Semester 2-Sports med Final

What does PCL stand for?

Posterior Cruciate Ligament

What are the functions of the Posterior Cruciate Ligament?

• Stops anterior translation of the femur on the tibia in weight bearing

• Stops posterior translation of the tibia on the femur in non weight bearing 

• Resists internal rotation

• Resists hyperextension of the knee

What tendons make up the pes anserine?

joint tendon for the gracilis, sartorius, and semitendinosus muscle

What is the Infrapatellar fat pad?

Seperates the patellar tendon from rubbing on Tibia

What is the largest fat pad in the body?

Infrapatellar fat pad

What is normal flexion for the knee?

120-150 degrees

What is normal extension for the knee?

0 degrees

Overextension

Recurvatum-anywhere from 50-20 degrees

Tibia Internal Rotation

10 degrees

External Rotation

30-40 degrees

What does MCL stand for?

Medial Collateral Ligament

What else is the Medial Collateral Ligament known as?

Tibial Collateral Ligament

Function of MCL

• Prevent knee valgus forces

• Prevent external rotation

What does LCL stand for?

Lateral Collateral Ligament

What else is the Lateral Collateral Ligament known as?

Fibular Collateral Ligament

Function of Lateral Collateral Ligament

• to resist knee varus forces

ACL stand for

Anterior Cruciate Ligament

ACL tear symptoms

• Experience pop with severe pain and disability

• Positive anterior drawer and Lachman’s

• Rapid swelling at the joint line

• Other ACL tests may be positive

ACL tear mode of injury

tibia externally rotated and valgus force at the knee (occasionally the result of hyperextension from direct blow)

What does PCL stand for?

Posterior Cruciate Ligament

Posterior Cruciate Ligament Mode of injury

Fall on bent knee

What is a PCL injury also known as?

Dashboard injury

Posterior Cruciate ligament Signs and Symptoms

• Feel a pop in the back of knee

• Tenderness and relatively little swelling in the popliteal fossa

• Laxity with posterior sage test

Cruciate

Cross match

Intracapsular ligament

…

Extra capsular ligaments

…

What is the strongest ligament in the knee?

Posterior Cruciate Ligament

What is the longest muscle in the body?

Sartorius

What is the strongest bone in the body?

Femur

What bones make up the knee joint?

• Femur

• Tibia

• Patella

What artery is the major blood supplier to the knee?

Popliteal artery

How many types of cartilage around found in the knee?

2 types

What are the types of cartilage found in the knee?

- Articular Cartilage (hyaline cartilage)

- Meniscus-medial and lateral (fibro-cartilage)

Articular Cartilage is also known as…

Hyaline Cartilage

Meniscus Cartilage is also known as…

fibro-cartilage

How many zones are in the meniscus?

3 zones

Describe the different zone levels of the Meniscus

• Zone 1 - vascular and closest to joint capsule

• Zone 2- in the middle of each ring and has minimal blood supply

• Zone3-Closest to center and is avascular

What else Zone 1 known as?

Red-red zone

What else is Zone 2 known as?

Red-White Zone

What else is Zone 3 known as?

White white zone

What does pes anserine mean?

“goose’s foot”

Quadriceps means

Four heads

Biceps means

Two heads

What is the major veins that drains the knee?

Popliteal vein

What is a Bursa?

Fluid filled sac

What type of injury causes effusion in 2-6 hours?

…

What type of injury causes effusion in 48-72 hours?

Meniscal Lesions

What is unique about a grade III MCL Sprain?

Most severe and complete tear of ligament

Grade III MCL Sprain Signs and symptoms

• Complete tear of supporting ligaments

• Complete loss of medial stability

• Minimum to moderate swelling

• Immediate pain followed by ache

• Loss of motion due to effusion and hamstring guarding

• Positive valgus stress test

What are the functions of the meniscus

• To deepen the articular facets on the tibia

• Act as a shock absorber.

• Provide space between the tibia and femur

• Help with knee stabilization, specifically when flexed

Elbow Articulations

• Humeroulnar joint

• Humeroradial joint

• Proximal Radioulnar joint

What type of joint is the Humeroulnar?

Modified hinge joint

What sets of motion does the Humeroulnar joint perform?

Only 1 set of motion-flexion/extension

What type of elf joint is the Humeroradial?

Modified hinge joint

What sets of motion does the Humeroradial perform?

2 sets of motion-Flexion/extension and Internal rotation/external rotation

What sets of motion does the Proximal Radioulnar joint perform?

1 set of motion-Flexion/extension

What is normal extension for the Elbow?

0 degrees

What is normal flexion for the Elbow?

150 degrees

What is the normal range of motion for Supination/Pronation in the Elbow?

80-90 degrees

What structure is very superficial and susceptible to injury?

Olecranon Bursa

What artery is the main supply in the Elbow?

Brachial artery

Arterial Supply of Elbow

• Brachial artery main supply

• Branches to radial and ulnar arteries to supply blood to the forearm

What are the four major veins of the Elbow?

• Medial cubital

• Basilic

• Cephalic

• Brachial vein

What do all of the four major veins of the elbow drain into?

Axillary Vein

What are the ligaments of the elbow?

• Ulnar Collateral Ligament

• Radial Collateral Ligament

• Annular Ligament

What else is the Ulnar Collateral Ligament known as?

Medial Collateral Ligament

The Ulnar Collateral Ligament supports against the…

valgus force

What else is the Radial Collateral Ligament known as?

Lateral Collateral Ligament

The Radial Collateral Ligament resist against the…

varus stress

What movements does Annular Ligament help?

Internal rotation and External rotation of the radius/ulna

Annular Ligament Fibers

• Anterior fibers are taut with supination

• Posterior fibers are taut with hyperpronation

What is the normal carrying angle?

• Elbow demonstrates a carrying angle due to distal projection of humerus

What is the normal carrying angle in females?

10-15 degrees

What is the normal carrying angle in males?

5 degrees

Who was the team physician that operate on Tommy John?

Dr. Frank Jobe

What is Tommy John Surgery?

Surgical procedure to repair the Ulnar Collateral Ligament in the elbow

What structure is temporarily moved during Tommy John Surgery?

The Ulnar Nerve

What structure is used for Tommy John Surgery?

Palmaris Longus

What are the nerves of the elbow?

• Median Nerve

• Radial Nerve

• Ulnar Nerve

What arteries does the Brachial Artery branch off into?

Radial and Ulnar Arteries

Where is the Subcutaneous Olecranon Bursa located?

Between the skin and Olecranon

What is the role of the UCL in the forearm?

Holds together the Ulna and Humerus

Who was the second elbow surgeon to perform Tommy John Surgery?

Dr. James andrews

What percentage of all current major league pitchers have had Tommy John surgery?

33%

What is the success rate of Tommy John surgery?

Over 80%

Bennett’s Fracture

• Etiology

  • Occurs at carpometacarpal joint of the thumb as a resul of an axial and abduction force to the thumb

• Signs and symptoms

  • CMC may appear to be deformed-X ray will indicate fracture

  • Athlete will complain of pain and swelling over the base of the thumb

Bennetts Fracture Management

• Structurally unstable and must be referred to an orthopedic surgeon

• Surgery and immobilization-season ending

Bikers Palsy

Ulnar Nerve compression

Bikers Palsy Management

padding (Gloves), ICE, NSAIDs

Boutonniere Deformity

• Rupture of extensor tendon dorsal to the middle phalanx-bone passes through central slip

• Forces DIP joint into extensions and PIP Joint into flexion

Boutonniere Deformity-Management

• Cold application, followed by splinting in PIP extension and DIP flexion

• Splinting must be continued for 5-8 weeks

Boxer’s Fracture

Fractures of 5th metacarpal

Carpal Tunnel Syndrome

Compression of Median Nerve

Carpal Tunnel Syndrome-Special Tests

Tinel’s sign and Phalen’s

Carpal Tunnel Syndrome-Mangement

Conservative (PRICE, NSAIDs) and Surgical

deQuervain’s Disease

• Stenosing(narrowing) tenosynovitis of the extensor pollicis brevis and abductor pollicis longus.

deQuervain’s Disease-Special Test

Finklestein’s test

deQuervains Disease-Management

• RICE, NSAIDs

Gamekeepers Thumb

• Etiology

  • Sprain of UCL of MCP joint of thumb

  • Mechanism is forceful abduction of proximal phalanx occasionally combined with hyperextension.

• Signs and symptoms

  • Pain over UCL in addition to weak and painful pinch

• Management

  • Immediate follow up must occur

  • Thumb splint should be applied for protection for 3 weeks

  • Splint should extend from wrist to end of thumb in natural position 

  • Surgery may be required

Jersey Finger

• Etiology

  • Rupture of flexor digitorum profundus tendon from insertion of distal phalanx

  • Often occurs with ring finger when athlete tries to grab a jersey

• Signs and Symptoms

  • PIP can not be flexed, finger remains extended

  • Pain and point tenderness over distal phalanx

• Management

  • Must be surgically repaired

  • Rehab requires 12 weeks and tehre is often poor gliding of tendon with possible of re-repture