kine 3p80 final exam

Concussion

- impairment of brain function caused by impact or rotational force
- dysfunction can occur in absence of actual damage to brain tissue
- majority of concussions do NOT involve unconsciousness

symptoms of concussion

headache, nausea, vomitting

Physical effects of concussion

LOC, balance problems, visual problems, fatigues, photophobia, sensitivity to noise

emotional effects of concussion

irritability, sadness, more emotional, nervousness

cognitive effects of concussion

feeling like in a 'fog', dazed or stunned, feeling slowed down, difficulty concentrating, difficulty remembering, forgetful of recent information, confused about recent events, answers questions slowly, repeats questions

disordered sleep effects of a concussion

insomnia, drowsiness, sleeping more/less than usual, difficulty falling asleep

Concussion decision-making

concussion recognition tool, SCAT5, child SCAT5

S/S of second impact syndrome

- may not lose consciousness
- may leave field under own power
- rapid deterioration of condition (LOC, dilated pupils, loss of eye movement, respiratory failure)

effect of second impact syndrome

brainstem failure in 2-5 minutes

management of second impact syndrome

activate EMS

physical s/s of post concussion syndrome

headache, vertigo, dizziness, fatigue, low energy, sleep disturbance, nausea, vision changes, tinnitus, photophobia

cognitive s/s of post concussion syndrome

slowed thinking and response time, mental fogginess, poor concentration, distractibility, trouble with learning and memory, disorganization, problem-solving difficulties

behavioural s/s of post concussion syndrome

depression, anxiety, panic attacks, irritability, increased emotionality, apathy, lowered frustration tolerance, personality changes, clinginess

Chronic Traumatic Encephalopathy (CTE)

progressive degenerative brain disease found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head; marked by same neurofibrillary tangles as in AD

S/S of CTE

buildup of abnormal tau protein in the brain, memory loss, confusion, impaired judgement, impulse control problems, aggression, depression, progressive dementia

return to learn

Treatment for concussion
- Time off from school
- Shortened day
- Shortened classes
- Rest breaks in quiet place
- Extended time to complete assignments
- Reduced homework
- No significant testing

clavicular fracture

force is applied to the bone

FOOSH

fall on outstretched hand

shoulder joint

glenohumeral joint made up of 2 bones - humerus and scapula

shoulder girdle

acromioclavicular joint (AC joint) made up of the clavicle and scapula

sternoclavicular sprain

- very rarely injured
- gliding joint (only allows a tiny amount of movement)
- major artery ending is right behind it
- arm would be in a sling for ~6 weeks

acromioclavicular sprain

- forces apply to AC joint
- separates the clavicle from the acromion process of the scapula

Type I AC Sprain

-1st degree
-stretch or partial damage of the AC ligament and capsule

Type II AC sprain

-2nd degree
-rupture of AC ligament and partial strain of coracoclavicular ligament

Type III AC sprain

-2nd degree
-rupture of AC ligament and coracoclavicular ligament

Type IV-VI AC sprain

-3rd degree
-rupture of AC ligament and coracoclavicular ligament and tearing of deltoid and trapezius fascia

S/S of type I AC sprain

no deformities, slight swelling, mild palpable pain over joint line, some discomfort on abduction greater than 90 degrees, no instability

treatment of type I AC sprain

Ice, NSAIDs, regain full ROM and strength, return to activity as tolerated, with protection

S/S of type II AC sprain

slight elevation of lateral clavicle, AC ligaments are disrupted, moderate swelling, moderate palpable pain with downward pressure on distal clavicle, palpable gap or minor step present, snapping may be felt on horizontal adduction, unable to abduct the arm or horizontally adduct the arm across the chest without noticeable pain, some instability

treatment of type II AC sprain

ice, NSAIDs, immobilize with sling, TENS, interferential EMS for pain relief, ultrasound, strengthening and stability exercises, return to activity with protection

S/S of type III AC sprain

prominent elevation of clavicle, AC ligaments and coracoclavicular ligaments are disrupted, severe swelling, severe pain on palpation and depression of acromion process, definite palpable step deformity present, limited movement but pain is more severe, demonstrable instability

treatment for type III AC sprain

ice, immobilize, and immediately refer to physician, if treated conservatively, deformity remains but function should be within normal limits

Shoulder (GH) Dislocation

- head of humerus is completely pulled out forward and goes down (anteriorly & inferiorly)
- mobilize the arm in whatever way is comfortable and take them to the hospital
- if you have had this injury before it increases the chances of it occurring again

signs of GH dislocation

-very easy to see
-drop off after the acromion
-patient usually leans into the direction of the damage so you can tell

MOI of GH sprain

abduction with external rotation

treatment of GH sprain

ice, rest, sling (if very sore), not as serious as a dislocation, not a lot of swelling bc body is upright

Apprehension Test

- hold wrist with one hand and passively externally rotates the humerus to end range with the shoulder in 90 degrees of abduction
- forward pressure is applied to the posterior aspect of the humeral head by the examiner

positive test for anterior instability - apprehension test

if the patient reports pain during this test

rotator cuff muscles

Infraspinatus, teres minor, supraspinatus, subscapularis,

rotator cuff strain

-eccentrically contract
-supraspinatus is usually the most often injured

treatment of rotator cuff strain

ice, compression, elevation

impingement syndrome

occurs when inflamed and swollen tendons are caught in the narrow space between the bones within the shoulder joint, become compressed or pinched

Neer Test (shoulder)

-passively flex the shoulder to the end range to see if there is pain
-doesn't matter if the arm is internally or externally rotated

Positive Neer Test

if pain is produced

Empty Can Test

-to see if the supraspinatus is impinged
-hold arm out
-horizontal adduction (scapular plane)
-internally rotate the arm - this puts the supraspinatus in direct force

Speed's Test

Bicipital Tendinitis
Elbow full extension, forearm supinated
Resist shoulder flexion

Painful Arc Test

-subacromial impingement
-patient actively abducts arm in scapular plane
-while abducting patient must report if they experience any pain, once they say they have pain they must abducting as high as they can
-once patient reaches 120 degrees of abduction there should be a reduction of pain
-then the patient must adduct the arm back down

positive painful arc test

when the patient experiences pain between 60-120 degrees of abduction which reduces past 120 degrees of abduction

myositis ossificans

-bone formation within the muscle
-caused by continuous compression
-if you use massage/ ultrasound too early it can encourage this formation
-have to wait until they are fully formed to get it surgically removed (if you get it removed too early they will just continue to grow)

"pulled" elbow

-"pull" \= MOI
-head of the radius slips out of the annular ligament to hold it against the ulna
-can be partially/fully dislocated
-can happen in adults, mainly kids when they are lifted by their hands

Olecranon Bursitis

-inflammation of the bursa of the elbow
-pretty harmless
-common in soccer goalies because they land on their elbows a lot
-have to manage this quickly because the fluid can solidify (sometimes you have to acidify but can cause infection, want to try to fix with ice and compression)

Elbow injuries

-dislocation and fracture
-very serious
-not much you can do except activate EAP
-can apply ice but not directly on injury (above/below)

elbow dislocation

caused when a great deal of force is applied to an elbow that is in a slightly flexed position

Elbow Fracture

-due to a fall, direct impact, twisting injury
-usually right above the joint on the humerus

tennis elbow

-inflammation of the tendon that connects the arm muscles to the elbow
-lateral humeral epicondyle
-wrist extensors could be weak/fatigued

golfer's elbow

-Inflammation and pain of the flexor and pronator muscles of the forearm where their tendons originate on the medial epicondyle of the humerus; Epicondylitis
-affects the wrist flexors
-treat inflammation and fix the problem (wrist strength exercises)

UCL repair

-palmaris longus (ex) can be harvested to repair the ulnar collateral ligament
-can use other tendons
-at least a year but ~18 months for recovery bc tendons have to stay thinking like a ligament

hand grips

power grip, precision grip

wrist sprains MOI and S/S

-MOI- fall on hyperextended wrist
-S/S- tenderness, swelling, limited ROM

treatment of wrist sprain

apply ice and compression, immobilize with a sprint, do not go to hospital right away wait 24 hrs

MOI of scaphoid fracture

FOOSH

scaphoid fracture

-anatomical snuff box
-has blood supply only on one end
-fracture usually occurs in the middle of the scaphoid

MOI of colles fracture

FOOSH

colles fracture

dorsally and radially angulated fracture of the radius, within 3cm of the wrist

Lunate Dislocation

MOI: fall on an outstretched hand; hyperextended wrist
S/S: Pain; swelling; deformity (toward the palm); loss of function (wrist and finger flexion); numbness due to pressure on median nerve
Tx: PRICEMM; refer to MD for possible surgery

Carpal Tunnel

-8 finger tendons, a thumb tendon, median nerve \= all covered over band (flexor retinaculum) this allows your tendons to be covered when you flex your wrist
-overuse that causes inflammation may be a little too much to fit into that space so the median nerve gets compressed, sensation in the hand becomes different which causes a weakness in the muscle

2 tests for carpal tunnel syndrome

Carpal tunnel compression test, Phalen's test

Phalen's test

hyper flexion for a period of time to see if you can create the weakness in muscles and tingling

Ulnar nerve entrapment

A painful disorder of the lower arm and wrist caused by compression of the ulnar nerve at the wrist

Cutaneous Nerve distribution

-median nerve - first two fingers on palmer surface, first finger on the distal surface
-ulnar nerve for cyclists, median nerve for carpal tunnel

Fight bite

-occurs when the hand is in a clenched position
-teeth penetrate the skin
-extensor tendons on dorsal side are stretched out
-if the tooth penetrates the skin it can strike the extensor tendons
-infection can travel from this (esp. in locker rooms)

Bennett's fracture

-Articular fracture proximal end of first metacarpal
-fracture is not through the bone but it is up through the end of the metacarpal bone

MOI of Bennett's fracture

-punch thrown with a closed fist
-fall on a closed fist

Treatment of Bennett's Fracture

stabilize with some kind of forearm splint, ice, x-ray, immobilized in some way

Boxer's fracture

Fracture of 4th and 5th metacarpal

MOI of boxers fracture

punching an object with a closed fist

Treatment of Boxer's Fracture

-rolled up tensor and hold onto fracture and then tensor around to hold position in place
-x-ray

Phalangeal Fracture

running/disrupting a joint surface

Fracture assessment

-try to set up a vibration in the bone by tapping it
-vibration will travel up bone, it will dissipate into the soft tissue \= not injured
-if broken the vibration will move the two ends of the bone and cause pain
-tap test

'Buddy' taping

-if it is a simple phalangeal fracture you can use it
-tape fractured finger to un-fractured finger next to it
-if it is going to be like this for a long time, you should put padding in between fingers

Gamekeeper's thumb

sprain of ulnar collateral ligament of the thumb

test for gamekeeper's thumb

-hold a coin between your thumb and index finger
-if you cannot hold it your ligament is most likely torn

MOI of gamekeeper's thumb

-MP joint near full extension, thumb forcefully abducted away from hand
-skiing, baseball, football, hockey

dislocations of thumb

-needs to be seen at a hospital because there is a lot of soft tissue that crosses over these joints
-these things can get caught from a bone when you 'pop' it back into place
-apply ice/cold

Mallet Finger

avulsion of the extensor tendon from distal attachment

MOI of mallet finger

-object hits end of finger when extensor tendon is taut
-aka "baseball finger"

Boutonniere deformity

torn extensor tendon at PIP

MOI boutonniere deformity

-blunt trauma to dorsal aspect of joint
-rapid, forceful flexion against resistance

Sublingual Hematoma

collection of blood under the nail

treatment of sublingual hematoma

-ice on it to slow down the bleeding and minimize the pain
-need to create an opening for the blood to get out of their
-use a very small drill bit to make a small hole in the nail
-need to apply pressure to make sure the space doesn't fill up again

foot arches

longitudinal and transverse

foot alignments

pes cavus and pes planus

1st degree ankle sprain

-inversion and plantar flexion: anterior talofibular stretched
-inversion: calcaneofibular stretched
-dorsiflexion eversion: tibiofibular stretched, deltoid stretched, or an avulsion fracture of medial malleolus

2nd degree ankle sprain

-inversion and plantar flexion: partial tear of anterior talofibular, with calcaneofibular stretched
-inversion: calcaneofubular torn and anterior talofibular stretched
-dorsiflexion eversion: partial tear of tibiofibular, partial tear of deltoid and tibiofibular

3rd degree ankle sprain

-inversion and plantar flexion: rupture of anterior talofibular and calcaneofibular, with posterior talofibular and tibiofibular torn
-inversion: rupture of calcaneofibular and anterior talofibular with posterior talofibular stretched
-dorsiflexion eversion: rupture of tibiofibular, rupture of deltoid, and interosseous membrane with possible fibular fracture above syndesmosis

5th metatarsal fractures

avulsion fracture and jones fracture

avulsion fracture

peroneus brevis inserts below the 5th metatarsal - could be damaged or separated from the bone

Jones Fracture

fracture of the base of the 5th metatarsal

MOI of calcaniofibular sprain

inversion

MOI of deltoid sprain

-inversion
-takes a lot of force to do this (thick ligament)