Sports Medicine: Lower Extremity Injuries

Question 1

What is an Avulsion Fracture?

Answer 1

strong muscle contraction causes a tendon to pull off a piece of immature bone

Question 2

What are the common sites of an avulsion fracture and what muscle is involved?

Answer 2

ASIS - sartorius
AIIS - rectus femoris
Ischial Tuberosity - hamstrings

Question 3

What lower extremity injury is documented to have occurred in dinosaurs?

Answer 3

avulsion fracture

not kidding, its on the wiki page for it… and now I’m picturing a limping T rex

Question 4

groin pain + clicking or snapping of hip joint with limited range of motion

Answer 4

labral tear

Question 5

Where on the labrum are tears most common?

Answer 5

anterior and superior

Question 6

What is the C sign?

Answer 6

the patient places their index finger over the anterior aspect of the hip and thumb over the posterior trochanteric region to indicate the location of their pain

Question 7

Where is the pain usually found with a labral tear?

Answer 7

groin

Question 8

This condition is characterized by abnormal contact between the proximal femur and rim of the acetabulum.

WHat does this abnormal contact lead to?

Answer 8

Femoroacetabular Impingement

shearing of the cartilage with hip flexion –> arthritis in the hips by 40s

Question 9

What are the different types of FAI?

Answer 9

1. Cam = mass at neck of femur)
2. Pincher = bony mass on ox coxae adj to acetabulum
3. combined

Question 10

platelet rich plasma

Answer 10

spin down pts blood to get the plasma with all the platelets and growth factors… inject it into them to speed up healing process after a hamstring or quad tear

**only rich athletes do this

Question 11

What are the 4 types of meniscal injury?

Answer 11

1. longitudinal (peripheral)
2. bucket handle (flip into joint)
3. flap (nub of cartiladge)
4. radial

Question 12

Why is the longitudinal type of meniscal tear usually repaired surgically?

Answer 12

the tear in the periphery where there in a increased vascularization (need to repair there it to heal in this location? or something along those lines?)

Question 13

“I heard/felt a pop, the knee feels hyperextended and comes in and out of place” + swelling + difficult to walk

Answer 13

ACL tear

Question 14

herarthrosis

Answer 14

assc with ACL and accounts for the swelling in the joint which is due to accumulation of blood

Question 15

What are the test you would perform to check for an ACL tear?

Answer 15

Lachman Test

• -The knee is flexed at 30 degrees
• -pull on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur
• -An ACL-deficient knee will lack a firm endpoint!
• –be sure to test the opposite leg too
• Best test for ACL*

Question 16

What are the characteristic bone bruises assc with an ACL tear?

Answer 16

mid 1/3 lateral femoral condyle (LFC)

post 1/3 lateral tibial plateau (LTP)

Question 17

What ligament is most commonly torn with an ACL injury?

Answer 17

MCL

Question 18

What are the test you would perform to check for a MCL tear?

Answer 18

Pivot Shift:

• -patient must be completely relaxed (easier to elicit under anesthesia)
• -extension to flexion: mimics the actual pathologic motion/event (i.e. they will only let you do it once)

Question 19

ACL tears are more common in men or women? Why?

Answer 19

WOMEN

• body movement
• muscle strength
• hormones
• joint laxity
• ligament size
• limb alignment
• notch dimensions

Question 20

How must a pt be postioned during an MRI to see an ACL injury?

Answer 20

knee externally rotated 15 degrees

• can visualize ACL, menisci, collateral ligs, and chondyles in one frame

Question 21

treatment of an ACL injury?

Answer 21

low demand pts = non-operative

active pts = surgical repair

Question 22

see posterior sag of the knee

Answer 22

PCL tear

Question 23

What are the 3 ways the PCL usually gets torn?

Answer 23

1. direct trauma to tibia (dashboard)
2. fall on flexed knee (usually with foot plantar flexed)
3. hyperextension

Question 24

Treatment of PCL tear?

Answer 24

usually non-operative due to inc risk to develop arthritis

Question 25

valgus blow to the knee could cause an ____ injury

Answer 25

MCL

Question 26

Is an MCL or an LCL injury more common?

Answer 26

MCL

Question 27

non-contact with pivoting, awkard landing, and sliding into base

Answer 27

MCL

Question 28

Treatment for MCL/LCL injury

Answer 28

usually do not operate unless assc with another ligament injury

Question 29

How do pts typically dislocate their knee?

Answer 29

high velocity fall = MVA or fall > 5ft low velocity fall = sports or fall < 5 ft ultra low velocity fall = obese person

Question 30

Why must a knee dislocation be caught quickly?

Answer 30

get injury to popliteal N (which can be permanent) and to popliteal artery --> AMPUTATION if >8 hr delay

Question 31

What determines the timing of surgery with a knee dislocation?

Answer 31

which ligaments are torn Delayed if collaterals are intact or ACL/PCL/MCL All other combos immediate (i.e <10-14 days)

Question 32

Fulkerson osteotomy or MPFL reconstruction

Answer 32

operative treatments of patellar instability

Question 33

What is the test to determine patellar instability

Answer 33

patellar apprehension sign | patella dislocated laterally?

Question 34

high riding patella

Answer 34

petella tendon hear

Question 35

How does the patella look with a quad tendon rupture

Answer 35

normal

Question 36

Treatment of petellar or quad tendon rupture

Answer 36

surgical bc will not heal on its own

Question 37

Knee joint popping/locking, weakness, dec ROM, swelling, tenderness

Answer 37

osteochondral defect (OCD) or chondral knee injury

Question 38

What is the cause of OCD/chondral knee injury?

Answer 38

vascular, trauma, and/or genetic

Question 39

treatment for OCD/chondral knee injury

Answer 39

microfracture fixation of fragment OATs (bone plug ~ hair plug)

Question 40

What tendons rupture in ... 20-30 yo 30-40 yo 40-50 yo

Answer 40

20-30 yo = achilles 30-40 yo = petellar 40-50 yo = quad **pandout said differently, but I went with that the prof said

Question 41

syndemosis

Answer 41

high ankle sprain (ligs that connect tibia and fibula)

Question 42

inversion of the foot will sprain the ankle at what ligaments?

Answer 42

lateral - anterio tibiofibualr - calcaneal **will heal on their own

Question 43

Which ligaments will not heal on their own when the ankle is sprained?

Answer 43

medial ligament = deltoid ligament

Question 44

What is the difference between a jones and a pseudo-jones fracture?

Answer 44

pseudo-jones = an avulsion fracture of 5th metatarsal caused by pull from the peroneus brevis = HEALS jones = a fracture of the diaphysis of the fifth metatarsal of the foot (at the proximal end) = DOES NOT HEAL without immobilization or surgery

Question 45

change in exercise routine a few weeks before onset of leg pain + dreaded black line on Xray Tx?

Answer 45

stress fracture black line = severe = insert rod others = rest, but hard to heal

Question 46

tibial stress fractures occur (anteriorly, posteriorly)

Answer 46

anteriorly

Question 47

mid foot sprain due to dorsal dislocation of 2nd metatarsal Tx?

Answer 47

lisfranc injury surgery

Question 48

extreme dorsal flexion of big toe

Answer 48

turf toe

Question 49

pop/snap follwed by pain ~ to being kicked/hit in heel. Cannot stand on their toes on affected side

Answer 49

achilles tendon rupture

Question 50

What test is used for an achilles tendon rupture?

Answer 50

thompson = squeeze gastrocnemius, if the foot does not plantar flex = positive test = Achilles tendon rupture

Question 51

T or F: a pt with a torn achilles tendon can plantar flex on their own

Answer 51

T: their posterior tibialis is still intact