Sports Medicine: Lower Extremity Injuries Flashcards
What is an Avulsion Fracture?
strong muscle contraction causes a tendon to pull off a piece of immature bone
What are the common sites of an avulsion fracture and what muscle is involved?
ASIS - sartorius
AIIS - rectus femoris
Ischial Tuberosity - hamstrings
What lower extremity injury is documented to have occurred in dinosaurs?
avulsion fracture
not kidding, its on the wiki page for it… and now I’m picturing a limping T rex
groin pain + clicking or snapping of hip joint with limited range of motion
labral tear
Where on the labrum are tears most common?
anterior and superior
What is the C sign?
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
Where is the pain usually found with a labral tear?
groin
This condition is characterized by abnormal contact between the proximal femur and rim of the acetabulum.
WHat does this abnormal contact lead to?
Femoroacetabular Impingement
shearing of the cartilage with hip flexion –> arthritis in the hips by 40s
What are the different types of FAI?
- Cam = mass at neck of femur)
- Pincher = bony mass on ox coxae adj to acetabulum
- combined
platelet rich plasma
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
What are the 4 types of meniscal injury?
- longitudinal (peripheral)
- bucket handle (flip into joint)
- flap (nub of cartiladge)
- radial
Why is the longitudinal type of meniscal tear usually repaired surgically?
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?)
“I heard/felt a pop, the knee feels hyperextended and comes in and out of place” + swelling + difficult to walk
ACL tear
herarthrosis
assc with ACL and accounts for the swelling in the joint which is due to accumulation of blood
What are the test you would perform to check for an ACL tear?
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*
What are the characteristic bone bruises assc with an ACL tear?
mid 1/3 lateral femoral condyle (LFC)
post 1/3 lateral tibial plateau (LTP)
What ligament is most commonly torn with an ACL injury?
MCL
What are the test you would perform to check for a MCL tear?
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)
ACL tears are more common in men or women? Why?
WOMEN
- body movement
- muscle strength
- hormones
- joint laxity
- ligament size
- limb alignment
- notch dimensions
How must a pt be postioned during an MRI to see an ACL injury?
knee externally rotated 15 degrees
- can visualize ACL, menisci, collateral ligs, and chondyles in one frame
treatment of an ACL injury?
low demand pts = non-operative
active pts = surgical repair
see posterior sag of the knee
PCL tear
What are the 3 ways the PCL usually gets torn?
- direct trauma to tibia (dashboard)
- fall on flexed knee (usually with foot plantar flexed)
- hyperextension
Treatment of PCL tear?
usually non-operative due to inc risk to develop arthritis
valgus blow to the knee could cause an ____ injury
MCL
Is an MCL or an LCL injury more common?
MCL
non-contact with pivoting, awkard landing, and sliding into base
MCL
Treatment for MCL/LCL injury
usually do not operate unless assc with another ligament injury
How do pts typically dislocate their knee?
high velocity fall = MVA or fall > 5ft
low velocity fall = sports or fall < 5 ft
ultra low velocity fall = obese person
Why must a knee dislocation be caught quickly?
get injury to popliteal N (which can be permanent) and to popliteal artery
–> AMPUTATION if >8 hr delay
What determines the timing of surgery with a knee dislocation?
which ligaments are torn
Delayed if collaterals are intact or ACL/PCL/MCL
All other combos immediate (i.e <10-14 days)
Fulkerson osteotomy or MPFL reconstruction
operative treatments of patellar instability
What is the test to determine patellar instability
patellar apprehension sign
patella dislocated laterally?
high riding patella
petella tendon hear
How does the patella look with a quad tendon rupture
normal
Treatment of petellar or quad tendon rupture
surgical bc will not heal on its own
Knee joint popping/locking, weakness, dec ROM, swelling, tenderness
osteochondral defect (OCD) or chondral knee injury
What is the cause of OCD/chondral knee injury?
vascular, trauma, and/or genetic
treatment for OCD/chondral knee injury
microfracture
fixation of fragment
OATs (bone plug ~ hair plug)
What tendons rupture in …
20-30 yo
30-40 yo
40-50 yo
20-30 yo = achilles
30-40 yo = petellar
40-50 yo = quad
**pandout said differently, but I went with that the prof said
syndemosis
high ankle sprain (ligs that connect tibia and fibula)
inversion of the foot will sprain the ankle at what ligaments?
lateral
- anterio tibiofibualr
- calcaneal
**will heal on their own
Which ligaments will not heal on their own when the ankle is sprained?
medial ligament = deltoid ligament
What is the difference between a jones and a pseudo-jones fracture?
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
change in exercise routine a few weeks before onset of leg pain + dreaded black line on Xray
Tx?
stress fracture
black line = severe = insert rod
others = rest, but hard to heal
tibial stress fractures occur (anteriorly, posteriorly)
anteriorly
mid foot sprain due to dorsal dislocation of 2nd metatarsal
Tx?
lisfranc injury
surgery
extreme dorsal flexion of big toe
turf toe
pop/snap follwed by pain ~ to being kicked/hit in heel. Cannot stand on their toes on affected side
achilles tendon rupture
What test is used for an achilles tendon rupture?
thompson = squeeze gastrocnemius, if the foot does not plantar flex = positive test = Achilles tendon rupture
T or F: a pt with a torn achilles tendon can plantar flex on their own
T: their posterior tibialis is still intact
