Ortho Principles Exam 1

define differential diagnosis

the list of possible pathologies we can’t rule out after a full clinical elavuation

different parts of the initial injury survey and what is included

primary: life or limb threatening

secondary: seriousness? next steps and how to move them in the safest way

difference between clinical and on-field assessments

on the field you don’t have access to evaluation tools, medical record, or time

what are the SINS of an injury

severity - signs and symptoms (mild, moderate, severe)

intensity - pain scale (1-10)

nature - structures involved (sprain, strain, fracture)

stage - acute vs chronic

subjective section of a SOAP note

information provided by the athlete

objective section of a SOAP note

information gathered from special tests or other assessments performed by the clinician

define a comparable sign

recreating a feeling an athlete is feeling during play to better understand the affected structures

role of the uninjured limb during an injury evaluation

gives baseline and allows you to begin mirroring

what can be observed during an injury assessment

redness, heat, swelling, mood/demenor, limping, eximosis, cognition, breathing, and/or atrophy

what can you palpate during an injury assessment

deformity, spasm, moisture, general contour of the structure, pulse, and/or clammy skin

define AROM

patient is moving the joint on their own, bone/ligament injury

define PROM

clinician moves the joint for the patient, muscle injury

difference between manual muscle testing and resisted range of motion

MMT: bringing patient to certain ROM and trying to bring them out of it, incorporated full ROM against gravity and the muscle against resistance

RROM: provide resistance through full ROM and adjust the resistance based on muscle length

purpose of joint stability testing

the assess the integrity of non-contractile tissues (ligaments and joint capsules)

difference between laxity and instability

laxity is objective

instability is subjective

define stress tests

test that applies direct force or stress to a joint or ligament to assess the stability and integrity

define joint play

small amount of passive movement within a joint that cannot be performed actively

define selective tissue test

isolate and place stress on a specific tissue or structure to determine whether that tissue is involved in an injury

the purpose of medical documentation

coommunicate between healthcare providers, track progress, provide legal record

sections of a SOAP note

S - subjective, what the patient tells you

O - objective, what we find

A - assessment, differential diagnosis

P - plan, first 72 hours

define sign, where should it go in the SOAP

a finding that can be measured or observed, objective

define symptom, where should it go in the SOAP

a finding a patient describes, subjective

define acute, describe the mechanism

sudden onset and short duration, single traumatic event or mechanism

define chronic, describe the mechanism

gradual onset and prolonged duration, accumulation of minor insults or repetitive stress

define apophysitis

inflammation of a bony projection or outgrowth that serevs as a muscle attachment

define bursitis

inflammation or swelling of a bursa

define capsulitis

inflammation of a joint capsule

define myositis

inflammatory response in a muscle or its surrounding connective tissue; can lead to ossification

define neuritis

inflammation or irritation of a nerve or nerve sheath

defins periostitis

inflammation of the membranous lining of a bone

define tendinitis

inflammation of the membranous lining of a bone

define tendinosis

microscopic tearing and degeneration of tendious tissue from repetitive trauma

define tendosynovitis

inflammation of the synovial sheath covering a tendon

what is snowball crepitus and what chronic inflammatory condition presents with it

a crackling or crunching sensation found in tenosynovitis

define neuropraxia

signal block in a compressed peripheral nerve

define axonotemesis

moderate to severe peripheral nerve damage to outer sheath

define neurotmesis

nerve is completely cut

define neuralgia

sharp, shocking, or burning following the path of a damaged nerve

define neuroma

abnormal growth or thickening of nerve tissue

what is the SAID principle

specific adaptations to imposed demands

clinical signs of atrophy and how it occurs

girth of the muscle is significantly less due to long-term immobilization, meaning stress levels fall below normal

clinical signs of hypertrophy and how it occurs

girth of the muscle is greater due to the magnitude and duration of stress levels being increased

“desirable” physical stress levels contribution to chronic injury

stress in the desirable region causes changes in the cellular structure, and it takes time for that structure to repair itself and prepare for another session and its physical demands. Without proper time, the individual is stressing tissue that is still recovering, and the stress will create a cumulative effect, possibly resulting in a chronic injury.

define the toe region

the beginning stage of tension development. There is no change in the strength or stability of the joint. The tissue of the ligament is getting rid of the slack and reaching a point of resistance.

define the elastic region

more load is applied, and collagen fibers within the ligament are beginning to stretch. There is not enough force for the ligament to stay at that length, and it will always return to its original length.

define the plastic region

reached the end of the elastic region; microfailure of the collagen fibers, meaning that when the load is released, the ligament is lengthened and can no longer return to its normal length.

is an increase in tissue stiffness with aging a good thing or a bad thing and why

bad thing, more stiffness = less stretch available in the ligament and the microfibers will tear with much less force, increasing the chance for injury

define microtrauma

when a single force exceeds the tissue’s failure point

what might a patient say during your history taking process that would lead you to believe the MOI was in the form of macrotrauma

I was playing soccer yesterday, and when I went to change directions, my foot stayed planted and my knee twisted. I felt a pop right away, and it immediately started hurting.

define microtrauma

when the body recieves repeated sub maximal forces over time and the tissue is unable to adapt

what might a patient say during your history taking process that would lead you to believe the MOI was in the form of microtrauma

I don’t remember doing anything specific to injure it. I’ve been running and practicing every day for the past few weeks, and my shin has gradually started hurting more

how do compression forces lead to chronic injury

when a patient is a goalkeeper and repeatedly dives on the ground, resulting in microtrauma due to the compression forces

example of a “high mass, low velocity” direct blow

person getting checked into the boards by someone with a larger body

describe tensile force

overstretching of tissue, common in muscle, tendon, ligaments, and fascia

describe compression force

stress applied at each end of a structure, common in bone

describe shear force

force applied perpendicularly, common in bones (dislocations)

describe torsion force

twisting, common in bone and ligaments

define ecchymosis

blue or purple area of skin caused by blood escaping into the extravascular spaces under the skin

define hematoma

collection of clotted blood within a confined space, localized blood tumor

signs and symptoms of a first-degree contusion

·      superficial tissue damage

·      minimal swelling and localized tenderness

·      no limitations to strength or ROM

signs and symptoms of a second-degree contusion

·      increased pain and hemorrhage

·      increased area and depth of tissue damage

·      results in mild to moderate limitations to strength or ROM or both

signs and symptoms of a third-degree contusion

·      severe pain

·      significant hemorrhage

·      hematoma formation

define heterotopic ossification

bone tissue forms abnormally inside soft tissues and muscles, outside of the normal skeletal system

define extracapsular

outside the joint capsule

define intracapsular

inside the joint

are intracapsular or extracapsular ligaments going to swell more

intracapsular

define joint end-feel

quality of the feel the examiner feels when applying pressure at the end of ROM

define joint laxity

denotes hypermobility

functional vs structural muscle strain

functional - pain and dysfunction, not due to actual damage, more of a neurological defense mechanism

structural - actual damage to the muscle fibers

predisposing factors for muscle strains

·      Fatigue

·      Lack of proper warm-up

·      Muscle imbalance

define dyssynchrony

misfiring or mistiming of a muscle contraction

british muscle injury grading scale

0 - soreness

1 - small tear

2 - moderate tear

3 - extensive muscle tear

4 - complete muscle tear

munich muscle injury grading scale

1A - fatigue-induced muscle discomfort

1B - DOMS

2A - spine-related neuromuscular muscle disorder

2B - muscle-related neuromuscular muscle disorder

3A - minor partial muscle tear

3B - moderate partial muscle tear

purpose of the paratenon, and how is it related to tendinopathy

where inflammation that occurs with teninopothay will occur

define tendinopathy

any tedon pathology

define tendinitis

the inflammation of the structures encases within a tendon’s outer layering

define tendinosis

degenerative condition

define tendosynovitis

an inflammation of the synovial sheath

signs and symptoms of tendinopathy

·      Localized pain

·      Mild symptoms and pain during activity, especially towards the end

·      Substantial change in ROM and gait

describe bursae

fluid filled sacs that serve to buffer muscles, tendons, and ligaments from other frictioning surfaces

describe bursitis

irritation of the bursae sac causing inflammation

If the patient has an inflamed bursa sac, but has no history of trauma to the area, what may have caused the bursitis to develop?

infection

What will you do during your evaluation to determine if infection is the root cause of the patient’s bursitis?

look up the leg from red streaks and/or feel for any enlarged lymph nodes within the femoral triangle

describe hyaline cartilage

cartilage located on the articular surface of bones, suited to withstand compressive and shearing forces

how can hyaline cartilage be injured

• Macrotrauma causing acute trauma

• Chronic trauma occurring with age - degeneration

partial thickness vs full thickness tear

partial - going through the superficial and middle layers

full - going all the way through the layers of the hyaline cartilage to expose the underneath

Between partial-thickness and full-thickness tears, which one is more likely to cause symptoms of pain and dysfunction?  Why?

Full thickness because the tear goes through the entire thickness

What are signs and symptoms of osteochondritis dissecans?

·      Locking

·      Decreased function

·      Increasing pain within the joint without a specific mechanism

gait pattern the may develop if there is isteochondritis dissecans in the knee

hip external rotation

describe a diaphyseal fracture

involves only the bones diaphysis and are associated with a good prognosis for recovery

describe a epiphyseal fracture

involves the fractre crossing the bone’s unsealed line and can have long term consequences by disrupting the bones normal growth

describe a osteochondral fracture

involves the joint’s articular cartilage

describe incomplete fracture

fracture line does not completely dissociate the proximal from the distal ends

describe non-displaced fracture

fracture line completely dissociated the two ends of the bone, but the two ends maintain proper allignment

describe displaces fracture

bony alignment is lost between the two segments; surrounding tissues may be jeopardized and/or put in danger

describe open fracture

a bony segment of a displaced fracture protrudes through the skin

describe comminuted fracture

fracture resulting in multiple fragments or shattering of the bone at the side of injury

describe compression fracture

failure of the bone and subsequent compression or impaction of the fracture ends due to axial compression forces

describe greenstick fracture

Incomplete fracture through the bone, most often occurring in young bones, resembling the breaking of a green stick

describe oblique fracture

The fracture line extends obliquely or diagonally in relation to the long axis of the bone