Sports medicine

Question 1

Finding of HOCM

Answer 1

• crescendo-decrescendo murmur that increases with valsalva

Question 2

management of sports related concussion

Answer 2

• return to academic baseline

- return to light exercise when able to tolerate 30-45 minutes of cognitive activity without symptom exacerbation

Question 3

What is female athlete triad?

Answer 3

• menstrual irregularity
• low energy availability
• osteoporosis

Question 4

Management of anterior shoulder dislocation?

Answer 4

• early reduction

- surgical treatment for pts < 25 yo with first anterior shoulder dislocation

Question 5

What are signs and symptoms of femoral acetabular impingement?

Answer 5

• pain in anterolateral groin, “C-sign”
• exam: FAdIR, reproduce pain with flexion/adduction/internal rotation
• predisposition to OA
• NSAIDs and physical therapy

Question 6

clinical recommendations for ankle sprains

Answer 6

• NSAIDS
• Ankle bracing
  graded exercise programs and proprioceptive training are recommended to reduce risk

Question 7

Ottawa ankle rules

Answer 7

Xray if..
- malleolar pain or pain in region of navicular or proximal 5th metatarsal
AND
- inability to weight bear 4 steps at exam
OR
- discrete bone tenderness at any side

Question 8

What is handlebar neuropathy?

Answer 8

• cyclists
• entrapment of ulnar nerve at Guyan’s canal
• paresthesias in the palmar 5th and ulnar aspect of 4th digits of affected hand

Question 9

What is peroneal neuropathy?

Answer 9

• trauma to lateral aspect of knee/foreleg or compression

- causes foot drop

Question 10

What are beneficial therapies for acute low back pain?

Answer 10

• NSAIDs
• advise to remain active
• muscle relaxants may be helpful
• PT may be helpful

Question 11

recommendations for lumbar disc herniation

Answer 11

• remain active
• oral steroids and NSAIDs have limited benefit
• if no red flags, then radiculopathy may be managed conservatively without imaging for up to 6 weeks
• if radiculopathy no improving after 6 weeks, may benefit from discectomy

Question 12

What sort of exercise should you recommend for overuse injuries?

Answer 12

Eccentric strengthening

Question 13

Treatment for plantar fasciitis

Answer 13

rest, ice, analgesics, stretching, weight loss

• night splint use for up to 3 weeks
• orthotics

Question 14

What is morton’s neuroma?

Answer 14

• irritation or trauma to intermetatarsal plantar nerve
• 3rd and 4th web space most common
• burning pain in forefoot with toe numbness
• palpable mass or click between metatarsals (mulder’s sign)
• treatment: shoes with wide toe box, low heels, orthotics, injection

Question 15

What is tarsal tunnel syndrome?

Answer 15

• entrapment of posterior tibial nerve posterior to medial malleolus
• provoked by subtalar pronation (flat foot)
• often mistaken for planta fasciitis but has nontender medial calcaneal tubercle
• need to correct biomechanics