
• ap and lateral view
• xray ap view: acromion is very prominent, humeral head is ant to glenoid cavity

Question 18

treatment for shoulder dislocation

Answer 18

• closed reduction: force in longitudinal axis and sling under axilla

Question 19

what is a bankart lesion

Answer 19

• tear to the labrum within 3 o clock and 5 o clock position in front

Question 20

treatment for bankart lesion

Answer 20

• first time: arm sling

- two or more: surgery (anchor sutures and tie torn labrum into rim of glenoid)

Question 21

pathoanatomy of elbow dislocation

Answer 21

• fail on upper extremity (axial force) wherein elbow goes into valgus
• excessive valgus on elbow causes tear in medial collateral ligament

Question 22

elbow dislocation xray

Answer 22

• ap and lateral view

- always described in terms of distal fragment (ex. posterior dislocation of distal fragment)

Question 23

treatment of posterior elbow dislocations

Answer 23

closed reduction via:

• patient in prone: gentle traction and minimal extension to bring coronoid away from perching position on back part of trochlea
• patient in supine: flex humerus by pushing olecranon back into place

Question 24

majority of sports injuries are __

Answer 24

knee injuries

Question 25

extensor mechanism of the knee involves

Answer 25

• quadriceps muscle and tendon
• patella
• medial and lateral retinaculum
• patellar tendon
• tibial tubercle
• tibia

disruption = limitation of extension movement

Question 26

acl injury tests

Answer 26

• lachman’s test (most sensitive): 30 deg
• anterior drawer’s test: 90 deg
• pivot shift (need anes)

< 5 mm displacement: grade 1
5-10 mm: grade 2
> 1 cm: grade 3

Question 27

mechanisms of acl injury

Answer 27

• rotation + valgus stress

- hyperextension

Question 28

acl bundles

Answer 28

• knee full extension = posterolateral bundle is tight

- knee full flexion = anteromedial bundle is tight

Question 29

objective tests for acl injury

Answer 29

kt2000: more objective
- amount of pull
- > 2 mm difference reading
- translation without acl tear: avulsion of tibial spine

mri: objective

Question 30

treatment of acl injury

Answer 30

• gold standard: arthroscopic acl reconstruction using bone patellar tendon bone plug
• bone to bone healing
• replaced by hamstring graft

Question 31

disruptions in quads and patellar tendons

Answer 31

• disruption of patellar tendon = patella will have high riding position = patella alta
• disruption of quadricpes tendon = patella will be lower = patella baja

Question 32

tears of the retinaculum

Answer 32

medial retinaculum and medial patellofemoral ligament = lateral dislocation of patella

Question 33

meniscal tear

Answer 33

• meniscus = shock absorber

- mcmurray test (read!!)

Question 34

treatment for meniscal tear

Answer 34

• only peripheral longitudinal tears in the outer third can be repaired (good blood supply)
• inner third = will not heal, debridement
• middle third = ?

Question 35

stages after post-op

Answer 35

• range
• strengthening (2 mos)
• endurance exercises