Sports Injury/MSK/Ortho Flashcards by Vanessa Soetanto

Sprain classifications

Grade 1: ligament is stretched.
Grade 2: A partial ligament tear
Grade 3: complete tear of the ligament

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Ottowa Ankle Criteria

Radiographs of the ankle are indicated for individuals
1. Unable to bear weight on the affected ankle
2. Tenderness involving the tip or posterior aspect of the ankle malleoli

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Ankle sprains should be treated with _______, if tolerated

early mobilization

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Pain associated with spondylolysis, what causes it, and how to evaluate

pain with EXTENSION of lumbar spine and some local radiation
caused by repeated sports injury,
evaluate by radiology (only 50-60% sensitive), can also evaluate by MRI

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Greenstick Fracture
- mechanism of fall

outstretched hand
long bone break

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Physeal fractures are called

Salter-Harris fractures

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Define:
Salter-Harris type I
Salter-Harris type II
Salter-Harris type III
Salter-Harris type IV

I: bony injury across physis (none to metaphyseal or peiphyseal)
II:
III:
IV: cross 3 regions of bone (epiphysis, physis, mataphysis)

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Pain with ambulation in a multisport athlete, better with resting, comes right back with exercise. Dx?

Femoral neck stress fracture

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Evaluation of and Management of femoral neck stress fracture

Passive leg roll with reproduction of joint pain
MRI
crutches (fully non-weight bearing)
Screw-fixation

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Management of femoral anteversion “knock-knees”

reassurance if asymptomatic
Close re-evaluation if intermalleolar distance is 7 cm or more

If knee pain, hip pain, or restricted hip ROM, hip XR

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Management of in-toeing

If before 6-8 yo, reassurance

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Cause of in-toeing
<3 yo
>3 yo

<3 yo: internal tibial torsion
>3 yo: femoral anteversion

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Adolescent has congenital scoliosis, next step?

renal ultrasound

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Diagnosis of congenital scoliosis

Malformation of vertebra (wedge formation)

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When should you refer to orthopedic surgeon in scoliosis? When is surgery indicated?

Referral: > 20 degrees

Surgery:
progression > 10 degrees per year OR
>40 degrees
>50 degrees in skeletly mature individuals (will progress)

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Management of stress fracture through growth plate from “little league shoulder”

cessation of use for 3 months
Sling if there is significant discomfort at rest or pain with ADL

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Inferior patellar pain bilateral, worse with resisted knee extension, no ligamentus laxity noted. Dx?

Distal patellar apophysitis (Sinding-Larsen-Johansson syndrome SLJS)

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Inferior patellar pain bilateral, worse with resisted knee extension, no ligamentus laxity noted. Dx?

Distal patellar apophysitis (Sinding-Larsen-Johansson syndrome SLJS)

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Pain in tibial tuberosity

Osgood-Sclatter

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gradual onset of diffuse anterior patellar pain after period of increased activity

patellofemoral syndrome

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Gradual onset of pain along patellar tendon after a period of increased high intensity running +/- jogging

patellar tendinitis

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When should valguss knee deformity (knock-knee) resolve by

2 yo - 4 yo

When should varus/valgus deformity be evaluated further?

Valgus onset before age 2
>7 yo with intermalleolar distance > 8 cm
+ pain/swelling
Prior trauma
Abnormal growth curve

Evaluation of septic arthritis

ultrasound of joint to rule out/in effusion

Abx of septic arthritis

cover staph and strep, kingela Unasyn/zosyn and 3rd gen cephalosporin to cover H. flu and gonorrhea

When does surgical intervention need to happen in septic arthritis

hip or shoulder joint

Atraumatic groin pain in adolescent ddx

femoroacetabular joint pathology - femoroacetabular impingement - acetabular labrum tear "C-sign" - femoral neck stress fracture - hip flexor tendinitis +/- bursitis

What syndrome/disease is associated with Leg-length dyscrepancy

Wilms tumor

Management of leg-length discrepancy

Skeletally immature <2 cm: reassess every 6-12 mo 2-6 cm: surgical referral for possible epiphysiodesis (destruction of growth plate) >6 cm: surgical referral for possible limb lengthening or prosthetic fitting Skeletally mature <2 cm: reassureance or heel lift if symptomatic 2-6 cm: surgical referral for possible limb-shortening procedure >6 cm: surgical referral for possible limb lengthening or prosthetic fitting

Management of leg-length discrepancy

Pathophys of osteogenesis impefecta

abnormality in type 1 collagen COL1A1, COL1A2

Respiratory sequelae of osteogenesis imperfecta

small chest cavity = restrictive disease

How do you monitor hip joints in infants with osteogenesis imperfecta?

Hip ultrasound

Heel pain in athlete, dx and management

Sever apophysitis (injured calcaneal growth plate) Management: heel cups or cushions

What ages should one be evaluated for scoliosis

Girls: 10 and 12 yo Boys: 13 and 14 yo

What is considered positive screening for scoliosis and what is the next step

>5-7 degrees Radiographs of the spine

Radiologic finding of legg-calve-perthes (femoral head AVN) and next steps

radiolucency of femoral head crutches and non-weight bearing status

Radiologic finding of legg-calve-perthes (femoral head AVN) and next steps

radiolucency of femoral head crutches and non-weight bearing status

Where is the most reassuring place for polydactyly on a hand?

postaxial (ulnar/fibular aspect)

Pattern of development in children with achondroplasia

Delayed gross motor development

What is the normal passive rotational and lateral flexion range of neck in children 0-3?

110 degrees on each side (rotational) 70 degrees on each side (lateral flexion)

If congenital muscular torticollis continues after 6 mo of therapy, what is the next step?

radiography .. if >1 year, maybe surgery

Visual acuity cut off for athletes

if 20/40 uncorrected, need to go get glasses if best is 20/40, then need additional eye protection

Difference in management of flexor tendon vs. extensor tendon injury of the hand

flexor = surgical referral extensor = conservative

What is the "neck rule"

above the neck, ok to play for athletes Below the neck symptoms (pna, emesis, systemic), should be withheld from sports

Tackled kid has injury to lateral neck...symptoms resolved with free ROM of neck, but still weakness of shoulder abduction and elbow flexion. Next steps?

watch for resolution "stinger" or "burner"

After concussion, what is the medical clearance protocol

Full symptom resolution, return to prior levels of academic performance, no symptom recurrence with physical activity.

Pitcher throwing with medial elbow pain that is worsening, now with swelling. Next step?

Bilateral elbow xray to assess for medial apophysitis or progression to avulsion Need bilateral to assess subtle changes in growth plate alignment

Pitcher throwing with medial elbow pain that is worsening, now with swelling. Next step?

Bilateral elbow xray to assess for medial apophysitis or progression to avulsion Need bilateral to assess subtle changes in growth plate alignment

Management of medial apophysitis of elbow

cast immobilization for 2-3 weeks if >2 mm displacement, possible surgical fixation

Recommendation for Osgood-Schlatter

spend at least 2-3 mo/yr away from structured sports participation

Girl with syncope during exertion and no other symptoms after. No family history of cardiac deaths. Next steps?

Cardiac clearance.

Recurrent ankle injuries, management

Radiography IF: tenderness along posterior edge, tip or distal 6 cm of tibia or fibula OR inability to bear weight immediately after injury in the office Otherwise, PT

healthy rate of weight loss for adolescents is no greater than __

1.5% of body weight per week