common sports injuries presenting to FM

Family history of sudden cardiac death

red flags in family history to not in sports physial exam

Hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), congenital coronary anomalies.

cardiac findings to look for in athletes

Hypertrophic cardiomyopathy (HCM)

leading cause of sudden cardiac death in young athletes

Commotio Cordis

When the heart stops due to a sudden blow to the chest

Spirometry before/after exercise → ≥10-15% fall in FEV1 confirms diagnosis.

spirometry finding of exercise induced asthma

Pre-exercise SABA (albuterol)

first line management of exercise induced asthma

Increased iron loss (sweating, GI blood loss, hematuria, heavy menses).

Increased demand (endurance training).

Poor intake (vegetarian/vegan diets).

main causes of iron deficiency in athletes

Low hemoglobin/hematocrit.

Low ferritin (

lab findings indicative of iron deficiency anemia

sports anemia

False anemia or pseudo anemia caused by extensive aerobic training, which increases the plasma volume, producing a relative decrease in hematocrit

-normal ferritin and iron stores

heme iron

the iron in foods that is bound to the hemoglobin and myoglobin proteins; found only in meat, fish, and poultry.

vitamin C

supplement to hellp absorb iron

1. Low energy availability (with or without eating disorder).

2. Menstrual dysfunction (amenorrhea, oligomenorrhea).

3. Low bone mineral density (osteopenia/osteoporosis, stress fractures).

name the components of the female athlete triad

Amenorrhea >3 months.

History of stress fractures.

Restrictive eating or eating disorder.

red flags of the female athlete triad

ACL injuries

pts with female athlete triad have a higher risk for these injuries due to anatomic and hormonal factors

ensure adequate calcium/vitamin D intake

first line management for female athlete triad

spondylolysis

stress fracture of pars interarticularis — common in adolescent athletes, e.g., gymnasts, football linemen

spondylolisthesis

forward slipping of one vertebra over another

new fracture at same or other sites.

prior fracture history increases risk for

X-ray = initial.

MRI = best for stress fractures (early detection).

Bone scan = sensitive, less specific.

best forms of imaging for fractures

RED-S

Relative Energy Deficiency in Sport affecting health, new name for female athlete triad

Overuse, periostitis at tibial insertion

cause of medial tibial stress syndrome

medial tibial stress syndrome

-diffuse pain along medial tibia

-gradual onset, related to training errors, poor footwear

-xray normal

Rest, ice, stretching, footwear correction

treatment for mdeial tibial stress syndrome

chronic exertional compartment syndrome

-Increased pressure in fascial compartment with exercise

-Tight, burning pain with exertion, resolves with rest

Predictable: after certain distance/time of exercise

describe the onset of chronic exertional compartment syndrome

pressure testing

gold standard testing for chronic exertional compartment syndrome

surgical fasciotomy if severe

tx for chronic exertional compartment syndrome

stress fracture

Repetitive loading → microfracture

Localized point tenderness, worsens with activity; focal bony tenderness, possible swelling

MRI best for early detection

imaging for stress fracture

Rest, gradual return, activity modification; surgical fixation if severe

management of stress fracture

Spondyloysis

for low back pain in young athletes, think

Either:

Bone tenderness at the posterior edge or tip of the lateral malleolus, OR

Bone tenderness at the posterior edge or tip of the medial malleolus, OR

Inability to bear weight immediately after injury and for 4 steps in the emergency department/clinic.

an ankle X-ray is required if there is pain in the malleolar zone AND

Either:

Bone tenderness at the base of the 5th metatarsal, OR

Bone tenderness at the navicular bone, OR

Inability to bear weight immediately and for 4 steps in the ED/clinic.

a foot X-ray is required if there is pain in the midfoot zone AND

oblique

angled xray view for overlapping bones

Multiple views (≥2 perpendicular)

how many xray views are needed for an accurate diagnosis

acromion

an extension of the scapula that forms the high point of the shoulder

coracoid process

process above the glenoid cavity that permits muscle attachment

capitulum

Name this specific part of the humerus.

trochlea

Name this specific part of the humerus.

talus

Name this specific bone of the foot.

navicular

Name this specific bone of the foot.

cuboid

Name this specific bone of the foot.

ilium

Name this specific region of the pelvic bone.

ischium

the lower, posterior portions of the pelvis

obturator foramen

opening in hip bone formed by the pubic and ischial rami

fracture through the physis only

S= straight across

define a salter harris I fracture

fracture through the physis and metaphysis

A= above

define a salter harris II fracture

fracture through the physis and epiphysis

L=Lower

may involve joint surface--> moderate risk

define a salter harris type III fracture

Fracture through metaphysis, physis, and epiphysis

T= through

high risk for growth disturbance

define a salter harris type IV fracture

Crush injury to the physis

-high risk of premature growth plate closure

define a salter harris type V fracture

SALTR → Straight, Above, Lower, Through, Ramme

mnemonic to remember the salter harris fractures

types III-V

salter harris fracture types requiring orthopedic referral and possibly open reduction to restore growth plate alignment

tibia, metatarsals (2nd-3rd), navicular, femoral neck, fibula.

most common sites of stress fractures

anterior fat pad sign

indicates hemarthrosis in radial head fx

posterior fat pad sign

always pathologic; visible only when effusion displacees it out of the olecranon fossa

lateral xr

best view for elbow effusions

occult radial head fracture (adults) or supracondylar fracture (children).

common causes of elbow effusions

bulge sign

milk fluid toward the medial side; small wave on lateral side suggests effusion.

ballottement sign

patella "floats" and rebounds when pushed down.

-indicates pleural effusion

trauma, meniscal tear, ACL injury, infection, gout, inflammatory arthritis.

common causes of knee effusion

CT

imaging best for Bony detail, complex fractures (esp. pelvis, spine, facial bones, intra-articular)

MRI

imaging best for Soft tissue structures (ligaments, tendons, cartilage, marrow, menisci, discs)

Expensive, time-consuming, motion artifacts, contraindicated with metal

limitations of MRI

CT

what imaging should be used to evaluate comminuted fractures, subtle cortical breaks, preoperative planning.

MRI

what imaging should be used to Assess ACL/PCL tears, meniscal injury, rotator cuff tears, stress fractures not seen on X-ray.

inversion injury, which causes the fibular head to glide posteriorly at the proximal tibiofibular joint and the lateral malleolus to glide anteriorly at the distal fibula.

most common ankle sprain MOA

1. Patient PositionPatient seated or supine, knee flexed to 90°.

2. Physician PositionAt foot of table, stabilizing distal tibia with one hand; grasp lateral malleolus with the other.

3. Engage Restriction BarrierGently apply posterior pressure on the lateral malleolus to take up slack (toward correction).

4. Patient EffortAsk patient to evert the foot (activating peroneus longus/brevis) against physician's counterforce for 3-5 seconds

muscle energy for anterior medial mallolus