EXAM 2 - prevention and care

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175 Terms

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Acute injury
* result of trauma
* associated with specific MOI
* recent onset
* ex: fracture, sprain, strain, contusion, concussion, dislocation
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Chronic injury
* repetitive/ overuse injury
* gradual onset- develop overtime
* no specific MOI - mechanism
* ex: low back pain, shin splints, tendinitis, arthritis, stress fractures
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Periosteum
dense, white outer surface of the bone

* contains blood vessels and osteoblasts
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Compact bone
middle layer
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spongy bone
inner cancellous tissue
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Diaphysis
hollow, cylindrical shaft of bone
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Epiphysis
distal and proximal ends of the bone
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epiphyseal plate
hyaline cartilage line at the ends of the bone

* growth plate
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Acute fracture etiology
* extreme stress and strain on a bone
* stresses or loads can cause the bone to fail by tension, compression, bending, twisting and shearing
* Greater force causes more complex fractures
* subsequent forces that are not absorbed by the bone are absorbed by the adjacent **soft tissues**
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Fractures signs and symptoms
* deformity
* point tenderness
* swelling
* pain with AROM and PROM
* muscle guarding
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treatment for fractures
* immobilization
* 6 weeks for bones and legs
* 3 weeks for hands and feet
* normal stresses and strains after cast removal will aid in healing and remodeling process
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muscle guarding
trying to protect the injury and minimize pain
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AROM
active range of motion

* ex: knee contracting muscle to move it
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PROM
passive range of motion

* physician moves joint for you
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Healing- fractures
* osteoblasts will lay down bone and form callus
* osteoclasts will assist in reshaping of the bone in response to normal stress
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Dislocation
* at least one bone in a joint is forced **completely out** of normal and proper alignment
* high level of incidence in fingers, elbow, and shoulder
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FOOSH - fractures, sprains
falling on outstretched hand
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Subluxation
* partial dislocations causing **incomplete separation** of two bones
* often occur in shoulder and females (patella)
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signs and symptoms for dislocations and subluxations
* deformity
* apprehension
* loss of function
* point tenderness
* swelling
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Treatment for dislocation and subluxations
* treat as fracture until further imaging can rule it out (avulsions/ growth plate)
* RTP (return to play) determined by soft tissue damage
* needs to be reduced as quickly as possible
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avulsion fracture
the tendon attachment or ligament attachment pulls off a piece of bone
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Ligament sprains etiology
* damage (stretching or tearing) of a **ligament**
* ligaments attach bone to bone
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Ligaments
are thick portions of the capsule or individual bands
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Grade 1 - ligament sprains
some pain, minimal loss of function, no abnormal motion and mild point tenderness, slight swelling and joint stiffness
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Grade 2- ligament sprains
pain, moderate loss of function, swelling, instability, some tearing of ligament fibers and joint instability
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grade 3 - ligament sprains
extremely painful, inevitable loss of function, severe instability and swelling but may also represent subluxation
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Signs and symptoms of ligament sprains
* pain
* swelling
* heard a “pop”
* ecchymosis - bruising or discoloration
* limited range of motion
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treatment for ligament sprains
* restoring joint stability is difficult after grades 1 and 2
* original tension will not return and an inelastic scar will form
* must strengthen surrounding musculature for support/ stability
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Contusion etiology
* sudden, direct blow to body
* hematomas can form due to blood and lymph flow in tissue
* can be deep or superficial
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signs and symptoms of contusions
* painful to the touch
* discoloration
* painful with movement
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treatment of contusions
* ice on a stretch
* massage
* protect
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contusions
* calcium deposits can form which may limit soft tissue mobility
* protection is key and may allow for re absorption of calcium deposits
* surgery may be needed to remove deposits if not re absorbed
* **quadriceps and biceps** are both very susceptible to this condition
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Myositis Ossificans
can occur due to repeated blows
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Muscle strains etiology
* stretching or tearing of muscle, tendon or adjacent tissue
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Signs and symptoms of muscle strains
* muscle guarding
* limited range of motion
* point tenderness
* ecchymosis (sometimes)
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treatment
* minimize pain
* strengthen
* stretching
* generally a long process (hamstring 6-8 weeks)
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Muscle strains - grade 1
some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, movement painful but full range present
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Muscle strain - grade 2
number of fibers have been torn and active contraction is painful, usually a depression or divot is palpable, some swelling and discoloration result
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muscle strain - grade 3
complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage
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Nerve injuries etiology
* compression or tension
* can be acute or chronic
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signs and symptoms of nerve injuries
* burning/ tingling
* radiating pain
* pinching pain
* muscle weakness
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treatment for nerve injuries
* slow healing process
* CNS repair is rare and unlikely
* PNS can regenerate
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Stress fracture etiology
overload due to muscle contraction, altered stress distribution due to muscle fatigue
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signs and symptoms of stress fracture
* dull ache that progressively gets worse
* pain with activity
* swelling
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treatment for stress fracture
* stop activity for 2 weeks
* get imaging
* can immobilize but casting is generally not required
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Tendonitis etiology
repeated microtrauma and degenerative changes
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signs and symptoms of tendonitis
* gradual onset


* pain
* swelling
* crepitus
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Treatment for tendonitis
* rest


* ice cup massage
* strengthening programs to improve conditions
* remove causal factors
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NSAID
non steroidal treatment

ex: ibuprofen, tylenol
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Tenosynovitis etiology
inflammation of synovial sheath due to injury, overuse or inflammatory diseases
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Signs and symptoms of tenosynovitis
* pain
* diffuse swelling
* crepitus
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treatment for tenosynovitis
* NSAIDS
* rest
* ice cup massage
* strengthening programs to improve conditions
* remove causal factors
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Bursitis etiology
can be acute or chronic. due to direct blow irritating or rupturing the bursa sac or overuse that irritates the sac
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Signs and symptoms of Bursitis
* swelling (water balloon)
* pain
* loss of function/ ROM
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treatment of bursitis
* keep the area clean
* monitor for cuts/ abrasions
* compression
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Inflammation
must occur to initiate healing
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signs and symptoms of inflammation
* pain
* redness
* swelling
* warmth
* loss of function
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Treatment for inflammation
* create an optimal healing enviornment - PRICE (protect, rest, ice, compression, elevation)
* No heat for first 24-72 hrs
* will only increase inflammation and swelling
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Healing process - inflammatory response phase
* begins immediately after injury
* damaged cells break open and leak their contents
* in response to this, neurotransmitters and chemicals are sent to the injury site to begin the healing phases
* Subsequent phases will follow but inflammation must happen first
* acute inflammation phase typically lasts 2-4 days, post injury
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Foot can be divided into 3 areas
* forefoot
* midfoot
* hindfoot
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forefoot
19 bones

phalanges: distal, middle and proximal (14)

Metatarsals (5)
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Midfoot
5 bones

cuboid, navicular (3), cuneiforms
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hindfoot
2 bones

calcaneus and talus
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Arches
* longitudinal arch (medial and lateral)
* transverse arch
* metatarsal arch
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Plantar fascia
* connective tissue
* attaches on the heel
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Anterior compartment
* tibialis anterior
* extensor digitorum longus
* extensor hallucis longus
* peroneus tertius
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Lateral compartment
* peroneus longus
* peroneus brevis
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High arch
pes cavus
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Superficial posterior compartment
* gastrocnemius
* soleus
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Deep posterior compartment
* tibialis posterior
* flexor digitorum longus
* flexor hallucis longus
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prevention of foot injuries
* highly vulnerable area to variety of injuries


* injuries best prevented by selecting appropriate footwear, correcting biomechanical structural deficiencies through orthotics
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Foot assessment
* athletes should be preferred to qualified personnel for injury evaluation
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Foot assessment - history
* Location of pain - heel, foot, toes, arches
* training surfaces or changes in footwear
* changes in training, volume, type
* does footwear increase discomfort
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Palpation - foot assessment
* should assess the bony anatomy first
* checking for deformities and areas of tenderness


* Assessment of soft tissue ( muscle and tendons) will allow for detection of point tenderness, swelling, muscle spasms or muscle guarding
* circulation must also be monitored using the __**dorsal pedal pulse**__
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Retrocalcaneal bursitis (pump bump)
* caused by inflammation of bursa beneath achilles tendon
* Result of pressure and rubbing of shoe heel counter of a shoe
* Chronic condition that develops over time and may take extensive time to resolve, exocytosis (pump bump) may develop
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Signs and symptoms of retrocalcaneal bursitis
* Signs of inflammation
* Tender, palpable bump on calcaneous
* Pain w/ palpation superior and anterior to Achilles insertion, swelling on both sides of the heel cord
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Care for retrocalcaneal bursitis
* routine stretching of achilles, heel lifts to reduce stress, donut pad to reduce pressure
* Select different footwear that results in increasing or decreasing height of heel counter
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Calcaneus fracture
* usually from direct blow
* ex: landing from tall height such as ladder
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Heel bruise causes
caused by sudden starts, stops or changes in direction, irritation of fat pad
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Signs of injury - heel bruise
* severe pain in heel and is unable to withstand stress of weight bearing
* may progress to chronic inflammation of bone covering
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sever’s disease
growth plate injury in heel found in young adolescents
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Care of heel bruise
* reduce weight bearing for 24 hours, RICE and NSAIDS
* resume activity with heel cup or doughnut pad after pain has subsided
* Applying tape can also be effective in generating a heel cup
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Plantar Fasciitis - cause
* increased stress on fascia
* change from rigid supportive footwear to flexible footwear
* poor running technique
* leg length discrepancy, excessive pronation, inflexible longitudinal arch, tight gastroc soleus complex
* Running on soft surfaces, shoes with poor support
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Signs and symptoms - plantar Fasciitis
* pain in anterior medial heel, along medial longitudinal arch
* increased pain in morning, loosens after first few steps, pain in forefoot dorsiflexion
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Care - plantar fasciitis
* extended treatment (8-12 weeks) is required
* orthotic therapy is very useful (soft orthotic with deep heel cup)
* Simple arch taping, use of a night splint to stretch
* vigorous heel cord stretching and exercises that increase great toe dorsiflexion
* NSAIDS and occasionally steroidal injection if symptoms don’t improve with conservative treatment
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itis
chronic
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Lateral ankle ligaments
* anterior talofibular ligament
* Calcaneofibular ligament
* Posterior talofibular ligament
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Medial ligaments
* deltoid ligament
* calcaneonavicular ligament
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Anterior ligament
Anterior inferior tibiofibular ligament
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avulsion fracture
occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone
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Achilles tendon stretching
* a tight heel cord may limit dorsiflexion and may predispose athlete to ankle injury
* should routinely stretch before and after practice
* Stretching should be performed with knee extended and flexed 15-30 degrees
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Strength training
* static and dynamic joint stability is important in preventing injury
* develop a balance in strength throughout the range
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Neuromuscular control training
can be enhanced by training in controlled activities on uneven surfaces or a balance board
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Footwear - ankle injuries
* can be important factor in reducing injury
* shoes should not be used in activities they were not made for
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Preventive taping and orthoses
* tape can provide some prophylactic protection
* however, improperly applied tape can disrupt normal biomechanical function and cause injury
* lace up braces have even been found to be effective in controlling ankle motion
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Assessing the ankle and lower leg - history
* past history
* mechanism of injury
* when does it hurt
* type of quality or duration of pain
* sounds or feelings
* how long were you disables
* swelling
* previous treatments
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Assessing the ankle and lower leg - observations
* postural deviations
* genu valgum or genu varum
* is there difficulty with walking
* deformities, asymmetries or swelling
* Color and texture of skin
* patient in obvious pain
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Assessing the ankle and lower leg - palpation
* begin with body landmarks and progress to soft tissue
* Attempt to locate areas of deformity, swelling and localized tenderness
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Percussion
bump
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Compression
squeeze