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Musculoskeletal 2 > Sports Med Objectives > Flashcards

Sports Med Objectives Flashcards

1
Q

Define concussion

A

A complex pathophysiology process affecting the brain inducing by biochemical forces.

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2
Q

Concussion presentation

A

Immediate:

  • HA, dizziness, double vision
  • Nausea, light/sound sensitivity
  • Feeling foggy
  • LOC, amnesia
  • Behavioral changes
  • Cognitive impairment

Later…

  • Sleep disturbance
  • Depression/anxiety
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3
Q

Concussion diagnosis

A

Based on clinical symptoms?? Not really sure what she’s looking for on this one.

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4
Q

Concussion management

A
  • physical and cognitive rest until sx resolution
  • avoid medications and let symptoms be your guide
  • wear sunglasses if photophobia is present
  • sleep in a dark room as much as possible for 2-3 days, then resume normal sleep/wake hours with 15-20 minute naps
  • limit exposure to telephone, texting, music, tv
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5
Q

If you have a concussion, can you take meds for headache?

A

Yes, acetaminophen is ok but no NSAIDs

*can also take melatonin for HA and/or sleep

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6
Q

If a pt has concussion, should they be woken up during the night?

A

Nope! You don’t need to awaken throughout the night, just observe for normal breathing pattern.

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7
Q

Do helmets prevent concussion?

A

NO

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8
Q

Concussion prevention

A

Football helmets, for example, reduce impact force to head but not concussion incidence

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9
Q

AC sprain/separation

-Mechanism

A

“aka shoulder separation”

  • impact to tip of shoulder
  • fall on outstretched arm
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10
Q

AC sprain/separation

-S/Sx

A
  • deformity at AC joint  distal end of clavicle rides superiorly
  • pain with movement and palpation
  • (+) piano key sign
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11
Q

AC sprain/separation

-1st degree of injury

A
  • no deformity
  • pain with palpation & motion
  • mild stretching of AC ligament
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12
Q

AC sprain/separation

-2nd degree of injury

A
  • displacement of distal end of clavicle
  • unable to abduct arm or bring it across body
  • pain
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13
Q

AC sprain/separation

-3rd degree of injury

A
  • compete rupture of AC and CC ligaments
  • with dislocation of the distal end of clavicle
  • severe pain
  • LOM
  • instability
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14
Q

AC sprain/separation

-general tx

A
  • RICE
  • Immobilization
  • NSAIDs
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15
Q

AC sprain/separation

-tx based on separation grade (1-6)

A
  • Grade 1 separation: RTP in 1-2 weeks
  • Grade 2 separation: RTP in 3-4 weeks
  • Grade 3 separation: RTP in 6-12 weeks; possible surgery
  • Grade 4-6: surgery
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16
Q

Sternoclavicular (SC) sprain

-mechanism

A
  • indirect force transmitted through the humerus, the shoulder joint and the clavicle
  • direct impact to clavicle
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17
Q

Sternoclavicular (SC) sprain

-S/Sx

A
  • may have deformity at sternal end
  • swelling
  • pain
  • inability to abduct shoulder through full ROM
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18
Q

Sternoclavicular (SC) sprain

-1st degree separation

A

no deformity, pain w/ palpation & motion, mild stretching of SC ligament

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19
Q

Sternoclavicular (SC) sprain

-2nd degree separation

A

subluxation of the proximal end of clavicle

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20
Q

Sternoclavicular (SC) sprain

-3rd degree separation

A

complete rupture of SC and CC ligaments, with dislocation of the proximal end of clavicle

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21
Q

Sternoclavicular (SC) sprain

-general tx

A
  • RICE
  • Immobilization
  • NSAIDs

*same as AC sprain

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22
Q

Sternoclavicular (SC) sprain

-tx based on grade of separation (1-3)

A
  • Grade 1 separation: RTP in 1-2 weeks
  • Grade 2 separation: RTP in 3-4 weeks
  • Grade 3 separation: surgery
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23
Q

When is SC sprain a medical emergency?

A

any posterior subluxation or dislocation in an emergency due to potential cardiovascular compromise

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24
Q

What is the MC fracture around the elbow in children?

A
  • supracondylar humerus fractures

- 95% are d/t extension-type injuries

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25
Q

Supracondylar humerus fractures

-mechanical factors

A
  • occurs from a fall on an outstretched hand
  • ligamentous laxity and hyperextension of the elbow are important mechanical factors
  • may be associated with a distal radius or forearm fractures
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26
Q

Supracondylar humerus fractures

-classifications, type 1

A
  • non-displaced (note posterior fat pad)
  • in most cases, these can be treated with immobilization for approx. 3 weeks, at 90 degrees of flexion (unless significant swelling)
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27
Q

Supracondylar humerus fractures

-classifications, type 2

A

angulated/displaced fracture with intact posterior cortex

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28
Q

Supracondylar humerus fractures

-classifications, type 3

A

complete displacement, with no contact between fragments

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29
Q

Ulnar collateral ligament injuries at the elbow are usually d/t…

A
  • chronic valgus stress placing ligament at risk for laxity or tearing
  • pitchers are at highest risk
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30
Q

Ulnar collateral ligament

-evaluation

A
  • medial pain during late cocking, acceleration or deceleration is hallmark
  • pain with valgus testing more reliable than laxity
  • laxity on valgus testing at 30 minimal unless tear is complete
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31
Q

What do you find on MRI for ulnar collateral ligament injury?

A

MRI with contrast – fluid leakage outside of joint represents complete tear

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32
Q

Ulnar collateral ligament

-tx

A
  • rest
  • physical therapy
  • NSAIDs
  • return to throwing when pain-free
  • surgery
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33
Q

What is the surgical procedure for ulnar collateral ligament?

A

autologous tendon secured in tunnels in humerus and ulna in figure-of-eight fashion, ulnar N transposed

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34
Q

Aseptic olecranon bursitis etiology

A
  • direct blow of fall (hemiarthrosis)

- gout

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35
Q

Septic olecranon bursitis etiology

A
  • insect bite
  • cut/abrasion
  • hematogenous
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36
Q

Olecranon bursitis

-S/sx

A
  • pain
  • swelling
  • erythema/febrile (septic)
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37
Q

Olecranon bursitis

-tx

A
  • ice and compression

- aspirate (if serous/blood, give steroid injection; if pus, required I&D -ortho consult)

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38
Q

When does olecranon bursitis require surgery?

A

With recurrent aseptic bursitis

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39
Q

Define myositis ossificans traumatica

A

Where bone-like tissue grows in the muscles of the thigh (MC) or upper arm after an injury

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40
Q

Myositis ossificans traumatica

-etiology

A
  • formation of ectopic bone
  • MOI = repeated blunt trauma
  • may be the result of improper thigh contusion treatment (too aggressive)
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41
Q

Myositis ossificans traumatica

-S/sx

A 
-X-ray shows Ca2+ deposit 2 - 6 weeks post injury
Sx:
-pain
-weakness
-swelling
-tissue tension
-point tenderness
-decreased ROM
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42
Q

Myositis ossificans traumatica

-management

A
  • tx must be conservative

- may require surgical removal

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43
Q

Quadricep strain

-mechanism of injury

A

over-stretching or too forceful contraction

44
Q

Quadricep strain

-S/sx

A

-Sx: pain, point tenderness, spasm, loss of function, and ecchymosis
NOTE: superficial strain results in fewer S&S than deeper strain
-complete tear results in deformity (athlete displays little disability and discomfort)

45
Q

Quadricep strain

-management

A
  • RICE, NSAIDs, analgesics
  • manage swelling via compression and/or crutches
  • stretching
  • PRE strengthening exercises
  • neoprene sleeve for added support
46
Q

Hamstring strain

-etiology

A
  • there are multiple theories of injury
  • hamstrings and quadriceps contract together
  • change from hip extender to knee flexor
  • fatigue
  • posture
  • leg length discrepancy
  • lack of flexibility
  • strength imbalances
47
Q

Hamstring strain

-S/sx

A
  • pain in muscle belly or point of attachment
  • capillary hemorrhage
  • ecchymosis
48
Q

Grade 1 hamstring strain

A
  • pain with movement
  • point tenderness
  • < 20% of fibers torn
49
Q

Grade 2 hamstring strain

A
  • partial tear ( < 70% of fibers torn)
  • sharp snap or tear
  • severe pain
  • loss of function
50
Q

Grade 3 hamstring strain

A
  • rupture of tendinous or muscular tissue ( > 70% muscle fiber tearing)
  • severe hemorrhage
  • disability
  • edema
  • loss of function
  • ecchymosis
  • palpable mass or gap
51
Q

Hamstring strain

-general management

A
  • RICE, NSAIDs, and analgesics
  • Modalities
  • PRE exercises
  • when soreness is eliminated, focus on eccentrics strengthening
  • recovery may require months to a full year
  • scarring increases risk of injury recurrence
52
Q

Hamstring strain

-grade 1 management

A

Do not resume full activity until complete function restored

53
Q

Hamstring strain

-grade 2 and 3 management

A
  • treat conservatively

- gradual return to stretching and strengthening in later stages of healing

54
Q

Groin strain

-etiology

A
  • injury usually occurs to the adductor longus

- others include iliopsoas, sartorius, gracilus

55
Q

Groin strain

-mechanism of injury

A

MOI = running, jumping, or twisting with hip external rotation; over-stretching; or too forceful contraction

56
Q

Groin strain

-S/sx

A
  • sudden twinge or tearing during movement

- pain, weakness, and internal hemorrhaging

57
Q

Groin strain

-management

A
  • RICE, NSAIDs, and analgesics
  • **rest is critical
  • modalities: daily whirlpool and cryotherapy; ultrasound
  • delay exercise until pain free
  • restore normal ROM and strength
  • provide support with elastic wrap
58
Q

Define Legg-Calve-Perthes disease

A

Avascular necrosis of the femoral head in child ages 4-10

59
Q

Perthes disease mechanism of injury

A

trauma

60
Q

Perthes disease

-S/sx

A
  • pain in groin: referred pain to the abdomen or knee
  • limping
  • may exhibit limited ROM
61
Q

Slipped Capital Femoral Epiphysis (SCFE)

-etiology

A
  • found mostly in overweight boys between ages 10-17
  • may be growth hormone related
  • MOI = trauma (accounts for 25% of cases)
  • 25% of cases are seen in both hips
  • femoral head slippage on X-ray appears in posterior and inferior direction
62
Q

SCFE S/Sx

A
  • pain in groin that progresses over weeks or months
  • hip and knee pain during passive and active motion
  • limitations of hip abduction, flexion, and medial rotation
  • limp
63
Q

SCFE management

-minor vs. major slippage

A
  • Minor slippage: rest and non-weight bearing may prevent further slippage
  • Major slippage results in displacement: requires surgery

**If condition goes undetected or if surgery fails, severe problems will result!

64
Q

Snapping hip

-etiology

A
  • common in young female dancers, gymnasts, and hurdlers
  • MOI = repetitive movement that leads to muscle imbalance
  • related to narrow pelvis, increased hip abduction, and limited lateral rotation
  • hip stability is compromised
65
Q

Snapping hip

-S/sx

A
  • pain while balancing on one leg

- possible inflammation

66
Q

Snapping hip

-management

A

ROM exercises to increase flexibility:

  • flexion and lateral rotation
  • cryotherapy and ultrasound may be utilized

PRE exercises to strengthen weak muscles

67
Q

Hip dislocation is a result of…

A

traumatic force directed along the long axis of the femur

68
Q

Hip dislocation

-etiology

A

Posterior dislocation more common:

  • Hip flexed, adducted, and internally rotated
  • Knee flexed

*Rarely occurs in sport - MC in trauma such a MVA

69
Q

Hip dislocation

-S/sx

A
  • flexed, adducted, and internally rotated hip
  • palpation reveals displaced femoral head
  • medical emergency
  • complications include soft tissue damage, neurological damage, and possible fracture
70
Q

Hip dislocation

-management

A
  • requires immediate medical care
  • blood and nerve supply may be compromised
  • contractures may further complicate reduction
  • 2 weeks immobilization and crutch use for at least one month
71
Q

Ankle sprains

-etiology

A
  • MC athletic injury
  • the medial malleolus is shorter than the lateral malleolus so there is naturally more inversion than eversion
  • greater inversion increases the potential for over-stretching of the lateral ligaments
72
Q

Which ligaments are sprained more/less often in the ankle?

A
  • of the lateral ligaments, the ATFL is sprained the most often followed by the CFL
  • Deltoid ligament is sprained less often (25% of ankle sprains)
73
Q

Match the 3 special tests for the ankle to their ligament

A
  1. Anterior Drawer – ATFL
  2. Posterior Drawer – PTFL
  3. Talar Tilt – CFL
74
Q

1st degree ankle sprain

A
  • stretching of the ATFL
  • little or no edema
  • tenderness
  • maintain function
75
Q

2nd degree ankle sprain

A
  • partial tear of the ATFL and/or CFL
  • moderate edema
  • some function loss
76
Q

3rd degree ankle sprain

A
  • complete tear ATFL, CFL, and/or PTFL
  • total loss of function
  • significant edema
77
Q

An ankle sprain with no tendon tear, minimal loss of functional ability, minimal pain, minimal swelling, usually no ecchymosis, and no difficulty bearing weight is graded as…

A

Grade 1

78
Q

An ankle sprain with partial tendon tear, some loss of function, moderate pain & swelling, frequent ecchymosis, and that usually includes difficulty bearing weight is graded as…

A

Grade 2

79
Q

An ankle sprain with complete tendon tear, great loss of function, severe pain & swelling, ecchymosis, and that almost always includes difficulty bearing weight is graded as…

A

Grade 3

80
Q

Ankle sprain tx

A
  • RICE
  • ice for 20 minutes on and 20 minutes off for the first two hours.
  • after that, 20 min intervals over the next 48-72 hours,
  • compression wrap with donut or horse shoes to fill in gaps around malleolus from 24-36 hours
  • NSAIDS
  • bracing – Lace-up vs. Stirrup vs. Boot
81
Q

What is the mechanism of a syndesmosis injury?

A
  • External rotation
  • For example, a football player with direct posterior force on the leg of a down player whose foot is ER’d
  • ER force at the knee with the foot firmly planted
82
Q

Classification of syndesmosis injury

A
  • AITFL (anterior inferior tibiofibular ligament) Sprain

- Grade I, II, III

83
Q

Syndesmosis injury

-physical exam

A
  • palpate IOL & fibula
  • prox tib/fib joint dislocation
  • squeeze test
  • ER stress test
  • direct eversion maneuver
  • eversion/abduction force applied to foot as tibia stabilized
84
Q

Syndesmosis injury tx

-grade I & III

A
  • RICE
  • weight bearing as tolerated (WBAT) after 48-72 hrs
  • symptomatic tx: ROM, strengthening, proprioception, boot, taping
85
Q

Syndesmosis injury tx

-grade III

A

*based on displacement & stability

Latent Injuries (normal XR but wide stress view)

  • -NWB SLC or Moonboot
  • -NWB 6-10 weeks
  • -if osseous or ligamentous medial injury, then ORIF

Frank Injuries require ORIF

86
Q

What are the 3 types of 5th metatarsal fractures?

A
  1. avulsion
  2. jones
  3. stress fracture
87
Q

What are the general causes of 5th metatarsal fractures?

A
  • acute inversion injury
  • overuse/stress on a metatarsal
  • abnormal foot structure or mechanics (e.g. flatfoot, over inversion)
88
Q

Describe styloid avulsion fractures

  • type of injury
  • healing potential
  • tx
A
  • Acute inversion injury
  • TTP base of 5th metatarsal
  • good healing potential
  • treat with Fracture Shoe/Boot for 4-6 weeks, may WBAT (weight bear as tolerated)
89
Q

Describe Jones fractures

  • type of injury
  • healing potential
  • tx
A
  • Acute inversion injury
  • TTP base of 5th metatarsal
  • fair healing potential
  • treat with Cast/Boot for 6 weeks NWB
  • -then WB in Cast/Boot for 4-6 weeks
  • consider surgical screw for sooner RTP
90
Q

Describe diaphyseal stress fractures

  • type of injury
  • healing potential
  • tx
A
  • overuse injury
  • TTP proximal to mid 5th metatarsal
  • poor healing potential
  • treat with Cast/Boot for 10-16 weeks NWB
  • -then WB in Cast/Boot for 4-6 weeks
  • consider surgical screw for non-Athlete
  • surgical screw fixation for Athlete
91
Q

What is the MC ruptured tendon in the LE?

A

Achilles tendon

92
Q

Describe a complete Achilles tendon rupture

A
  • complete ruptures are due to eccentric loading during abrupt stopping, landing from a jump
  • usually a popping sound is heard with a complete tear
  • there may or may not be an obvious gap 2 to 6 cm from the calcaneus attachment
93
Q

Exam and tx of Achilles tendon rupture

A

Exam:

  • “Hatchet deformity”
  • significant ecchymosis and edema
  • inability to actively plantar flex the foot
  • pain with passive dorsiflexion of ankle
  • (+) Thompson Squeeze Test

Tx may or may not include surgery, but both require immobilized for 3 months

94
Q

Where is the plantar fascia?

A

the plantar fascia runs from the calcaneus to the metatarsals - it acts like a bow string to maintain the arch of the foot

95
Q

Define plantar fasciitis

A
  • refers to an inflammation of the plantar fascia
  • inflammation is usually due to repeated trauma to where the tissue attaches to the calcaneus.
  • the trauma results in microscopic tears at the calcaneus attachment site.
  • this may produce heal spurs

*pain is worse in the morning or after a period of inactivity

96
Q

Causes of plantar fasciitis

A
  • high arch
  • excessive pronation
  • footwear (worn out, stiff)
  • increase in intensity
97
Q

Plantar fasciitis tx

A
  • stretch***
  • Ice Massage (Frozen water bottle)
  • NSAIDs, Arch Supports, Night Splint/Boot
  • Steroid Injection, PT, Surgery
98
Q

Define “turf toe”

-when does it occur

A
  • sprain that occurs at the base of the big toe at the first metatarsal phalangeal joint.
  • it usually occurs when the toe is jammed forcibly into the ground or, more commonly, when the toe is bent backward too far (hyperextended)
  • it causes significant pain and swelling at the base of the big toe and can be a significant problem because players use the toe when they run and plant and push off
99
Q

Class I turf toe

-tx

A

attenuation, swelling, minimal ecchymosis

Tx: non-Surgical: taping, early rehabilitation

100
Q

Class II turf toe

-tx

A

partial tear, moderate swelling, restricted ROM

Tx: Non-Surgical: 2 weeks rest, taping; “turf-toe” or carbon-fiber orthosis to prevent MTP extension

101
Q

Class III turf toe

-tx

A

complete disruption, FH weakness, instability

Tx:

  • Non-Surgical: Immobilization 10-16 weeks
  • Surgical: open repair of capsule
102
Q

Define TMT (Lisfranc) injury

A
  • an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus
  • axial loading mechanism that is often missed
  • often ligamentous, subtle clinical and radiographic findings
103
Q

Dx of Lisfranc injury

A
  • “pop” in midfoot, rapid onset pain.

- tender on midfoot compression, pronation, supination, stressing

104
Q

Imaging of Lisfranc injury

A

Xray:

  • B/L WB AP, 30° Oblique, Lateral
  • > 2mm between 1st and 2nd metatarsal bases, fleck sign
  • stress views if plain radiographs equivocal

MRI: not indicated if diastasis seen on plain film

105
Q

Tx of Lisfranc injury

-sprain

A
  • Non-displaced, stable midfoot on stress radiographs
  • Non-Surgical Management
  • Non-weight bearing 3-4 weeks in boot/cast
  • Protected weight bearing 3-4 weeks and rehab
106
Q

Tx of Lisfranc injury

-rupture/avulsion

A
  • diastasis > 2mm (compared to other foot) on stress XR
  • Principle: Obtain and maintain anatomical reduction of the midfoot
  • Treatment - Surgical

Musculoskeletal 2 (14 decks)

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