DIagnosis and management of sport injuries - Upper limbs

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Name the 3 bones in the shoulder joint
Clavicle (collarbone), Scapula (shoulder blade) and humerus (upper arm). Note: the acromion and coracoid process are on the scapula
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Which joint does the 'should joint' normally refer to?
The glenohumeral joint; the humerus attaches to the scapula with the had sitting in the gleniod cavity.
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Name the 4 muscles of the rotator cuff and their function
Supraspinatus = abducts the humerus. Infraspinatus and Teres Minor = externally rotate the humerus. Subscapularis = internally rotates the humerus
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What does the rotator cuff do?
It surrounds the shoulder joint and keeps the upper arm bone (humerus) in the shallow socket of the shoulder (glenoid cavity)
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How can you injure/tear the rotator cuff?
Repeatedly performing overhead motions in jobs or sports (e.g. swimmers, tennis, builders). Repeated shoulder abduction motion squeezes soft tissue into subacromial space.
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What is a rotator cuff impingement?
If movement irritates and inflames the bursa and rotator cuff. If the impingement is on the tendon its called overuse tendinitis. Repeated overuse could cause tear -> usually on supraspinatus tendon
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What is the name of a ROM test for the shoulder and how do you do it?
Abley Scratch Test = patients attempt to touch the opposute scapula from A) above and B) below. A = tests abduction and external rotation, B = tests adduction and internal rotation. Compare with uneffected shoulder to notice difference in ROM
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Name the 2 tests that examine for implingement
Hawkins' Test and Neer's Test
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Describe the Hawkins Test
Elevate the patients arm forward to 90 degrees. Internally totate the shoulder by pulling the forearm sownward with force. Observe for pain/popping sensation which suggests subacromial implingement
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Describe the Neer’s Test
Patients fully pronates the arm. Assessor flexors the arm (lifts it up and pulls it back) with force). Feel the scapula, should be stabilised to avoid scapulothoracic motion (compensating to avoid pain). Pain is a sign of injury.
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What test rules out Acromioclavicular Joint Dysfunction?
Cross-arm test = patient raises affected arm to 90 degrees, then adducts the arm (move medially crossing the chest) to force acromion into the distal end of the clavical. Pain suggests dysfunction. Rotator cuff impingement = no pain with this test
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Name the 2 tests for rotator cuff tear
Empty can test and Infraspinatus/teres minor test
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What is the empty can test?
Patients abducts the shoulder to 90 degrees in forward flexion with the thumb pointing down. then elevates the arms against the resistance provided by the assessor. (look for true weakness as apose to weakness from pain!)
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What is the infraspinatus/teres minor test?
Patients with arms at the sides, flexes both elbows to 90 degrees, performs external rotation against the resistance provided by the assessor. (Look for true weakness [at full range] and not weakness due to pain!)
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How can you treat impingement conservatively?
Rest, stop painful exercise, physical therapy aiming at the range of movement, imrpove posture, strengthen shoulder muscles, relieve pain using anti-inflammatory drugs and ice. Injections of corticosteroid may be used.
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How can you treat impingement with surgery?
Arthroscopic or open surgery can be done to remove the impinging structure, such as inflamed bursa or bone spurs, or to widen the subacromial space by resection of the distal clavicle and excision of osteophytes at the bottom of the clavicle.
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How can you treat a rotator cuff tear?
Similar conservative treatment to impingement should be tried. Patients with functional deficit of athletes of over-head and throwing sports should consider surgical repair, to have rotator cuff sutured.
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Describe the post-operative rehabilitation process?
oral pain medicine and ice to relieve pain and swelling in first 2 weeks. Arm immobilised for 6 weeks for muscle to heal. Physiotherapy - passive exercises to regain ROM followed by active exercises to regain strength.
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What is a shoulder rating scoring system?
The University of California at LA (UCLA) Shoulder Rating Scale. Max score is 35. 34-35 excellent, 28-33 good, below 27 poor. Tests shoulder recovering, ROM etc
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What injury is also called 'lateral epicondylitis' (inflammation) or 'lateral epicondylalgia' (pain)?
Tennis elbow
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What is Tennis elbow?
Acute or chronic inflammation of the tendons that join the forearm muscles (extensor muscles) on the outside of the elbow (lateral epicondyle)
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What is Golfer's Elbow?
Acute or chronic inflammation of the tendons that join the forearm muscles (extensor muscles) on the medial side of the elbow (medial epicondylitis)
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How is tennis/golfer's elbow causes? (simple reason)
By excessive use of extensor muscles.
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What are the causes? (extended)
Repetitive strain injury from over use and failed healing of tendon. Traumatic injury such as direct impact, sudden forceful pull or extension, bad tennis technique so excess shock to tendon,
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What are the signs and symptoms of Tennis Elbow?
Outer part of elbow becomes sore and tender (lateral epicondyle), pain from gripping, lifting movements, and wrist extension. Stiffness in morning, weakness in the forearm, can't carry heavy objects
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What are the 2 tests for physical examination of tennis/golfers elbow?
Cozen's test and Chair lift test
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What is the Cozen's Test?
Patient extends the elbow and performs active wrist extension against resistance provided by assessor. Pain at lateral aspect of elbow indicates tennis elbow
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What is the Chair Lift Test?
Patient grasps the back of the chair while standing behind it and attempts to raise it by putting their hands on the top of the chair back with their fingers pointing to the floor. Pain in lateral epicondyle is a positive test
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How can you treat Tennis Elbow?
80-95% of tennis elbow can be treated without surgery. Research = wrist extensor eccentric exercise with a rubber bar is very effective in improving the elbow function, reducing pain and tenderness, and improving the wrist and middle finger strength.
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Give some ideas for prevention of tennis elbow?
Decrease playing time, stay in good shape, strengthen forearm, upper arm, shoulder and upper back muscles. Increased muscular strength increases stablity of joints. Bands or sleeves on elbow.Use correct equipment: lighter racket, less string tension?
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What are the 3 bones and 2 joints of the 4 fingers called?
Proximal, middle and distal phalanges and 3 hinge joints: metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP).
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What provides stability for the finger?
The joints are in volar plates (collateral ligaments attached to dense fibrous connective tissue) which provide stability
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Describe the dorsal extensor tendon of the finger
The dorsal extensor tendon extends the finger. It divides into a central slip that extends the PIP joint, then into 2 lateral bands that extend the DIP joint.
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What are the 2 lateral bands called?
Flexor digitorum superficialis tendon and the flexor digitorum profundus tendon = they function the flex the DIP joint
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What is Mallet Finger?
Extensor Tendon Injury at the DIP joint.
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How is Mallet Finger Caused?
Usually caused by an object (e.g. ball) striking the finger, creating sudden forceful flexion of an extended DIP joint. Extensor Tendon can be stretched, partially torn, or seperated from the bone.
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What is a distal phalanx avulsion fracture?
Where the extensor tendon is seperated from the bone.
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What are signs and symptoms of Mallet Finger?
pain and swelling at the dorsal DIP joint. Inability to actively extend the joint, flexion deformity. Bony avulsion fracture occurs in 1/3 of patients with MF.
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Physical Examination of Mallet Finger
Ask the patient to actively flex and extend the finger by opening and closing the fist.
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What does a reduced ROM in passive extension of the finger performed by the assessor mean?
It could indicate entrapment of bony or soft tissue, which may require surgical operation to clear the entrapment
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How can you treat Mallet Finger?
(if no avulsion fracture) Splint DIP joint at neutral position for 6 weeks. Physician follow up every 2 weeks to ensure compliance, and reexamine after 6 weeks. Do not flex at all when changing splint or 6 weeks starts over!
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What is a central slip extensor tendon injury?
Occurs when the PIP joint is forcibly flexed while actively extended. Common in basketball.
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How do you test for Central Slip Extensor Tendon injury?
Hold the joint in a position of 15-30 degrees of flexion. Ask participant to extend the joint. If injured, extension is not possible. Tenderness over dorsal aspect of the middle phalanx.
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What happens if a Central Slip Extensor Tendon Injury is left untreated?
Boutonniere deformity may occur, the intact lateral bands of the extensor tendon slip inferiorly, causing the hyperextension of the DIP and MCP joints when the PIP joint flexes
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What treatment is advised for a CSET Injury?
Splinted in full extension for 6 weeks (if no avulsion or avulsion involves less than 1/3 of joint). Use aluminum splint or ring splint.
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What happens if full extension is not possible for splint following a CSET injury?
Patient should consult orthopaedic hand sergeon as there might be loosen bony or soft tissue jamming the PIP joint which needs to be cleared.
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What is Jersey Finger?
Flexor Digitorum profundus tendon injury = occurs when finger catches anothers playing shirt, e.g. in a tackle. This causes forces extension of the DIP joint during active flexion; over-stretches and injures flexor tendon
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Which finger is most commonly effected by Jersey Finger Injury?
75% of jersey fingers occur on the ring finger
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What are the signs and symptoms of Jersey Finger?
Hear/feel a pop or rip in finger at time of injury, pain, swelling, tenderness, finger may be extended with hand at rest, bruising after 48 hours, occasionally lump in palm of finger if torn tendon bunches up.
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How do you examine the flexor digitorum profundus tendon?
Hold the affected finger's MCP and PIP joints in extension while other fingers are in flexion. Ask patients to flex DIP joint of affected finger. If digitorum profundus tendon is damaged, joint will not move.
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How do you examine the Flexor Digitorum Superficialis Tendon?
Hold the unaffected fingers in extension and ask the patients to flex the injured finger. An injured flexor digitorum superficialis tendon will not produce flexion.
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How can you treat Jersey Finger?
Surgical repair is necessary to reattach the flexor digitorum profundus tendon and or the flexor digitorum superficialis tendon back to the bone. The use a plastic splint for 6 weeks.
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What are collateral ligament injuries?
Forced lateral (valgus/varus) movement at the interphalangeal joints can cause partial or complete collateral ligament tears. Sometimes called 'jammed fingers'. Very common in basketball.
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How can you tell if someone have collateral ligament injuries?
Pain at the affected ligament, when the finger is tested by applying valgus or varus stress with the joint flexed to 30 degrees and the MCP joint flexed at 90 degrees. Compare laxity with unaffected fingers. Radiography to check avulsion fracture
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How can you treat Collateral Ligament Injuries?
If joints are stable without fracture, tape the injured finger above and below the joint to an adjacent finger. If ring finger is injured, tape to the 5th digit (little finger) as an isolated little finger can easity get injured!
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Other cards in this set

Card 2

Front

Which joint does the 'should joint' normally refer to?

Back

The glenohumeral joint; the humerus attaches to the scapula with the had sitting in the gleniod cavity.

Card 3

Front

Name the 4 muscles of the rotator cuff and their function

Back

Preview of the front of card 3

Card 4

Front

What does the rotator cuff do?

Back

Preview of the front of card 4

Card 5

Front

How can you injure/tear the rotator cuff?

Back

Preview of the front of card 5
View more cards

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