Sports LE Flashcards
What is the staged return to play after concussion
Start after asymptomatic
5 stages - 24hrs each (therefore earliest RTP is 5days)
What is post concussion syndrome
Sx>3mo
What is the lucid interval
Temporary improvement of concussion sx
Beware epidural hematoma!
How to immobilize/transfer C spine injury
8 person lift > log roll
Helmet on, facemask off - taking helmet off can cause C spine hyper-lordosis
What are some C spine conditions that are CI to return to sports
Occipital cervical fusion
AA or C spine instab
Fusion >2 levels
Spear tackler’s spine
What is Spear Tackler’s spine
Congenital vs acquired C spine stenosis
Presents as less lordosis
Canal diameter <13mm (nml 17)
What is the workup for stingers
Nothing if 1 episode
Recurrent episodes: XR, voluntary F-E views
Bilateral - get MRI
Treat auricular hematoma
Aspirate
Tape
RTP for bloody nose
Must stop before RTP
Check for CSF leak - ring sign - CSF makes a ring in the blood on a surface
Septal hematoma
1. What is it
2. Treat
3. Complications
Subperiosteal hematoma
Treat = aspirate
Comp:
1. AVN septal cartilage - saddle nose deformity, collapse
2. Septal abscess
What to do for avulsed tooth
“Medical emergency”
Replace the root
Rinse saline, then in milk (buffer) solution
Hold by the top of the tooth (not the root)
Ideal replace within 1hr
What is the anatomy change for HOCM
Ventricle septum thickening
Will get a systolic murmur
What is the rhythm that develops for commotio cordis
V fib
Treat asthma
Beta 2 agonist (albuterol)
Where put a need for decompression tension PTX (adults vs peds)
Mid-axial line, 2nd vs 5th IC space
Peds: second intercostal space, midclavicular line
What is exercised induced laryngeal obstruction? Dx + trt
Exertional stridor
NO response to beta agonists (not exercise induced asthma)
Dx: laryngoscope during exercise
Trt: speech therapy (relaxation training)
Workup of exercise induced hematuria
Stop exercise
Repeat UA 48-72hrs
Further w/u
- Persists >7d after stopping exercise
- >50yo
Workup for suspected blunt kidney injury (think lower rib frx)
Sx: flank pain, hematuria
CT A/P
Remember single kidney si not a CI for RTP
Where do spleen injuries refer to
L shoulder
Difference in presentation testicular rupture vs torsion
Rupture: pain, hard voiding, doesn’t transilluminate
Torsion: rotated, high riding, lose cremasteric reflex
- Detorsion (manual vs OR) within 12hrs
Trt + RTP for herpes
Trt: -cyclovir
OK for RTP after 5 days
CI to RTP:
- Lesions within 48hrs
Bug + RTP impetigo
Beta hemolytic staph/strep
RTP
- All crusting gone
- Anti-virals for 72hrs
- No new lesions 48hrs
What is a gene specific to CA MRSA (vs HA)
PVL SCC Mec gene type 4
Trt + RTP CA-MRSA
TMP-SMX, clinda, doxy, linazolid
Often will require IV abx
RTP:
- 72hrs meds
- No new lesions 48hrs
Bug, dx, treat ringworm
Tinea corporis
Dx: fluoresces, KOH prep
Trt: topical antifunal
RTP: 72hrs meds
What is the female athlete triad
Period issues >3mo
Energy deficiency (doesn’t require formal eating disorder dx)
Osteopenia (>2 stress frx)
What temp / sx differentiate heat exhaustion vs stroke
104F (40C)
Stroke:
- CNS dysfunction
- No sweating
What is temp for hypothermia
<35C
Mechanism / complications of steroids
Increases mRNA -> increase muscle mass
SE:
- Testicular atrophy
- Alopecia
- Decrease HDL
What is:
Isotonic
Isokinetic
Isometric
Tonic - constant force
Kinetic - constant speed
Metric - constant length
What are the 3 skeletal muscle fibers? What cell heals skeletal muscle
1 = slow ox (endurance training)
2a = fast ox
2b = glycolytic (anaerobic - produces lactic acid)
Satellite cells
What is the difference between sickle cell trait and disease
Trait: heterozygous
- Exertional risk of rhabdo or arrhythmia
Disease: homozygous
- Sickle crisis
Risks with ant, postlat, and ant lat hip scope portals
Ant: LFCN>femoral
Ant-lat: SGN
Post-lat: sciatic, esp if hip ER
Cam lesions hallmarks
Alpha angle >55
Femoral RV
See a CARTILAGE inj - delam/flaps
Pincer lesions hallmarks
Tab RV = crossover sign
Increased CEA
Labral injury +/- ossification of the labrum (ant-sup most common)
Contre coup lesion - postinf tab
What is the CEA on an XR
What is normal vs dysplasia
Why do you care
CEA = AP XR, vertical line center hip, line off edge of the lateral tab
Nml 25-40
Dysplasia < 20 (aka shallow socket)
Don’t scope dysplasia!
What is the alpha angle (nml and CAM morphology)
Lateral XR
Line middle neck
Line where head exists perfect circle
Nml <50
>55 = CAM
Comp FAI surgery
HO
Frx if you take down >30% femoral neck diameter
What is ischiofemoral impingement? PE finding,
LT on ischium - entraps quad fem
Worse with ext/add
Diagnostic injection
What is athletic pubalgia (sports hernia) + trt
Lower abd pain 2/2 muscle imbalance
PE:
- Tight adductor longus
- Pain with valsalva
Trt:
- Conservative
- Pelvic floor repair vs adductor/rectus recession
What is the difference between external vs internal snapping hip
External
- IT over GT
- Snaps with hip add, knee ext
- Conservative vs Z plasty lengthening
Internal
- IP over pelvis/prox fem
- Hip ex
- Conservative vs Z plasty
Diagnosis:
Cyclist, leg pain after exercise
Pulses in legs diminished after activity
External iliac artery endofibrosis
US vs arteriogram for dx
Avulsion frx - name the muscle + innervation
1. ASIS
2. AIIS
3. IT
- ASIS - sartorius (femoral n)
- AIIS - rectus (femoral n)
- IT - hamstrings (sciatic / tibial)
Trt avulsion frx pelvis
Min disp = nonop = NWB 4wks
ORIF only with
1. High level athlete + 2-3cm displaced
2. Symptomatic non union
2 ACL bundles
- Where tight
- Primary role
ACL = AM/PM
AM - tight in flexion, limits translation (Lachman)
PM - tight in extension, limits rotation (pivot)
What is the lateral intercondylar vs bifurcate ridges?
Lateral femoral condyle ACL origin
Bifurcate bifurcates the ACL bundles into ant/post
Intercond is horizontal w/ knee flexed, dets anterior border of ACL
2 bundles PCL - when are they tight
PCL is your PAL
AL - tight flexion
PM - tight extension
What are the 2 meniscofemoral ligaments
Alphabetical
Hemphry = anterior
Wrisberg = posterior
Components of the post-med corner (3 layers)
Superficial : sartorius
Middle : sMCL, POL, semi-mem
Deep : dMCL
Components postero-lat corner
Biceps, IT
LCL, popliteus, pop-fib lig
What ROM is the MPFL the primary restraint
0-20deg flexion
What is Schottle’s point
MPFL repair here
Back of Blumenstaats + posterior cortex femur
Describe pivot shift
Lat tib plateau starts subluxed anterior
Clunk = relocated as move into flexion
What is the difference with valgus/varus stress at 30 vs 0 deg
30 = isolated LCL or MCL
0 = combined injury
Describe dial test
Supine, ER
30deg - PLC only
90deg - PLC + PCL
What is a Segond
Lateral capsule frx = ALL
Indicates ACL injury
What is Insall Salvati and normal values
Patellar tendon length : patella height
Nml: 0.8-1.2
What is Caton Deschamps and normal values
Patella cartilage to plateau : patella height
Knee in 30deg flex
Nml: <.3
What is TT-TG and normal values
Trochlear groove to posterior fem cond : tib tub to post fem cond
CT better than MR (under-estimates)
Nml: <20
Where is the trad bone bruising on MRI for ACL tear
LFC + posterior lat tib plateau
What is the double PCL sign
Bucket handle medial men
What is the double ant horn sign
Bucket handle lateral men tear
How do meniscus repairs heal
Inflam cell infiltration
Where are safe zones for dissection w/ outside in meniscus repair
Medial: anterior to satorius, avoid saphenous
Lateral: anterior to biceps, avoid peroneal
CI to meniscus transplant
OA (flattening condyles, narrowing on WB XR)
>50yo
BMI >30
Lig instab
RA
Dx discoid
3 consecutive MR cuts (4-5mm images)
Trt discoid
Only if sx: saucerization
Otherwise observation only
Osteochondritis dissecans
- Common location
Lateral MFC
What is a subchondral insuff frx - treat
Older patient with a cresentic lesion - in same category as AVN
UKA or TKA
What is the ideal minimum ACL graft size
Min 8.5, less that this have increased failure rate
What happens if your ACL tunnel femur is too anterior vs posterior
Ant: tight in flexion
Posterior: tight in extension
What happens if your ACL tibia tunnel is too anterior vs posterior
Tibial tunnel must be posterior to Blumenstaats line on hyper-ext XR
Ant: limits full ext, tight in flexion
= roof impingement
Post: PCL impingement, lax in flex + ext
Structure at risk with hamstring harvest for ACL
Saphenous between gracilis and satorius
Lose terminal knee flexion strength
What is a cyclops lesion
Anterior scar tissue
Blocks extension
What tibial slope increases risk of graft fracture
Normal = >9
High risk >12
Think supra tubercle ant closing wedge osteotomy
Which sport is the only sport that ACL bracing is recommended
Skiiers
What compartments are higher risk OA with non op of PCL
Patello-fem AND medial
If you are going to treat PLC injury acutely how do you do it
Primary repair PLUS recon
Vs delayed recon only
Rehab avoid HS
How reduce + immobilize prox tib-fib dislocation
Most likely fib comes out anterior and lateral
Reduce: flexion + pressure
Immobilize in ext
Why do you aspirate pre-patellar bursitis in wrestlers
R/o MRSA
What is the J sign
Knee in full extension, patella deviates lateral out of the groove
RF for patellar instability
Hip AV
Patella alta
Valgus alignment
Chondral lesions for patellar instab
Medial patellar facet
Lateral LFC
What is the Fulkerson osteotomy
Tibial tub osteotomy for patellar maltracking
Ant+medial with tubercle
Off loads the distal lateral patella
Indications for tubercle osteotomy for patellar maltracking
TT-TG > 20
+ lateral tracking/tilt
What 2 procedures are the WRONG answers for patellar maltracking
Trochleoplasty
Isolated lateral release
What structure may be interposed for an tibial spine fracture
Med meniscus
Treat tibial spine fracture
If reduces, keep in extension
IF reduction needed, ORIF
Traction apophysitis: Osgood Sclatters vs Sinding-Larsen-Johnsson
OS: tib tub
SLJ: inf patella
What is the most common distal femur physeal injury in kids
SH2
Hypertrophic zone
MRI : stress XR
What are the abnormal measurements for exertional compartment syndrome
15 - 30 - 20
>15 at rest
>30 1min post exercise
>20 5min post exercise
Diagnose:
Night pain
Pain better with running
Diffuse longitudinal update on bone scan
Medial tibial stress syndrome
= periostitis of PT and soleus origins
Non op
Ankle scope portals - structure at risk
1. AL
2. AM
3. PL
- AL = SPN (dorsal int cut br)
- AM = tib ant, saphenous v/n
- PL = sural n/short saph v
Ankle exam / structure tested
1. Ant drawer
2. Lat tilt
3. ER stress test / squeeze test
- ATFL
- CFL
- Syndesmosis
Treat longitudinal peroneal tears
<50% tubularize
>50% tenodesis
Describe the difference in the following concussion tests:
SCAT5 - sports concussion assessment tool
ImPACT - immediate post concussion assessment and cognitive testing battery
SCAT5 - sideline tool
ImPACT - computer test given as baseline and then after injury
