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Professional Practice > Sports Injury > Flashcards

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
Q

what are teh red flags for sports injuries

A
  • 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
Q

what are the typical symptoms of musculoskeletal pain

A
  • 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
Q

when to follow up after recommending therapy for sports injury?

A
  • 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
Q

how long shoudl you take NSAIDs for fever vs pain

A

Fever 3days

pain 5days

29
Q

how many poeple misuse NSAIDS?

who typically does this and how

A

1/3 people

  • more likely to be: older, non white, low income
  • More likely to take multiple NSAIDs, exceed max dose
30
Q

Cox 1 vs cox 2

A
  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
Q

what are the 3 main body parts to keep in mind when assesing patient for NSAID therapy?

A

kidney, stomach and heart

32
Q

why is the kidney relevant when treating with NSAIDs?

A
  • 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
Q

who is at higher risk of adverse effects on the kidney during NSAID treatment

A

>65

CHF

hypertension

Renal Disease

ACE/ARB (somebody on ramipril, HCTZ then add NSAID), will do into acute renal failure

Diuretics

Dehydration

34
Q

how to reduce risk to the kidneys while taking NSAID

A
  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
Q

How do NSAIDs affect GI tract

A
  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
Q

Describe dyspepsia and heart burn when taking NSAIDs

A
  • 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
Q

ulcers and death when taking NSAIDs

A
  • Estimated incidence of <1%/year
  • perforated ulcers (hole)
  • hemorrhage (throwing up what looks like coffee grounds -> black stool)
  • Obstruction
38
Q

What are alarm symptoms

A

* 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
Q

who is at higher risk of stomach issues when taking NSAIDs

A
  • >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
Q

how to reduce risk of stomach upset when taking NSAIDs

A
  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
Q

How do NSAIDs affect the heart?

A
  • 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
Q

what is interaction between ASA and Ibuprofen

A
  • 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
Q

Who is at higher risk of heart complications when taking NSAIDs

A

> 65

CHF
vascular disease

Diabetes

Hypertension

Rheum Arthritis

44
Q

How to reduce risk of heart probelms when taking NSAIDS

A
  1. Avoid in high risk patients
  2. Choose non selective NSAIDs

*do this knowing you are risking stomach to protect heart

  1. Monitor BP
  2. Start low go slow
  3. use lowest effective dose
45
Q

How to reduce risk of adverse effects of NSAIDS overall

A
  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
Q

implications of COX -1 vs COX-2 drugs

A
  • 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
Q

acetaminophen for treatment of sports injury

A

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
Q

ASA for treatment of sports injury

A

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
Q

ibuprofen for treatment of sport injury

A

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
Q

Naproxen sodium for treatment of sports injury

A

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

Professional Practice (23 decks)

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