ATH 267 FINAL WSU

what makes an injury acute?

one time event - fractures, dislocations, sprains, contusions, strains

what makes an injury chronic?

repetitive motions - tendinitis, tenosynovitis, bursitis, osteoarthitis

muscle strains

damage from a muscle being overstretched by tension or forced to contract against too much resistance, separation or tearing

muscle strain grade 1

some muscle fibers stretched, tenderness/pain with AROM, full ROM possible

muscle strain grade 2

number of muscle fibers have been torn, active contraction of the muscle is painful, depression/divot can be felt at site of tearing, swelling, discoloration, decreased ROM due to pain

muscle strain grade 3

complete rupture of the muscle, significant impairment/total loss of motion; pain is initially intense, but diminishes due to nerve fiber separation

tendinitis

inflammation of a tendon

S&S of tendinits/tendinosis

pain with movement, swelling, warmth, crepitus

tendinosis

degeneration of the tendon if the tendon fails to heal/without inflammation

pes planus

flat foot

pes cavus

high arch

foot pronation

eversion of the foot with lateral rotation

foot supination

inversion of the foot with medial rotation

metatarsal stress fracture causes

change in training surface, structural deformities of the foot, errors in training: footwear, surfaces, volume

march fx

2nd metatarsal stress fracture

S/S of metatarsal stress fracture

pain and tenderness along metatarsal, pain with running/walking, continued pain/aching when non-weight bearing

TX of metatarsal stress fracture

determine cause of injury, rest-2-4 weeks, return to running should be gradual over a 2-3 week period with appropriate shoes

grade 1 ankle sprain

Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity

grade 2 ankle sprain

Feel or hear pop or snap; moderate pain w/ difficulty bearing weight; tenderness and edema,
Possible tearing of the anterior talofibular and calcaneofibular ligaments

grade 3 ankle sprain

Severe pain, swelling, discoloration
Unable to bear weight
Instability due to complete ligamentous rupture

eversion ankle sprain

Eversion force resulting to damage of deltoid, slower to heal than inversion ankle sprains, possible fx's: avulsion fx of tibia, transverse fx of fibula

Syndesmotic Sprain

High Ankle sprain
Injury to the distal tibiofemoral joint (anterior/posterior tibiofibular ligament), jamming of talus into mortise

syndesmotic sprain MOI

torn w/increased external rotation or dorsiflexion

Tx for syndesmotic sprain

PRICE, avoid weight-bearing for at least 24 hours, return to participation should be gradual

Medial Tibial Stress Syndrome

shin splints, diffuse pain on medial border of distal tibia

MTSS MOI

repetitive micro trauma, weak muscles, improper footwear, training errors, biomechanical abnormalities, can progress to stress fx

TX for MTSS

physician referral for X-ray and bone scan, activity modification, correction of abnormal biomechanics/flexibility, ice massage

what can compartment syndrome be classified as

acute, acute exertional or chronic

compartment syndrome MOI

traumatic syndrome due to direct blow or excessive exercise

S&S of compartment syndrome

deep achy pain, tightness/swelling, pain with passive stretching, weakness with foot and toe extension, decreased circulation, numbness in dorsal region of foot, 5 P's

TX for acute compartment syndrome

medical emergency, fasciotomy

acute exertional/chronic compartment syndrome TX

conservative treatment, possible treatment

what NOT to do with compartment syndrome

no compression wraps

MOI achilles tendon rupture

occurs w/sudden stop and go; forceful plantar flexion w/knee moving into full extension

what group is achilles tendon ruptures commonly seen in

athletes older than 30, athletes with history of chronic inflammation

S/S of achilles tendon rupture

sudden snap with immediate pain which rapidly subsides, point tenderness, swelling, discoloration, decreased ROM, obvious indentation, positive Thompson test

Tx for achilles tendon rupture

surgical repair, non-operative care includes PRICE and non-weight bearing cast for 6 weeks, long rehab

MCL sprain MOI

severe lateral blow or outward twist

special test for MCL sprain

Valgus stress test

S/S of Grade 1 MCL sprain

stable valgus test, little or no joint effusion, some joint stiffness, point tenderness, relatively normal ROM

S&S of grade 2 MCL sprain

partial tear, slight laxity, slight effusion, moderate to severe joint tightness w/decreased ROM, pain along medial aspect of knee

S&S of grade 3 MCL sprain

complete loss of medial stability, possible meniscus tear, minimum to moderate effusion, immediate pain followed by ache, loss of motion

MOI of LCL sprain

varus force, generally w/tibia internally rotated

S&S of LCL sprain

pain and tenderness over LCL, swelling and effusion around LCL

LCL sprain special test

varus stress test

MOI of ACL sprain

deceleration with foot planted and turns forcing tibia into internal rotation

Cause of ACL sprain

femoral notch, ACL size, laxity, malalignments, faulty biomechanics

what other structures can be injured when an ACL sprain occurs

meniscus, MCL, articular surface, capsule

S&S of ACL sprain

pop w/severe pain and disability, rapidly forming effusion

TX for ACL sprain

PRICE, surgery: joint reconstruction w/grafts or transplantation of external structures

PCL sprain MOI

fall on bent knee with plantar flexion

S&S of PCL sprain

- feel a POP in the back of the knee
- tenderness/swelling in the popliteal fossa

TX for PCL sprain

PRICE, surgery or non-operative care

MOI of meniscus injury

rotary force w/knee flexed or extended while weight bearing

S&S of meniscus injury

effusion, palpable joint line pain, loss of motion, intermittent locking and giving away, pain w/squatting

TX for meniscus injury

immediate care = PRICE, surgical vs non surgical options

runners knee cause/MOI

repetitive/overuse knee flexion and extension

S&S of runners knee

pain on palpation of insertion on lateral femoral condyle, inflammation, pain with activity

TX for runners knee

correction of malalignments, ice before and after activity, proper warm-up and stretching, NSAIDS, avoidance of aggravating activities

runners knee

iliotibial band friction syndrome

jumpers knee

patellar tendonitis

cause of jumpers knee

jumping or kicking, placing tremendous stress and strain on patellar or quads tendon

S&S of jumpers knee

pain with activity, pain on palpation at inferior pole of patella

TX for jumpers knee

avoid aggravating activities, ice, rest, NSAIDS, exercise, patellar tendon brace

Osgood-Schlatter disease cause

apophysitis: at tibial tubercle, result of repeated pulling by tendon, begins cartilagenous and develops a bony callus

S/S Osgood-Schlatter Disease

inflammation, enlarged tubercle, pain w/activity, pain w/palpation on tibial tubercle

TX Osgood-Schlatter Disease

reduce stressful activity until union occurs (6-12 mo), padding, possible casting, ice before and after activity, isometrics

cause of hip labral tear

repetitive overuse

S&S of hip labral tear

clicking, locking, catching, pain in groin, stiffness, limited motion

TX Hip labral tear

exercises to maintain ROM, strength and stability, avoid aggravating activities, surgical repair

Cause of Piriformis Syndrome

Compression of sciatic nerve; irritation due to tightness or spasm of muscle

s/s of piriformis syndrome

tenderness, numbness/tingling, difficulty sitting, pain

Tx of Piriformis Syndrome

avoid aggravating activities, NSAIDS, ice/heat, use correct form and equipment

sciatica cause

inflammation of sciatic nerve

what is the sciatic nerve vulnerable to

torsion, overstretching, or direct blows

S&S of sciatica

description of pain: sharp, shooting, burning, tingling, and numbness posterior-medial thigh, pain on palpation

TX for sciatica

rest, recovery 2-3 weeks

Cause/MOI of herniated disk

abnormal stresses and degeneration due to use, MOI: forward bending and twisting

S&S of herniated disk

central pain that radiated unilaterally along dermatome, pain w/forward bending and sitting, pain w/straight leg raise to 30 degrees

when are symptoms worse for herniated disk

in the morning

what reduces pain for herniated disk

back extension

TX for herniated disk

rest, ice, extension exercises

spondylosis cause

degeneration of vertebrae due to congenital weakness, stress fx results defect in articular process

spondylosis and spondylolisthesis S&S

pain and persistent aching, low back stiffness with increased pain after activity, frequent need to change position or pop back to reduce pain, localized tenderness

spondylolisthesis cause

slipping of one vertebrae above or below another

TX for spondys

bracing, bed rest for 1-3 days, exercises for controlling or stabilizing hypermobile segments, activity modifaction

acute torticollis

stiff neck, describes pain on 1 side of the neck on awakening

acute torticollis cause

small piece of synovial membrane lining the joint capsule is impinged within a facet joint

s/s of acute torticollis

point tenderness, muscle spasm, decreased motion

Tx of acute torticollis

modality usage to decrease pain/spasm, cervical collar

stenosis cause

narrowing of the spinal canal, impinging the spinal cord, congenital (related to injury)

S&S of stenosis

transient quadriplegia, neck pain, burning, tingling, weakness

TX of stenosis

diagnostic testing, discontinuation of contact sports

brachial plexus neuropraxia cause

stretching or compression of brachial plexus, forced lateral flexion of the neck with shoulder depression, compression of brachial plexus when neck is extended and rotated

S&S of brachial plexus neuropraxia

weakness, numbness, burning, altered neurological function, tenderness to trapezius, "milking of hand"

TX of brachial plexus neuropraxia

RTP once symptoms have decreased, strengthening, neck roll, cowboy collar

mandible injuries MOI

direct blow

mandible injuries S&S

deformity, loss of normal alignment/touching of teeth, pain when biting, bleeding, lower lip anesthesia

zygomatic fracture MOI

direct blow

S&S of zygomatic fracture

deformity, nosebleed, double vision