BRONZE Combined - Executive Summary

Anterior Compartment Syndrome

• Characterized by increased pressure in the lower leg secondary to swelling, which can occlude blood flow and cause ischemia and necrosis of the surrounding nerves and musculature

• This may occur secondary to athletic exertion. Acute cases are often caused by a traumatic injury and are considered a medical emergency

• Symptoms include:

Tightness and tenderness over the muscle belly of the tibialis anterior

Pain with passive stretching or active use of the muscle

Paresthesia and/or numbness in the distribution of the deep fibular nerve

Colles’ Fracture

• Frequently occurs when an individual reaches forward with their hands while attempting to break a fall; it is characterized by a transverse fracture of the distal radius

• Trauma related to this maneuver is commonly termed a FOOSH injury

• X-ray of the wrist is the preferred method of confirming a Colles' fracture and identifying displaced fragments or damage to adjacent bony structures

De Quervain's Tenosynovitis

• Results from an inflammatory process involving the tendons and synovium of the adductor pollicis longus and extensor pollicis brevis at the base of the thumb

• Onset is typically due to repetitive actions involving thumb abduction and extension, such as racket sports and repeated heavy lifting

• Symptom onset may be gradual or sudden (depending on the mechanism of injury) with reports of localized pain and tenderness in the area of the anatomical snuffbox, which may radiate

Myositis Ossificans

• characterized by the calcification of muscle that is usually caused by neglecting to properly treat a muscle strain or contusion

• Development of this condition occurs within a few weeks after the initial injury and may include: a noticeable hard lump in the muscle belly, n increase in pain, and a decrease in range of motion

• An X-ray is the primary imaging study used to confirm the diagnosis

Osteochondritis Dissecans

• Condition in which loss of blood flow to subchondral bone causes a piece of bone and its associated cartilage to crack and separate away from the end of the bone

• Symptoms may include:

Pain with functional activities

Joint popping or locking

Weakness

Swelling

Decreased range of motion

• X-ray imaging can be used to confirm the diagnosis

Osteomyelitis

• An infection that occurs within the bone, most commonly secondary to the Staphylococcus aureus microbe

• Damage to the bone from a surgical procedure, compound fracture, or puncture wound that penetrates the bone may directly expose the bone to infectious microbes

• A bone biopsy is the most conclusive procedure for diagnosing osteomyelitis and determining the specific infectious microbe present

Piriformis Syndrome

• Characterized as a result of compression or irritation to the proximal sciatic nerve due to piriformis muscle inflammation, spasm, or contracture

• Location of pain is often imprecise, but typically presents first in the area of the mid-buttocks, then progresses to radicular complaints in the sciatic nerve distribution

• Patients typically respond well to physical therapy interventions and are able to return to regular activities without restrictions

Posterior Cruciate Ligament Sprain

• Occurs when a posteriorly directed force is applied to the tibia in relation to the femur, such as when the knee hits the dashboard in a motor vehicle accident

• Individuals participating in contact activities requiring a high level of agility are particularly susceptible to injury

• A large majority of patients who experience PCL sprain are able to return to their previous level of function, including participation in athletics

Tarsal Tunnel Syndrome

• Occurs as a result of compression of the tibial nerve as it passes through the tarsal tunnel, causing neuropathy in the distribution of the nerve

• Signs and symptoms include:

Pain, numbness, and paresthesia in the foot

Muscle atrophy and weakness

Diminished light touch and temperature sensation

Antalgic Gait Pattern

• Tinel's sign can be used to confirm the presence of the condition. Diagnostic tests, (MRI, ultrasound, EMG, and NCV) may also be performed

Trochanteric Bursitis

• May occur as a result of acute or cumulative trauma to the lateral hip, causing irritation to the trochanteric bursa

• Causative factors may include:

A true or functional leg length discrepancy

History of lateral hip surgery

Participation in sports with significant running or contact

• Patients typically respond well to conservative treatment and should be able to return fully to their prior level of function (including sport activity)

Ulnar Collateral Ligament Sprain - Thumb

• Occurs secondary to a traumatic event in which an excessive valgus force is applied to the metacarpophalangeal joint in the thumb

• The therapist should perform ligament stability testing of the thumb by applying a valgus force to the joint. A movement of greater than 30-35 degrees indicates a complete tear of the UCL

• X-rays should be ordered to rule out the existence of a fracture or dislocation