wk 2- multi discinplinary team and reflags

Question 1

red flags

Answer 1

1. 50+ years
2. injury appears disproportionate to mechanism
3. systemic symptoms (fever, chills, sick, weight loss)
4. atypical symptoms
5. medical risk factors (osteoporosis, immune deficiency, diabetes, etc)
6. symptoms worse at night
7. significant morning stiffness
8. complex past medical history
9. family history of inflammatory joint disease (gout, RA, OA, PsA, ankylosing spondylitis, reactive arthritis, scleroderma, lupus)
10. multiple body systems involved (endocrine, derm, neuro, urinary)
11. poor response to conservative treatment

Question 2

red signs of serious pathology examples

Answer 2

1. cauda equina syndrome
2. fracture
3. tumour
4. unremitting night pain
5. sudden weight loss (10 pounds over 3 months)
6. bladder/bowl incontinence
7. history of cancer
8. saddle anaesthesia

Question 3

orange flags examples

Answer 3

personality disorder
clinical depression

(psychiatric behaviours)

Question 4

yellow flags examples

Answer 4

(emotional responses/ pain behaviour/ coping mechanisms/ beliefs)

poor outlook on treatment
distress
avoiding activities out of fear

Question 5

blue flags

Answer 5

(perceptions about work and health)

work will cause further injury
unsupported at workplace

Question 6

black flags

Answer 6

(system obstacles)

legislation restricting return to work
conflict with insurance
heavy work

Question 7

acute injuries of the bone

Answer 7

1. fracture (also in growth plates)
2. periosteal contusion: dense fibrous tissue surrounding bone that is vascular and innervated. Direct blow can lead to subperiosteal haematoma which is painful and palpable lump

Question 8

chronic injuries of bone

Answer 8

1. overuse (stress fracture/reaction)
   2.osteitis/periositis (shin splints)
2. apophysitis
3. enthesopathy
4. osteophyte/bone spur

Question 9

overuse injury of bone

how can u diagnose

symptoms

Answer 9

1. stress reaction
2. stress fracture

fatigue fractures caused by repetitive mechanical loading without sufficient rest (overuse)
imbalance between bone strain (microdamage) and bone repair leading to weakness in the bone

can be diagnosed and graded using MRI

localised pain and tenderness

Question 10

low risk bone stress injuries

Answer 10

• posteriormedial tibia
  -fibula/ lateral mall
• femoral shaft
• pelvis
• calcaneus
• 2-4th mets

Question 11

high risk bone stress injuries

Answer 11

• femoral neck
  -anterior cortex of tibia
• medial mall
• talus (lateral process)
• navicular
• proximal diaphysis of 5th
• base of 2nd
• sesamoids

Question 12

bone stress injury prognosis

Answer 12

dependent on bone size

Low risk BSIs
- mets 4-6weeks
- tibia/calc 6- 8weeks
- femur 10-12 weeks

stress reactions take 1/3 of the recovery time
-2 weeks
-3 weeks
-4 weeks

Question 13

rehab for low risk BSI

Answer 13

rest and cross training to maintain condition, avoid atrophy and accelerate return to sport

Question 14

rehab for high risk BSI

Answer 14

non weight bearing cast immobilisation for 6-8 weeks or surgery

unless
sesamoids (4 weeks)
met 2nd base (2 weeks)
femoral neck (1 week bed rest)

Question 15

acute injuries of jointS

Answer 15

1. Dislocation
2. sublaxation

Question 16

chronic injuries of joints

Answer 16

Hyaline cartilage
1. osteochondral defect
2. chondropathy/chondromalacia
3. OA

fibrocartilage
1. mensical tear
2. labral tear
3. disc herniation

capsule
1. synovitis
2. gout
3. RA etc

1. impingement

Question 17

ligament injuries

Answer 17

1. sprain or tear grade 1-3
2. inflammation

Question 18

muscle injuries

Answer 18

1. strain
2. tear
3. contusion
4. myositis ossificans -bone in muscle
5. acute compartment syndrome - bleeding in fascial compartment - tissue ischaemia- emergency
6. chronic compatment syndrome- raises in pressure- impaired blood supply - pain
7. DOMS

Question 19

classifying muscle injury

Answer 19

grade 0-4

site: myofascial, musculotendinous, intratendinous

Question 20

tendon/fascia injuries

Answer 20

1. tear
2. tendinopathy/fasciopathy

Question 21

bursa injuries

Answer 21

1. bursitis (acute/chronic)

Question 22

neural referred pain injuries

Answer 22

1. radicular pain
   spinal nerve root compression
2. somatic referred pain
   from joints and muscle, pain moves around
3. neuropathic pain
   -nerve injury/entrapment
4. neural mechanosensitivity

Question 23

fat pad injuries

Answer 23

1. acute
   -bruise
   -tear
2. chronic
   -impingement
   -inflammation

Question 24

skin injuries

Answer 24

1. acute
   laceration
   abrasion
   wound
2. chronic
   blistering
   callus
   haemtoma
   infection

Question 25

sensitivity

Answer 25

% of people who test positive within a sample having the disease/condition rule in

Question 26

specificity

Answer 26

% of people who test negative within a sample who don't have the disease/condition rule out

Question 27

when do you refer out for an image

Answer 27

-diagnosis uncertain -extent of injury affects treatment -red flags present -objective documentation required -pre operative planning

Question 28

normal physiological changes that occur with exercise

Answer 28

1. tendons show increase in vascularity on power doppler after exercise 2. bones show transient asymptomatic marrow oedema in response to altered weightbearing 3. muscles demonstrate 10-15% increase in volume, vascularity and diffuse increase in MRI signal after exercise 4. asymptomatic joints and bursa show efusion on MRI and US

Question 29

pods can refer for what imaging

Answer 29

-X RAY of foot, leg, knee and femur -US soft tissue of foot others can be ordered but expensive and not covered by medicare

Question 30

Ottawa ankle rule chart

Answer 30

for suspected fractures bone tenderness at posterior edge or tip of lat mall/medial mall and inability to WB for 4 steps

Question 31

ottawa foot rule chart

Answer 31

bone tenderness at base of 5th, navicular, and inability to WB for 4 steps

Question 32

what is the best imaging modaility for bone

Answer 32

X ray then: MRI CT Bone scan

Question 33

what is the best imaging moaility for myotendinous unit

Answer 33

US then MRI

Question 34

imaging for ligaments

Answer 34

US xray if avulsion fracture suspected

Question 35

imaging for cartilage

Answer 35

US MRI

Question 36

imaging for synovial membrane

Answer 36

US MRI

Question 37

imaging for nerves

Answer 37

CT scan

Question 38

compartment pressure testing what does it involve, how long, what happens if positive

Answer 38

pt needs to exercise until symptoms come on a pressure manometer needle is inserted into the muscle takes approx 1 hour positive test - referral to orthopod for fasciotomy

Question 39

red flags for concussion

Answer 39

-neck pain/tenderness -double vision -weakness/tingling burning in arms or legs -increasing or severe headache -seizure -loss of consciousness -vomiting -agitated

Question 40

is it okay to train with a head cold

Answer 40

yes

Question 41

okay to train with systemtic symptoms like fever, tachycardia, fatigue

Answer 41

no