Sports medicine exam 2 review

Why do we assess our clients?

- To gather baseline data like age, sex, and athletic norms

-To gather information to help with exercise prescription

- Evaluate profess in a training block

- Motivational

SMARRT Goals

Specific, measurable, aggressive but attainable, relevant, time-bound

When should we assess our clients?

- Prior to exercise training program

- Periodically during/ after training block

- Long-term

How do we interpret our assessments?

- External comparisons

- Internal Comparisons

External Comparisons

Compared to age, sex, athletic norms

Internal Comparisons

- Comparing bilaterally

Comparing longitudinally

Testing Organization

- Create testing protocol and organization of tests

- Have all data collection sheets prepared

- Check all equipment

- Room temperature (68-72)

Test Enviorment

- Test anxiety

- Client emotions

- Room temperature

- Room ventilation

General Indications for stopping and exercise test

- Onset of angia or angia like symptoms

- Drop in SBP less than or equal to 10mmHG with an increase in work rate

- Excessive rise in BP

- Shortness of breath, wheezing, leg cramping

- Signs of poor perfusion

- Noticeable change in heart rhythm by palpation or ausculation

Signs of poor perfusion

Light-headness, confusion, neasuea, pallor, cyanosis, cold and clammy skin

Test Administartion

- Selection and training of testers

- Recording forms

- Test format

- Testing batteries and multiple testing trials

- Preparing athletes for testing

How long should one rest between attempts that are close to the athletes maximum?

2 to 3 minutes

How long should one rest between tests are close to maximum

3 to 5

How long should be the rest between test batteries?

5

What is the kinetic chain?

Consists of the muscular system, skeletal system, and nervous system

Muscular system

Functional anatomy

Skeletal system

Bones and their articulation

Nervous system

As it relates to movement

Endomorph

Round and heavy body type

Mesomorph

Broad shoulder, narrow hips, muscular

Ectomorph

Narrow shoulders and hip, very little muscle or body fat

What are common deviations

- Upper crossed syndrome

-Lower crossed syndrome

- Pronation distortion syndrome

What muscles are tight or over active in upper crossed syndrome

Pec major/minor, Levator scapulae, upper trapezius, cervical extensors

What muscles are inhibited or weak in upper crossed syndrome

Rhomboids, middle/ lower trap, serratus anterior, cervical flexors

What is upper crossed syndrome?

forward head and rounded shoulders

What is lower crossed syndrome?

anterior tilt to the pelvis (arched lower back)

What muscles are tight or over active in lower crossed syndrome?

Hip flexors, gastrocnemius/ soleus, lumbar extensors, adductor complex

What muscles are inhibited or weak in lower crossed syndrome?

Abdominals, gluteus maximas, gluteus medius, and hamstrings

What is pronation distortion syndrome

Excessive foot pronation, knee flexion, internal rotation, and also prevents valgus stress during functional activity

What is the FMS?

A batteru of 7 fundamental movement patterns (tests) designed to evaluate movement dysfunction and asymmetries

What are movemnts of the FMS?

Deep squat, incline lunge, shoulder mobility, active straight leg raise, trunk stability pushup, rotary stability

What is a 3 in FMS Scoring?

Able to perform the test correctly

What is a 2 in FMS Scoring?

Able to perform the test correctly in a modified position or able to partially complete the test

What is a 1 in FMS Scoring?

Unable to successfully complete the test

What does a 0 mean in FMS Scoring?

Pain during the test or clearing test

What is ROM?

The total avilable amount of movement in a joint

How can we evaluate precise ROM?

Goniometer, inclinometer, and tape measure

What are the three types of ROM?

Active, passive, resisted

Active Range of Motion

The arc of motion attained by a subject during unassisted voluntary joint motion

Passive Range of Motion

The arc of motion attained by an examiner without assistance by the subject

End Feel

The limitation at the end of the ROM that prevents the movement from going any further

Normal end feel

Soft tissue approximation, firm muscular, capsular, or ligamentous stretch, hard bone contracting bone

Abnormal end feel

Soft tissue edema, synovitis, firm increase muscular tonus, capsular, ligamentous or muscular shortening, hard osteoarthritis, loose bodies in joint, myositis ossificans, fracture

Empty end feel

No real end feel, rom never reached due to pain, no resistance except patient gaurding, acute joint inflammation, brusitis, fracture, psychogenic origin

Goniometry

The use of instruments to measure the range of motion of body joints

Goniometer starting position

0 degrees

Exceptions for goniometer starting position

Shoulder and hip rotation and forarm pronation/supination

Strength assessment

-MMT/RROM

-Isokinetic

-Dynamometry

-Max strength tests???

Handheld Dynamometry

Easy and objective measurement of strength

Fusiform

Fibers arranged parallel to line form origin insertion

Pennate

Fibers inserted obliquely into tendon that extends length of muscle on one side or through the belly

Does a long fusiform increase or decrease the vulnerability to stretch

Increase

Does pennate increase or decrease the vulnerability to stretch

Decrease

Fan Shaped fasciculi arrangement

Looks like a group of muscles formed side by side in a fan shape

Subluxation

Excessive translation of the humeral head without complete seperation

Anterior dislocation

The result of an anterior force on the shoulder, forced abduction, and external rotation

Posterior dislocation

Occurs due to forced adduction and internal rotation or fallon on an extended and internally rotated shoulder

Characteristics of an anterior dislocation

Flattened deltoid, prominent humeral head in axilla, arm carried in slight abduction and external rotation, and moderate pain and disability

Characteristics of posterior dislocation

Severe pain and disability, arm carried in adduction and internal rotation, prominent acromion and coracoid process, limited external rotation and elevation

Bankart Lesion

Permanent anterior defect of labrum

Hill Sachs Lesion

Caused by compression of cancellous bone against anterior glenoid rim creating a diviot in the humeral head

SLAP lesion

Defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum

Possible complications of shoulder dislocations

Bracial nerves and vessels may be compromised, rotator cuff injuries, fractures, bicipital tendon subluxation and transverse ligament rupture

Type 1 SLAP

Fraying of the superior labrum with no detatchment of the biceps insertion

Type II SLAP

Detachment of the superior labrum and biceps tendon

Type III SLAP

Bucket handle tear of the superior labrum with the biceps tendon

Type SLAP IV

Bucket handle tear of superior labrum with biceps tendon tearing

Anterior chronic instability

May have clicking or pain; complain of dead arm during cocking phase; pain posteriorly possibly impingment, positive apprehension test

Posterior Chronic Instability

Possible impingement, loss of internal rotation; crepitation; increased laxity; pain anteriorly and posteriorly

Multidirectional Chronic Instability

Inferior laxity; positive sulcus sign; pain and clicking with arm at side, possible signs and sympotoms associated with anterior and posterior instability

What is an acromioclavicular sprain commonly called?

Seperated shoulder

How does an acromioclavicular strain happen?

Direct blow that is upward force from humerus

What is an acromioclavicular sprain?

Force driving clavicle away from scapula

What is ruptured during an acromioclavicular sprain?

Ac and or coracoclavicular ligament

Grade 1 AC joint sprain

Point tenderness and pain w/ movement; no disruption of AC joint

Grade 2 AC joint sprain

tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abduction/adduction)

Grade 3 AC Joint Sprain

Rupture of AC and CC ligaments

Grade 4 AC Joint Sprain

Posterior dislocation of clavicle

Grade 5 AC Joint Sprain

Loss of AC and CC ligament; tearing of deltoid and trapezius

Grade 6 AC Joint Sprain

Displacement of clavicle behind the coracobrachials

AC Joint Sprain Management

Ice, stabilization, referral to physcian

What AC Joint sprains are non-opprative?

1-3

What AC Joint sprains require surgey?

4-6

How do fractures of the elbow occur?

FOOSH and a direct blow

What bones are still aligned during a dislocation of the elbow?

Condyles and humerus

What may condyle fractures result in?

Gunstock deformity

Postolateral dislocation stage 1

Disruptions of the ulnar portion of the laterally collateral ligament complex with postolateral subluxation and spontaneous reduction

postolateral dislocation stage II

Continues disruption anteriorly and posteriorly with accompanying partial dislocation

postolateral dislocation stage 3A

A disruption of all soft tissues except for the anterior bundle of the MCL. Complete posterior dislocation

Postolateral dislocation stage 3B

Complete rupture of the MCL complex with gross valgus and vargus instability

Scaphoid fracture MOI

FOOSH- compressing scaphoid between radius and second row of carpal bones

Signs and symptoms of schaphoid fracture

- Pain and swelling in anatomical snuff box

- Pain with radial deviation

- May be confused with a sprain

Scaphoid fracture management

- Immobilization = 6wks

- Remobilize --> restore strength

Often has complications

May require surgery

Protect against impact = 3months

Impingment Syndrome

Strong relationship between rotator cuff weakness, altered glenohumeral and scapulothoracic kinemetics, and impingement

Impingement Syndrome Signs and Symptoms

• pain with palpation of subacromial space or tendons

• Overhead athletes = may see increased GH external rotation and decreased internal rotation (GIRD)

• Positive impingement and empty can tests

Neer's progressive stages of shoulder impingement: Stage 1

- Supraspinatus or biceps tendon injury

- Point tenderness

- Pain with abduction and resisted supination with external rotation; edema, thickening of rotator cuff and bursa

- Occurs in patients less than 25 years old

Neer's progressive stages of shoulder impingement: Stage 2

- Permanent thickening

- Fibrosis of supraspinatus and biceps tendon

- Aching during activity that worsens at night

- May experience restricted arm motion

Neer's progressive stages of shoulder impingement: Stage 3

- History of shoulder problems and pain

- Tendon defect (3/8") or possible muscle tear and permenant scar tissue and thickening of rotator cuff

- Patients 25-40 years old

Neer's progressive stages of shoulder impingement: Stage 4

- Infraspinatus and supraspinatus wasting

- Pain during abduction

- Tendon defect greater than 3/8"

- Limited active ROM

- Weak resistive ROM and clavicle degeneration

What is lateral epicondylitis known as

Tennis elbow