Sports-Related Injuries (Week 5--Fish) Flashcards
Who is a sports medicine physician?
Orthopedic surgeons
Family practice
Internal medicine
Emergency medicine
Pediatrics
Physical medicine and rehabilitation
What does a sports med physician do?
Leader of sports med team
Pre-season: athlete clearance to participate; education/counseling on nutrition, strength, substance abuse, etc
Game day: anticipate/manage life threatening injuries; ensure appropriate equipment available for common injuries
Post-game: integrate medical expertise with other providers; documentation
Post-season: rehab; safe return to participation; assess injury, equipment and make improvements
Injury identification
Joint involved
Anatomy
Mechanism of injury
Definition of injury
Functional loss
Treatment options
Rehabilitation process
Spectrum of injuries
Sprain
Strain
Tendinitis
Tendinosis
Partial tears
Complete tears
Fractures
Treatment
PRICE!
Protect
Rest
Ice
Compression
Elevation
(then rehab)
Rotator cuff tendonitis/tear
Injury: supraspinatus tendon, impingement signs, overuse, weak external rotators, strong internal rotators
Functional loss: overhead activities
Shoulder dislocations
Anatomy: rotator cuff, labrum (scapula), humeral head
Anterior is most common type of dislocation, axillary nerve injury in 1/20
Mechanism: abduction and extension
Functional loss: pain, instability, weakness; if don’t put shoulder back in place can get vascular problem
AC joint separation
Anatomy: clavicle, acromion process, ligaments
Classification system is Type I through IV
Mechanism: lateral force, top force
Functional loss: throwing, weakness
Treatment: conservative tx if minor separation, surgery if higher grade separation
Tennis elbow
Anatomy: extensor carpi radialis brevis, lateral humeral epicondyle
Mechanism: overuse syndrome, poor technique
Functional loss: weak wrist extensor, weak hand grip
Treatment: compression splint, steroid injection, ECRB rehabilitation
Little league elbow
Anatomy: flexor carpi ulnaris, flexor digitorum, medial epicondyle
Mechanism: poor technique, too many pitches, age 10 and younger, repetitive valgus stretch, medial epicondylar physis, most stress during acceleration phase
Function: abnormal development, career ending, tendon rupture, chronic pain
Biceps tendon rupture
Anatomy: distal vs. proximal attachments of muscle, radial, humerus
Mechanism: proximal most common site of injury, distal is rare but occurs at radial tuberosity, elbow flexion against resistance
Functional: strength loss (30% elbow flexion; 40% supination)
Treatment: early surgical treatment
Jersey finger
Anatomy: flexor digitorum profundus (FDP), flexor tendon, A4 pulley, PIP joint
Mechanism: FDP avulsion or disruption, hyper-extension
Type I: tendon retracts into palm
Type II: tendon retracts to PIP joint
Type III: bony avulsion, tendon retraction limited by A4 pulley
Function: loss of distal finger flexion
Treatment: surgical treatment (7-10 days for Type I; 3 weeks for Type III)
Mallet finger
Anatomy: extensor hood, PIP
Mechanism: avulsion or rupture, tip force, hyper-flexion
Function: minimal
Treatment: conservative (splint, cast) and it will scar in place
ACL rupture
Anatomy: ACL, lateral femoral condyle, medial tibial plateau
Mechanism: hyperextension with planted foot, anterior translation of tibia on femur, valgus movement (lateral force)
Testing: anterior drawer, Lachman’s
Function: knee instability, locking, give way, swelling
Meniscus
Anatomy: medial meniscus, lateral meniscus, fibrocartilage for shock absorption and changes flat surface of tibial plateau to fit femoral condyles better, peripheral 1/3 is vascularized (better chance of healing as opposed to debridement)
Functional: locking, joint line pain, McMurry test
Treatment: arthroscopy, removal vs. surgical repair
Triad of O’Donahue in knee
AKA Unhappy Triad
ACL, MCL, medial meniscus
Patellar ligament (tendon) rupture
Anatomy: transmits force of the quadriceps muscle group to the tibia, knee extension
Mechanism: prior injury history exists
Function: absence of knee extension, extensor lag
Treatment: surgical repair for complete tears
Ankle sprain
Anatomy: anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL), calcaneous bone, fibula, talus bone
Grade I: partial tear ATF or CF; (-) drawer, (-) talar tilt
Grade II: torn ATF but intact CF; (+) drawer, (-) talar tilt
Grade III: torn ATF and torn CF, (+) drawer, (+) talar tilt
Treatment: RICE, strengthen dorsiflexors, plantarflexors, evertors, proprioception retraining
Turf toe
Anatomy: first MTP joint (big toe), plantar capsule ligament complex
Mechanism: hyperextension (most common), hyperflexion, valgus
Function: push-off pain
Treatment: rest, ice, prevent hyperextension
Spondylolisthesis
Present as back pain, often with spasm in hamstring muscles
Percent slip: I is less than 25%, II is 25-50%, III is 50-75% and IV is 75% and greater
Hyperextension mechanism
Functional loss: lower motor nerve injury, bladder or bowel dysfunction, weakness lower extremity (L5-S1), pain
Stingers (burners)
Mechanism: pinch/stretch roots or plexus
Symptoms: unilateral radiating pain, burning, paresthesias +/- weakness
Duration: seconds to minutes
Usually occur by forceful blow to side of head (increases angle of exiting brachial plexus cords in relation to nerve roots; traction)
Commonly involve C5 and C6 dermatomes, upper trunk only
May occur when head is driven toward shoulder pad (compresses neural foramen and DRG)
Cowboy collar protective device if had greater than 2; limits lateral neck flexion and hyperextension
