Sports Medicine Flashcards
Spear Tackler’s Spine
- loss of cervical lordosis
- cervical stenosis
- arthritic changes
Stinger
- stinging/burning or electric shock sensation
- arm numbness or weakness
- C-5 is most common
- traction/pinching the nerve
C-Spine Fracture-Dislocation
Mech: axial load most common
Levels:C5-6 most common
C4-5, C6-7 next
Lower Thoracic Spine Compression Fracture
Mech: axial load
fall
Older population
Lumbar Spine: Stress Fracture of Pars
Symptoms: Pain in lower back
Rare neuro sx
Treatment: rest, brace, bone growth stimulator
Ruptured Lumbar Disc
Symptoms: Pain down leg
Neuro sx
L4-5
Rotator Cuff: Physical Exam
- empty can test (supraspinatus)
- external rotation, stress test, lag test
- pseudoparalysis
- belly press (subscapularis)
Rotator Cuff Muscles
supraspinatus
infraspinatus
subscapularis
teres minor
Treatment of Rotator Cuff
- pain management
- surgery
Shoulder Instability
80-90% are anterior
dislocations
sublaxations: dislocated, but someone put back in
(never fully dislocated)
younger you are: higher recurrence riskShoulder Instability
closed reduction maneuvers
-sedate patients
Clavicle Fracture
most common fracture in the body
OCD Capitellum Etiology:
unclear, articular forces during throwing, compressive loads, excessive axial loading (gymnists, lifters), 10-15 y/o, 85% males
OCD Capitellum Symptoms
dull, poorly loccalized elbow pain
- aggravated with use, relieved with rest
- loose body, catching, locking of elbow
OCD Capitellum Treatment
Nonoperative: activity limitation, RICE, physical activity
Operative:
Distal Biceps Tendon Rupture
- Functional deficits: elbow flexion, forearm rotation
- rarely operate
Ulnar Collateral Ligament Injures
- pain, tenderness inner side of elbow, especially when throwing
- swelling and bruising at inner elbow
- inability throw at full speed, loss of control
- elbow stiffness
- numbness/tingling in ring and little fingers
- clumsiness/weakness of hand grip
Treatment for Ulnar Collateral Ligament
Tommy John Procedure
-take palmaras longus muscle and weave it around
Scaphoid Fracture
- wrist pain
- hard to see fracture
- difficult to heal
Metacarpal Fracture
3rd metacarpal fracture
-normally just heal on own (cast for comfort)
-functionally fine, knuckle may be lower
4th-boxer’s fracture
PIP Joint Dislocation
fix: increase deformity then pop back on
Jersey Finger
flexor tendon injury
- avulse funds tendon from attachment of distal phalanx - can’t bend
- fix with surgery
Mallet Finger
extensor tendon injury
- need x-ray to verify not bone
- splint 6-8 weeks
Pelvic Avulsion Fractures
- strong muscular contraction during sports activities
- skeletally immature patients
- pan and popping sensation at site of fracture
- most common sites: ASIS, AIIS, IT
Pelvic Avulsion Fractures Treatment
Nonoperative: rest, activity limitation, rehab
Operative: reattachment of tendon
Hip: Labral Tears
Symptoms: groin pain, clicking/snapping of hip
-limited motion of hip joint
FAI
Femoralacetabular impingment
- cam lesion-bony buildup on neck of femur
- pincer lesion-acetaublar side (bony buildup)
- combined lesion
Meniscal Injuries
Semilunar cartilage of the knee
Treatment: nonoperative
-repair
-remove
Knee Ligament Injuries
- anterior cruciate
- posterior cruciate
- medial collateral
- lateral collateral
Quadriceps/Hamstring Tears
very common
-once one happens, prone to get more
-muscle heals with scare tissue
PRP (platelet rich plasma) with healing factors and inject into tear sight
ACL injury
- noncontact deceleration, jumping, or cutting (70%)
- external forces applied to knee (MCL)
- 80% sports related
- knee is “hyperextended”, 70% hear/feel pop, knee seems to pop out of joint and then reduce
- fall to ground, walking difficult
- knee swells within hours (hemarthrosis)
ACL injury Gender/Causes
Female 2-4X increase in basketball, soccer, rugby, volleyball
Extrinsic: body movement, muscle strength
Intrinsic: joint laxity, hormonal influences, limb alignment, notch dimensions, ligament size
ACL physical exam
Lachman test: most sensitive (95%) -increased excursion relative to opposite knee -lack of firm end point Pivot Shift: -relaxed patient -intact MCL -reproduces pathologic motion
ACL MRI
95-100% accurate
-non-orthogonal plane-knee external rotated 15 deg
(usually catches entire ACL in one frame)
-identify associated meniscal/chondral injures, collateral ligaments
-bone bruises-LFC (mid1/3), LTP(post1/3)
ACL Treatment
Nonoperative: low-demand patients with less laxity
Operative: higher demand, active patients
- reduces incidence of chondral & meniscal injury
PCL injury
5%
-mechanism: direct blow to the tibia (dashboard injury)
-fall on flexed knee
-hyperextension
posterior sag
treatment: nonoperative: PRICE, immobilization, rehab
operative: arthroscopic reconstruction
MCL/LCL injuries
- MCL>LCL
- LCL usually associated with other injuries
- Direst (MCL) outward (LCL)
- Non-contact: pivoting, awkward landing, sliding into base
MCL/LCL Treatment
unually non-operative unless associated with other ligament injuries
Knee Dislocations
- high-velocity -MVA, falls>5 feet
- low-velocity-sports, fall<5 feet
- ultra-low velocity-ADL, obese
- multiple ligament repair/reconstruction procedures
- neurovascular injury*
Peroneal Nerve injury
~26% of knee dislocation
-1/2 result in permanent neurological deficit
Popliteal artery injury
~24%
-86% amputation rate for revascularization > 8 hours
OCD/Chondral Injuries of the Knee
- Cause: vasuclar, traumatic, genetic
- Symptoms: pain, joint popping/locking, joint weakness, decreased ROM, swelling/tenderness
- Treatment: micorfracture, fixation of fragment, OATS (move parts of bone)
Ankle Sprains
Lateral ligament (inversion) - most common
Syndesmosis (high ankle) sprain
Nonoperative: boot, corset, physical therapy
Operative: lateral lig reconstruction, fixation of syndesmosis
5th Metatarsal Fracture
- Pseudo-Joones fracture
- Jones fracture
- Stress Fracture
TIbial Stress Fracture
- anterior
- dreaded black line
- delayed union
- nonunion
- acute fracture
Lisfranc Injuries
midfoot
tarsal-metatarsal region
swelling
Turf Toe
hyperdorsiflex big toe
tear the plate
rest, carbonfiber insert
Achilles Tendon Tears
- pop or snap, followed by sharp pain
- swelling near heal
- inability to stand on toes
- inability to push off with injured leg
- peak age 30-40 y/o
Achilles Tendon Tears Exam
- resting position of foot
- palpable defect
- swelling
- Thompson test
- *open repair, percutaneous repair**
