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BPK 241 > Week 4 [not including lab] > Flashcards

Week 4 [not including lab] Flashcards

1
Q

Define: Achilles tendinitis
Define: Achilles tenosynovitis
Define: Achilles tendinosis

A

Define: Achilles tendinitis: acute inflammatory condition that involves Achilles tendon

Define: Achilles tenosynovitis: inflammation of Achilles tendon sheath

Define: Achilles tendinosis: collagen fibers of tendon degeneration, scarring, and disorganization (no inflammation)
- causes fibrosis and scaring that restrict the Achilles tendon’s motion within the sheath

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2
Q

Etiology of Achilles tendinopathy (3)

A
  • Overloading of tendon during repetitive motions such as running or jumping
  • Usually occurs when doing too much too soon with insufficient recovery time
  • Decreased gastrocnemius and soleus complex flexibility can also increase symptoms
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3
Q

Achilles tendinopathy symptoms and signs

A
  • generalized pain and stiffness about the Achilles tendon region (just proximal to calcaneal insertion)
  • Uphill running aggravates condition
  • Reduced gastrocnemius and soleus flexibility (weakness with resisted plantar flexion like toe raises)
  • Morning stiffness and discomfort with walking after long periods of sitting
  • Tendon may be warm and painful to palpation
  • Tendon may appear thickened
  • Crepitus when palpated with active plantar flexion and dorsiflexion
  • Pain elicited with passive stretching
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4
Q

Achilles tendinopathy management

A
  • Proper footwear and orthotics
  • Icing to reduce pain and inflammation
  • Ultrasound to facilitate an increased blood flow to the tendon in the later stages of rehabilitation
  • Eccentric loading program
  • Cross friction massage (breaks down adhesions that may form from healing response and further improve gliding ability of the paratenon)
  • Strengthening of the gastrocnemius and soleus
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5
Q

Define: Medial tibial stress syndrome (MTSS)

A

aka shin splints, pain in the anterior part of the shin

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6
Q

What % of running injuries and what percent of all conditions that cause pain in athlete’s legs are MTSS?

A
  • 10-15%

- 60%

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7
Q

Etiology and factors that contribute to MTSS

A
  • Repetitive microtrauma common in running and jumping activities
  • periostitis, strains, cortical bone microfractures

Factors:

  • Weakening of leg muscles
  • Shoes with improper support or cushioning
  • Training errors (running on hard surfaces and overtraining)
  • Misalignment problems (varus foot, tight heel cord, hypermobile pronated foot, forefoot supination)
  • obesity
  • heredity
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8
Q

What are the 2 syndromes that MTSS involves?

A

MTSS involves 1 or 2 syndromes:

  • Tibial stress fracture
  • Overuse syndrome (can progress to irreversible exertional compartment syndrome)
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9
Q

MTSS signs and grades of severity

A
  • pain and tenderness
    4 grades of pain
    Grade 1: pain after activity
    Grade 2: pain before and after activity
    Grade 3: pain before, during, and after activity (affects performance)
    Grade 4: debilitating pain (activity is now impossible)
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10
Q

MTSS management

A
  • Modify activity immediately
  • NSAIDS
  • Address abnormal pronation (rehab, proper footwear, orthotics)
  • Ice massage
  • Flexibility program for gastrocnemius and soleus
  • Taping
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11
Q

Define: periosteum

A

a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the joints.

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12
Q

Describe the 2 layers of the periosteum

A

outer fibrous layer:

  • contains blood vessels, nerves, lymphatic vessels that nourish bone.
  • Contains sharpey’s fibres that attach periosteum to bone AND ligaments and muscle tendons to bone

inner cellular layer:
- responsible for bone repair and growth, contains osteoblasts which lay down new bone cells as bones grow or repair when damaged

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13
Q

Define:

  • osteocyte
  • osteoblast
  • osteogenic cell
  • osteoclast
A
  • osteocyte: maintains bone tissue
  • osteoblast: forms bone matrix
  • osteogenic cell: stem cell
  • osteoclast: breaks down bone tissue
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14
Q

Fill in the blank: the anterior and posterior deep section of the lower leg is separated by the _____________

A

interosseous membrane

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15
Q

List everything in the anterior compartment of the leg (5)

A
  • tibialis anterior
  • EHL
  • EDL
  • deep peroneal nerve
  • anterior tibial artery
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16
Q

List everything in the superficial posterior compartment of the leg (2)

A
  • gastrocnemius

- soleus

17
Q

List everything in the deep posterior compartment of the leg (5)

A
  • tibialis posterior
  • FHL
  • FDL
  • tibial nerve
  • posterior tibial artery
18
Q

List everything in the lateral peroneus compartment of the leg (3)

A
  • peroneus longus
  • peroneus brevis
  • superficial branch of peroneal nerve
19
Q

Lower leg strain

  • Ssx
  • Tx
A
  • Hx: most common at the gastrocnemius/soleus musculotendinous junction or medial soleus/ tibialis posterior/ FDL muscle belly
  • Ssx: pain, tenderness, step deformity, bruising, limp, snap with 2nd or 3rd degree injury
  • Tx: P.O.L.I.C.E., taping, physio, ROM exercises, rehab
20
Q

What is the importance of the tendon sheath

A

sheath prevents tendon from being pressed upon by surrounding soft tissues or causing frictional issues

21
Q

Define: peritendon

A

sheath that covers the achilles tendon

22
Q

Give the names of the 2 layers that make up the peritendon

A
  • paratenon

- epitenon

23
Q

State the importance of an eccentric loading program for achilles tendinopathy; give an exercise example

A
  • decreases pain and helps to transition the collagen from weak type 3 to strong type 1 while stimulating the collagen to lay down in a linear pattern

exercise example

1) Assisted raising onto both feet
2) Weight transferred to injured leg
3) Non-assisted lowering
4) Starting with 1 set of 10 reps, increasing to 3 to 5 sets of 10 reps

24
Q

What are some differential diagnoses of exercise induced lower leg pain.

A
  • medial tibial stress syndrome
  • stress fracture
  • chronic exertion anterior compartment syndrome
25
Q

Contributing factors of exercise induced lower leg pain.

A
  • Poor running mechanics
  • Inappropriate footwear
  • Foot shape and biomechanics
  • Lower limb structural abnormalities
  • Muscle tightness and imbalance
  • Poor conditioning/overweight
  • Inadequate warm-up and training errors • Terrain and training surfaces
26
Q

Describe the stress overload cycle (7)

A
  • muscle fatigue
  • loss of shock absorption
  • structural stress to bone
  • remodeling process
  • pain
  • voluntary or involuntary disuse
  • muscle inhibition/atrophy
  • repeat
27
Q

When an illness has syndrome at the end of the name, what does it mean?

A

several causes

28
Q

Tibial stress fractures

  • Hx
  • Ssx
  • DDx
  • Tx
A
  • Hx: overuse (running, jumping)
  • Ssx: aching pain that is worse with exercise, tenderness with palpitation, x-ray positive (may not show up initially), bone scan positive
  • DDx: shin splints
  • Tx: adequate rest, walking boot or cast or only light activity, correcting etiologic factors, alternate program of fitness, slow return to activity as tolerated
29
Q

What does it mean when a bone scan is sensitive but not specific

A

bone scans show osteoblastic activity

  • very sensitive: will pick up anything wrong with the bone
  • not specific: will not tell us whats wrong with the bone
30
Q

What does it mean when the concept of a stress fracture is a healing failure continuum?

A

bone fracture continuum
- Normal bone → Stress reaction → Stress Fracture → Full (Acute) Fracture

  • osteoclastic activity > osteoblastic activity
31
Q

Define: ischaemia

A

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

32
Q

Define: anterior compartment syndrome

A

ischaemia of muscles

33
Q

anterior compartment syndrome causes

A
  • internally cause – increased volume of blood (meaning an increase in pressure) possibly from hemmorhage from fracture, swelling from burns, contusion, tumour
  • external cause – decreased blood volume: tight casts, bandage dressing
  • Overuse (excessive running)
34
Q

Give the 5 P’s of compartment syndrome symptoms

A
  • pain: out of proportion for their injury, pain with rest or with passive stretch in suspect compartment
  • parasthesias: may be earliest subjective complaint due to increase pressure on nerve in tight compartment
  • paralysis: also sign of muscle and nerve dysfunction, difficult to differentiate from muscle guarding as a result of pain
  • pallor and pulselessness: implies arterial insufficiency. Once pulses are diminished, the damage has been done.
35
Q

parasthesias

A

abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause.

36
Q

Chronic Anterior compartment syndrome

- Tx

A
  • Adequate rest!
  • Correct predisposing factors
  • Physician to assess and monitor
  • Physiotherapy
  • Slow return to activity as tolerate
37
Q

What is the danger with acute compartmental syndrome and acute exertional compartment syndrome and the treatment plan?

A
  • Potential surgical emergency!!!
  • without fast treatment, muscle tissue could die and result in loss of limb function
  • NPO & transport to M.D. ASAP
  • May need fasciotomy
  • Then treat otherwise as for chronic
38
Q

Differentiate between acute and chronic anterior compartment syndrome

A
  • acute = 30mmHg

- chronic (from exercise) = >30mmHg 1 min after they stop exercise, >25 mmHg 5 min after they stop exercising

39
Q

Acute lower leg fractures

  • Hx
  • Ssx
  • Tx
A
  • Hx: kick, fall, or ankle sprain
  • Ssx: pain, tenderness, bruising, swelling, crepitus, deformity
  • Tx: recognize, stabilize, transport to hospital

BPK 241 (7 decks)

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