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Sports Medicine Flashcards

1
Q

Tibiotalar joint

A

True ankle joint

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2
Q

Talacalcaneal (subtalar) joint

A

Main shock absorber

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3
Q

Pes cavus

A

Possible cause: xs supination

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4
Q

Pes planus

A

Possible cause: xs pronation

1. “Too many toes sign”

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5
Q

Sprain

A

Abnormal stretch/tear of ligament

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6
Q

Strain

A

Abnormal stretch/tear muscle or tendon

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7
Q

Inversion ankle sprains

A
  1. 90% ankle sprains
  2. Likely because:
    A. Ankle usually in plantarflexion when wt comes down on inverted ankle
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8
Q

Eversion ankle sprains

A
  1. <10% ankle sprains
  2. Unlikely because:
    A. Medial ligaments stronger than lateral
    B. Ankles usually dorsiflexed when wt comes down on exerted ankle
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9
Q

Grade 1 ankle sprain

A 
1. Stretching/partial tear of ligament
  A. Ant talofibular
  B. Calcaneofibular
2. Mech of injury
  A. Forces inversion and plantarflexion
3. Clinical presentation
  A. Mild tenderness and swelling
  B. Little/no fxn loss
    1. Can bare wt and ambulate w/ min pain
  C. No mech instability of ankle
     1. negative/equivocal clinical stress exam
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10
Q

Grade 2 ankle sprain

A
  1. Partial/complete tear anterior talofibular ligament
  2. Stretching calcaneofibular ligament
  3. Mech of injury
    A. Forced inversion and plantarflexion
  4. Clinical presentation
    A. Moderate tenderness and swelling
    B. Mild to moderate ecchymosis
    C. Tenderness to palpation
    D. Some motion and fxn loss
    1. Pain w/ wt bearing and ambulation
      E. Mild to moderate instability of ankle
    2. Mildly positive clinical stress exam
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11
Q

Grade 3 ankle sprain

A
  1. Tear ant talofibular lig
  2. Tear calcaneofibular lig
  3. Partial tear post talofibular lig
  4. Partial tear tibiofibular lig
  5. Mech of injury
    A. Forces inversion and plantar flexion
  6. Clinical presentation
    A. Severe tenderness and swelling
    B. Severe ecchymosis
    C. Tenderness to palpation
    D. Motion and fxn loss
    1. Incapable wt bearing or ambulation
      E. Mech instability of ankle
    2. Moderate to severe (+) clinical stress exam
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12
Q

Clinical stress exams for ankle sprains

A
  1. Ant drawer test for ankle

2. Talar tilt

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13
Q

Ankle sprain tx

A 
1. Days 1-3
  A. RICE
  B. Activity as tolerated
  C. Pain management
  D. OMT
2. Days 4+
  A. Ice
  B. Heat after 48-72 hrs
  C. Pain management 
  D. ROM exercises
  E. OMT
  F. PT as tolerate
3. Air cast/Velcro brace support w/ ambulation
4. Crutches if ambulation difficult
5. X-ray if can’t walk
6. Surgery rare lateral injury, more likely medial
7. Prolotherapy for chronic laxity
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14
Q

High ankle sprain/syndesmotic injury

A 
1. Stretching/tearing high ligs
  A. Ant inf tibiofibular lig
  B. Post inf tibiofibular lig
  C. Interosseous membrane
2. Clinical presentation
  A. No fracture: pain w/ dorsiflexion
  B. W/ fracture: can’t bear wt or ambulate
3. Clinical stress exam
  A. Compression test (w/ dorsiflexion)
  B. External rotation of foot and ankle
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15
Q

High ankle sprain tx

A
  1. Surgical stabilization
    A. Unstable ankle
    B. Frank diastasis
    C. In >4mm widening of medial clear space on x-rays
  2. Conservative tx
    A. NSAIDs
    B. RICE
    C. 1st phase
    1. Non-wt bearing boot 5-7 days (passive ROM exercises w/o boot several times/day)
      D. 2nd phase
    2. Transition full wt bearing in brace (gait and light proprioceptive exercises)
      E. 3rd phase
    3. Start when painless hop on foot and ankle
    4. Protected full wt bearing
    5. Resistive exercises, multi-axial movement, proprioceptive training
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16
Q

Peroneal muscle strain

A 
1. Risk factors
  A. Ankle injury
  B. Repeat inversion injuries
  C. Pes planus
  D. Gait w/ excessive eversion
  E. Poor fitting athletic equipment
2. Clinical presentation
  A. Pain and swelling along lateral ankle
  B. Feeling weakness/instability
  C. If retinaculum is torn: snapping sensation along lateral malleolus
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17
Q

Peroneal muscle testing

A
  1. Resisted eversion
    A. Assesses peroneus brevis
  2. Resisted eversion and dorsiflexion w/ palpation post lateral malleolus
    A. Assesses subluxation peroneus brevis due to disruption retinaculum
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18
Q

Peroneal muscle strain tx

A 
1. Mild to moderate cases
  A. RICE
  B. Pain management
  C. PT (ankle ROM, proprioceptive training, muscle strengthening)
2. Severe cases
  A. Walking boot
  B. Surgery if subluxing (prevent tendon rupture)
3. Prevention
  A. Adequate time for rehab
  B. Slow return to activity
  C. Prep for sports
  D. Properly fitting equipment
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19
Q

Medial ankle musculature

A
  1. Tibialis posterior tendon
  2. Flexor digitorum longus tendon
  3. Flexor hallucis longus tendon
20
Q

Tibialis posterior muscle strain risk factors

A
  1. Overuse
  2. High-impact sports
  3. 40+ y/o
  4. Obesity
  5. Acute injury
21
Q

Tibialis posterior muscle strain clinical presentation

A
  1. Pain along medial foot and ankle
  2. Swelling medial foot and ankle
  3. Pain w/ activity (walking, prolonged standing)
  4. Pes planus
    A. From inflamed/torn tendon
    B. Can cause lateral foot pain
22
Q

Tibialis posterior muscle strain testing

A
  1. Single limb heel rise

2. Limited flexibility (dorsiflexion)

23
Q

Tibialis posterior muscle strain tx

A 
1. Mild to moderate cases
  A. RICE
  B. Pain management
  C. Low-impact exercises
  D. Arch support
  E. PT (ROM, proprioceptive training, muscle strengthening)
2. Severe cases
  A. Immobilization
  B. Surgery if fail conservative tx 6-9 mo
24
Q

Anterior ankle musculature

A
  1. Tibialis anterior tendon
  2. Extensor hallicus longus tendon
  3. Extensor digitorum longus tendon
25
Q

Tibialis anterior muscle strain risk factors

A
  1. Overuse (inc workout intensity or duration)
  2. High-impact sports
  3. Running/jumping
  4. Acute injury
  5. Gait
  6. Pes cavus
26
Q

Tibialis anterior muscle strain clinical presentation

A
  1. Pain anterolateral tibia and dorsum of foot
  2. Swelling anterolateral tibia and dorsum of foot
  3. Pain worse w/ activity (walking)
  4. Dorsiflexion weakness
27
Q

Tibialis anterior muscle strain tx

A 
1. Mild to moderate cases
  A. RICE
  B. Pain management
  C. PT
    1. ROM
    2. Muscle stretching (tibialis ant and gastrocnemius)
2. Severe cases
  A. Surgery if fail conservative tx 6-9 mo (lengthen gastrocnemius)
28
Q

Plantar fasciitis

A

Pain at ant portion calcaneus on plantar aspect or anywhere along plantar aponeurosis

29
Q

Plantar fasciitis causes

A
  1. Obesity
  2. Pregnancy
  3. Long-distance runner
  4. Tight calf musculature
  5. Prolonged time standing
  6. Bare feet/shoes w/ bad support
  7. 40+ y/o
    A. F>M
30
Q

Plantar fasciitis clinical presentation

A
  1. Pain worse in morning, after inactivity
    A. Improves w/ activity
  2. Pain worse w/ stairs
  3. Prolonged activity -> flares afterward
31
Q

Plantar fasciitis tx

A
  1. Avoid provoking activities
  2. Ice
  3. Pain management
  4. Stretching
    A. Plantar fascia
    B. Gastrocnemius
  5. Orthotics
  6. Steroid injections
  7. OMT
  8. PT
32
Q

Achilles tendonitis risk factors

A
  1. 40+ y/o
  2. Overuse (inc workout intensity/duration)
  3. Running/jumping
  4. Tight/inflexible calf musculature
  5. Pes planus
  6. Bone spur
33
Q

Achilles tendonitis clinical presentation

A
  1. Pain/stiffness Achilles’ tendon in morning
  2. Pain worse after activity
  3. Severe pain day after exercising
  4. Tendon thickening
  5. Swelling that worsens throughout day or after activity
  6. Tendon rupture
    A. Other symptoms first
    B. “Pop” in back of calf or in heel
    C. Lost at “watershed” where vasculature is (4-5cm prox calcaneus)
34
Q

Achilles tendonitis tx

A 
1. Mild to moderate cases
  A. RICE
  B. Pain management 
  C. Limit/eliminate exercise/factors that exacerbate pain (slowly re-introduce after tx)
  D. PT (ROM, muscle stretching)
2. Rupture -> surgery
35
Q

Ottawa ankle rules

A
  1. Pain in malleolar zone AND one of following:
    A. Bone tenderness distal 6 cm of posterior edge fibula or tip of lateral malleolus
    B. Bone tenderness distal 6 cm of posterior edge of tibia or tip of medial malleolus
    C. Inability to bear wt (4 steps) immediately after injury and in ED
36
Q

Ottawa foot rules

A
  1. Pain in mid-foot zone AND one of following:
    A. Bone tenderness base MT5
    B. Bone tenderness base navicular bone
    C. Inability to bear wt (4 steps) immediately after injury and in ED
37
Q

Ankle X-ray views

A
  1. AP: slight overlap talus on fibula
  2. Lateral: fibula should be on post portion of distal tibia
  3. Mortise
    A. 20 degrees rotation of foot
    B. See medial and lateral joint spaces
    C. Slight overlap talus on fibula
38
Q

Maisonneuve fracture

A
  1. Mech of injury: forces external rotation of foot and ankle
  2. Fracture prox fibula
  3. Tear/disruption interosseous membrane and tibiofibular syndesmosis
  4. Malleolar fracture (usually medial)
  5. Rupture deep deltoid ligament
39
Q

Avulsion fracture of MT5

A
  1. Most common fx on MT5
  2. Styloid process
  3. Causes
    A. Pull from peroneus brevis
    B. Foot/ankle inversion
  4. Tx:
    A. Wt bearing cast/hard sole cast shoe 4-6 wks
    B. Surgery for large or displaced fractures
40
Q

Jones fracture

A 
1. Base MT5 at metaphyseal-diaphyseal junction
  A. 1.3 cm distal to tuberosity
  B. Prox to Mt cuboid junction
2. Causes
  A. Pull from peroneus tertius
  B. Foot/ankle inversion
  C. Lateral motions of foot 
  D. Dancing en pointe
  E. Overuse/repetitive trauma
3. Tx: 
  A. Non-wt bearing cast 6-8 wks for acute and minimally displaced
  B. Surgery for chronic or displaced fractures
41
Q

MT5 stress fractures

A
  1. Not in avulsion or Jones fx regions
  2. Causes
    A. Sudden inc physical activity
    B. Repetitive microtrauma
    C. Overuse
  3. Tx
    A. Non-wt bearing cast 6-8 wks
    B. Surgery for athletes, people preferring surgery, or displaced/non-healing fxs
42
Q

Tarsal tunnel syndrome

A
  1. Entrapment/compression of tibial n. Along medial ankle under retinaculum
  2. Causes
    A. Pes planus
    B. Ankle swelling
    C. Diabetes
    D. Enlarged structure
  3. Clinical presentation
    A. Numbness/tingling, pain radiating from medial ankle to plantar aspect foot
    B. Worse w/ eversion and dorsiflexion
  4. Testing
    A. Tinel’s test
    B. EMG/NCS
  5. Tx
    A. Rest
    B. NSAIDs
    C. Steroid injection
    D. Steroid injection
    E. Orthotics/bracing/splinting
    F. Surgical decompression if fail conservative
43
Q

Morton neuroma

A 
Interdigital nerve irritation or entrapment
1. Usually between 3rd and 4th Mt bones
2. Causes
  A. Chronic over-pronation
  B. Wearing tight shoes
  C. Ballet dancing
3. Clinical presentation:
  A. Hyperesthesia, numbness, aching, burning
  B. Feeling like stone in shoe
4. Testing: squeeze test
5. Tx 
  A. Wear shoes w/ wide toe area
  B. Pain management
  C. Steroid injection
  D. Orthotics
  E. Surgery
44
Q

Osteochondral defect

A
  1. Following acute ankle sprain
    A. Dome of talus meets distal tibia w/ higher force
  2. Pain doesn’t improve w/ conservative tx
  3. Might be “locking” sensation
  4. Do second set of images
  5. Tx
    A. RICE
    B. Pain management
    C. Immobilization (4-6 mo) w/ non-wt bearing
    D. PT
    E. Surgery
    1. Bone fragments
    2. Large lesions that require resurfacing/reshaping of talus
45
Q

Os trigonum syndrome

A 
(Ankle posterior impingement syndrome)
1. Bone at post of talus
  A. Congenital accessory bone
  B. Result of trauma
    1. Acute ankle sprains
    2. Repetitive plantar flexion injuries
2. Symptoms
  A. Pain w/ activity 
  B. Pain behind ankle but in front of Achilles’ tendon 
3. Tx 
  A. RICE
  B. Pain management
  C. Immobilization w/ walking boot
  D. Surgery on rare occasions
46
Q

Lisfranc joint injury

A
  1. Bone in mid-foot are broken or ligaments torn
  2. Mech of injury
    A. Direct crush injury or indirect rotational twisting on plantarflexed fixed foot
  3. Presentation
    A. Painful and swollen dorsum of foot
    B. Ecchymosis dorsum and/or plantar aspect of foot
    C. Pain worse w/ standing, walking, plantar flexing during gait cycle
  4. Tx:
    A. No fracture, dislocation, or complete lig rupture
    1. RICE
    2. Pain management
    3. Strict non-wt bearing cast/boot 6 wks
    4. PT once wt-bearing
      B. Fracture, dislocation, or complete lig rupture
    5. Surgery

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