1
Q
plica
A
- fibrous tissue extending from joint capsule that is supposed to reabsorb during growth and development
- can get in the way of the joint
***mimick meniscus injury
2
Q
structures of hip and pelvis
A
- iliac crest
- ASIS (origin of sartorius)
- AIIS (origin of rectus femoris)
- PSIS
- ischial tuberosity (origin of hammies)
- pubic symphysis
- hip joint and articular cartilage
3
Q
ORIGIN of EO
A
outer surface of ribs 5-12
4
Q
INSERTION of EO
A
- inferiorly onto anterior 1/2 of iliac crest
- medially into linea alba
5
Q
ACTIONS of EO
A
- trunk rotation
- flexion
- side bending
- compresses abdominAl VISCERA
6
Q
hip flexors
A
- psoas
- iliacus
- sartorius
- rectus femoris
- pectineus
- TFL (assists)
7
Q
quadriceps muscle
A
- rectus femoris (origin AIIS)- hip flexion
- vastus lateralis
- vastus intermedius
- vastus medialis
- common insertion via quad tendon into patella
8
Q
medial hamstrings
A
- semimembranosus
- semitendinosus
9
Q
lateral hamstrings
A
biceps femoris
10
Q
adductors
A
- pectineus
- adductor longus
- adductor magnus
- adductor brevis
- gracillis
11
Q
ORIGIN of sartorius
A
ASIS
12
Q
INSERTION of sartorius
A
medial aspect of proximal tibia
13
Q
acetabular labrum
A
- fibrous cartilage
- ribs acetabulum
- deepens socket
- increases stability
- base of labrum heals well (blood supply) but free edge labrum doesn’t heal well (bad supply)
14
Q
hip pointer
A
contusion of iliac crest (periosteum has lots of sensory nerves)
15
Q
MOI of hip pointer
A
blunt trauma to iliac crest
16
Q
S&S of hip pointer
A
- pain (often severe) with trunk flexion
- pain with rotation
- pain with side bending or hip flexion
- bruising and swelling over iliac crest
- muscle spasm of surrounding muscles
17
Q
other structures affected with a hip pointer
A
- external obliques
- TFL
18
Q
pain pattern with hip pointer
A
- pain with forced exhalation
- pain with bowel movements
- pain with all functions of external obliques
19
Q
acute management with a hip pointer
A
- PIER (sometimes cannot tolerate pressure pad)
- lymph drainage to settle spasm
- donut pad with cover for RTP - with hip flexor wrap if hip flexion affected
20
Q
MOI of acetabular labral tears
A
- acute plant and twist
- hyperabduction (splits)
- overuse degeneration
21
Q
S&S of acetabular labral tears
A
- pain
- clicking/catching in hip or groin
- decreased hip ROM
- audible pop/sensation at time of injury
“C” sign is a common descriptor of pain
22
Q
special test for acetabular labral tears
A
scouring test
23
Q
acute management of acetabular labral tears
A
- ice
- rest
- pain management
- correct mechanics (stable base, core and hip stability)
- increase proprioception
- refer - surgery if needed
24
Q
scouring test
A
- highly sensitive, but lacks specificity
- good indicator of pathology in jint itself
25
what does the scouring test test for
1. hip labrum tears
2. capsulitis - inflamm of capsule leading to scar tissue
3. osteochondral defects - bone & cartilage
4. acetabular defects
5. osteoarthritis
6. avascular necrosis - bone death from decreases blood supply
7. femoral acetabular impingement syndrome
26
MOI of ITB friction syndrome
1. ITB friction over lateral femoral condyle 2 degree to biomech causes
2. overuse condition from friction over lateral femoral condyle
3. glut medius weakness
4. winter books/ walking in snow
***common in sports with continuous knee flex and ext like running or cycling
27
acute management of ITB friction syndrome
1. check type of footwear and wear patterns
2. biomech assessment
3. PIER
4. lymph drainage
28
MOI of hip flexor tendonitis
1. overuse
2. repetitive flexion
***common in cyclists, dancers, gymnasts (repetitive motions)
29
S&S of hip flexor tendonitis
1. pain with active & resisted hip flexion
2. stretch pain with passive hip extension
3. TOP affected tendon
30
acute management of hip flexor tendonitis
1. ice
2. rest/altered activity
3. hip flexor wrap
31
MOI of hip flexor strain
1. forceful hip flexion
2. leg caught in hip extension (or combo)
32
MOI of quad strain
1. forceful quad contraction
2. hip extension with knee flexion (or combo)
33
MOI of hamstring strain
1. excessive hip flexion with extended knee in sprinting
2. eccentric hams contraction in late stance phase
34
MOI of adductors strain
1. quick cutting (overstretch with forceful contraction)
2. splits type motion (contact, slippery surface)
35
S&S of hip and thigh strain
1. "pull" or "pop" sensation
2. weakness (Gr 2&3)
3. bruising (Gr 2&3) due to high blood pressure
36
acute management of hip and thigh strain
1. PIER (pressure pad)
2. educate
3. NWB (crutches)
4. hip flexor wrap of adductor wrap for daily wear as needed
5. effleurage/lymph drainage to help with bruising
37
MOI of thigh contusions
blunt trauma
38
S&S of thigh contusions
1. discolouration
2. muscle weakness possible
3. risk of myositis ossificans
39
acute management of thigh contusions
1. care for contusion to prevent secondary complications
2. effleurage/lymph drainage
3. ice
4. no deep tissue massage
5. protective passing - donut pad with cover pad
40
spine features
1. facet (zygapophyseal joints)
2. vertebral body
3. disc/disk
4. nerve roots
5. spinous processes
6. transverse processes
41
right upper quadrant
1. liver
2. gallbladder
3. duodenum
4. head of pancreas
5. right kidney + adrenal gland
6. hepatic flexure of colon
7. part of transverse + ascending colon
42
left upper quadrant
1. stomach
2. spleen
3. left lobe of liver
4. body of pancreas
5. left kidney + adrenal gland
6. splenic flexure of colon
7. parts of transverse + descending colon
43
right lower quadrant
1. caecum
2. appendix
3. right ovary and tube
4. right ureter
44
left upper quadrant
1. part of descending colon
2. sigmoid colon
3. left ovary and tube
4. left ureter
45
palpation of abdomen
1. palpate 4 quadrants
2. start superficial and gradually increase pressure
46
sports hernias (athletic pubalgia)
1. fascial weakness in abdominal wall where the abdominals and adductors attach into pubic bone
2. common in hockey, football, soccer, sprinters/hurdlers, rugby
3. easily re-irritated so sequential RTP
47
MOI of sports hernias
repetitive strain to the area
48
S&S of sports hernias
1. pain with sitting up
2. pain with quick cutting
3. pain with sprinting and coughing
49
special test for sports hernias
resisted sit-up
50
acute management of sports hernias
1. PIER
2. adductor wrap
3. conservative treatment 4-6 wks
51
visceral structures potentially affected in sport
1. kidney contusions
2. spleen rupture = mono
3. lungs = pneumothorax
4. bladder rupture= empty bladder
5. testicles - must stop spasm to control hemorrage
6. heart
52
MOI of abdominal injuries
1. direct blow
2. fall from height
53
S&S of abdominal injuries
1. pain
2. rigidity in abdomen
3. feeling unwell
4. shock
54
signs of internal hemorrhage
1. cullen sign (umbilicus discoloration)
2. grey turner sign (flank discoloration)
55
acute management of abdominal injuries
1. quadrant palpation
2. call 911
3. rest comfortably
4. treat for shock
5. reassure
56
MOI of kidney injuries
blow to the back
57
S&S of kidney injuries
1. pain in lower back
2. peeing blood
3. feeling unwell
4. shock
58
treatment to kidney injuries
refer
59
causes of sudden death in athletes
usually due to cardiac disease
1. congenital abnormalities of coronary arteries
2. hypertrophic cardiomyopathy
60
hypertrophic cardiomyopathy
genetic condition causing thickening of heart muscle
61
warning signs of hypertrophic cardiomyopathy
1. fainting or seizure
2. dizziness or light-headedness
3. chest pain (even at rest)
4. palpiatations - quick fluttering/irregular/pounding heart beats
5. shortness or breath
62
emerging causes of acquired heart disease in young athletes
1. anabolic steroids
2. peptide hormones (growth hormone)
3. stimulants (energy drinks)
63
blow to the solar plexus
spasm to the diaphragm muscle
"wind knocked out of you"
64
MOI of blow to the solar plexus
1. blow to abdomen of chest
2. fall on buttocks or back
65
S&S of blow to the solar plexus
1. pain
2. difficulty breathing
3. panicky
66
acute management of blow to the solar plexus
1. bring athletes knees gently towards chest
2. guided breathing
3. diaphragmatic breathing
67
RTP for blow to the solar plexus
able to RTP one symptoms resolve pending no other kind of injury
68
MOI of facet joint sprain
forced rotation
69
S&S of facet joint sprain
1. hear/feel pop
2. sharp localized pain
3. pain with motions that open the joint
4. muscle guarding
70
facet joint sprain
1. common in contact sports - unexpected hit
2. common in c-spine due to large ROM - lig taken beyond available length
71
special test for a facet joint sprain
quadrant test
- positive if pain on opposite side
72
acute management of a facet joint sprain
1. PIER
2. refer for treatment
73
facet joint effusion
irritation of the facet joint
74
MOI of facet joint effusion
1. sudden episode of extreme ROM
2. felt a click of sharp pain
3. localized pain
4. spasm around inflamed joint
5. nerve root becomes irritated
6. closing joint will be painful
75
special test for a facet joint effusion
quadrant test
- positive if pain on same side
76
acute management of a facet joint effusion
1. PIER
2. refer for treatment
77
MOI of disc protrusions
acute or chronic compression through disc often in flexed position
- results in a bulge in the disc (usually posterolateral) resulting to changes to myotomes and dermatomes
78
S&S of disc protrusions
1. pain with repeat forward bending (for posterior protrusion)
2. relief with extension
3. pain with cough/sneeze
79
acute management of disc protrusions
refer for treatment
80
dermatomes
1. sensory areas of the skin innervated by specific nerve roots (afferent nerve fibres)
2. sensations can include pain, tingling, numbness, pressure
81
C1 nerve root resisted motion
cervical flexion
82
C2 nerve root resisted motion
cervical rotation
83
C3 nerve root resisted motion
cervical side bending
84
C4 nerve root resisted motion
shoulder elevation (shrug)
85
C5 nerve root resisted motion
shoulder abduction
86
C6 nerve root resisted motion
elbow flexion
87
C7 nerve root resisted motion
elbow extension
88
C8 nerve root resisted motion
thumb extension
89
T1 nerve root resisted motion
hand intrinsics (spread fingers)
90
cervical nerve root involvement for testing myotomes
resisted tests are performed 5x bilaterally to look for weakening
91
lumbosacral nerve root involvement for testing myotomes
resisted tests are performed 5x bilaterally to look for weakening
92
L1, L2 nerve root resisted motion
hip flexion (in high sitting)
93
L3 nerve root resisted motion
knee extension
94
L4 nerve root resisted motion
foor dorsiflexion + inversion
95
L5 nerve root resisted motion
hallux extension
96
S1, S2 nerve root resisted motion
plantarflexion in standing (toe raises)
97
S1 nerve root resisted motion
knee flexion
98
S2 nerve root resisted motion
hallux flexion
99
pressure on C5 nerve root
biceps reflex will be damaged
100
pressure on C6 nerve root
brachioradialis reflex will be damaged
101
pressure on C7 nerve root
triceps reflex will be damaged
102
pressure on L3, L4 nerve roots
patellar tendon reflex will be damaged
103
pressure on S1 nerve root
achilles tendon reflex will be damaged
104
patellar tendon reflex
quads contract, hamstrings inhibited
105
MOI of muscle strains of the neck and back
1. overstretch of eccentric load (loading muscle while forward bending)
2. rotation at high velocity
3. external force
106
muscle strains of neck and back
common in tennis, gold, baseball
- even minor strains become quite limiting
107
S&S of muscle strains of neck and back
1. abrupt "pull"
2. pain
3. protective spasm
4. divot (large strains)
108
acute management of muscle strains of neck and back
1. PIER (but never to anterior neck)
2. altered activity
109
pain-spasm cycle
must break it
- find the cause and treat it
110
MOI of rib and scapula fracture
1. direct blow
2. compression (ribs)
111
S&S of rib fractures
1. pain with deep breath (shallow breathing)
2. pain with compression
3. TOP area of fracture
112
S&S of scapula fractures
1. TOP
2. pain with movement of shoulder
113
acute management of rib and scapula fracture
1. stabilize the segment with padding and tensor if tolerated
2. tube sling for scapula fracture
3. send for imaging
114
4 spondys of spine
1. pars interarticularis
2. spondylolysis
3. spondylolisthesis
4. spondylitis
115
spondylolysis
stress fracture in pars interarticularis
116
spondylolisthesis
stress fracture and sliding of vertebra
117
spondylitis
inflammation in vertebra that could lead to fusion
118
MOI of spinal fractures
1. axial load
2. compression through spine
119
S&S of spinal fractures
1. central pain
2. tingling
3. numbness
4. unwillingness to move
5. spasm
120
spinal fracture
displacement of segments can put pressure on spinal cord or nerve roots resulting in paralysis
121
c-spine spinal fracture
quadriplegia
122
t-spine + l-spine spinal fracture
paraplegia
123
acute management of a spinal fracture
1. stabilize
2. call 911
124
pharynx
throat
125
larynx
"voice box"
- connects throat and trachea preventing food from getting into trachea while breathing
126
trachea
brings air from throat to lungs
127
esophagus
brings food from throat to stomach
128
nerves and blood supply in the neck
1. carotid artery
2. jugular vein
3. subclavian artery & vein
4. vagus nerve
129
bones of the face
1. frontal bone (forehead)
2. orbital bones (around eyes, along eyebrows)
3. nasal bone (nose)
4. zygomatic bones (cheekbones)
5. maxilla bones
6. mandible (jaw)
130
bones of head and face
1. frontal bone
2. parietal bones
3. temporal bones
4. occipital bone
5. temporomandibular joint (TMJ)
131
temporomandibular joint (TMJ)
1. joint between temporal bone and mandible
2. articular disc within joint
3. hinge joint
132
muscles that act on TMJ
1. temporalis
2. pterygoids (med and lat)
3. masseter
133
MOI of injuries to anterior neck
blunt force to anterior neck/throat by stick, puck, ball or opponent
134
injuries to anterior neck
common in field hockey, lacrosse, and hockey
135
S&S of injuries to anterior neck
1. pressure
2. difficulty swallowing
3. "feels thick"
4. difficulty breathing
5. panicky
136
what do injuries to anterior neck cause risk of
risk of larynx fracture
137
MOI of common carotid artery laceration
skate to the neck causing a laceration to the common carotid artery
138
S&S of common carotid artery laceration
1. pale
2. sweating heavily
3. tachycardiac
139
acute management of common carotid artery laceration
1. pressure
140
why was CCA laceration a success story
1. trained personnel
2. rapid recognition
3. emergently evacuate
4. planned evacuation and communication
5. very prepared
141
MOI of major bleeds
1. skate
2. stick
3. contact with boards
4. laceration of carotid artery, jugular vein and subclavian vein
142
major bleeds
common in hockey and figure skating
143
acute management of major bleeds
1. pressure (lots)
2. rapid call to EMS
3. treat for shock
4. requires vascular surgical team to repair damaged vessels
144
prevention of major bleeds
neck guards
145
facial injuries
1. eye-poke injuries
2. fractures
3. auricular hematomas
4. lacerations
5. TMJ conditions
6. dental injuries
146
eye-poke injuries
commonly results in subconjuctival hemmorrhage or corneal abrasion
147
subconjunctival hemorrhage
bright red bleeding/spot on white of eye from broken blood vessel
148
corneal abrasion
scratch on surface of eye
149
S&S of eye-poke injuries
1. mild discomfort
2. irritation
150
acute management of eye-poke injuries
1. cold compress
2. refer for eye exams
151
when should you refer for eye-poke injuries
1. any vision changes
2. shadows
3. floaters
4. pressure
5. pain should be referred urgently due to risk of more serious conditions (retinal tears/detachment, deeper damage to eye and/or vessels)
152
MOI of facial fractures
1. direct trauma via opponent (head-to-head, fist)
2. puck
3. ball
153
facial fractures
common in ice hockey, football (mandible), rugby, baseball
154
common facial fractures
1. unilateral zygomatic-maxillary-orbital
2. isolated mandibular
3. nasal fractures
155
S&S of facial fractures
1. TOP of fracture site
2. racoon eyes
3. swelling
4. divots
5. deformities
156
acute management of facial fractures
1. PIER if tolerated
2. refer
157
MOI of auricular hematoma
1. blunt trauma
2. repetitive friction
3. resulting contusion to ear
158
S&S of auricular hematoma
1. pain
2. swelling
3. bruising
159
auricular hematoma
1. blood accumulates between connective tissue and cartilage of the ear
2. results in pressure
3. can lead to necrosis of the cartilage form blood supply being cut off
4. if not drained the cartilage can become deformed resulting in "cauliflower ear" aka wrestlers ear
5. common in wrestling, rugby, judo, boxing
160
acute management of auricular hematoma
1. PIER
2. add pressure by packing ear with folded gauze to prevent fluid accumulation
3. magnets?
161
MOI of lacerations
1. blunt trauma
2. sharp object (including teeth)
***tend to open up
162
lacerations to the face
refer for stitches
163
acute management of lacerations
1. pressure
2. steri-strips
164
MOI of TMJ conditions
1. direct trauma to mandible
2. cumulative repeat impacts
165
TMJ conditions
most common in contact sports
166
result of TMJ conditions
1. dislocations
2. sprains
3. articular disc injuries
4. muscle tension/strains
5. clicking/altered joint mechanics
5. headaches
167
MOI of dental injuries
direct blow
168
common sports related dental injuries
1. tooth (crown) fractures
2. tooth intrusion
3. tooth extrusion
4. tooth avulsion
169
tooth intrusion
tooth gets forced into the bone
170
tooth extrusion
tooth gets forced out of the bone
171
tooth avulsion
complete removal from socket (tooth knocked out)
172
acute management of dental injuries
1. ensure broken teeth removed from mouth (choking hazard)
2. rule out concussion and C-spine
3. refer to dentist
4. ER (for severe cases)
5. rolled gauze to control bleeding
6. on-field Dr. can supply numbing agent
173
prevention of dental injuries
mouthguards
174
headache types in sport
1. dehydration (approx 90% due to this)
2. cervicogenic
- muscle tension: referred pain patterns
- joint dysfunction
3. concussion
175
MOI of concussions (mTBI)
direct blow or indirect blow
- land on bum or whiplash mechanism
176
are concussions physical or functional injury
functional injury
- and a transient change of neurological function
177
cause of a concussion
stretch and shearing of axons
178
concussion
stretch, ion exchange, depolarization of action potentials
- results in an electrical storm
179
signs of a concussion
1. vomiting
2. disorientation/confusion
3. memory loss
4. loss of consciousness (only in <10% of concussions)
180
symptoms of concussions
1. headache, pressure, migraines
2. cognitive changes: reduced focus and though processing, difficulty following instruction
3. vestibular system: dizziness, motion sensitivity, reduced balance and coordination
4. nausea: due to vestibular dysfunction or migraines
5. fatigue
6. fogginess, detached from self
7. mood changes: anxiety, depression, irritability
8. c-spine injuries often get missed and can contribute to symptoms
181
assessing a concussion
1. interviews
2. physical exams
3. testing
182
common assessment tools for assessing a concussion
1. SCAT6
- sideline/clinical
- 10-15 min to be done correctly
2. imPACT testing (immediate post-concussion assessment and cognitive testing)
- clinical only
- measures memory, attention span, visual and verbal problem solving
183
component of SCAT6
1. observable signs
2. glasgow coma scale (LOC)
3. cervical sign assessment
4. coordination and ocular/motor screen (visual, vestibular)
5. memory assessment maddocks question (cognitive)
184
observable signs
athlete position/behaviour/MOI
185
glasgow coma scale (LOC)
eye/verbal/motor responses
186
cervical spine assessment
1. pain at rest
2. TOP
3.AROM
4. limbs
187
coordination and ocular/motor screen
finger to nose, follow finger
188
memory assessment maddocks questions
1. questions re venue
2. game
3. past games
189
on field assessment of SCAT6
1. athlete background
2. symptom evaluation
3. cognitive screening
- orientation
- immediate memory
- concentration
4. coordination & balance examination
5. delayed recall
6. decision - summary of scores with decision
190
post-concussion syndrome
timeframes vary as to what is considered post-concussion syndrome
- >3 months
- >4 weeks
- >7-10 days post-injury
191
concussion testing and rehab tools
1. helps to zero in on primary issues limiting recovery
2. focuses on establishing functional neural pathways in the brain to support complete recovery
3. complete rest with no stimulation is no longer the recommendation
192
primary issues options limiting recovery
1. visual
2. vestibular
3. physiologic
4. cervicogenic
5. psychological
193
chronic traumatic encephalopathy (CTE)
progressive degenerative brain disorder caused by repeat head injuries
194
S&S of CTE
1. memory loss
2. confusion
3. headaches
4. irritable mood
5. aggression
6. depression
7. slurred speech
8. unsteady/altered motor control
195
concussion injury prevention
1. mouthguards
2. proper fitting helmet
3. safe technique
- no high tackles
- no spearing
4. concussion education
- early identification
- no RTP with even 1 symptom
- safe and progressive RTP
***most at risk of injury immediately post-concussion
196
shoulder girdle made up of 4 joints
1. glenohumeral joint
2. acromioclavicular joint
3. sternoclavicual joint
4. scapulothoracic joint
197
glenoid labrum
made up of ligs to keep everything contained
- gives more support
198
pectoral muscles
1. pec major
2. pec minor
- brachial plexus and subclavian artery and vein under armpit
***if tight it can pinch brachial plexus
199
muscles acting on the scapula
1. levator scapulae
2. rhomboid minor
3. rhomboid major
4. latissimus dorsi
5. trapezius
200
rotator cuff muscles
1. supraspinatus
2. infraspinatus
3. teres minor
4. subscapularis
201
supraspinatus
major dynamic stabilizer of the shoulder
202
GH joint dislocation
head of humerus translates completely out of the glenoid
- ball completely out of socket
203
GH joint sublexation
a partial or incomplete dislocation of the GH joint
- ball out of socket then back in
***can recover easily
204
anterior shoulder dislocation
most common
- head sits in front of socket
205
posterior shoulder dislocation
head sits behind the socket
206
inferior shoulder dislocation
head sits below the socket
207
MOI of anterior shoulder dislocation
1. 90 degrees abduction, 90 degrees elbow flexion and ER
2. force to back of shoulder
208
S&S of anterior shoulder dislocation
1. uneven instability
2. deformation
3. tingling and numbness (brachial plexus)
4. pain and unwillingness to move
5. bruising/swelling
6. limites ROM
209
structures affected with a shoulder dislocation
1. labrum
2. scapula
3. brachial plexus
4. clavicle
5. surrounding muscles
210
acute management of anterior shoulder dislocation
1. sling (stabilize)
2. PIER
3. immobilize
4. refer for x-rays
5. manage shock
211
re-establishment of stability for a shoulder dislocation
1. rest
2. slow progression of muscle
3. decrease second degree complication
4. increase proprioception and slowly weight-bear
5. support surrounding muscles
6. sport specific movements
212
MOI of posterior shoulder dislocation
1. force to front of shoulder
2. fall on outstretched hand
213
S&S of posterior shoulder dislocation
1. uneven instability
2. deformation
3. tingling and numbness (brachial plexus)
4. pain and unwillingness to move
5. bruising/swelling
6. limites ROM
214
acute management of posterior shoulder dislocation
1. sling (stabilize)
2. PIER
3. immobilize
4. refer for x-rays
5. manage shock
215
MOI of inferior shoulder dislocation
1. handstand
2. hyperabduction or hyperflexion
216
S&S of inferior shoulder dislocation
1. uneven instability
2. deformation
3. tingling and numbness (brachial plexus)
4. pain and unwillingness to move
5. bruising/swelling
6. limites ROM
217
acute management of inferior shoulder dislocation
1. sling (stabilize)
2. PIER
3. immobilize
4. refer for x-rays
5. manage shock
218
special test for anterior GH dislocation
apprehension test
219
SLAP lesions/tears (superior labrum anterior and posterior)
1. injury to superior aspect of labrum from anterior to posterior
2. may also injure biceps tendon due to pull
3. 4 types
220
MOI of a SLAP lesion
1. repetitive overhead movements
2. FOOSH (fall on outstretched hand)
3. sudden traction to the arm
4. dislocation of GH
221
S&S of SLAP lesion
1. clicking/catching/popping
2. pain moving arm overhead
3. pain lifting heavy objects
4. pain deep in joint or in back of joint
5. anterior shoulder pain if biceps involved
222
bankart lesion
an injury to anterior-inferior glenoid labrum
- result of an anterior dislocation
223
S&S of bankart lesion
1. pain and limited ROM with most shoulder movements
2.clicking/catching/grinding/popping/subluxation
224
hills-sachs lesion
1. a divot-type fracture of the head of humerus following a dislocation
2. head of humerus gets compressed against rim of the glenoid
***compression fracture
225
rotator cuff injuries
1. impingement
2. tendonitis and tendonosis
3. rotator cuff tears
226
MOI of rotator cuff impingement
1. overuse
2. poor mechanics
227
MOI of tendonitis/osis
1. overuse
2. poor mechanics
228
MOI of rotator cuff tears
acute or overuse
229
MOI of acromioclavicular (AC) sprains
1. FOOSH
2. fall/tackle - landing on the side of shoulder
3. checked into boards (compression)
230
S&S of AC sprains
1. pain
2. step deformity at AC
3. weakness in shoulder/arm
231
acute management of AC sprain
1. PIER
2. sling
3. swath
4. severe deformities must be referred
6. AC tape job to support healing and decrease pain
232
Type I rockwood classification
1. sprained AC ligaments
2. normal CC ligaments
233
Type II rockwood classification
1. disruption of the AC ligaments
2. sprained CC ligaments
234
Type III rockwood classification
disruption of the AC and CC ligaments
235
Type IV rockwood classification
posterior displacement into or through the trapezius muscle
236
Type V rockword classification
rupture of the deltotrapezial fascia
237
Type VI
inferior displacement of the distal clavicle under the conjoined tendon
***uncommon - clavicle rupture
238
treatment for acute shoulder injuries
1. PIER
2. sling for support
3. AC tape job to help approximate joint/any remaining lig to support healing
4. rehab to promote tissue healing and regain mobility
239
when is surgery considered for treatment of acute shoulder injuries
1. middle third clavicle fractures
2. type III AC sprains in active people
3. types IV, V and VI 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
240
MOI of subacromial impingement syndrome/ shoulder impingement
1. overuse
2. biomechanical imbalances (compensation patterns)
241
shoulder impingement
pinching and subsequent inflammation of structures under the coracoacromial ligament
- roll up and glide down doesn't happen
***common in swimmers, overhead athletes (tennis, pitchers, quarterbacks)
242
what structures are involved in a shoulder impingement
1. supraspinatus tendon
2. long head of biceps tendon
3. subacromial bursa
243
S&S of a shoulder impingement
1. pain and weakness in painful arc of abduction (reaching especially with a weight)
2. catching/clicking
3. pain with sleeping on affected side
4. pain putting jackets/sweaters on
244
special test for shoulder impingement
painful arc
245
positive test of shoulder impingement
pain during GH abduction between 60 degrees and 120 degrees (pinch area)
- pain clears beyond 120 degrees
246
referred pain pattern for positive test for shoulder impingement
pain in supraspinatus pattern down middle deltoid
247
MOI of a humerus fracture
high-energy direct blow
248
S&S of a humerus fracture
1. pain
2. swelling
3. bruising
4. unable to move arm or grinding when they do
249
what is the most common fracture site on humerus
surgical neck
250
how many of humerus fractures are non-displaced
80 % are non-displaced and non-surgical
251
acute management of a humerus fracture
1. PIER
2. sling
3. treat for shock
4. send to emerge if stable otherwise call EMS
252
management of a humerus fracture
1. sling
2. pain management
3. start treatment early to avoid frozen shoulder
- encourage early movement
253
MOI of scapula fractures
1. high-energy blunt trauma
2. fall from height
254
S&S of scapula fractures
1. extreme pain with arm movements
2. localized swelling
3. swelling/bruising/trauma to the areas
255
management of scapula fracture
sling
- most cases are non-surgical
256
surgery indicated for scapula fractures if...
1. displaced fractures of the glenoid
2. displaced fracture at neck of scapula
3. acromion fractures causing impingement
257
MOI of clavicle fractures
1. force to lateral shoulder (tackle, check into boards)
2. FOOSH
3. direct trauma
258
S&S of a clavicle fracture
1. severe pain and swelling over sites
2. deformity
3. unwillingness to move the arm
259
acute management of clavicle fractures
1. tube sling (to avoid pressure on clavicle)
2. PIER
260
treatment of a clavicle fracture
1. sling or figure 8 brace
2. PIER
3. pain management
4. alleviate association spasms
261
shoulder girdle
1. 3 joints
2. muscles spanning from multiple joints
262
important considerations for treating shoulder girdle
1. thoracic spine mobility
2. scapular mobitlity
3. scapular stability
4. upper limb proprioception
- needs stable base for upper limb (scapula)
263
physiological ROM of the GH joint
1. abduction/adduction
2. flexion/extension
3. IR (0-90 degree abduction)
4. ER (0-90 degree abduction)
5. horizontal adduction (cross-flexion)
6. horizontal abduction (cross-extension)
264
elbow joint (hinge)
made up pf 3 joints:
1. ulnohumeral joint
2. radiohumeral joint
3. proximal radioulnar joint
265
elbow ligaments
1. ulnar (medial) collateral ligament
2. radial (lateral) collateral ligament
266
collateral ligaments of wrist
1. ulnar (medial) collateral lig
2. radial (lateral) collateral lig
267
ligaments of fingers
1. collateral ligaments
2. intercarpal ligaments (dorsal and palmar)
3. triangular fibrocartilage complex (TFCC)
268
triangular fibrocartilage complex (TFCC) aka triangular disc
1. complex made up of load-bearing triangular fibrocartilage articular disc and ligaments on medial aspect of wrist
2. disperses axial load from carpals to ulna
3. thickened by the UCL medially
269
what is the TFCC a major stabilizer of
1. ulnocarpal joint
2. distal radioulnar joint
270
function of the TFCC
facilitates articulations at the wrist joint
271
nerves at the elbow and wrist
1. ulnar nerve both at elbow and wrist
2. median nerve under flexor retinaculum
272
elbow flexors
1. biceps brachii (long and short head)
2. brachialis
3. brachioradialis
273
elbow extensors
1. triceps brachii
2. anconeus
274
common flexor tendon origin for muscles
medial epicondyle
275
common extensor tendon origin for muscles
lateral epicondyle
276
carpal tunnel
median nerve is compressed
277
elbow physiological ROM
1. flexion/extension
2. pronation/supination
278
wrist physiological ROM
1. flexion/extension
2. radial/ulnar deviation
279
digits physiological ROM
1. flexion/extension
2. abduction/adduction
3. 1st-5th opposition/reposition
280
lateral epicondylitis aka tennis elbow
most common in tennis, squash, badminton
281
MOI of tennis elbow (LE)
overuse of forearm extensors
282
most common extensors affected in tennis elbow (LE)
1. extensor carpi radialis longus
2. extensor carpi radialis brevis
283
S&S of tennis elbow (LE)
1. TOP common extensor origin (lateral epicondyle)
2. pain and weakness with wrist extension
284
acute management of tennis elbow (LE)
1. stretch wrist extensors in elbow extension and flexion
2. PIER (if itis)
3. tennis elbow brace
4. eccentric strengthening program for forearm extensors
285
MOI of medial epicondylitis aka golfers elbow
overuse of wrist flexors
286
medial epicondylitis aka golfers elbow
common in golfers and pitchers
287
most common flexors affected in golfers elbow (ME)
1. flexor capri radialis (FCR)
2. pronator teres (PT)
288
S&S of golfers elbow (ME)
1. TOP of common flexor origin (medial epicondyle)
2. pain and weakness with wrist flexion
289
acute care of golfers elbow (ME)
1. PIER
2. stretch forearm flexors
290
MOI of ruptured biceps
1. sudden lengthening of contracting muscle (eccentric)
ex. sudden load when lifting or catching a heavy load
291
what biceps are most commonly affected in a ruptured biceps
distal biceps tendon
292
S&S of ruptured biceps
1. "popeye muscle"/muscle balled up
2. bruising
3. pain near insertion of biceps into radial tuberosity
4. pain and weakness with elbow flexion and supination
***complete ruptures might be painless
293
acute management of ruptured biceps
1. PIER
2. pressure pad to approximate any remaining fibres
3. shorten biceps in sling to remove tension
4. surgical repair within first couple weeks for active people
294
MOI of dequervain's syndrome aka tenosynovitis
overuse of thumb due to gripping/wringling
295
dequervains syndrome aka tenosynovitis
inflammation of tendons and sheath around the thumb tendons
1. extensor pollicis brevis
2. abductor pollicis longus
***common in golf
296
S&S of dequervains syndrome aka tenosynovitis
1. pain over tendons of thumb
2. weakness with thumb abduction or extension
3. pain with gripping
297
special test for dequervains syndrome aka tenosynovitis
finklestein test
298
acute management of dequervains syndrome aka tenosynovitis
1. PIER
2. thumb spica brace
3. if left untreated can progress to thickening/scarring and reduced ROM
299
MOI of elbow hyperextension injuries
FOOSH
300
S&S of elbow hyperextension injuries
1. anterior elbow pain and swelling from ligament/capsule sprain and/or muscle strain
2. posterior elbow pain from osteochondral lesion
301
what must be ruled out for an elbow hyperextension injuries
olecranon fracture - may see deformity
302
acute management of elbow hyperextension injuries
1. PIER
2. shorten injured tissues (elbow flexion) by a sling
3. tape job is very effective
303
MOI of UCL sprains of elbow
1. FOOSH
2. overuse by repeat valgus force on elbow
304
S&S of UCL sprains of elbow
1. pain and laxity (instability) in medial elbow joint
2. ulnar nerve symptoms
305
UCL sprains of the elbow
common in pitchers due to repeat high velocity force
306
tommy john surgery
reconstructs UCL using a graft tendon- palmaris longus, semitendinosus or gracilis
307
MOI of collateral ligament sprains of wrist
1. FOOSH
2. forced forearm rotation
308
MOI of UCL sprain in wrist
valgus force
309
MOI of RCL sprain in wrist
varus force
310
S&S of collateral ligament sprains of the wrist
1. pain
2. swelling and instability on medial (UCL) or lateral (RCL) aspect wrist
311
special test for UCL (MCL)
valgus stress test
312
special test for RCL (LCL)
varus stress test
313
acute management of collateral ligament sprains of the wrist
1. PIER
2. wrist wrap
3. wrist tape job for RTP
314
MOI of UCL sprain of thumb aka skiers thumb or gamekeepers thumb
traumatic or overuse hyperabduction of the thumb (1st metacarpophalangeal joint)
315
traumatic MOI of UCL sprain of thumb
skiers thumb: thumb gets caught, FOOSH, catching ball
316
overuse MOI of UCL sprain of thumb
gamekeepers thumb: repeat gripping/twisting
317
what can a UCL sprain of thumb result in
avulsion fracture
318
S&S of UCL sprain of the thumb
1. pain
2. swelling
3. instability at 1st MCP joint
319
is surgery recommended for UCL sprain of thumb
yes due to instability so it can stabilize the joint and prevent osteoarthritis longer term
320
acute management of thumb UCL spain
1. PIER
2. possible x-ray to rule out avulsion
3. brace for healing
4. thumb tape job/brace for RTP
321
MOI of an acute TFCC tear
1. FOOSH
2. forced forearm rotation
322
S&S of an overuse TFCC tear
1. medial wrist pain
2. pain with ulnar deviation and loading through wrist
3. popping/clicking
4. wrist weakness
323
special test for a TFCC tear
TFCC compression test (passive ulnar deviation with axial compression - loads through discs)
324
acute management of TFCC tear
1. PIER
2. brace as heals
3. anti-inflammatory injections if needed, surgery for the persistent instability
325
elbow dislocations
elbow joint bony structure provides a lot of stability - but enough force can cause dislocations
326
MOI of the elbow dislocations
FOOSH
327
S&S of the elbow dislocations
1. deformity
2. lots of pain
3. holding elbow
4. tingling /numbness
5. shock
328
acute management of an elbow dislocation
1. stabilize
2. splint
3. monitor/treat for shock
4. ER/EMS
5. reduction under sedation
329
MOI of elbow fractures
direct trauma/fall
330
S&S of elbow fractures
1. lots of pain
2. unable or unwilling to move elbow
331
acute management of elbow fractures
1. splint
2. monitor for shock
3. ER for x-rays/surgical referral
4. ORIF = open reduction internal fixation
332
MOI of colles' fracture - distal radius fracture
FOOSH
333
colles' fracture - distal radius fracture
distal radius gets displaced posteriorly
334
S&S of colles' fracture - distal radius fracture
1. "dinner fork deformity"
2. lots of pain
3. numbness
***don't need to test, cause deformity is very obvious
335
acute management of colles' fracture - distal radius fracture
1. splint
2. monitor for shock
3. emerge for x-rays
4. surgery if unable to align
336
MOI of scaphoid fractures
FOOSH
337
S&S of scaphoid fractures
TOP of anatomical snuffbox
338
scaphoid healing
scaphoid has poor blood supply so it has a decreased ability to heal
339
acute management of a scaphoid fracture
identify early and immobilize with a cast or brace
340
MOI of metacarpal (MC) and finger fractures
1. axial compression (jammed) finger
2. direct trauma
3. being stepped on
341
S&S of MC and finger fractures
1. localized pain
2. swelling
3. unable to grip
342
acute management of hand (MC)
SAM splint
343
acute management of fingers
buddy tape to stabilize
344
what can happen with MC and finger fractures
avulsion fractures - tendon pulls of piece of bone
- immobilization or surgical repair
345
MOI of cyclist palsy
compression from handlebars
346
S&S of cyclist palsy
1. tingling/numbness/nerve pain
2. decreased muscle strength of 5th digit
3. hand cramping
347
cyclist palsy
common in new cyclists and distance cyclists
348
prevention of cyclist palsy
1. avoid hyperextension of wrist on handlebars
2. proper bike fit
349
acute management of cyclist palsy
1. PIER
2. splint
3. may require NSAIDs
350
MOI of carpal tunnel syndrome
overuse of wrist flexor tendons causing pressure on median nerve within carpal tunnel
351
S&S of carpal tunnel syndrome
1. burning/tingling/numbness in anterior wrist and hand (along median nerve distribution - digits 1-3 and 1/3 of digit 4)
2. decreased grip strength
352
acute management of carpal tunnel syndrome
1. bracing
2. PIER
3. anti-inflammatory treatment
4. proper ergonomic set up
5. steroid injection
6. surgery to open up tunnel if conservative treatment unsuccessful
353
growth plates
1. area of new bone growth in kids and teens
2. located at the end of long bones
3. made of cartilaginous tissue
354
when do growth plates close
1. 14-15 years old for females
2. 16-17 years old for males
355
pediatric medial conditions/considerations
1. juvenile diabetes (type 1 - insulin dependent)
2. juvenile arthritis
3. asthma
4. epilepsy
5. allergies (anaphylaxis)
6. water safety/CPR for drowning
7. choking
356
pediatric sized emergency supplies
1. oropharyngeal airway (OPA)
2. neck collar
3. splints
4. epipen jr
5. child SCAT6 (ages 8-12)
357
injury prevention in youth sports
1. proper warm up
2. properly fitted protective equipment
3. diversifying their activities
4. playing time limits for training and competition
5. max games/day for tournaments
6. minimum hours between games
7. rotating positions
8. proper nutrition and hydration
9. avoid overtraining
10. baseline concussion testing
11. psychological wellness
12. pre-season screenings
13. pitch count limits - mandated rest days
358
pre-season screenings
1. identify current pain/injuries
2. review medical conditions
3. assess functional movement patterns
4. concussion baseline testing
5. discuss important topics (concussions, nutrition, hydration, overtraining, communicating injuries easily)
KEEP SPORTS FUN
359
psychological wellness
1. support following injury - parents, coach, team
2. healthy competition
3. healthy eating habits
4. inclusivity
5. motivational talks
6. encouraging cheers
7. promoting homework
360
growth plate injuries/fractures
1. excessive repeat stress on growth plate of the bone which causes a widening of the growth plate
2. growth plate becomes inflamed
3. if not addressed it can affect growth - deformities and bone stops growing prematurely
361
management of growth plate injuries/fractures
1. altered activity is essential
2. may require 2-3 months of rest from aggravating sport skill
362
little league shoulder - proximal humeral epiphysitis
1. irritation of the growth plate in proximal humerus
2. may lead to stress fractures through growth plate
3. most common in pitchers and baseball players, tennis, volleyball
363
MOI of proximal humeral epiphysitis (LLS)
overuse in overhand motions causing excessive strain on growth plate
364
S&S of proximal humeral epiphysitis (LLS)
progressive increase in pain in proximal humerus or shoulder
365
prevention of proximal humeral epiphysitis (LLS)
1. limiting pitch counts
2. proper throwing mechanics
3. train kinetic link
366
MOI of patellar tendonitis aka jumpers knee
excessive traction on patellar tendon
- often associated with growth spurts
367
S&S on patellar tendonitis aka jumpers knee
1. pain
2. swelling and heat over patellar tendon
3. pain with jumping, running, quick change in direction or strong quad contraction
4. pain with flexion and extension
5. can train and compete through the pain
368
special tests for patellar tendonitis aka jumpers knee
thomas test - resisted quads
369
acute management of patellar tendonitis aka jumpers knee
1. PIER
2. roll/soft tissue mobility for quads
3. lower extremity mechanics
4. important to train hammies to prevent anterior translation of tibia on femur and stability at hip and knee
5. tendinopathy rehab = eccentric, x-training
370
RTP for patellar tendonitis aka jumpers knee
a patellar tendonitis tape job
371
osgoode schlatter's disease
irritation of growth plate at tibial tuberosity (attachment patellar tendon)
372
MOI of osgoode schlatters disease
overuse - excessive traction of quads via patellar tendon
373
S&S of osgoode schlatters disease
1. pain over tibial tuberosity
2. visual bump over tibial tuberosity
3. pain with contraction and stretch of quads
4. jumping especially painful
374
special test of osgoode schlatters disease
thomas test with resisted quads
375
acute management of osgoode schlatters disease
1. PIER
2. roll/soft tissue mobility for quads
3. lower extremity mechanics
376
prevention of osgoode schlatters disease
diversify activity
- important to train hammies to prevent anterior translation of tibia on femur and stability at hip and knee
377
sever's disease
irritation of the calcaneal tuberosity growth plate (attachment achilles tendon)
378
S&S of sever's disease
1. pain over achilles insertion into calcaneus
2. pain with forceful achilles contraction (jumping, sprinting, starts/stops)
379
special test for sever's disease
single leg calf raise
380
acute management of sever's disease
1. stretch gastrocnemius and soleus
2. NSAIDs
3. heel lift
381
MOI of little league elbow
chronic valgus overload to medial elbow from throwing
382
where does injury occur during a little league elbow injury
1. medial epicondylitis
2. medial epicondylar apophysitis (growth plate injury)
3. avulsion fracture
4. MCL sprain (older kids tho)
383
S&S of little league elbow
1. pain and inflammation over medial elbow
2. pain and weakness with throwing
3. medial instability
384
special test for little league elbow
1. wrist flexor muscle testing
2. valgus stress
3. x-rays
385
acute management of little league elbow
1. PIER
2. alter activity and rest
386
prevention of little league elbow
1. limited pitch counts
2. proper throwing mechanics
387
growth plate irritation sites for gymnastics
distal radius -from repeat load
388
growth plate irritation sites for tumbling sports
AIIS - rectus femoris contracts strongly while on stretch
389
growth plate fractures
1. rest, cast or splint
2. surgical repair
390
principles of splinting
1. include the joint above and below injury
2. pad splint for comfort and added support
3. check distal pulse before and after splinting
391
heat illness
heat cramps>heat exhaustion>heat stroke
392
heat cramps
muscle cramping during/after activity in heat
- thought to be caused by fluid and salt loss form sweating
- common in long distance runners
***should be seen as warning to about more severe heat illness
393
S&S of heat cramps
1. pain
2. spasm (usually legs or abdomen)
394
acute management of heat cramps
1. rest in cool area
2. water/sports drink
3. gentle stretching or massage
395
prevention of heat cramps
1. sufficient hydration and electrolytes (more than usual)
2. avoid/minimize activity in high temperatures
396
heat exhaustion
1. results from activity in hot temperatures
2. body's ability to regulate temperature becomes stressed
397
S&S of heat exhaustion
1. normal or slightly elevated body temperature
2. cool, moist, pale skin (red initially)
3. headache
4. nauseau (vomiting, dizziness)
5. weakness
6. exhaustion
7. level of consciousness starts to decline in later stages
398
acute management of heat exhaustion
1. rest in a cool place
2. cold cloths in armpits, groin, back of neck
3. drink cool water - early stages it is very treatable
***if left untreated it can progress to heat stroke (emergency)
399
heat stroke
1. results from untreated heat exhaustion
2. body becomes unable to cool itself
3. life threatening emergency
400
S&S of heat stroke
1. dry
2. red
3. hot skin
4. progressive loss of consciousness
5. rapid and weak pulse
6. rapid and shallow breathing
7. high body temperature
401
acute management of heat stroke
1. cool the body
2. give fluids
3. minimize shock
4. call EMS
402
cold-related emergencies
frostbite>hypothermia
403
frostbite
1. when body tissues freeze following prolonged exposure to cold
2. water within and surrounding cells freeze and swell which damage the cells
3. can result in loss of digits or limbs
404
superficial frostbite
skin only
405
deep frostbite
skin and underlying tissues freeze
406
S&S of frostbite
1. decreased sensations
2. skin is cold and waxy
3. discolouration (flushed, white, yellow, blue, black)
4. tingling
5. swelling
6. pain with rewarming
7. blisters within 24 hours
407
acute management of frostbite
1. gentle rewarming by soaking in warm water
2. apply dry sterile dressing
3. gauze between fingers/toes
4. warm drink
5. blanket
*** DO NOT RUB THE AREA - FURTHER DAMAGE TISSUES
408
when do you refer frostbite
1. infection
2. red streaks
3. blisters
4. drainage
5. no return of sensation or normal skin tone
409
prevention of frostbite
1. dressing in layers
2. removing wet clothing/gear
3. avoid extended time during extreme cold weather
410
hypothermia
1. a dangerous drop in body temperature below 95 degree F and 35 degree C following extended exposure to cold
411
S&S of hypothermia
1. shivering (stops in later stages)
2. slow irregular pulse
3. slow breathing rate
4. numbness
5. confusion
6. drowsiness
7. pale cold skin
8. loss of coordination
412
what can hypothermia lead to
1. shock
2. coma
3. cardiac arrest
413
acute management of hypothermia
1. ABCs
2. gradual rewarming with dry clothes
3. blankets
4. warm environment
5. heating pads
6. warm drinks if alert
414
415
KNPE 331
flashcards
Decks in class (3)
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