Final Exam PED 315

Fractures

diagnosed by radiograph (X-ray)

Stress fractures

gold standard MRI

Dislocation

Bones in the joint completely come out of place

Subluxation

Bones in teh joint partially come out of place

Sprain

Injury to connective tissue that connects two bones together (ligament)

Strain

injury to muscle or tendon

Grade 1 Muscle Strain

Limited muscle fibers

Pain, tenderness, normal strength and ROM

Grade 2 Muscle Strain

Nearly ½ muscle fibers

more severe pain, tenderness, swelling, loss of strength and ROM, maybe bruise

Grade 3 Muscle Strain

Complete rupture

Pain, swelling, tenderness, discoloration, complete loss of muscle function

Grade 1 Ligament Sprain

Microscopic tearing

Minimal tenderness and swelling

Grade 2 Ligament Sprain

Tears of some but not all fibers

Moderate tenderness and swelling, decreased ROM, mild joint instability at most

Grade 3 Ligament Sprain

Complete Rupture

Significant swelling, bruising, tenderness, instability

P in PEACE

Protection- avoid movements that increase pain

1st E in PEACE

Elevation- elevate higher than heart as often as possible

A in PEACE

Avoid Anti-Inflammatories

C in PEACE

Compression- use elastic bandage or taping to reduce swelling

2nd E in PEACE

Education- body knows best avoid passive unnecessary treatments

L in LOVE

Load- let pain guide how you return to natural actiities

O in LOVE

Optimism- condition your brain for optimal recovery

V in Love

Vascularization- choose pain free cardiovascular activites to inc blood flow

E in LOVE

Exercise- restore mobility, strength and proprioception

Tendinopathy treatments

PEACE and LOVE

Eccentric exercises

Heavy slow resistance

cartilage

moderate mechanical loading helps maintain this

Osteoarthritis

progressive lose of articular cartilage

Osteochondritis dissecans (OCD)

Fragment of cartilage and bone separates from surrounding regions

childhood/adolescence 

Rotator Cuff Muscles

Supraspinatus

Infraspinatus

Subscapularis

Teres Minor

Causes of Rotator Cuff Tear

Macro or micro trauma to the shoulder

Symptoms of Rotator Cuff Tear

Limited/painful ROM

Full thickness may see shrug instead of shoulder flexion

Painful and weakness in muscles with testing

Pain laying on the side

External Impingement

Inflammation, irritation on the top of the rotator cuff tendon in the subacromial space

External Impingement Symptoms

Visible changes in the acromion

Painful arc between 60 and 120 degrees

similar to partial rotator cuff tear

Internal Impingement

Tendons pinched between humeral head and glenoid rim (bottom)

Internal Impingement Causes

Overhead athlete repetitive movements

Internal Impingement Symptoms

Pain at end range

Pain in 90/90

GIRD

GIRD- Glenohumeral Internal Rotation Deficit

loss of 20 degrees internal rotation+loss of total rotational motion

if total ER and IR is the same its fine not GIRD

Labrum

Fibrocartilage

Long head of Biceps attachment

stabilizes shoulder 

SLAP

Superior Labrum Anterior to Posterior

Bankart

Front lower

Posterior

posterior of glenoid

Labrum Causes

Direct Blow

falling on outstretched arm

quick violent motion

microtrauma

Labrum Symptoms

Instability

Pain with overhead activities

Painful popping or catching in shoulder

Decreased ROM and strength

Instability anatomy

Rotator cuff and scapular muscles

Instability Causes

History of dislocation or subluxation, general hypermobility, sport specific

Instability Symptoms

Increased ROM

Decreased strength of rotator cuff and scapular muscles

Episodes of instability

Can be associated with labral tear

AC sprain anatomy

Acromioclavicular ligament

Coracoclavicular ligament

Acromioclavicular joint

AC Sprain Cause

Fall onto shoulder

Impact injury 

AC Sprain Symptoms

Deformity

palpable tenderness at AC joint

Pain with overhead motion and reaching across body

Scapulothoracic Dyskinesis Causes

Muscle imbalances and weakness

Prior injury history

Nerve dysfunction

Scapulothoracic Dyskinesis Symptoms

Pain with motion especially overhead

Altered scapular pattern

Relief of pain with proper scapular pattern

PROM

Passive, arm not doing anything

AAROM

Active assisted, stick exercises

AROM

Active

Acute Phase- Shoulder Exercises

Higher pain levels

Isometrics

PROM and AAROM

Below shoulder height

Light low range resistance bands

Intermediate Phase- Shoulder Exercises

Pain levels still there- lower and more stable

More AROM less AAROM

Beginning resistance training with external load

Exercises performed in more ROM but still in respect to pain

Advanced Phase- Shoulder Exercises

Minimal to no pain with movement

Progress resistance with exercises

High functional or sport specific exercises

Build strength, Motor control, Patient performance goals

UCL injury

Ulnar Collateral Ligament

Pain in medial elbow in late cocking phase of throwing

UCL Causes and symptoms

Macro and Micro trauma

may have Ulnar nerve symptoms as well

UCL Surgery Reconstruction

Graft replaces regular UCL

UCL Surgery Internal Brace

Collagen-coated tape placed at the damaged ligament to protect and promote healing

OCD in Elbow

Cartilage and subchondral bone become separated at humeral capitellum

OCD Elbow Causes

Repetitive stress to the elbow

OCD Elbow Symptoms

Pain, Clicking

radiograph to determine size and location

OCD Elbow Treatment

Rest from the overuse activity 3 month MINIMUM

May require surgery

Cubital Tunnel Syndrome

Ulnar Nerve

Cubital Tunnel Syndrome Causes

Compression, Stretching, and Other elbow injury

Cubital Tunnel Syndrome Symptoms

Numbness and pain along inner forearm and 4th and 5th digits

Cubital Tunnel Syndrome Treatment non- surgical

Brace, ROM, Strength and Nerve guides

Cubital Tunnel Syndrome Treatment - surgical

Release pressure in cubital tunnel

Transposition of ulnar nerve

Lateral Epicondylitis

Extensor tendons that attach to the lateral epicondyle of the humerus 

Wrist extensors

Lateral Epicondylitis Causes

Repetitive stress (tennis elbow)

Lateral Epicondylitis Symptoms

Palpable pain

Reduces and painful grip strength

Reduced flexibility of wrist extensor muscles

Painful resistances testing of wrist extensor muscles

Medial Epicondylitis

Flexor tendons attached to the medial epicondyle of the humerus

Wrist flexors

Medial Epicondylitis Causes

Tendon Inflammation, Micro tearing or degeneration

Repetitive stress

Medial Epicondylitis Symptoms

Palpable pain

Reduced and painful grip strength

Reduced flexibility of wrist flexor muscles

Painful resistance testing of wrist flexor muscles

Distal Biceps Rupture Causes

Sudden injury

Distal Biceps Rupture Symptoms

Felt ‘POP’

Bruising

Unable to flex elbow or painful to do so

Distal Biceps Rupture Treatment

Surgery for full rupture

performed within days 

Lateral Epicondylitis Exercises

Wrist extensors Eccentric exercises

Medial Epicondylitis exercises

Wrist flexors Eccentric exerrcises

Distal Biceps Repair

Brace to limit ROM early on (first 6 wks)

Full ROM (6-12 wks)

Isometrics and progress resistance beginning at weeks 6-8

Cubital Tunnel exercises

Nerve glides

Hand and finger strengthening

Total arm strengthening

FAI- Pincer

Outgrowth on acetabulum

FAI-Cam

Outgrowth on the femoral head

FAI- Combined

Growths on both Acetabulum and Femoral head

Femoroacetabular Impingement (FAI)

Osseous condition in the hip joint

3 categories

FAI symptoms

Pain in groin

Pain wit hip Flexion, Adduction and Internal rotation

May have clicking

Decreased ROM

FAI Treatment

Conservative: strengthening and ROM

Surgical: arthroscopic debridement and labral repair

Hip Labrum Causes

Trauma

Repetitive stress

Osseous abnormality

Hip Labrum Treatment

Conservative: Build up everything else, flexibility, strength

Surgery 

Gluteal Tendinopathy

Pain in lateral hip on greater trochanter

Gluteal Tendinopathy Symptoms

Pain in lateral hip

Pain exacerbated with resisted hip abduction resistance testing

Weakness with testing of gluteal muscles

Gluteal Tendinopathy Treatment

Gradually strengthen gluteal muscles

Hamstring Strain Cause

Quick Hip Flexion and Knee Extension

Hamstring Strain Symptoms

Sudden onset of posterior hip pain

Palpable

Pain and Weakness with resisted knee flexion

Bruising?

Hamstring Strain Treatment

PEACE and LOVE

Gradually rebuild strength and ROM

Surgery if setbacks occur

Adductor Strain Causes

Sudden acceleration

Sudden change in direction 

Adductor Strain Symptoms

Pain in inner thigh

Pain with resisted hip Adduction

Adductor Strain Treatment

PEACE and LOVE

Gradually Rebuild Adductor strength and ROM

Athletic Pubalgia (sports hernia)

Weakening of abdominal wall without evidence of a true hernia

Athletic Pubalgia Symptoms

Groin and lower abdominal pain

Pain with kicking, cutting, sprinting

Pain with resisted sit-up!!

Pain with forced cough/sneeze

Athletic Pubalgia

Rest

Gradual build up in strength and activity

Surgery maybe