Sports Medicine Flashcards
Define Sports Medicine
Treatment & prevention of injuries related to sports activities
Non-Orthopedic Conditions Seen by Sports Medicine Providers
ID: dermatology DM Exercise induced issues Concussions Pre-participation assessment Female triad Psychology: athlete, parent, coach
Female Triad
Eating disorders
Amenorrhea
Osteoporosis
Shoulder Injuries
Rotator cuff disease
Degeneration
Instability
Biceps & SLAP tears
Elbow Injuries
Medial pain issues
Lateral pain issues
Knee Injuries
ACL PCL MCL LCL Meniscus Articular cartilage Anterior knee pain
Foot & Ankle Injuries
Sprains
Risk Factors for Rotator Cuff Injuries
Trauma
Repetitive overuse
What tendons are more difficult to repair due to a degenerative tendon?
Rotator cuff
Achilles
Non-Operative Treatment of Sports Injuries
Reduce inflammation Activity shutdown NSAIDs Sub-acromial injection Modalities PT: ROM & strength
Surgical Options for Rotator Cuff Tears
Open repair
Mini-open repair
Arthroscopic repair
Post-Op Course for Rotator Cuff Tears
Sling: 6 weeks Rehab: 3 months Golf: 4-5 months Tennis: 6 months Swimming: 7-8 months Full recovery: 1 year
What muscle performs the first 30 degrees of abduction of the arm?
Supraspinatus
How does a reverse prosthesis work?
Switches abduction force from the supraspinatus to the deltoid
Treatment of Early or Moderate Shoulder Arthritis
Activity modification NSAIDs Steroid injections PT?? Arthroscopy??
Treatment of Severe Shoulder Arthritis
Shoulder replacement
Results of Total Shoulder Replacement if a Good Rotator Cuff
3% failure
Predictable pain relief
Excellent function
Treatment of First Shoulder Dislocation
Reduction: x-ray
Immediate: external rotation brace
Surgical
Pro’s of Open Instability Treatment
Higher success rate
Better in ligamentously laxity
Glenoid reconstruction possible
Con’s of Op Instability Treatment
Risk of over tightening
Painful post-op
Reasons for Outlet Impingement of the Shoulder
Acromion shape/slope
AC joint enlargement
Cuff & biceps problems
Important History for Biceps Disease
Age Occupation Injury Activities Handedness (R/L) Chief complaint Pain: location, duration Weakness
Biceps Disease Physical Exam Tests
Speed's Yergason's Hawkin's Neer's Belly press Lift-off test Bear hug
Diagnostic Imaging for Biceps Disease
MRI: biceps
US
Non-Operative Management of Biceps Disease
Rest
NSAIDs
PT: rotator cuff strengthening
Injections
Surgical (Tenotomy or Tenodesis) Indications for Biceps Disease
Subluxation or dislocation of biceps
>25% tear
Significant inflammation, atrophy, hypertrophy
Irreparable rotator cuff tear
Tenotomy vs. Tenodesis
Tenotomy: elderly, easier rehab, revision
Tenodesis: less than 50, cosmetic/strength
Important History for SLAP Tears
Age Occupation Injury Activities Handedness (R/L) Chief complaint: instability, pain (location, duration), weakness, mechanical symptoms
SLAP Tear Tests
O’brien’s test
Crank test
Non-Operative Management of SLAP Lesions
Rest
NSAIDs
PT x 3 months
Throwing program
Indications for SLAP Repairs
Young patient (less than 40) Mechanical symptoms Associated instability, internal impingement, acute rotator cuff tear
Contraindications for SLAP Repairs
Elderly: tenotomy
Frozen shoulder
Anatomic variant
Chronic rotator cuff tear
Conditions with Medial Elbow Pain
Medial epicondylitis Ulnar neuropathy Flexor pronator strain Zpronator syndrome Medial ulnar collateral ligament Olecrenon stress fracture
Conditions with Lateral Elbow Pain
Lateral epicondylitis
Radial tunnel syndrome
Lateral ulnar collateral ligament
Capitellar OCD
Reason for Lateral Epicondylitis
Overuse injury involving eccentric overload at origin of common extensor tendons
Repetitive pronation/supination with elbow extended
Presentation of Lateral Epicondylitis
Pain with resisted wrist extension, gripping
Treatment of Lateral Epicondylitis
Ice NSAIDs Rest Ultrasound Larger racket grip
Lateral Epicondylitis & Injections
Some benefit
No indication for PRP
Medial Collateral Ligament Complex
Anterior bundle
Posterior bundle
Transverse portion
Treatment for Medial Collateral Ligament Tear
Rest
Ice
NSAIDs
Throwing program x 3 months
Parts of a Throwing Program
Short toss
Long toss
Mound
Reasons for an ACL Injury
Sudden deceleration Twist Pivot Cut Clipping/pile-up Backward fall skiing
Surgery for ACL Injuries
Reconstruction
Due to synovial environment
Reconstruction Tendon Options for an ACL Repair
Patella tendon
Hamstring tendon
Quadriceps tendon
Allograft tendon
Conditions with Anterior Knee Pain
Patello-femoral pain
Quadricep or patellar tendon pain
Osgood Schlatters’ disease
Treatment for Anterior Knee Pain
Rehab
Brace
Surgery
Age Groups for Osgood Schlatter’s Disease
Boys: 12-15
Girls: 8-12
Presentation of Osgood Schlatter’s Disease
Pain at anterior aspect
Worse with kneeling
Tender over enlarged tubercle
Worse with resisted extension
Treatment of Osgood Schlatter’s Disease
NSAIDs Rest Ice Activity modification Quad/Hamstring strengthening Cast: severe
Lateral Ankle Ligament Complex
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Medial ligament injuries result from what?
Ankle external rotation
Ankle eversion
Positions in the Ankle that Provide Little Bony Stability
Plantar flexion
Inversion
Predictable Pattern of Ankle Ligament Tears
Anterior tibiofibular ligament
calcaneofibular ligament
Posterior tibiofibular ligament
Risk Factors for Inversion Injuries
Tight Achilles tendon
Varus hindfoot
Limited subtalar motion
Testing for Ankle Instability
Anterior drawar test
Talar tilt test
Describe Talar Tilt Test
Ankle in neutral to place stress on CFL
Apply varus stress
Must block subtalar motion
Diagnostic Tests for Lateral Ankle Injuries
X-rays: palpable pain on bony areas MRI: chronic pain Radiographic stress test Radiographic anterior drawer: >4 mm abnormal Radiographic talar tilt: >6 mm abnormal
Treatment of Grade I and II Ankle Sprains
Early weight bearing & ROM show less pain, less atrophy, & earlier return to activities
Treatment of Grade III Ankle Sprains
Controversial
Early mobilization
Cast immobilization
Primary surgery
When may reconstruction be indicated with chronic ankle instability?
Failure of rehab program of proprioception, muscle strengthening & Achilles stretching
Ankle Sprains are a Combination of
Mechanical instability
Functional instability
What does mechanical instability include?
Ankle mobility
What does functional instability include?
Feeling of ankle giving way
Mechanism of Injury for Syndesmotic Injuries (High Ankle Sprains)
External rotation
Dorsiflexion
3 Ligaments that Unite the Distal Tibia-Fibula
Anterior tibiofibular
Posterior tibiofibular
Interosseous
Diagnosing Syndesmotic Injuries
Tender over anterior syndesmosis
Tenderness at proximal fibula
Compression squeeze test
External rotation test
Compression Squeeze Test for Syndesmotic Injuries
Squeeze at mid-calf
Will cause pain at anterior syndesmosis
Treatment of Syndesmotic Injuries
Boot or walking cast 2-4 weeks
Rehab
Widening noted: surgery
Recovery for Surgical Repair of Syndesmotic Injuries
Non-weight bearing cast: 4 weeks
Weight bearing immobilization: 4 weeks
Screw removal: 10-12 weeks
Sequelae of Persistently Painful Sprained Ankles
Vague pain Feeling of giving way Problems walking on uneven surfaces Swelling Stiffness Locking
Define Stress Fracture
Fatigue induce fracture of the bone caused by repeated stress over time
Most Common Bones for Stress Fractures
Tibia
Metatarsals
Navicular
Femoral
Etiology of Stress Fractures
Osteoblasts overwhelmed
Bone & muscles serve as shock absorbers to stress
Muscles fatigue- bone may be taxed
Female triad
Presentation of Stress Fractures
Pain with weight bearing that increases with exercise or activity
Resides with rest
Localized tenderness
Generalized swelling
Diagnosis of Stress Fractures
X-rays: may take 10-14 days
MRI
Bone scan
Treatment of Stress Fractures
Rest
Unloading of stress area: boot, crutches
Gradual return to activities
Don’t respond: surgery
Prevention of Stress Fractures
Gradual ramp up of loading activities Strengthening of muscles Replace shoes every 300-500 miles Increase calcium & vitamin D Address female triad
Treatment of Tibial Stress Fractures
Activity restriction
Protected weight bearing
IM nail: rare
Diagnosis of Femoral Neck Stress Fracture
MRI
What type of femoral neck stress fracture requires surgical treatment?
Tension side
Superior-lateral
Other Overuse Injuries
Little league elbow Rotator cuff tendinitis Greater trochanteric bursitis IT band tendinitis Hamstring tendonitis