DIagnosis and management of sport injuries - Lower limbs

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What is the hypermobility test called?
Beighton Score
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What are the 5 tests of the beighton score?
1) Hands flat on floor with legs straight, 2) Bend elbow backwards, 3) Bend knee backwards, 4) Thump touches forearm when bent backwards, 5) little finger bends back more than 90 degrees. (one point for each limb)
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Hamstring Strain Injury epidemiology:
Common in track and field, mostly sprinting. Reoccurance rate is high, 32% in American Football, most on biceps femoris
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What is the mechanisms of a hamstring strain injury?
During eccentric contraction. Common in hurdling and forceful ficking
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What are the signs and symptoms of a Hamstring Strain?
acute sharp pain, limp, slow down, stop, stiffness, tightness, swelling, redness, bruising, can't walk, muscle belly rupture.
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Name the 2 Tests for a Hamstring Strain Injury?
Puranen-Orava test and Bent-knee stretch test
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Desribe the Puranen-Orava test
Patient stands, with hip flexed to 90 degrees, knee fully extended, heel on a support (e.g. bed). = Hurdle test
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Desribe the Bent-knee stretch test
Patient lie supine (on back) on a bed, hip and knee maximally flexed. Patient relaxes and examiner slowly and passively extends the knee. Increasing posterior thigh pain with extension indicates strain or tendinopathy
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What is the mechanism of an ACL injury?
During excessive valgus and/or internal rotation motion at the knee (knee-in toe-out)
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What are the signs and symptoms of an ACL injury?
Acute and sharp pain, reduced ROM, 'pop' sound, can't play, swelling within 2 hours, anterior tibial traslation
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Name the 3 tests for an ACL injury
Lachman test, Anterior drawer test, and the Pivot Shift test
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Describe the Lachman test
Knee flexed at 30 degrees, apply anterior stress to the tibia, signs of anterior subluxation
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Describe the Anterior drawer test
Knee flexed at 90 degrees, apply anterior stress to the tibia (try to pull shin in/out), signs of anterior subluxation
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Describle the Pivot shift test
Patient supine and hip flexed to 30 degrees, hold lower leg and ankle and maintain at 20-degree internal tibial rotation. Apply valgus force and flex the knee to feel any subluxation. Reduction of a subluxed tibia with flexion as the iliotibial band
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What is the meniscus?
Shock absorber at the knee. Distribute the force evenly over the joint
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What is the mechanism of a meniscus injury?
Pivoting and twisting motion
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What are the signs and symptoms of a meniscus injury?
Swelling over a longer time (24-48 hours - because of limited blood supply), locking of knee joint, loss of ROM, full extension limited, repair needed asap (as soon as swelling gone), or limb suffers contracture
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Name and describe the test for a meniscus injury?
McMurray Test = examine the focal joint line tenderness. Bend knee to 90 degrees, doctor twists lower leg holding heel. Observe patient's reaction. As the paitient for tenderness. Feel for clicking of joint
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What is the proper name for shin splints?
Medial tibial stress syndrome
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Desribe medial tibial stress syndrome
Pain along the inner edge of tibia. Caused by repeated trauma to the connective muscle tissue surrounding the tibia, often from running or jumping.
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Aetiology and risk factors for medial tibial stress syndrome
Aetiology = fascial insertion of the medial soleus is most probably. Risk factors = runners who suddenly increase mileage, change from flat to hill running, or change shoes abruptly. 13-17% of all running injuries
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Biomechanics of shin splints
While running, foot lands with a supinated positions and moved into a relatively more pronated posture as the foot progresses through stance phase. Soleus primary plantarflexor and invertor of the foot. Possible eccentric contraction for this motion
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What are the signs and symptoms of shin splints
Dull aching pain along middle or distal posteriomedial tibia (lower 2 thirds), severe sharp pain with continued running, subsides with rest, occurs after abrupt increase of training, chronic injury pain may be at rest and in training.
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What is the difference between stress fracture pain and shin splints pain
Pain in stress fractures is very localised, while pain in shin splints in along the lower two-tirds of the tibia.
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How should you examine for shin splints?
Palpate pain and tenderness. Look for oedema and warmth. A) do forced passive dorsiflexion, B) active plantarflexion against resistance, toe raises, standing jump or hop. Look for pain over middle and lower tibia. Scan for stress fracture only!
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How would you treat shin splints?
Rest, avoid inciting activity. possible use of crutches is painful at rest, non-weightbearing exercises, ice and anti-imflammatory drugs. Heel cord stretching (pull toe towards body).
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What rehab could be recommended for shin splints?
walking/light running once pain-free, thorough warm-up, cool-down and stretching, increase duration and distance by 10% each week for 3-6 weeks, plyometric exercises (jump training)
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What is plyometric training?
Muscles exert maximum force in short intervals of time, with the goal of increasing power. Move from a muscle extension to contraction in a trapid explosive manner, such as repeated jumping.
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Name 5 ideas for prevention of shin splints?
1 - wear correct shoes with cushioning and arch support, 2 - use orthotics to correct overpronation or flat feet, 3 - avoid hard surface training, 4 - gradually build up activity level, 5 - improve overall strength and flexibility
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Name the 3 ligaments involved in lateral ankle sprains
Anterior talofibular ligament (ATFL), Posterior talofibular ligament (PTFL) and Calcaneofibular ligament (CFL)
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Name the 2 aspects of the ankle involved in a high ankle sprain (syndesmosis sprain)
Syndesmotic ligament (anterior inferior tibiofibular ligament) and the interosseous membrane
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Which ligament is involved in a medial sprain?
Deltoid Ligament
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What is the prevelance of each ankle sprain?
Lateral sprain = 85%, high ankle sprain (syndesmosis sprain) = 10%, and medial sprain = 5%
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When and why was the Ottawa Ankle Rules created?
Introduced in 1994 to reduce the use of x-rays.It reduced 28% of ankle x-rays and 14% of foot x-rays
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According the the Ottawa Ankle Rules, when should the ankle by x-rayed?
Only if there is pain in malleolar zone and any of: bone tenderness at posterior edge of lateral malleolus, bone tenderness at posterior of medial malleolus, or inability to weightbear both immediatly after and in a+e
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According the the Ottawa Ankle Rules, when should the foot be x-rayed?
Only if there is any pain in the mid-foot zone, and any of: bone tenderness at the base of the 5th metetarsal, bone tenderness at the navicular, or inability to weightbear both immediatly after and in a+e
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What is the mechanism of an ankle sprain?
excessive inversion or supination
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What are the signs and symptoms of an ankle sprain?
may hear 'pop', pain on palpation, immediate swelling, can't continue to play, discolouration.
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What is the anatomical grading system for an ankle sprain?
I = for one ligament, usually ATFL; II = for any two; III = for any three
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What is the severity grading system for an ankle sprain?
I = mild/stretched; II = partial tear; III = complete tear
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Whar are the 2 main tests for an ankle sprain?
Anterior Drawer Test and Talar Tilt Test
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Describe the Anterior Drawer Test
Test for ATFL tear. Hold the ankle at 10-20 degree plantarflexion. Stabilise tibia with one hand, pull foot forward with the other. Anterior translation indicated stability
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Describe the Talat Tilt Test
Test for calcaneofibular ligament (CFL) tear. Hold the foot and ankle in a neutral position. Invert hind-foot, feel for separation fo articular surfaces of the tibia and talus
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Why does the foot and ankle need to be in a neutral position for the Talat Tilt Test?
If plantarflexed, anterior talofibular ligament is stressed more, so test not sensitive to CFL test!
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How is a high ankle sprain caused? (Syndesmosis sprain)
Caused by excessive inversion and dorsiflexion
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Name the 3 syndesmosis sprain tests
External rotation test, Squeeze test and Crossed leg test
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Describe the external rotation test
Knee flexed to 90 degrees, ankle in neutral. Rotate the foot outward. Pain in distal lower leg indicates injury
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Describe the Squeeze Test
Compress the tibia and fibula together at mid-calf. Pain in distal lower leg indicates injury
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Describe the Crosses Leg Test
Patient sits in a chair, crosses the affect leg over the opposite knee. Applied pressure to the medial knee. Pain in distal lower leg indicates injury
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What does the Achilles tendon connect and what is it's function
COnencts the gastrocnemus and soleus muscles to the calcaneus. Function = plantarflex the ankle joint
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What could cause the Achilles tendon to rupture?
A contraction of the calk muscle which is too forceful.
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What are signs and symptoms of an Achilles Tendon Rupture?
Sudden pain, 'pop' sound, heel area swollen and bruised, can't walk properly, palpable defect in tendon, weak plantarflexion, can't lift toes, 'dropped' foot during walking
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What is the test called for an Achilles Tendon Rupture and describe it
Thompson Test = patient lies face-down on bed. Feet extend over end of bed. Examined squeezes calk muscle. (normal = foot should plantarflex, ruptured = foot won't raise). Finally, Palpate to feed ruptured Achilles tendon
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Other cards in this set

Card 2

Front

What are the 5 tests of the beighton score?

Back

1) Hands flat on floor with legs straight, 2) Bend elbow backwards, 3) Bend knee backwards, 4) Thump touches forearm when bent backwards, 5) little finger bends back more than 90 degrees. (one point for each limb)

Card 3

Front

Hamstring Strain Injury epidemiology:

Back

Preview of the front of card 3

Card 4

Front

What is the mechanisms of a hamstring strain injury?

Back

Preview of the front of card 4

Card 5

Front

What are the signs and symptoms of a Hamstring Strain?

Back

Preview of the front of card 5
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