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MS ORTHO > SPORTS MEDICINE: UE INJURIES > Flashcards

SPORTS MEDICINE: UE INJURIES Flashcards

1
Q

SPORTS MEDICINE: UE INJURIES

A

…

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2
Q

CERVICAL SPINE INJURIES IN SPORTS

A
  • Common in contact/collision sports
  • include trauma to the tissues of the neck, including the muscles, ligaments, discs, and bones and neurologic structures
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3
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CERVICAL DISC

A

•Seen in more mature athletes
•Affects: C5-C6 C6-C7 C4-C5
•Soft injuries
–Acute disc herniation
–`with or without neurologic involvement,
–depending on the degree of mechanical or chemical irritation by the HNP

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4
Q

Hard Disc

A
  • Result of events occurring over time and the progressive decline in the cervical disc and surrounding structures resulting in spondylosis.
  • Characterized by disc bulges, herniations, thickening of the PLL, thickening of ligamentum flavum, or osteo- phytes.
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5
Q

CERVICAL CORD NEUROPRAXIA

A

•Results from an injury to the spinal cord presenting with complete transient paralysis, motor impairment, sensory changes, or a combination of these in at least two limbs
•From local cord anoxia and increased intracellular Ca
•Hyperextension,
–“pincer” effect can occur, causing the posterior inferior aspect of the superior vertebra and anterior superior aspect of the inferior vertebra to produce a resultant compression of the spinal cord

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6
Q

TRANSIENT QUADRIPARESIS

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•Caused by axial loading of the neck in extension or flexion  nonpermanent complete sensory and motor impairment in all four limbs resolving in 10 minutes to 48 hour
•any neurologic impairment in more than one extremity is a central nervous system injury unless proven otherwise
–Burning hands syndrome

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7
Q

HISTORY & PE

A

•Location, Referral Pattern, Quality of symptoms, and associated abnormalities
•Complete PE
–Detailed neurologic exam of the upper and lower extremities
•Xrays
•Functional MRI

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8
Q

Cervical spinal table

A
  1. Canal/ vertebral body ratio <0.8 in asymptomatic individuals, no contraindication
  2. Ratio of < 0.8 with one episode of cervical cord neuropraxia, relative contraindication
  3. Documented episodes of cervical cord neuropraxia associated with intervertebral disc and or degenerative changes, relative contraindication
  4. Documented episode of cervical cord neuropraxia associated with MRI evidence or cord defect or cor edema, relative/ absolute contraindication
  5. Documented episode of cervical cord neuroprAxia associated with ligamentous instability, symptoms of neurological findings lasting more than 36h and or multiple episodes, absolute contraindication
  6. Spear tackles spine, absolute contraindication
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9
Q

PROXIMAL NERVE PATHOLOGY

A
  • The most common cervical root and brachial plexus injury in an athlete is a “burner or stinger.”
  • An athlete (most commonly a football player) sustains a trauma resulting in symptoms of pain and paresthesias down one limb
  • Symptoms usually last less than 1 minute and typically there are no abnormal neurologic signs on examination.
  • cervical spine may be side bent and extended  compression of the nerve
  • Shoulder may be forcefully depressed while the head is driven in the opposite direction  traction
  • Direct blow to the plexus
  • The injury usually affects the upper cervical nerves of the plexus (C5 to C6), but can extend to involve additional portions of the plexus.

MANAGEMENT
•Rehabilitation:
–Addresses tackling techniques, neck ROM, postural alignment, muscle shorten-ing from spasm, strengthening of the involved muscles, and muscle retraining
–Use of a neck orthosis such as the “Cowboy Collar” should be considered
–Neck orthoses : prevent excessive cervical extension,.

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10
Q

SHOULDER

A

•Rotator cuff : SITS
– function is to maintain the humeral head centered on the glenoid
–True joint: SC, AC, GH
–Pseudojoint: Scapulothoracic joint
–The glenoid and acromion are portions of the scapula

SHOULDER: PE
•ROM
•Glenohumeral joint and scapulothoracic rhythm.
• Strength, sensation, and reflexes
•Specialized testing for impingement, instability, and labral and rotator cuff.

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11
Q

ROTATOR CUFF TENDINITIS

A

•Rotator cuff tendinitis typically occurs either from scapular dysfunction causing subsequent impingement or rotator cuff dysfunction, allowing excessive movement of the humeral head and resultant impingement

ROTATOR CUFF TENDINITIS: STAGES
•Stage 1
– consisted of edema and hemorrhage of the tendon
• Stage 2: the development of fibrosis and tendinitis, usually occurring in patients older than age 25
•Stage 3: the degeneration, bony changes, and tendon rupture, usually occurring after age 40

  • Impaired motion  degeneration or tearing of the
  • Weakness of the scapula stabilizers inadequate scapula rot tion during shoulder elevation.
  • Muscle incoordination  lead to inadequate scapula rotation > narrow the outlet through which the supraspinatus tendon passes.
  • Excessive scapula motion > repetitive irritation of the undersurface of the acromion as spurs or acromial “hooking”
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12
Q

SHOULDER DISLOCATION/ INSTABILITY

A
  • TUBS:Traumatic, unidirectional, Bankart, surgery
  • AMBRI: atraumatic, multidirectional, bilateral, rehabilitation, and inferior capsular shift.

PHYSICAL EXAMINATION
•On physical examination, one can use the apprehension and relocation test, sulcus sign, load and shift test (drawer), or “jerk” test

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13
Q

DISLOCATION/INSTABILITY

A
  • Treatment depends on the patient’s age, activity level, and the number of subluxations & dislocations experienced
  • The redislocation risk may depend, in part, on the patient’s age, amount of trauma sustained, postdislocation activity level, and postdislocation rehabilitation program.
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14
Q

Static vs Dynamic Stabilizer

A

STATIC STABILIZERS
•anterior band of the inferior ligament complex for ante- rior translation
• posterior band of the inferior glenohumeral ligament complex for posterior motion
•Superior glenohumeral ligament for inferior movement

DYNAMIC STABILIZERS
•rotator cuff muscles.

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15
Q

REHABILITATION OF THE SHOULDER

A

•PHASE 1:
–pain control and inflammation reduction are required to allow progression of healing and the initiation of an active
•accomplished with a combination of relative rest, icing (20 minutes TID-QD), ES, and acetaminophen or an NSAID
•PHASE 2: restoration of motion internal rotation
•Poor internal ROM results from a tight posterior capsule or dysfunction of the rotator cuff, causing the humeral head to translate forward

•PHASE 3
–Strengthening and should be performed in a pain-free range.
–Scapulothoracic stabilizers should first be addressed because the glenoid is the platform on which the arm moves
–Strengthening can then progress to the rotator cuff muscles and  shoulder’s prime movers.

•The fourth phase is proprioceptive training.
–To retrain neurologic control of the strength- ened muscles
–Improved dynamic interaction and coupled execution of tasks for harmonious movement of the shoulder and arm
•5th
–to return to task- or sport-specific activities. This is an advanced form of proprioceptive training for the muscles to relearn prior activities

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16
Q

NERVE INJURIES

A 
•Parsonage-Turner Syndrome
–Axillary
–Suprascapular
–Long thoracic
•Axillary nerve
–Deltoid and Teres Minor
–Anterior dislocations
•Suprascapular nerve:
–Supraspinatus and Infraspinatus
–Rarely with GH dislocations
–Repetitive trauma from traction
•Suprascapular notch:
–Infraspinatus = Supraspinatus
•Spinoglenoid notch
–Infraspinatus
17
Q

BRACHIALPLEXOPATHIES

A

•Results from a Burner or Stinger
–Beginning at the point where the cervical spinal nerves have joined to form the upper, middle, and lower trunks
•Shoulder dislocations
–Anterior GH dislocations: Posterior cord and axillary nerve

18
Q

ELBOW INJURIES

A
  • Distal humerus + proximal radius and ulna
  • Humeroulnar jt: Flexion + Extension
  • Humeroradial: capitelum of the humerus and head of the radius
19
Q

TENDINITIS

A 
•Etiology
–Overuse
–Abnormal loading of the tendon
•Lateral epicondylitis
–ECRB and EDC
•Medial Epicondylitis:
–PT, FCR, PL, FCU and FDS
•Posterior elbow tendonitis
–Upper triceps
20
Q

LATERAL EPICONDYLITIS

A
  • ECRB + EDC
  • “Tennis Elbow:
  • pain is typically produced with palpation approximately 1 to 2 cm distal to the extensor origin.
  • Pain with resisted wrist extension and supination, and passive wrist flexion.
21
Q

MEDIAL EPICONDYLITIS

A
  • occur from microtearing of the common flexor tendon’s origin of the medial epicondyle
  • Golfers elbow
22
Q

NEUROPATHIES OF THE ELBOW

A

•Ulnar Nerve
–Posterior to the elbow
–Most susceptible to injury

23
Q

CUBITAL TUNNEL SYNDROME

A
  • entrapment of the ulnar nerve in the cubital tunnel where the two heads of the FCU form a rooflike structure above the nerve
  • pain or paresthesias along the ulnar portion of the FA with or without accompanying 4th and 5th digit sx
24
Q

RADIAL NERVE

A
  • innervates the triceps and anconeus in the arm
  • Branches to innervate the brachioradialis and ECRL
  • forearm, it splits into the superficial and deep branches
25
Q

RADIAL NERVE

A

•Deep branch  PIN
•PIN
–Posterior interosseus nerve
–Lateral elbow aching localized to the region of the extensor origin or symptoms may be referred distally to the wrist.
–Paresthesias in the lateral forearm or hand

26
Q

WRIST AND HAND INJURIES

A

…l

27
Q

DE QUERVAIN’S STENOSING TENOSYNOVITIS

A
  • Inflammation of the first dorsal compartment
  • APL and EPB
  • Finkelteins test
28
Q

FRACTURES

A

•Scaphoid and Triquetrium
–Most commonly fractured
•Scaphoid na dLunate
–Most susceptibel to avascular necrosis

29
Q

COLLES FRACTURE

A

•Radial metaphyseal injuries usually of low energy and do not involve the articular surface

30
Q

LIGAMENTOUS INJURIES

A

•Most common carpal instability occurs between the scaphoid and the lunate

31
Q

GAMEKEEPERS THUMB

A 
•AKA Skiers Thumb
•Injury to the Ulnar Collateral Ligament
•Causes problems in the key pinch
•Complete tears
–Stener Lesion
•Entrapment of the adductor aponeurosis in the MCP joint
32
Q

TRIANGULAR FIBROCARTILAGE COMPLEX

A
  • The fibrocartilage begins at the distal radius, blending with the hyaline cartilage of the lunate fossa.
  • It narrows toward the ulna, with deep fibers inserting into the fovea of the ulnar styloid.
33
Q

COACH’S FINGER

A
  • AKA “Jammed” Finger
  • PIP dislocation reduced by the coach or the trainer
  • Dorsally directed dislocation: most common
  • Stable: splinting
34
Q

MALLET FINGER

A

•Rupture of the terminal extensor tendon of the distal phalanx causing loss of active extension

35
Q

JERSEY FINGER

A
  • Avulsion of the flexor digitorum profundus from the distal phalanx
  • Usually at the 4th finger
  • Athlete tackles a player when his finger is caught in the jersey  forced extension
36
Q

TRIGGER FINGER

A

•thickening of the proximal portion of the flexor tendon sheath, which may develop from chronic irritation of the palmar surface of the metacarpal phalangeal joint by

37
Q

CARPAL TUNNEL SYNDROME

A
  • Median nerve

* Numbness and paresthesias in the median nerve distribution

MS ORTHO (21 decks)

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