Sports Injury Flashcards

1
Q
A

*bursa = soft cushion protecting are from tendon and muscle

*tendon = attaches muscle to bone

*Ligament: attached bone to bone (helps w/ joint stability)

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2
Q

an injury to the ligament will cause

A

issues with stability

*attach bones to bones

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3
Q

vaccines injected into shoudler area can accientally be injected into the ____ and cause pain

A
  • bursa
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4
Q

what is bursitis

(description, impact, cause, location, symptoms)

A
  • inflammation of the bursa -> fluid filled sack that cushions ,uscle/tendon from joint

Impact: Pain during movement

CauseL prolonged pressure (resting elbows, kneeling), repetitive use

Location: joints (shoulder, knee

Symptoms: redness, pain and swelling

  • can be acute or chronic

*have 4 burse in knee

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5
Q

tendonitis

A

in achilles tendon

  • impacts walking, triggered by walking long distance, poor fitted footwear, overusing achilles tendno

Tennis elbow

  • occurs by repeated movements -> carrying briefcase, exceeding strength/ability to carry
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6
Q

What is tendinitis

A
  • Description: inflammation of tendon, which connects muscle to bone or joint

Impact: pain during movement (tendons help you mvoe)

cause: usually repeated overuse, improper training technique (new job at factory w/ repeated movement, carry heavy breifcase)
location: near joints (shouldner, knee, elbow, ankle)

Symptom: Pain, swelling

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7
Q

What is a strain (description, impact, cause, location, symptom)

A

Description: tear in muscle/tendon (minor tear to full rupture)

Impact: minaly distrupts movement

Cause: over extertion, voer stretching, repetitive movement, trauma

Location: Common in back, shoulder, hamstrings

Symptoms: pain, swelling

*common to encouner in pharmacy

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8
Q

What is a sprain (description, impact, cause, location, symptom)

A

Description: Tear in ligament (partial or full rupture)

Impact: Mainly distrupts stabiltiy

Cause: Mainly trauma, from twisting, falling leading to ligament being over stretched or twisted)

Location: common in ankles, knees writes and fingers

Symptom: pain, swelling, tenderness, bruising

*without X ray a bad sprain can appear as a break

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9
Q

What is a stress fracture

description, impact, cause, location and symptom

A

*micro breaks from repeated use ->load injury

description: small fractures in bone resulting from repetitive strain
impact: pain during excersie

Cause: repetitive force (e baseball, long distance running_

location: common in lower libs

Symptom: pain during exercise, decreases during rest. May have swelling

* may only experience the pain during activity, typcally just treated by rest and avoiding activity

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10
Q

plantar facitis

description, impact, cause, location and symptom

A

Description: inflammation of periosteum of bottom of foot

Impact: pain while walking

Cause: long walks, poorly fitted footwear

location: bottom of foot

Symptom: pain

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11
Q

Skin splints

Description, impact, cause, location, symptom

A
  • AKA medial tibial stress syndrome

Description: Inflammation of muscles and surrounding tissues of lower leg around tibia (skin) bone

impact: pain while walking and running
cause: change in excerise (more running, running up hills, gymnastics)

*often caused by high ipmact exercise that overloads tibia,

location: lower legs
symptom: shin pain, during and after excersie

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12
Q
A
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13
Q

summary

A
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14
Q

what are the therapy goals for sports injuries?

A

symptom relief, heal injury, prevent re-injury

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15
Q

how to prevent sports injury

A

trian, stretch, warm up and cool down

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16
Q

when would a sports injury be an emergency?

A
  • severe pain, obvious fracture, joint deformity, inabiltiy to bear weight on injured limb

*children usually dont show signs of pain -> more mobility issues

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17
Q

how to treat a sports injurt (non pharmacologic)

A

RICE

R: rest at least 24 h

I: Ice (with bag, cold pack, frozen peas wrapped with a thin cloth)

*do for 1-30 min q3-6h x 48h (10 min for boney areas, 20-30 for fatty)

C: caution for ciruclatory disorders (ex Raynauds desase, diabetes cold stops blood flow to area,)

E: elevate above heart level to drain fluid and reduce swelling

*useful for bursitis, sprains, strains, plantar fasciitis, skin splints, tendinitis

*for stress fractures, rest area and train using low ipmact activity like swimming or cycling

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18
Q
A
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19
Q

when should you apply heat to a sports injury

A

2-14 days after injury

  • hot water bottle (bath temp), electric heat pad, heat pack, infrared heat lamp
  • wrap bottled and pads in towel to avoid burns, apply for 20-30 min q2-4 h prn

*Cool first!

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20
Q

when should you not heat a sports injury

A
  • in first 48h
  • avoid in: unconscious patients, impaired skin sensitivity, poor circulation, open wounds
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21
Q

If sports injury still persits after 14 days

A

refer to physician

  • follow up with patient after 14d of therapy, asses for: dec pain, swellling, improved ability to just joint, return to daily activites without pain
22
Q

What analgesics are used to treat sports injuries

A

Oral: acetaminophen and NSAIDs

Topical: diclofenac

Injections: corticosteroids (tendinitis)

Vapocoolants: ethyl chloride, spray and strech (pentafluoropronane 95%/tetrafluroethane 5%) *mostly just provide dsitraction from coolingfeeling on skin

23
Q

cautons for analgesics used for sports injuries

A
  • do not use topical agent more than 4x/daily, do not use under heating pads
  • topical counter irritants are ineffective for pain releif but can be used for muscle massage rub (A535)
24
Q

When a patietn ahs a sports injury what are the first questions to assis them on (patient factors)

A
  • younger than 2 or younger than 12 (if requring an Rx product)
  • pregnancy (if planning, or 1st trimester or 20+ weeks)

*NSAIDS area avoided during preg

  • CV or GI disease or risk factors
  • Renal impairment (CrCl <30 mL/min)
  • Asthma (if prev rxn to ASA or NSAID)
  • bleeding disorder or antiplatelet or anticoagulant

*if any are yes then refer

25
what are teh red flags for sports injuries
- visible joint changes, abnormal movemnt, mobility limitations (weakness, cant bear weight) - pelvic or abdominal pain - systemic symptoms (nausea, vomitting, fever) - pain present for \>2 weeks or \>7 days with treatment without improvement - increase intensity or change in character of pain - significant trauma (fall, or suspected fracture) if yes refer, if not check if symptoms are typical of musculoskeletal pain
26
what are the typical symptoms of musculoskeletal pain
- mild to moderate pain - swelling +/- bruising - does patietn attribute symptoms to overexertion or muscle/ligament injury? if yes then reccommend non pharmacological treatment, over counter analgesics x 7d or prescription strenght oral NSAIDS
27
when to follow up after recommending therapy for sports injury?
- follow up in 7 days - patient should continue treatment until symptoms resolve (max 14d) and dsicontinue once symptoms resolve - if no imporvement then refer
28
how long shoudl you take NSAIDs for fever vs pain
Fever 3days pain 5days
29
how many poeple misuse NSAIDS? who typically does this and how
1/3 people - more likely to be: older, non white, low income - More likely to take multiple NSAIDs, exceed max dose
30
Cox 1 vs cox 2
1. Cox 1 * consituative (always there) * Protects GI mucosa * platelet aggregation * renal function * if inhibit it will inhibit these thigns 2. Cox 2 * inducible * innflamation and renal functoin
31
what are the 3 main body parts to keep in mind when assesing patient for NSAID therapy?
kidney, stomach and heart
32
why is the kidney relevant when treating with NSAIDs?
- NSAIDs can cause renal damage \*if dehydrated not drinking and take NSAID can cause renal damage Pre-renal damage: due to dehydration, volume depletion) \*effects pressure going into kidney Intra-renal (injury): acute interstitial nephritis, nephrotic syndrome, chronic renal failure
33
who is at higher risk of adverse effects on the kidney during NSAID treatment
\>65 CHF hypertension Renal Disease ACE/ARB (somebody on ramipril, HCTZ then add NSAID), will do into acute renal failure Diuretics Dehydration
34
how to reduce risk to the kidneys while taking NSAID
1. Stop NSAIDs if can't eat/drink 2. Avoid Ace/Arb + diuretic + NSAID 3. Start low go slow 4. Use the lowest effective dose
35
How do NSAIDs affect GI tract
1. Disrupt mucous layer (mucus in stomach is protective if taking NSAIDS stomach dec mucus secretion) 2. Inhibit bicarbonate secretion (neutralizes acid, inhibition causes more acidic env) 3. Cause epithelial necrosis \*can use COX2 selective like celebrex
36
Describe dyspepsia and heart burn when taking NSAIDs
- occurs in 1/10 poeple - especially if prior intolerance, female, prior ulcer, ASA - May help to take with food - D/C if dyspepsia \> 7d - treat heartburn with antacids, H2RAs, switch NSAID
37
ulcers and death when taking NSAIDs
- Estimated incidence of \<1%/year - perforated ulcers (hole) - hemorrhage (throwing up what looks like coffee grounds -\> black stool) - Obstruction
38
What are alarm symptoms
\* would need an endoscopy - new dysphagia (difficulty swallowing) - Hematemesis (vomiting blood) - Melena (black stool, blood from stomach) - persistent vomiting - new onset anemia (sudden drop in Hemoglobin) \*symptoms: fatigue, dizzinesss, shortness of breath
39
who is at higher risk of stomach issues when taking NSAIDs
- \>65 Priot PUD?UGIB - Rheum arthritis (uses lots of NSAIDs bc its an inflammatory condition) - NSAIDs + ASA (antiplatlet) - anticoagulants - glucocorticoids (prednisone, impairs wound healing -\> if NSAID burns stomach body cant heal the wound) \*steroids inhibit healing, the NSAID causes the injury - H. Pylori
40
how to reduce risk of stomach upset when taking NSAIDs
1. Avoid drug interactions 2. choose COXibs 3. Add misoprostol/PPI 4. Celecoxib/PPi if prior bleed 5. Start low. Go slow 6. use lowest effective dose \*\*\* PPI protien pump imhibitors can be used to gastroprotect
41
How do NSAIDs affect the heart?
- inc bp in Normotensive and hypertensive patients - also antagonize ACE-1, ARBs, (beta blockers ie candesartan) - Inc SBP 3-7 mmHg, inc DBP 1-3 mmHg - Monitor BP 1-3 wks after starting NSAID if have bp issue
42
what is interaction between ASA and Ibuprofen
- theoretical interaction 0 ibuprofe binds to platelets and blocks entry of ASA - observational studies are non conclusive - no direct clinical endpoint studies - FDA: says take ASA 30 min before or 8 hours after ibuprofen \*\* bc ASA binds irreversible, and ibuprofe bidns reversible
43
Who is at higher risk of heart complications when taking NSAIDs
\> 65 CHF vascular disease Diabetes Hypertension Rheum Arthritis
44
How to reduce risk of heart probelms when taking NSAIDS
1. Avoid in high risk patients 2. Choose non selective NSAIDs \*do this knowing you are risking stomach to protect heart 3. Monitor BP 4. Start low go slow 5. use lowest effective dose
45
How to reduce risk of adverse effects of NSAIDS overall
1. identify high risk patients 2. minimize drug interactions:ACE, ARB, Diuretic, Steroids, ASA\< blood thinners 3. Weigh risks/ benefit of COX-2 selectivity 4. Gastroprotect: PPI, Misoprostol \*monitor: peeing, bleeding and bp, start low and go slow, use lowest effective dose
46
implications of COX -1 vs COX-2 drugs
* COX 2 * inc cardiovascular risk * thrombosis, myocardial infraction * discontinuation * blood pressure increase * ex: \*Etoricoxib (discontinued), refecoxib * COX1 * GI risk * bleeding ulcer complications, discontinuation * ex: Naproxen, ibuprofen
47
acetaminophen for treatment of sports injury
325-1000 mg q4-6h prn MDD = 4000 onset: 1hr Duration: 4-6 hr \*potential hepatotoxicity if chronic use, lvier disease, depleted glutathione levels
48
ASA for treatment of sports injury
325-1000 mg Q4-6H MDD: 4000mg Onset \<1hr Duration 2-6hr adv effect: sGenerally well-tolerated when used infrequently & at recommended doses; NVD, dyspepsia possible \*inc CV effects, GI ulcers & bleeding with prolonged high dose -\> avoid if dehydrated, severe renal impairment, older adults and pregnancy
49
ibuprofen for treatment of sport injury
Dosing 200-400mg PO Q4-8h prn MDD: 1200mg onset \<1hr duration 4-6hr adv effect: sGenerally well-tolerated when used infrequently & at recommended doses; NVD, dyspepsia possible \*inc CV effects, GI ulcers & bleeding with prolonged high dose -\> avoid if dehydrated, severe renal impairment, older adults and pregnancy
50
Naproxen sodium for treatment of sports injury
Doseing 220mg po q8-12hr prn MDD: 440 mg onset \<1h4 duration \<12hr adv effect: sGenerally well-tolerated when used infrequently & at recommended doses; NVD, dyspepsia possible \*inc CV effects, GI ulcers & bleeding with prolonged high dose -\> avoid if dehydrated, severe renal impairment, older adults and pregnancy