Midterm 1

Question 1

What are the purposes of documentation?

Answer 1

• protects the rights of patient and provider
• method of communication between providers
• insurance coverage

Question 2

What do SOAP notes stand for?

Answer 2

subjective, objective, assessment, plan

Question 3

What does the S of SOAP notes mean?

Answer 3

Subjective
- anything patient says that is relevant
- history, lifestyle, occupation, emotions, attitudes, stress
- their idea of pain/how it affects them
- their response to treatment

Question 4

What does the O of SOAP notes mean?

Answer 4

Objective
- was part of existing medical file
- result of objective measurement/observation (ROM)
- is part of treatment given/ability to perform treatment (level of competence or strength doing activity)

Question 5

What does the A of SOAP notes mean?

Answer 5

Assessment - contains 4 parts

Question 6

What are the 4 parts of assessment? (SOAP)

Answer 6

problem list - summarizes problems from S and O, provides diagnosis/index of suspicion
long-term goals - where patient wants to be at end of treatment, set after problem list is compiled
short-term goals - outlines incremental steps taken to achieve long-term goals, set after long-term goals
summary - correlations between SOA, can include inconsistencies in findings and complaints

Question 8

What does the P of SOAP notes mean?

Answer 8

Plan
- includes treatment regimen for patient including: frequency per day/week patient is seen, treatments clinically/exercise patient receives, if discharged where patient is going/how many times they were seen
- locations of treatment (pool, home, clinic, field)
- plans for future assessments
- equipment ordered/needed
- referral of services

Question 9

When should you chart?

Answer 9

• assessing or providing treatment to patient/athlete
• any communication with your patient/athlete regarding their injury (calls/texts)
• any communication with other health care professionals
• any test results or additional info

Question 10

What else is included in charts?

Answer 10

• history forms
• consent to treatment
• permission to release medical info
• copy of referrals
• copies of anything given to patient/athlete

Question 11

What is informed consent?

Answer 11

protects the individuals right to “security of the person”
- enhances communication and trust between caregiver and care recipient
- risk management measure to avoid potential litigation

Question 12

what are the criteria of informed consent?

Answer 12

• Informed - advantages and disadvantages
• physical and mental competence to provide consent
• mental capacity
• voluntary
• in best interest of patient - does something or makes people feel better
• specific and not misrepresented
• opportunity to ask questions

Question 13

What is the difference between primary and secondary MOI?

Answer 13

primary - injuries occur as direct result from stress of sport, can result from athlete or equipment, ex. sprains, strains, fractures
secondary - occur as indirect result of stress imposed by sport, can be result of environment, existing health conditions, hereditary, usually more common in endurance sports, ex. sickle cell syndrome reacts badly with altitude

Question 14

What are the 6 common musculoskeletal injuries?

Answer 14

sprains, strains, tendinopathy, bursitis, contusions, fractures

Question 15

What are sprains?

Answer 15

injuries to ligaments
- result from overseers of the ligament fibers or their bony attachment points

Question 16

What are strains?

Answer 16

injuries to muscles
- result from excessive forcible contraction or stretch, or stretching while contracting (eccentric contraction)
- Golgi tendon apparatus and muscle spindle activation

Question 17

What is tendinopathy?

Answer 17

• tendons connect muscles to bone, not a contractile fiber but sees stress every time muscle contracts
• usually include overuse mechanisms
• usually secondary to repeated micro-traumas or circulatory disturbances in the tendon

Question 18

What is the difference between tendonitis and tendinosis?

Answer 18

tendonitis - inflammation stage of tendinopathy
tendinosis - chronic tendonitis

Question 19

What is bursitis?

Answer 19

inflammation of a bursal sac
- bursa in places to relieve friction
- leads to pain and substantial swelling, if not left to resolve can be degenerative to bursa

Question 20

What are contusions?

Answer 20

tissues get crushed and causes damage
- crushing injuries to soft tissues with a blood supply
- common in muscle tissue, and result in intra-muscular hematoma formation
- can also be in other tissues

Question 21

What are fractures?

Answer 21

a break in the continuity of a bone
- numerous mechanisms and classifications that depend on age, severity, type, etc.
- closed fracture (simple): does not break skin
- open fracture (closed): bone breaks surface of skin

Question 22

What are the 3 stages of healing?

Answer 22

inflammation, proliferation, maturation

Question 23

What is inflammation?

Answer 23

reaction of tissue to damage on the cellular level
- meant to protect from further harm and get rid of damaged tissue in prep for healing and repair
- brings large quantities of oxygen/nutrients and clotting proteins
- healing does not start until inflammation stage Is over
usually lasts 24-72 hours

Question 24

What is the inflammation response in the first 10 mins?

Answer 24

localized vasoconstriction in response to some sort of break in vascularity in cells around the area
- to form a platelet plug - stop the bleeding

Question 25

What happens after the first 10 minutes in inflammation?

Answer 25

reversal to vasodilation - increased blood flow - brings nutrients to area, microphages to get rid of dead cells - collagen, elastin, etc. to rebuild

Question 26

What are the signs of swelling?

Answer 26

SHARP S - swelling H - heat A - altered function R - redness P - pain

Question 27

What is PEIR?

Answer 27

P - pressure E - elevate I - ice R - rest

Question 28

What is the proliferation stage?

Answer 28

begins at end of inflam, extends as long as 4 weeks - immature collagen/granulation tissue is laid down - collagen maturation depends on type of tissue, healing environment, stresses placed on it - tissue is very vulnerable

Question 29

what is the difference between primary healing and secondary healing?

Answer 29

primary - ends touching - like having stitches secondary - nothing touching, scar tissue builds up to heal

Question 30

What is maturation stage?

Answer 30

starts at end of proliferation, extends until tissue reaches full function/strength - varies greatly from tissue to tissue - type I and II collagen replace immature collagen within scar tissue to increase strength of repairs - elastin incorporated with healing - collagen aligns with stress - end of maturation will include return to sport activities and full use of injured structure

Question 31

what are healing rates for ligaments and tendons?

Answer 31

immature collagen/granular tissue deposition - 3-6 days 70% of pre-injury strength regained - 6-8 weeks full function restoration - 1 year - may require re-attachment to achieve primary healing

Question 32

What are the healing rates for muscles?

Answer 32

degeneration/replacement of myofibrillar proteins - 1-7 days 50% of strength regained - varies on sag 1/2/3 full return to sport - varies - good repair ability due to vascularity

Question 33

What are healing rates for bones?

Answer 33

hematoma formation - ~48 hours soft callous formation - 7-14 days hard callous formation - 4-6 weeks - longer for primary bones - up to 12 weeks - greatest risk for re-injury return to sport remodelling - as tolerated

Question 34

What are intrinsic risks for athletic injuries?

Answer 34

related to the athlete/individual - Age, Sex, Psychological state, Medical conditions

Question 35

How does age impact risk for injuries?

Answer 35

Scoliosis, growth plate injuries, osgood schlatter, legs cave perthes disease, can also include medications

Question 36

how does sex impact risk for injuries?

Answer 36

most injuries affect males and females relatively the same other than: - concussions - likely due to females being more likely to report even after the fact - knee injuries - anatomical reasons - female athlete triad

Question 37

What is RED-S?

Answer 37

relative energy deficiency in sport - affects both male and female athletes but is first domino in female athlete triad

Question 38

What is the female athlete triad?

Answer 38

- energy imbalance (RED-S) - with or without disordered eating, can lead to loss of body weight - lower estrogen/hormone production causing dysmenorrhea - menstrual dysfunction - premature bone loss causing osteoporosis and increased incident of fractures - result of low calories and decreased estrogen

Question 39

What medical conditions can have an impact on risk for injuries?

Answer 39

diabetes, asthma, heart conditions, previous injuries, leg length discrepancies, Marfan syndrome, absence of organs

Question 40

What are extrinsic risk factors for injuries?

Answer 40

- relate to sport/surface/environment - related to the sport not athlete - slippery surfaces ex. hockey on ice, turf vs. grass for ACL injuries, contact sports, equipment

Question 41

What info does functional testing gather?

Answer 41

athlete's ability to move, ROM, pain, strength, instability, tenderness, crepitus (snap, crackle, pop), functional capabilities

Question 42

What does functional testing consist of?

Answer 42

active, passive, resisted ROM

Question 43

What is AROM?

Answer 43

Active ROM - active testing done by athlete - observe quantity and quality of movement attained, note most painful ranges and do them last - always comes first - athlete can show their limits based on pain, etc.

Question 44

What is PROM?

Answer 44

Passive ROM - passive testing done by caregiver - intended to test the inert (non-contractile) tissues of the patient - ligaments - if ligament damage is suspected this should come last - best done with athlete relaxed and supported - note pain-free ROM, guarding, laxity - end feel is the sensation examiner gets when joints reach its end

Question 45

What are normal and abnormal end feels?

Answer 45

normal: bone on bone, soft tissue approximation, tissue stretch abnormal: muscle spasm, capsular, bone on bone, empty, springy block

Question 46

What is RROM?

Answer 46

Resisted ROM - resisted testing involves both the examiner and athlete - involves isometric muscle contraction with joint neutral - if muscle damage suspected should be last

Question 47

How is strength evaluated in RROM?

Answer 47

1-5 scale - must be 4/5 to return to sport 5 - normal - completed strength and ROM against gravity 4 - good - moderate strength 3 - fair - able to resist gravity 2 - poor - not able to resist against gravity 1 - trace - slight muscle contraction detectable 0 - none - not able to contract at all

Question 48

What do the ROMs gather info about?

Answer 48

Active - basic info about athlete's ability Passive - stresses inert (non-contractile) tissues Resisted - stresses active (contractile) tissues

Question 49

How does force and tissue properties affect injury mechanisms?

Answer 49

- force causes the body to accelerate and deform - when force is applied to tissues the amount of deformation will depend on the tissue's properties - greater stiffness = less seen deformation - greater elasticity = more likely to see deformation, may return to original shape

Question 50

What is the load deformation curve?

Answer 50

shows stiffness, peak load at failure and energy absorbed by tissue

Question 51

What factors affect the tissue ability to absorb force?

Answer 51

direction of force - tension (ligament), compression, shear (femur on tibia shears forward = ACL injury), torsion stress - force divided by surface area it is applied through - larger area = less stress, smaller area = more stress