Weeks 7-12 Flashcards
What is in the right upper abdomen? x7
1) Liver
2)Gallbladder
3)Duodenum
4)Head of Pancreas
5)Right kidney and adrenal gland
6)Hepatic flexure of the colon
7)Part of the transverse and ascending colon
What is in the left upper abdomen? x7
1)Stomach
2)Spleen
3)Left lobe of liver
4)Left kidney and adrenal gland
5)Splenic flexure of colon.
6)Parts of the transverse and descending colon
7) Body of Pancreas
What is in the right lower abdomen?x4
1)Caecum
2)Appendix
3)Right ovary and tube
4)Right ureter
What is in the left lower abdomen? x4
1)Part of the descending colon
2)Sigmoid colon
3)Left ovary and tube
4) Left ureter
How to palpate the abdomen?
Palpate the 4 quadrants
Start superficial and gradually increase pressure
What are sports hernias (athletic pubalgia)?
Fascial weakness in the ab wall, where the abdominals and adductors attach into pubic bone
MOI sports hernias
Repetitive strain on the area
-Common in hockey, football, soccer, sprinters/hurdlers, rugby
T of F Sports hernias result in a bulge?
F, no protruding intestines like a traditional inguinal hernias but can progress to that
Special test of a sports hernia?
Resisted Sit-Up
Acute Management of Sports Hernias? x2
PIER
Addutcor Wrap
How long is the treatment time for sports hernias?
4-6 Weeks
S&S sports hernia? x4
Pain with sitting up
Quick Cutting
Sprinting
Coughing
RTP for Sports hernias?
Sequential RTP
(easily re-irritated)
What 6 Visceral structures are potentially affected in sport?
Kidney Contusions
Spleen Rupture
Lungs
Bladder Rupture
Testicular Contusions
Heart
Visceral stricture potentially affected in sports if mono?
Spleen Rupture
Visceral stricture potentially affected in sports if pneumothorax?
Lungs
Visceral stricture potentially affected in sports if bladder is full and stiff?
Bladder rupture (recommend empty bladder before sports)
Visceral stricture potentially affected in sports that need to stop spasm and control haemorrhage?
Testicular contusions
Abdominal Injuries MOI
Direct blow, fall from height
S&S ab injuries? x4
Pain
Rigidity in Abdomen
Feeling Unwell
Shock
What is the cullen sign?
Umbilicus discolouration sign of internal hemmorhage
What is the grey turner sign?
Flank Discolouration sign of internal haemorrhage
What are the two signs of internal hemorrhage?
1)Cullen Sign
2)Grey Sign
Acute management of ab injuries? x5
1)Quadrant Palpation
2)Call 911
3)Rest comfortably (don’t move em)
4)Treat for shock
5)Reassure
Kidney injuries MOI
Blow to back
S&S kidney injuries x4
Pain in low back
Peeing Blood
Feeling Unwell
Shock
What to do if suspected kidney injury?
Refer
What are the two cases of sudden death in athletes?
Usually due to cardiac disease
1)Congenital abnormalities of coronary arteries
2)Hypertrophic cardiomyopathy
What is Hypertrophic cardiomyopathy?
The genetic condition causes thickening of the heart muscle
-Altered rhythm= reduced/blocked blood flow
Warning signs of Hypertrophic cardiomyopathy x5
1)Fainting or seizure
2)Dizziness or light-headedness
3)Chest pain (even at rest)
4)Palpitations - quick/fluttering/irregular/pounding heart beats
5)Shortness of breath
What are palpitations?
quick/fluttering/irregular/pounding heart beats
What are the 3 emerging causes of acquired heart disease in young athletes?
1)Anabolic steroids
2)Peptide hormones
3)Stimulants
AKA for blow to solar plexus?
Wind knocked out of you
What is a solar plexus?
Spasm of diaphragm muscle
MOI of solar plexus? x2
Blow to abdomen or chest
Fall on buttocks or back
S&S of solar plexus? x3
Pain
Difficulty Breathing
Panicky
Acute Management of solar plexus x3
Bring athletes knees gently towards chest
Guiding Breathing
Diaphragmatic breathing
When to RTP of solar plexus?
Able to RTP once symptoms resolve (pending no other injury)
MOI of Facet Joint Sprains?
Forced rotation
-Common in contact sports (Unexpected hit)
S&S facet joint sprains
Hear/feel pop
Sharp localized pain
Pain with motions that OPEN joint
Muscle Guarding
What part of the spine is most often prone to facet joint sprains?
Common is c-spine due to large ROM
-Ligaments taken beyond available length
Special test for facet joint sprains?
Quadrant test (+ if pain of OPPOSITE side)
Can be done L/S and C/S
Acute Management of facet joint sprains x2
PIER
Refer
What is facet joint effusion?
Irritation of the facet joint (inflammation)
MOI of facet joint effusion? x6
A sudden episode of extreme ROM
May have felt a click or sharp pain
Localized Pain
Spasm around the inflamed joint
Nerve root can become irritated
CLOSING joint = Pain
Special test Face Joint Effusion?
Quadrant Test (+ if pain on SAME side)
Acute management of facet joint effusion? x2
PIER
Refer
MOI Disc protusions
Acute or Chronic compression through disc, often in a flexed position
Disc Protrusions result
A bulge in the disc (usually posterolateral) resulting in changes to myotomes and dermatomes
S&S Disc Protusions? x3
Pain with repeat forward bending (for posterior protrusion)
Relief with extension
Pain with cough/sneeze
Treatment for disc protrusion?
Refer for conservative treatment
What are deratomes?
Sensory areas of the skin that are innervated by specific nerve roots (afferent nerve fibres)
Sensations of dermatomes?
Pain
Tingling
Numbness
Pressure
What is the special tests for dermatomes?
Myotome Testing (cervical Root and lumbosacral)
How is myotome testing done?
Resisted tests are performed 5x bilaterally (look for weakness)
Myotome Testing C1 Resisted Motion
Cervical Flexion
Myotome Testing C2 Resisted Motion
Cervical Rotation
Myotome Testing C3 Resisted Motion
Cervical Side Bending
Myotome Testing C4 Resisted Motion
Shoulder Elevation (Shrug)
Myotome Testing C5 Resisted Motion
Shoulder Abduction
Myotome Testing C6 Resisted Motion
Elbow Flexion
Myotome Testing C7 Resisted Motion
Elbow Extension
Myotome Testing C8 Resisted Motion
Thumb Extension
Myotome Testing T1 Resisted Motion
Hand Intrinsics (Spread fingers)
Myotome Testing L1,L2 Resisted Motion
Hip Flexion (in high sitting)
Myotome Testing L3 Resisted Motion
Knee Extension
Myotome Testing L4 Resisted Motion
Foot Dorsiflexion and inversion
Myotome Testing L5 Resisted Motion
Hallux Extension
Myotome Testing S1,S2 Resisted Motion
Plantarflexion in standing (Toe Raises)
Myotome Testing S1 Resisted Motion
Knee Flexion
Myotome Testing S2 Resisted Motion
Hallux Flexion
What reflexes will be dampened if pressure is on these nerve roots? x5
C5- Biceps
C6- Brachioradialis
C7- Triceps
L3,L4- Patellar Tendon
S1- Achilles Tendon
If pressure of L3, and L4 what happens
Patellar tendon reflex dampened
-Quads contract, hamstring inhibited
If pressure of C5 what happens
Biceps reflexes dampened
If pressure of C6 what happens?
Brachioradialis reflex dampened
If pressure of C7 what happens?
Triceps reflex dampened
If pressure of S1 what happens?
Achilles tendon reflect dampened
Muscle strains of neck and back MOI? x3
Overstretch or eccentric load
Rotation at high velocity
May have an external force
(Tennis, Golf, Baseball)
S&S Muscle strains of Neck and Back x4
Abrupt pull
Pain
Protective Spasm
Divot (large strains)
T or F even small strain can become limiting d/t stability role for muscle strains of neck and back
T
Acute Management of Muscle Strains of Neck and Back? x2
PIER but never to ant. neck d/t major vessels
Altered Activity
Rib and Scapula Fractures MOI? x2
Direct blow
Compression (ribs)
Rib fracture S&S x3
Pain with deep breath (shallow breathing)
Pain with Compression
TOP area of fracture
S&S Scapular Fracture x2
TOP
Pain with movement of shoulder
Acute management of rib and scapula fracture? x3
Stabilize the segments with padding and tensor (if tolerated)
Tube sling for scap fracture
Send for imaging
What are the 4 spondy’s of spine?
1)Pars Interarticularis
2)Spondylolysis
3)Spondylosisthesis
4)Spondylitis
What is spondyloysis?
Stress fracture in the Pars Interarticularis
What is spondyloslisthesis?
Stress fracture and sliding of vertebra
What is spondylitis?
Inflammation of the vertebra that could lead to fusion
What classification is used for scap fractures?
Ideberg Classification
1A,1b, 2, 3, 4, 5A, 5B, 5C, 6
MOI of a spinal fracture? x2
Axial Load
Compression through spine
S&S spinal fractures x5
Central Pain
Tingling
Numbness
Unwillingness to move
Spasm
What can occur with spinal fractures if displacement of segment put pressure on spinal cord or nerve roots?
Paralysis
C-Spine Paralysis
Quadrapaligia
T-Spine, L-Spine Paralysis
Quadripelgia
Acute Management of spine fracture x2?
Stabilize
Call 911
What is the special test used for spondylolysis or spindylothesis?
Stork Stance
Positive Test Stork Stance?
Pain localized to the affected segment
(+ test with with history of repeat backbending)
What is a hip pointer injury?
Contusion of iliac crest (periosteum has lots of sensory nerves)
MOI Hip Pointer
Blunt trauma to iliac crest
S&S Hip Pointer x3
Pain (often severe) with trunk flexion, rotation, side bending or hip flexion
Bruising and swelling over iliac crest
Muscle spasm of Surrounding muscle
Other structures that may be affected by hip pointer other than iliac crest? x2
External Obliques
Tensor Fascia Latae (TFL)
External Obliques and Hip Pointer S&S x2
Athletes often report pain with forced exhalation
Pain with bowel movements
Acute Management of Hip Pointer x2
PIER (with pressure pad if tolerated, sometimes can’t tolerate NOT having one)
Lymph Drainage to settle spasm
RTP for Hip Pointer
Donut pad with cover for RTP
Hip flexor wrap if hip flexion affected
MOI Acetabular Labral Tears x2
Acute plant and twist or hyperabduction (splits)
Overuse degeneration
S&S of Acetabular Labral Tears x4
Pain
Clicking/Catching in hip or groin
Decreased hip ROM
Audible pop/sensation at time of injury
A common description of pain for Acetabular Labral Tears?
C-Sign
Special Test for Acetabular Labral Tears?
Scouring Test
Acute management of Acetabular Labral Tears? x3
Ice
Rest
Pain Management
Other management of Acetabular Labral Tears? x3
correct mechanics (stable base –> Core and hip stability)
Proprioception
Surgery if conservative treatment to reduce pain and increase mobility isnt effective
Why is the scouring test useful? x2
Highly sensitive
Good indicator of pathology in the joint iteself
Why may the scouring test be bad?
Lacks Specificity
What does the scouring test use for? x7
1)Hip Labrum Tears
2)Capsulitis
3)Osteochondral defects
4)Acetabular defects
5)Osteoarthritis
6)Avascular Necrosis
7)Femoral Acetabular impingement syndrome
What is Femoral Acetabular impingement syndrome?
Irregular shape of one or both joint surfaces leading to labrum/cartilage tears
What is Avascular Necrosis?
Bone death from decreased blood supply
What is Osteochondral defects?
Bone and Cartilage
What is Capsulitis?
Inflamm of capsule leading to scar tissue
MOI ITB Friction Syndome
ITB friction over lat femoral condyle 2 degrees to biomech causes overuse condition from friction over lateral femoral condyle
ITB Friction Syndrome common in what sports?
Common in sports with continuous knee flex and ext like running or cycling
Common factors of ITB friction syndrome? x3
Glute med weakness
Camber of the road
Winter boots/walking in snow
What to assess for ITB friction syndrome?
Biomech assessment (check type of footwear and wear patterns)
What test for ITB Friction Syndrome
Thomas Test
Hip Flexor Tendonitis MOI x2
Overuse
Repetitive Flexion
Cyclists, Runner, Dancers, Gymnasts
S&S Hip Flexor Tendonitis x3
1)Pain with active and resisted hip flexion
2)Stretch Pain with passive hip extension
3)TOP affected Tendon
Hip Flexor Tendonitis acute management? x3
ICe
Rest/Altered Activity
Hip Flexor Wrap
Hip Flexor Strain MOI x2
Forceful hip flexion
Leg caught in hip extension
Quad Strain MOI x2
Forceful quad contraction
Hip Extension with knee flexion
Hamstring strain MOI?
Excessive Hip Flexion with extended knee
In Sprinting - Eccentric hams contraction in late stance phase
Adductors strain MOI x2
Quick Cutting (overstretched with forceful contraction)
Split type motion (Contact, slippery surface)
S&S strains of hip and thigh x3
Pull or Pop sensation
Weakness (Gr 2&3)
Bruising due to high blood supply (Gr 2&3)
Acute Management of strains of the hip and thigh x3
PIER (pressure pad with wrap over affected tissues)
NWB (crutches) if unable to walk normally
Educate
Effleurage/lymph drainage
RTP for strains of hip and thigh?
Hip flexor wrap or adductor wrap for daily use as needed and RTP
Why is education important for strains of hip and thigh?
Easily re-injured
(need to clearly communicate sequential steps to recovery)
MOI Thigh Contusions?
Blunt Trauma
S&S Thigh Contusions
Discolouration
Muscle weakness possible
Thigh Contusions at risk for
Myositis Ossificans
Treatment for Thigh Contusions
Need to care to prevent secondary complications
Effleurage or lymph drainage
Ice
No Deep tissue Massage
Protective padding - Donut pad with cover pad
RTP for Thigh Contusions? x4
Ensure 80% strength
FROM
Able to do demands of sports without compensation
-Risk of more severe injury, knee ligs depend of dynamic protections
MOI Injuries to ant. neck
Blunt force to ant, neck/throat by stick, puck, ball, opponent
S&S ant. neck injuries?
Pressure, difficulty swallowing “feels thick”, difficulty breathing, panicky
What fracture is common in a injury to ant. neck?
Larynx Fracture
Major Bleeds to Neck MOI x3
Skate, Stick, Contact with Boards
-Laceration of Carotid Artery
-Jugular Vein
-Subclavian Vein
Acute Management of Major Bleeds to Neck?x3
1)Pressure
2)Rapid Call to EMS
3)Treat for shock
As a AT what do you need to do to check for neck injuries?
Find out policies for neck guards for leagues you’re working with
What are the 6 facial injuries?
1)Eye-pole injuries
2)Fractures
3)Auricular Hematomas
4)Lacerations
5)TMJ conditions
6)Dental Injuries
Eye-Poke Injuries often result in x2?
1)Subconjunctival Hemorrhage
2)Corneal Abrasion
What is a Subconjunctival Hemorrhage?
Bright red bleeding/spot on white of eye from broken blood vessel
What is a corneal abrasion?
Scratch on surface of eye
S&S Eye-Poke Injuries
Mild Discomfort
Irritation
Acute Management of Eye-Poke Injuries?
Cold Compress
Eye Exam Refer
What are the symptoms of eye exam referral for eye-poke injuries? x5
Visions Changes
Shadows
Floaters
Pressure
Pain
Visions Changes, Shadows, Floaters, Pressure, Pain may be due to which eye inuries? x2
Retinal Tears/Detachment
Deeper damage to eye and vessels
Facial Fracture MOI?
Direct trauma via opponent, puck, ball
What are the common face fractures? x3
1)Unilateral zygomatic-maxillary-orbital
2)Isolated Mandibular
3)Nasal
S&S Facial Fractures? x5
TOP Fracture Site
Raccoon Eyes
Swelling
Divots
Deformities
Acute Management of Facial Fractures x2
PIER if tolerated
Refer
Auricular Hematoma MOI
Blunt Trauma, Repetitive Friction resulting contusion to ear
S&S Auricular Hematoma
Pain
Swelling
Bruising
Pressue
Why is there increased pressure for a Auricular Hematoma?
Blood accumulates btwn connective tissue and cartilage of ear
Is necrosis a possible result of an Auricular Hematoma?
Yes, necrosis of the cartilage is possible due to bl supply being cut off
What is cauliflower ear?
If auricular hematoma is not drained, cartilage can become deformed
Acute management Auricular Hematoma? x2
PIER
Add pressure by: packing ear with folded gauze to prevent fluid accumulation, magnets
Facial Lacerations MOI?
Blunt Trauma
Sharp Object
T or F Lacerations to Face have lots of bleeding and tend to “open up”
T
Acute Care of Facial Lacerations x2?
Pressure
Steri-Strips
(Refer for stitches)
TMJ Injury MOI
Direct trauma to mandible
Cumulative Repeat Impacts
TMJ Conditions/Injuries x6
1)Dislocations
2)Sprains
3)Articular Disc Injuries
4)Clicking/altered joint mechanics
5)Headaches
6)Muscle Tension/Strains
Dental Injuries MOI
Direct Blow
4 Common Dental Injuries
1) Tooth (crown) Fractures
2)Tooth Intrusion (Tooth into bone)
3)Tooth Extrusion (Tooth out of bone)
4)Tooth Avulsion (Removal of tooth from socket)
Acute Management of Dental Injuries? x7
1)Ensure broken teeth removed from mouth
2)Rule out concussion
3)C-Spine
4)Refer to Dentists
5)ER
6)Gauze to control Bleeding
7)Numbing agent
Prevention of Dental Injuries
Mouthguards
What type of joint is a TMJ
Hinge Joint
What are 3 causes of headaches?
1)Dehydration (90%)
2)Cervicogenic
3)Concussion
What are cervicogenic causes of headaches?
1)Muscle Tension: Referred Pain Patterns
2)Joint Dysfunction
MOI Concussions/mTBI
Direct blow or indirect (land on bum, whiplash)
What type of injury are concussions?
Functional Injury
What is the result of a concussion?
A transient change in neurological function
-Stretch and Shearing of Axons
-Stretch, ion exchange, depolarization of action potentials (results in electrical storm)
Concussions signs x4
1)Vomiting
2)Disorientation/confusion
3)Memory Loss
4)Loss of consciousness
Symptoms of concussions x8
1)Headache, pressure, migraines
2)Cognitive Changes
3) Vestibular system changes
4)Nausea
5)Fatigue
6)Fogginess, detached from self
7)Mood Changes
8)C-Spine injuries
T or F C-spine injuries are often missed in concussions?
True, need to be ruled out
Cognitive Changes of concussions x2
Decreased focus and though processing
Difficulty following instructions or directions
Vestibular changes due to concussions? x3
-Dizziness
-Motion Sensitivity
-Decreased balance and Coordination
What causes nausea in concussions? x2
Vestibular Dysfunction
Migraines
What are the 3 things included in assessing concussion
1)Interviews
2)Physical Injuries
3)Testing
What are the 2 common concussion testing tools?
1)SCAT-6
2)ImPACT Testing (Immediate Post-concussion Assessment and Cognitive Testing)
What age is the standard SCAT-6 Done?
13
What are the 5 components of the immediate assessment/neuro scan (on-field or 1st identifed) of SCAT-6?
1)Observable Signs
2)Glasgow Coma Scale (LOC)
3)Cervical Spine Assessment
4)Coordination and Ocular/Motor Screen
5)Memory Assessment Maddocks Questions (Cognitive)
6 Components of SCAT-6 off-field assessment?
1)Athlete Background (Head History)
2)Symptom evaluation
3)Cognitive Screening (orientation, immediate memory, concentration)
4)Coordination and Balance Examination
5)Delayed Recall
6)Decision
T or F timeframes vary as to what is considered post-concussion syndrome?
T
3 month
4 weeks
7-10 days
Complete concussions approach suggests how many days for post-concussion syndrome for proactive treatment?
7-10 days
T or F complete rest with no stimulation is no longer the recommendation for concussion rehabilitaions
t
What are the best ways to rehabilitate concussions? x2
1)Find the system that is exacerbating symptoms
2)Focuses of establishing functional neural pathways in the brain to support complete recovery
What is chronic traumatic encephalopathy (CTE)?
Progressive degenerative brain disorder caused by repeat head injury
S&S CTE? x8
1)Memory Loss
2)Confusion
3)Headaches
4)Irritable Mood
5)Aggression
6)Depression
7)Slurred Speech
8)Unsteady/altered motor control
What are the 4 things for concussion injury prevention?
1)Mouthguards
2)Proper fitting helmet
3)Safe Techniques
4)Concussion Education
What 4 things are important with concussion education?
1)Early ID
2)No RTP with even 1 symptom
3)Safe and Progressive RTP
4)Most at risk of injury immediately post-concussion
when are people with concussions most at risk?
Most at risk of injury immediately post-concussion
What is a Dislocation of GH joint?
Head of humerus translates completely out of glenoid
What is a Subluxation of GH joint?
A partial or incomplete dislocation of the GH joint
What is the most common shoulder dislocation?
Anterior
What is the most rare shoulder dislocation?
Inferior
What are the 3 types of shoulder dislocation?
Anterior
Posterior
Inferior
What is the special test for anterior GH dislocation?
Apprehension Test
What does SLAP lesion/tears mean?
Superior
Labrum
Anterior
Posterior
How many types of SLAP lesions/tears?
4 types
1,2,3,4
What are SLAP lesions and Tears?
Injury to the superior aspect of labrum from ant to post
-Biceps tendon can also be injured
SLAP Lesions MOI x4
-Repetitive overhead movements
-FOOSH (Fall On Out Stretched Hand
-Sudden Traction to the arm
-Dislocation of GH
S&S SLAP Lesions? x5
-Clicking/Catching/Popping
-Pain moving arm overhead
-Pain lifting heavy objects
-Pain Deep in Joint or in Back of Joint
-Anterior Should Pain if biceps involved
What is a Bankart lesion?
A injury to the anterior-inferior glenoid labrum
What injury is secondary to anterior dislocation?
Bankart lesion
S&S Bankart Lesion? x3
1)Pain and Limited ROM with most shoulder movements
2)Clicking, Catching, Grinding,
3)Subluxation
What is a Hill-Sachs Lesion? x2
A divot-type fracture of the head of humerus following a dislocation
Head pf humerus gets compressed against the rim of the glenoid
What are the 3 rotator cuff injuries?
1)Impingement
2)Tendonitis/osis
3)Rotator Cuff Tears
T or F Rotator cuff injuries only occur independently?
F, One can lead to the next, or they can happen independently.
Impingement Rotator Cuff Injury MOI?
Overuse, Poor Mechanics
Tendonitis/osis rotator cuff injury MOI?
Overuse, Poor Mechanics
Rotator Cuff Tears MOI?
Acute or Overuse
MOI Acromioclavicular (AC) sprains? x3
1)FOOSH (Fall on outstretched hand)
2)Fall/Tackle: Landing of side of shoulder
3)Checked into boards
S&S Acromioclavicular (AC) sprains? x4
1)Pain
2)Step Deformity at AC
3)Weakness in shoulder/arm
4)Athlete often supporting arm against body
Acute Management of Acromioclavicular (AC) sprains? x4
PIER
Sling
Swath
Severe Deformities need to be referred
How to treat Acromioclavicular (AC) sprains?
AC tape job to support healing and decrease pain
What is the Rockwood Classification of AC injuries?
Indicates which ligaments affected (AC and CC) and clavicle displacement position
6 types
Type 1 Rockwood Classification Pathology?
Pathology: Sprained AC Ligaments and Normal CC ligaments
Type 1 Rockwood Classification Examination?
Pain and Swelling of the AC joint without visible deformity
Type 2 Rockwood Classification Pathology?
Disruption of the AC ligaments
Sprained CC Ligaments
Type 2 Rockwood Classification Examination?
Distal Clavicle is unstable to horizontal stress
Pain over the CC interspace
Type 3 Rockwood Classification Pathology?
Disruption of the AC and CC ligaments
Type 3 Rockwood Classification Examination?
Distal Clavicle is unstable to horizontal and verticle stress; reducible
Type 4 Rockwood Classification Pathology?
Posterior displacement into or through the trapezius muscle
Type 4 Rockwood Classification examination?
Not Reducible
Type 5 Rockwood Classification pathology?
Rupture of the deltiotrapezial fascia
Type 5 Rockwood Classification examination?
Clavicale palpable subcutaneously
Not Reducible
Type 6 Rockwood Classification Pathology?
Inferior displacement of the distal clavicle under the conjoined tendon
Type 6 Rockwood Classification examination?
Associated with rib fractures and neurovascular injury
MOI Ant. Shoulder Dislocation x3
90 degrees abduction
90 degrees elbow flexion
External Rotation
S&S Shoulder Dislocation x4
Shock
Pop
Uneven Shoulder/deformities
Unwilling to move/pain
Acute Care Shoulder Dislocation x6
Sling (if Ant. or position works otherwise stabilize in position)
Treat Shock
Swath
Brachial Plexus
Call EMS
PIER
Do we reduce joints?
No, even though may help
Treatment of Ant. Shoulder Dislocation?
Improve ROM
Strengthen
Slings
Surgical
Accessory movements (roll, spin and glide)
Decrease Inflammation
Decrease secondary complications
Sports specific rehab
INCREASED PROPRIOCEPTION
Stability
MOI Post. Shoulder Dislocations?
FOOSH
T or F Slings can be used for all shoulder disolcations?
No, depends on the natural position it occurs in, may have to stabilize how you find the,
MOI inferior shoulder dislocation?
Abduction or Flexion
Treatment of Acute Shoulder injuries? x3
1)PIER sling for support
2)Once diagnosed, AC tape job to help approximate joint/any remaining ligaments to support healing
3)Rehab to promote tissue healing and regain mobility and stability
What is the AC tape job used for?
AC tape job to help approximate joint/any remaining ligaments to support healing
What does AC stand for?
Acromioclavicular
What does CC stand for?
Coracoclavicualr
When is surgery considered for Acute Shoulder injuries?
1)Middle Third Clavicle Fractures
2)Type 3 AC Sprains in Active People
3)Type 4, 5 and 6 AC Sprains
4) First-time GH dislocation in young athletes
5)Full-thickness rotator cuff tears
6)Displaced or unstable proximal humerus fractures
7)Urgent surgical referral for posterior sternoclavicular dislocations
Why is a posterior SC dislocation a concern?
Many structures that could be effected
-Stabilize right away and send
What is the common name for subacromial impingement syndrome?
Shoulder Impingement
Shoulder Impingement MOI x2
Overuse
Biomechanics Imbalances
What occurs in a Shoulder Impingement?
Pinching and subsequent inflammation of structures under the coracoacromial ligament
What may be affected by a Shoulder Impingement? x3
1)Supraspinatus Tendon
2)Long head of biceps tendon
3)Subacromial Bursa
S&S Shoulder Impingement? x4
1)Pain and Weakness in the painful arc of abduction (Reaching, especially with weight away from body)
2)Catching/Clicking
3)Pain with sleeping of affected side
4)Pain putting jackets and sweaters on
Referred Pain pattern for Shoulder Impingement?
Reported in supraspinatus pattern down middle deltoid
Special Test Shoulder Impingement?
Painful Arc
Positive Test: Pain during GH abduction btwn 60-120 (pain clears beyond 120)
Referred Pain Patterns infraspinatus and supraspinatus?
Lateral Arm Pain
WHo is most at risk for Shoulder Impingement? x2
Swimmers
Overhead athletes (tennis, pitchers, quaterbacks)
Humerus Fractures MOI?
High-energy direct blow
S&S Humerus Fractures?
Pain, Swelling, Bruising
Unable to move arm of grinding when they do
Where is the most common fracture site on the humerus?
Surgical Neck
What approx amount of humerus fractures are non-displaced?
80% (Non-surgical)
Acute Management of Humerus Fractures? x5
PIER
Sling
Treat for Shock
Send to emerge if Stable
Call EMS
Management of Humerus Fractures? x3
Sling
Pain Management
Start Treatment Early to avoid frozen shoudler
Scapula Fractures MOI? x2
High energy blunt trauma
Fall from height
S&S Scapula Fractures?
Extreme Pain with Arm Movements
Localized Swelling
Brusing/trauma to the area
Management of Scapula Fractures?
Sling
T or F Scapula Fractures are most likely surgical?
F non surgical
Surgery indications for Scapula Fractures x3?
1)Displaced fractures of the glenoid
2)Displaced fracture at neck of scapula
3)Acromion Fractures causes impingement
MOI Clavicle Fracture x3
Force to Lateral Shoulder
FOOSH (less common)
Direct Trauma
S&S Clavicle Fracture? x3
Severe pain and swelling over site
Deformity
Unwillingness to move arm
Acute Management of Clavicle Fracture?
Tube Sling (avoid pressure to clavicle)
PIER
Treatment of Clavicle Fracture x4?
1)PIER
2)Sling or figure 8 brace (uncomfy)
3)Pain Management
4)Alleviate Assoc. Spasm
What anatomy that needs to be considered for shoulder girdle?
3 Joints
Muscles spanning multiple joints
Important considerations for treating the shoulder girdle? x4
1)Thoracic Spine Mobility
2)Scapular Mobility
3)Scapular Stability
4)Upper limb proprioception
What are the 4 parts of the rotator cuff?
1)Supraspinatus
2)Infraspinatus
3)Teres Minor
4)Subscapularis
Why is the rotator cuff important to the shoulder?
The major dynamic stabilizer of the shoulder
ROM of GH Joint x9
Abduction
Adduction
Flexion
Extension
Internal Rotation (0 and 90 abd)
External Rotation (0 and 90 abd)
Horizontal Adduction (cross-flexion)
Horizontal Abduction (Cross-extenstion)
Accessory Movement
What are the 3 Joints of the Elbow
1)Ulnohumeral Joint
2)Radiohumeral Joint
3)Proximal Radioulnar Joint
What position should be notes in the olecranon fossa of humerus?
Olecranon (ulna)
What is the TFCC (Triangular Fibrocartilage Complex) a major stabilizer of x2:
Ulnocarpal Joint
Distal Radioulnar Joint
Where should the ulnar nerve be noted?
Elbow and Wrist
Where should the median nerve be noted?
Median nerve under flexor retinaculum
What should be noted by elbow flexors?
LH of biceps brachii also does shoulder flexion
ROM of Elbow x4
Flexion
Extension
Pronation
Supination
ROM of Wrist x4
Flexion
Extension
Radial Deviation
Ulnar Deviation
Digits ROM x5
Flexion
Extension
Abduction
Adduction
1-5 Opposition/Reposition
AKA Lateral Epicondylitis?
Tennis Elbow
MOI Lateral Epicondylitis/Tennis Elbow
Overuse of forearm extensors
T or F accesory movements are required for full ROM?
True
What are the most common extensors affected in Lateral Epicondylitis/Tennis Elbow? x2
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
S&S Lateral Epicondylitis/Tennis Elbow? x2
1)TOP common extensor origin (Lateral epicondyle)
2)Pain and Weakness with wrist extension
Acute Management of Lateral Epicondylitis/Tennis Elbow?
Stretch Wrist Extensors in elbow flexion and extension
PIER
Tennis Elbow Brace if Itis
Altered Activity
T or F R in PIER can mean altered activity?
True
Medial Epicondylitis AKA
Golfers Elbow
MOI Medial Epicondylitis/Golfers Elbow
Overuse of wrist flexors
Most common flexors affected in Medial Epicondylitis/Golfers Elbow x2
Flexor Carpi Radialis (FCR)
Pronator Teres (PT)
S&S Medial Epicondylitis/Golfers Elbow
TOP common flexor origin (medial epicondyle)
Pain and Weakness with wrist flexion
Acute Care of Medial Epicondylitis/Golfers Elbow
Stretch Forearm Flexors
PIER
MOI Ruptured Biceps?
Sudden lengthening of contracting muscle (eccentric)
(Sudden load when lifting or catching heavy load)
Which is the most common ruptured biceps tendon?
Distal Biceps Tendon
S&S Ruptured Biceps x4
1)Popeye Muscles/Muscles balled up.
2) Bruising
3)Pain Near insertion of biceps into radial tuberosity
4)Pain and Weakness with elbow flexion and supination
T or F complete ruptured biceps might be painless?
T
Acute Management of Ruptured Biceps? x4
PIER
Pressure pad to approximate any remaining fibres
Shorten biceps in sling to remove tension
Surgical Repair
MOI DeQuervain’s Syndrome Tenosynovitis x2
Overuse of thumb due to gripping/wringing
Inflammation of tendons and sheath around thumb
S&S DeQuervain’s Syndrome Tenosynovitis
Pain over Tendons of Thumb
Weakness with Thumb abduction or extension
Pain with Gripping
DeQuervain’s Syndrome Tenosynovitis common in what sport?
Golf
Special Test for DeQuervain’s Syndrome Tenosynovitis?
Finkelstein Test
Acute Management of DeQuervain’s Syndrome Tenosynovitis
PIER
Thum spica brace
What occurs if DeQuervain’s Syndrome Tenosynovitis is left untreated?
Can progress to thickening/scarring and reduced ROM
MOI Elbow Hyperextension Injuries
FOOSH via landing on extended elbow sometimes with added external force
S&S Elbow Hyperextension Injuries?
Anterior elbow pain and swelling from ligament/capsule sprain and/or muscle strain
Posterior Elbow pain from osteochondral lesion (olecranon in olecranon fossa of ulnohumeral joint)
What fracture must be ruled out with Elbow Hyperextension Injuries?
Olecranon Fracture (may see a deformity)
Acute Management of Elbow Hyperextension Injuries?
PIER
Shorten Injured Tissues (elbow flexion) = Sling
Tape Job for Elbow Hyperextension
MOI Ulna Collateral Ligament Sprains of Elbow
FOOSH
Overuse by repeat valgus force on the elbow
S&S Ulna Collateral Ligament Sprains of Elbow
-Pain and Laxity (instability) in medial elbow joint
-Ulnar Nerve Symptoms
What is Tommy John Surgery and what is it used for?
-Ulna Collateral Ligament Sprains of Elbow
Reconstructs UCL using a graft tendon-palmaris longus, semitendinosus or gracilis
MOI Collateral Ligament Sprains of the Wrist?
FOOSH, forced forearm rotation
UCL: Valgus Force
RCL: Varus Force
MOI ligament sprain of UCL
Valgus Force
MOI ligament sprain of RCL
Varus Force
S&S Collateral Ligament Sprains of Wrist?
Pain
Swelling and Instability of Medial (UCL) or Lateral Aspect (RCL) of Wirst
Special Test of UCL Sprain?
Valgus Stress Test (MCL)
Special Test for RCL Sprain?
Varus Stress Test (LCL)
Acute Management for Collateral Ligament Sprains of Wrist?
PIER –> Wrist Wrap
Wrist Tape Job for RTP
UCL Sprain of the thumb aka
Skier’s Thumb
Gamekeepers thumb
MOI of UCL Sprain of the thumb
Traumatic or overuse hyperabduction of thumb
MOI Skiers Thumb (traumatic)
Thumb Gets Caught
FOOSH
Catching Ball
MOI Gamekeepers Thumb (overuse)
Repeat gripping/twist
Possible fracture of UCL Sprain of the thumb
Avulsion Fracture
S&S UCL Sprain of the thumb?
Pain
Swelling and Instability at 1st MCP joint
t or F surgery recommended for the UCL sprain of the thumb?
T Surgery is recommended for instability to stabilize joint and prevents osteoarthritis longer term
Why may be there a increase of injury of Ulnar Collateral Ligament Sprain of the Elbow?
higher velocities for pitching, lots of force going through arm
Acute Management of UCL Sprain of the thumb?
PIER
Possible X-Ray to rule out avulsion
Brace
Thumb tape job/Brace for RTP
MOI TFCC Tear Acute?
FOOSH, Forced Forearm Rotation
MOI TFCC Tear overuse?
Repetitive Wrist Motions (Wrench, hammer, lifting)
S&S TFCC Tear?
Medial Wrist Pain
Pain with Ulnar Deviation and Loading through the wrist
Popping/Clicking
Wrist Weakness
Special Test TFCC Tear
TFCC compression test (passive Ulnar deviation with axial compression- loads through the disc)
Acute Management of TFCC Tear?
PIER
Brace As Heals
Ant-inflam injections if needed, surgery for persistent instability
MOI Elbow Dislocation?
FOOSH
S&S Elbow Dislocation? x5
Deformity
Pain
Holding Elbow
Tingling.Numbness
Shock
Acute Care of Elbow Dislocation? x5
Stabilize
Splint
Monitor/Treat for Shock
ER/EMS
Reduction over sedation
MOI Elbow Fractures?
Direct Trauma/Fall
S&S of Elbow Fractures?
Pain
Unable or Unwilling to move Elbow
Acute Care Elbow Fracture? x4
Splint
Monitor for Shock
ER for x/rays/surgical referral
ORIF
What is ORIF?
Open Reduction Internal Fixation
MOI Colles Fracture/Distal Radius Fracture?
FOOSH
Distal radius gets displaced posteriorly
S&S Colles Fracture/Distal Radius Fracture x3
Dinner fork deformity
Pain
Numbness
T or F, you test for Colles Fracture/Distal Radius Fracture?
False, Deformity is obvious so no need for testing
Acute Management of Colles Fracture/Distal Radius Fracture x4
Splint
Monitor for shock
Emerge for X-Rays
Surgery if unable to align
MOI Scaphoid Fractures
FOOSH
S&S Scaphoid Fractures?
TOP of anatomical snuff box
Why does the scaphoid have lower ability to heal?
Poor Blood Supply
What injury is important to identify early and immobilize via cast or brace?
Scaphoid Fractures
MOI of Metacarpal and Finger Fractures x3
Axial Compression (Jammed) Finger
Direct Trauma
Being Stepped on
S&S Metacarpal and Finger Fractures x3
Localized Pain
Swelling
Unable to Grip
Acute Care Metacarpal and Finger Fractures x2
FINGERS: Buddy Tape to Stabilize
Hand MC - SAM Spint
How does Metacarpal and Finger Fractures result in avulsion fractures and how to treat?
Tendon pulls off piece of bone
Immobilization or surgical repair
MOI of Cyclist Palsy
Compression from Handlebars
S&S of Cyclist Palsy x3
Tingling/Numbness/Nerve Pain
Decreased Muscle strength of 5th digit
Hand Cramping
Prevention of of Cyclist Palsy?
Avoid hyper extension of wrist on handlebars
Proper bike fit
Acute Care of Cyclist Palsy? x3
PIER
Splints
May require NSAIDs
MOI of Carpal Tunnel Syndrome
Overuse of wrist flexor tendons causing pressure on median nerve with carpal tunnel
S&S of Carpal Tunnel Syndrome? x2
Burning/Tingling/Numbness in Anterior Wrist and Hand
(Along median nerve distribution -digits 1-4 and 1/2 of 4)
Decreased grip strength
Acute care of Carpal Tunnel Syndrome x6
Bracing
PIER
Anti-inflame Treatment
Proper Ergonomic set up (prevention tool)
Steroid Injection
Surgery to pen up tunnel of conservative treatment is unsuccessful;
What is the growth plate?
Area of new bone growth in kids and teens
-At the end of long bones
-Cartilaginous tissue
Growth Plate Ages Men
16-17
Growth Plate Ages Women
14-15
What are the 7 Pediatric medical conditions?
-Juvenile Diabetes
-Juvenile Arthritis
-Asthma
-Epilsepsy
-Allergies
-Water Safety/CPR
-Choking
4 Pediatric Sized ER supplies?
-OPA
-Neck Collar
-Splints
-EPiPenr
Pediatric Tools
Child SCAT 6
Injury Prevention in Youth Sports x13
-Proper Warm Up
-Proper Fitted Equipment
-Diversifying Activity
-Playing time limits
-Max games per day
-Minimum hrs between games
-Rotating Positions
-Proper Nutrition and hydration
-Avoid Overtraining
-Baseline concussion testing
-Psychological Wellness
-Re-season screenings
-Pitch count limits
Pre-Season Screenings for youth x5
-Identify current pain/injuries
-Review medical conditions
-Assess functional movement patterns
-Concussion baseline testing
-Discuss Important Topics
Important topics to discuss for youth pre-season screenings?
- Nutrition
- Concussions
- Hydration
- Overtraining
- Communicating injuries early
-Emphasis on RTP sooner if caught early
Psychological Wellness Youth Sports x7
-Support Following Injury
-Healthy competition
-Healthy Eating Habits
-Inclusivity
-Motivational talks
-Encouraging cheers
-Promoting Teamwork
(Sport is about so much more than sport-skills)
Growth plate injuries/fractures MOI?
Excessive repeat stress on growth plate on the bone causes a widening of the growth plate.
-Growth plate becomes inflamed
If Growth plate is not addressed, can affect growth how x2?
Deformities
Bone Stops growing prematurely
MOI Little League Shoulder: Proximal Humeral Epiphysitis
Irritation of the growth plate in the proximal humerus
Overuse in overhand motions causing excessive strain on growth plate
Treatment of Growth Plate Injuries/Fractures x2
1)Altered Activity
2)May require 2-3 months of rest from aggravating sport skills
S&S Little League Shoulder: Proximal Humeral Epiphysitis
Progressive increase in pain in the proximal humerus or shoulder
-May lead to stress fracture through growth plate
MOI Patellar Tendonitis AKA Jumper’s Knee
Excessive Traction on Patellar Tendon
-Often associated with growth spurts
Prevention of Little League Shoulder: Proximal Humeral Epiphysitis x3
Limited Pitch Counts
Proper Throwing Mechanics
Train the Kinetic Link
S&S Patellar Tendonitis AKA Jumper’s Knee
Pain
Swelling and Heat over Tendon
Pain with jumping, running, quick change in direction or strong quad contraction
Pain with flex and extension
T or F kids with Patellar Tendonitis AKA Jumper’s Knee can train through pain
T
Special tests MOI Patellar Tendonitis AKA Jumper’s Knee x2
Thomas Test
Resisted Quad
Acute Management Patellar Tendonitis AKA Jumper’s Knee x3
PIER
Roll/Soft Mobility for Quads
Lower Extremity Mechanics
What are lower extremity mechanics Patellar Tendonitis AKA Jumper’s Knee *****
To train hamstrings to prevent ant translation of tibia on femur and stability at hip and knee
T or F Tendinopathy Rehab for Patellar Tendonitis AKA Jumper’s Knee
True, eccentrics/, x-training
RTP Patellar Tendonitis AKA Jumper’s Knee
Patellar Tendonitis Tape Job
What is Osgood Shlatter’s Disease?
Irritation of growth plate ate tib tuberosity (attachment of patellar tendon)
MOI Osgood Shlatter’s Disease?
Overuse
Excesse traction of quads via patellar tendon
S&S Osgood Shlatter’s Disease? x4
Pain over tib tub
Eventually, a visible bump over Tib tub
Pain with contraction and stretch of quads
Jumping with Pain
Special Tests Osgood Shlatter’s Disease? x2
Thomas Test
Resisted Quad
Acute Management of Osgood Shlatter’s Disease?x3
PIER
Roll/Soft Tissue mobility for quads
Low extremity mechanics
Low extremity mechanics Osgood Shlatter’s Disease? ***
Train hams to prevent ant translation of tibia on femur and stability at hip and knee
What is Sever’s Disease?
Irritation of the calcaneal tuberosity growth plate (attachment for Achilles tendon)
Prevention of Osgood Schlatters Disease?
Diversify Activity
MOI Sever’s Disease?
Overuse - Excessive Traction of Achillies
S&S Severs Disease? x2
Pain over Achilles insertion into calcaneus
Pain with forceful Achilles contraction (jumping, sprinting, starts/stops(
Special Tests Sever’s Disease?
Single Leg Calf Raise
Acute Care Sever’s Disease? x3
Stretch Gastric and Soleus
NASAIDS
Heel Lift
MOI Little League Elbow
Chronic Valgus overload to medial elbow form throwing
Structures injured Little League Elbow x4
One/Many Medial Structures
-Medial Epicondylitis
-Medial Epicondylar Apophysitis (GPI)
-Avulsion fracture
-MCL Sprain
S&S Little League Elbow
-Pain and inflammation over medial elbow
-Pain and Weakness with throwing
-Medial Instability
Special Test Little League Elbow x3
Wrist Flexor Muscle Testing
Valgus Stress
X-Rays
Acute Care Little League Elbow
PIER
Prevention Little League Elbow x2
Limited pitch counts
Proper throwing mechanics
2 Growth Plate Irritation Sites
Distal Radius
Anterior Inferior Illiac Spine
Distal Radius GPI
Gymnastics, Repeat Load
Anterior Inferior Illiac Spine GPI
Rectus Femoris Contract strongly while on stretch
-tumbling sports
Treatment for Growth Plate Fractures x4
Rest
Cast
Splint
Surgery
3 Principles of Spinting
- Include joint above and below the injury
2.Pad the splint for comfort and added support
3.Check distal pulse before and after splinting
3 Progressions of Heat Illness
- heat cramps
- heat exhaustion
- heat stroke
What are heat cramps?
Muscle cramping during/after activity in the heat
Thought to be caused by fluid and salt loss from sweating
Common in distance runners
S&S heat cramps? x2
Pain
Spasm (legs or abs)
Prevention heat cramps?
Sufficient Hydration and Electrolytes
Avoid /Minimize activity in high temp.
Acute Care heat cramps?
Rest in a Cool Area
Water/Sports Drink
Gentle Stretching or Massage
T or F heat cramps should be seen as a warning to avoid more severe illness?
T
What is Heat Exhaustion?
Results from activity in hot temps
Body ability to regulate temp becomes stressed
S&S Heat Exhaustion? x7
Normal or Slightly Elevated Body Temp.
Cool, Moist, Pale Skin
Headache, Nausea, Vomitting, Dizziness
Weakness
Exhaustion
Level of Consciousness starts decline
Acute Care Heat Exhaustion?
Rest in Cool Place
Cold Clotha s in Armpits, Groin, Back of Neck
Drink Cool Water
MOI Heat Stroke
Results from untreated heat exhaustion
Body becomes unable to cool itself
S&S Heat Stroke x5
Dry, red, hot skin
Progressive loss of consciousness
Rapid & weak pulse
Rapid & shallow breathing High body temp
T or F Heat Stroke is Life Threatening
T
Acute Care of Heat Stroke
Cool the body
Give Fluids
Min Shock
Call EMS
Cold Related Emergencies
Frostbite
Hypothermia
What is Frost Bite x3
When body tissues freeze following prolonged exposure to cold
Water within and surrounding cells freeze and swell which damages the cells
Results in Loss of digits or limbs
What is superficial frostbite?
skin only
What is deep frostbite?
Skin and Underlying Tissues Freeze
S&S Frostbite x7
Decreased Sensation
Skin is Cold and Waxy
Discolouration
Tingling
Swelling
Pain with Rewarming
Blisters
Acute Care Frostbite x5
Gentle Rewarming by Soaking in Warm Water
Apply dry sterile dressing
Gauze between finger/toes
Warm Drink
Blanket
When to refer to doctors for frostbite x5
- Signs of Infection
- Red Streaks
3.Blisters
4.Drainage - No Return of Sensation or normal skin tone
Prevention of Frostbite x3
Dressing in layers
Removing Wet Clothing/Gear
Avoid Extended Time during extreme cold weather
What is Hypothermia
A dangerous drop in body temp below 35c following a extended exposure to cold
S&S Hypothermia x8
Shivering (Stops in late stages)
Slow Irregular Pulse
Slow Breathing Rate
Numbness
Confusion
Drowsiness
Pale Cold Skin
Loss of Coordination
Results of Hypothermia x3
Shock
Coma
Cardiac Arrest
Acute Care Hypothermia x6
ABCs
Gradual Rewarming with Dry clothes
Warm EnvironmentC
Blankets
Heating Pads
Warm drinks if alert
