EXAM 2

ask this when assessing the history of the shoulder- good indicator to know if their function has decreased

"Has your distance or velocity decreased?" is an example of a good question to ask when assessing what? why would this be a good question?

Thorax Abdominal Male external

-Body position: •_________ injury - Leaning toward side that is injured or splinting area with hand •___________ injury - Lie on side with knees pulled to chest •_______ ______ genitalia injury - Lying on side holding scrotum

-Cold hands indicate decreased circulation

-Circulatory and neurological evaluation •Hands should be felt for temperature- cold hands would indicate what?

Press-ups

test in prone position: *_____-___ • While prone, push up trunk while hips remain fixed to extend the spine • Herniated disk would be apparent with radiating pain • Localized pain = Conservative treatment • Generalized pain = Surgery may be necessary

Hold nose and blow hard which ultimately increases the internal pressure which pulls on the derma matter

test to differentiate between piriformis & disc?

6

the AC joint sprain has how many different grades?

supraspinatus

the Drop arm test is used to determine ______________ muscle weakness: •Used to determine tears of rotator cuff (primarily the supraspinatus) •Patient abducts shoulder and gradually lowers to starting position •Inability to lower arm slowly with control indicates torn supraspinatus

lung

•Bright red blood indicates ______ injury •Vomiting bright red and frothy blood indicates injury to esophagus and stomach although blood may be swallowed from mouth and nose

10-15 in females 5-10 in males

•Elbow demonstrates a carrying angle due to distal projection of humerus -Normal in females is ___-___ degrees, males __-___ degrees

scapula

Trapezius, rhomboids, serratus anterior, and erector spinae all attach to which bone?

- Trunk rotation: Lumbar spine motion symmetry - Hip rotation: Internal and external rotation to assess status of the piriformis muscle (any tightness/paresthesia)

Trunk rotation test assesses? Hip rotation test asssess?

compartment syndrome

Volkmann's ischemia contracture is a sequella of?

iliopsoas and rectus femoris

What 2 muscles are responsible for hip flexion?

1-exaggerate deformite move (make them stand behind you) 2-apply longitudinal traction 3-put back in 4-check motion

What are the steps of fixing a PIP dislocation?

causes your finger to fling back when hyperextended

What does the volar plate do?

powerful contraction; occurs at distal end

What is a mechanism of biceps brachii rupture? Where does the tear normally occur?

Posterior Tibialis

What muscle are you able to find a pulse on?

median nerve

What nerve is compromised in carpal tunnel syndrome?

SC joint

Which joint is the main stabilizer for attaching the clavicle to the sternum in the shoulder girdle?

Middle and ring finger

Which two fingers should you never 'Buddy tape' together with a phalangeal fracture?

Causes the hip to flex more, and causes different surfaces that will cause more stress on the tensor fasciae latae

Why should runners avoid inclined surfaces & embanked surfaces?

Getting kneed, getting hit with a helmet , and getting stepped on

With a distal phalangeal fracture ,what is considered to be the 3 most common crushing forces? order from the greatest amount of pain to least

Put them on crutches Deep in the hip (rectus femoris is superficial)

With an iliopsoas injury, what should you do? Where does iliopsoas hurt the most?

1) Functional evaluation - ROM, and strength tests - Hip adduction, abduction, flexion, extension, and internal and external rotation 2) Tests for hip flexor tightness - Kendall test - Thomas test (Test for hip contractures)

define the 2 special tests that assess for hip and pelvis:

dermatome: area of skin that reflects back to spinal root myotome: muscle or group of muscles supplied by a specific spinal nerve deep tendon reflex: involuntary muscle contraction in response to striking muscle tendon with reflex hammer; test used to determine whether muscles respond properly **less informative (compared to myotome and dermatome) because it does not reflect back to the brain—stops at the spinal cord

define the 3 neurological sensation tests:

spondylosis

degeneration of the vertebrae due to congenital weakness; stress fracture of the pars interarticularis results

•Fibrous rim which deepens the glenoid fossa •Increases total surface contact area •Most effective in mid-ROM •Labrum is meant to stop the humerus from continuing on to dislocation

describe the glenoid labrum and its function:

-colles = wrist extended (hyper-extension) -Smith= wrist flexed

difference between Colles' and Smiths fracture?

-thumb down (pronated)= O'Briens test -thumb up (supinated)= biceps are involved-inserts on radial tuberosity (labrum)-- SLAP lesion

difference between testing using O'briens vs. SLAP lesion?

Leg Calf Perthes Disease

disease that causes decreased in blood flow to the head of the femur-at this joint

Straight-leg

done in supine (perform this test 1st) *_______-_____ raise test: • 0-30 degrees = Hip problem or nerve inflammation • 30-60 degrees= Sciatic nerve involvement • With ankle dorsiflexion due to nerve root • 70-90 degrees = Sacroiliac joint pathology

palmaris longus

during surgery on the UCL, what tendon is used to replace?

• Grade 1: Complain of tightness in front of thigh; near normal ambulation; swelling may be limited; mild discomfort during palpation • Grade 2: Abnormal gait cycle; may be splinted in extension; swelling may be noticeable with pain on palpation; possible defect in muscle; resistive knee extension will reproduce pain • Grade 3: Unable to ambulate; pain with palpation; may be unable to perform knee extension; isometric contractions may produce defect or bulge in muscle

explain the 3 grades of a quad muscle strain:

femoral neck

femoral stress fractures usually occur where

greater

greater scarring of a hamstring muscle strain = _______ recurrence of injury

hip dislocation

hip labral tear can be a sequella of what?

innominate

ilium, ischium, & pubis bones together make up what is called:

dynamic

is the shoulder a static or dynamic stabilizer?

synosis

lack of oxygen or decreased breathing

sciatic nerve complex

largest nerve in the body?

sartorius 3 actions: flexion, abduction, and external rotation of hip; knee flexion & internal rotation of lower leg

longest muscle in the body? what are the actions at hip and knee?

groin, femoral triangle, sciatic nerve, and lymph nodes

major regions of concern (in soft tissue at the hip)

FOOSHA (fall on outstretched hand)

mechanism of injury for fracture of scaphoid?

-cervical: performs flexion/extension, rotation, & lateral flexion -thoracic: performs rotation & lateral flexion -lumbar: performs flexion/extension -sacrum: unfused bones (no joints)

name the actions of cervical, thoracic, and lumbar:

· Cervical/lumbar= lordosis · Thoracic/sacrum= kyphosis

name the primary curves that occur in the spine:

-Deformities and swelling? -Carrying angle •Cubitus valgus versus cubitus varus -Flexion and extension •Cubitus recurvatus -Elbow at 45 degrees •Isosceles triangle (olecranon and epicondyles)

observations to look for with elbow injuries:

Slipped Capital Femoral Epiphysis

occurs when the head of the femur becomes displaced due to a separation at the growth plate

semimembranosus

out of the 3 hamstring muscles, which is most commonly sprained?

Positive test is indicative of nerve root inflammation or disk herniation

positive sign of straight-leg raise test indicated by?

capitulum

radial head rotates on?

rectus femoris is superficial iliopsoas is deep

rectus femoris & iliopsoas: which one is deep, which one superficial?

adducts hip & flexes knee

what are the 2 actions of Gracialis?

superficial great saphenous and the femoral veins

what are the 2 main veins of the thigh?

flexed, adducted, and internally rotated

what are the 3 classic symptoms for a posterior dislocated hip?

right lung has 3 lobes while left lung only has 2 lobes

why is your right kidney lower than your left?

Travelers

"___________'" diarrhea affects travelers to high-risk international destinations -Occurs during the first week of travel but may occur even after returning home -Affects young adults, immunosuppressed persons, individuals with inflammatory-bowel disease or diabetes, and people taking antacids

Anterior Posterior Anterior-inferior (most commonly dislocated)

*Acute subluxations and dislocations; -Etiology: •head without complete separation from joint •__________ dislocation is the result of an anterior force on the shoulder, forced abduction, and external rotation •__________ dislocation occurs because of forced adduction and internal rotation or falling on an extended and internally rotated shoulder -Signs and Symptoms: •_________-_______ dislocation: Flattened deltoid, prominent humeral head in axilla; arm carried in slight abduction and external rotation; moderate pain and disability (most common area to dislocate)

solar plexus

*Blow to the _______ _______ ("wind knocked out of you") -Etiology •Transitory paralysis of the diaphragm due to direct blow to stomach •Spasm of the diaphragm (diaphragm cannot downward to allow the lungs to expand) -Signs and symptoms •Stops respiration and leads to anoxia •Symptoms are generally transitory

Brachial plexus neurapraxia

*Brachial Plexus _______ (Burner) - Etiology • Result of stretching or compression of the brachial plexus - Disrupts peripheral nerve function without degenerative changes - Signs and symptoms • Burning sensation, numbness, and tingling, as well as pain extending from the shoulder into the hand • Some loss of function of the arm and hand for several minutes • Repeated injury can result in neuritis, muscular atrophy, and permanent damage

Spurling's

*Cervical compression and _______ test • Compression of cervical spine compresses facets and spinal roots • Level of pain determines specific nerve root impingement • Spurling's adds a rotational component to the cervical compression test · Looking for paresthesia **never do these tests if there is a fracture

Inability to urinate is present in case of a ruptured bladder -Urge to pee is still there but physically cannot because of ruptured bladder

*Contusion of ureters, bladder, and urethra -Etiology •Blunt force to the lower abdomen may avulse ureter or contuse/rupture bladder •Hematuria is often associated with contusion of bladder during running (runner's bladder) •Injury to the urethra (more common in males) may produce severe perineal pain and swelling -Signs and symptoms •Pain, discomfort of lower abdominal region, abdominal rigidity, nausea, vomiting, shock, bleeding from the urethra, and increased quantity of bloody urine •**what is the main S/S?

olecranon

*Contusion: -Etiology •Vulnerable area due to lack of padding •Result of direct blow or repetitive blows -Signs and symptoms •Swelling (rapidly after irritation of _________ bursa or synovial membrane)

abdominal wall

*Contusions of the _______ ______: -Etiology •Caused by a compressive force •Generally occurs in collision sports •Extent of injury depends on whether force is blunt or penetrating -Signs and symptoms •May cause a hematoma to develop under the fascial tissue surrounding muscle tissue

lunate

*Dislocation of ______ bone: -Etiology •Forceful hyperextension or fall on outstretched hand -Signs and symptoms •Pain, swelling, and difficulty executing wrist and finger flexion •Numbness/paralysis of flexor muscles due to pressure on median nerve

osteochondritis dissecans

*Elbow ________ __________: -Etiology •Impairment of blood supply to anterior surface resulting in degeneration of articular cartilage, creating loose bodies (joint mice) •Repetitive microtrauma in movements of elbow rotation, extension, and valgus stress leads to a compression of the radial head and shearing of the radiocapitellar joint •Seen in young athletes involved in throwing motion •Panner's disease in incidents of children age <10 -Osteochondrosis of capitellum due to localized avascular necrosis -Signs and symptoms •Sudden pain and locking; ROM usually returns in a few days •on posterior side of elbow on olecranon will be in pain •Swelling, pain at radiohumeral joint, crepitus, decreased ROM (full extension); grating with pronation and supination •X-ray may show flattening and crater of capitulum with loose bodies

humerus

*Fractures of the ___________: -Etiology: •Humeral shaft fractures -Occur as a result of a direct blow or a fall on outstretched arm •Proximal fractures occur due to a direct blow, a dislocation, or a fall on outstretched arm -May pose danger to nerve and blood supply •Epiphyseal fractures are more common in young patients -Occur due to direct blow or indirect blow travelling along long axis of humerus -Signs and symptoms: •Pain, swelling, point tenderness, and decreased ROM

mononucleosis -spleen: filtrating system--which is why it enlarges with a direct blow causing it to build up in blood -if athlete has mononucleosis: return back to activity starting at 60% of VO2max

*Injury of the spleen -Etiology •Result of a direct blow or infectious ______________ (causing an enlarged spleen) -Signs and symptoms •Indications of a ruptured spleen include history of a direct blow, signs of shock, abdominal rigidity, nausea, and vomiting •Kehr's sign •Ability to splint self may produce delayed hemorrhaging, which results in internal bleeding

pain; strain

*Lower Back _____: - Etiology • Congenital anomalies • Mechanical defects of the spine (posture, obesity, and body mechanics) • Back trauma • Recurrent and chronic low back pain - Signs and symptoms • Pain, possible weakness, antalgic gait, propensity to ligamentous sprain, muscle strains, and bony defects • Neurological signs and symptoms if it becomes disk related VS: *Lower Back _______: - Etiology • Sudden extension contraction overload, generally in conjunction with some type of rotation • Chronic strain associated with posture and mechanics - Signs and symptoms • Pain may be diffuse or localized; pain with active extension and passive flexion • No radiating pain distal to the buttocks; no neurological involvement

epicondylitis

*Medial and lateral ____________ tests: •Elbow flexed to 45 degrees and wrist extension or flexion is resisted •Pain at lateral or medial epicondyle, respectively, indicates a positive test •Common extensor= lateral •Common flexor= medial

Bankart Hill-Sachs SLAP

*Possible complications of shoulder dislocations: •_________ lesion - Permanent anterior defect of labrum (occurs as a sequella from anterior dislocation) •______-______ lesion - Caused by compression of cancellous bone against anterior glenoid rim creating a divot in the humeral head •________ lesion - Defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum •Brachial nerves and vessels may be compromised •Rotator cuff injuries •Fractures •Bicipital tendon subluxation and transverse ligament rupture

interphalangeal

*Sprains of ___________ joints: -Etiology •Can include collateral ligament, volar plate, and extensor expansion tears •Occurs with axial loading or valgus/varus stresses -Signs and symptoms •Pain, swelling, point tenderness, and instability •Valgus and varus tests may be positive

hip joint

*Sprains of the _____ ______: -Etiology • Any unusual movement exceeding normal ROM may result in damage • Force from opponent/object or trunk forced over planted foot in opposite direction - Signs and symptoms: • Signs of acute injury and inability to circumduct thigh • Pain in hip region with hip rotation increasing pain

serratus anterior

*Test for _________ ________ weakness: •Wall push-up - Looking for winging scapula •Could indicate injury to long thoracic nerve -Test for biceps irritation •Yergason's test and Speed's test utilized to determine pain and possible subluxation of biceps tendon -Externally rotating to see if bicep tendon pops out •Ludington's test used to assess possible rupture of biceps (feel for contraction while alternating contractions of each biceps)

capsular

*Test for _________ injury: •Tested after hyperextension of elbow -Elbow is flexed to 45 degrees, wrist is fully flexed and extended -If joint pain is severe, moderate/severe sprain or fracture should be suspected (chronic injury may present the same)

Forward Backward Side

*Tests done in standing position: - _______ bending: • Observe movement of posterior superior iliac spines (PSIS), test posterior spinal ligaments - ________ bending: • Anterior ligaments of the spine • Disk problem - ______ bending: • Lumbar lesion with sacroiliac dysfunction

thoracic outlet compression How it occurs: Your scales that attach to your first rib can be tight and pull that rib up and these nerves can get pinched between the rib and clavicle. The nerves, veins, and arteries can get pinched by the scalenes or the pec minor.

*Tests for ________ ________ _______ syndrome: 1) Anterior scalene syndrome (Adson's test) •Compression of subclavian artery (and neurovascular bundle-i.e. pec minor, subclavius, scalenes) by scalenes is assessed •Disappearance of pulse when patient turns toward extended arm and takes a breath indicates a positive test 2) Hyperabduction syndrome test (Allen test) •Used to assess if pressure from pectoralis minor is compressing brachial plexus and subclavian artery •2 muscles can compress: pec minor & scalenes 3) Costoclavicular syndrome test (Roo's test) -Compression of artery between clavicle and first rib -Positive if after opening and closing hands for 3 minutes strength or circulation decreases -Also indicates thoracic outlet syndrome 4) Sensation testing

asphyxia

*Traumatic __________: •Result of a violent blow or compression of rib cage •Causes cessation of breathing •Signs include purple discoloration of the trunk and head and conjunctivas of the eye •Condition requires immediate mouth-to-mouth resuscitation

Rib fractures

*____ ________: -Etiology •Caused by a direct blow or the result of a violent muscular contraction •Can be caused by violent coughing and sneezing (rare) •A flail chest is one where 3 or more consecutive ribs are fractured -Signs and symptoms •History is critically important •Pain with inspiration, point tenderness, and possible deformity with palpation

Legg-Calve-Perthes

*____-____-_____ disease (Coxa plana) - Etiology • Avascular necrosis of the femoral head in child ages 4- 10 • Trauma accounts for 25% of cases • Articular cartilage becomes necrotic and flattens - Signs and symptoms • Pain in groin that can be referred to the abdomen or knee • Limping is also typical • Varying onsets and may exhibit limited ROM

Rib tip

*_____ _____ syndrome: -Etiology •Involves ribs 8, 9, and 10 •Damage of fibrous tissue connecting ribs results in impingement of ribs on intercostal nerve -Signs and symptoms •Localized pain in upper abdomen •Pain with lateral flexion and extension away from injury •May present popping sensation or slipping movements •Pain reproduced by pulling inferior rib anteriorly; positive sign is clicking

Nobel's Test

*_____ _______: - Lying supine, the athlete's knee is flexed to 90 degrees - Pressure is applied to lateral femoral condyle while knee is extended - Pain at 30 degrees at lateral femoral condyle indicates a positive test

quad muscle strain

*______ ______ _______: - Etiology: • Sudden, violent, and forceful contraction of hip and knee into flexion • Overstretching of quadriceps - Signs and symptoms • Peripheral tear causes fewer symptoms than deeper tear • Pain, point tenderness, spasm, loss of function (decreased knee flexion), and little discoloration • Complete tear may leave patient with disability, discomfort, and some deformity

Pelvic tilt

*______ ______ test - Anterior and posterior tilts that increase the pain on the side being stressed indicate irritation of the SI joint

Sudden cardiac death

*______ _______ _______ (SCD) syndrome in athletes: -Etiology •Hypertrophic cardiomyopathy (HCM) - Thickening of cardiac muscle with decrease in chamber size (One of the chambers is thickened and cannot push out blood adequately) •Coronary artery and peripheral artery disease •Right ventricular dysplasia, cardiac conduction abnormalities, and aortic stenosis •Noncardiac causes include drugs and alcohol, intracranial bleeding, and obstructive respiratory disease -Signs and symptoms •Most do not exhibit any signs prior to death •May exhibit chest pain, heart palpitations, syncope (fainting), nausea, profuse sweating, shortness of breath, malaise (discoloration), and fever

Hip labral tear

*______ _______ _______: - Etiology: • Often occurs due to repetitive movements such as running or pivoting resulting in degeneration or breakdown of the labrum • Can also occur acutely due to a hip dislocation - Signs and symptoms • Often asymptomatic • May present with clicking, locking, stiffness, and limited ROM • Pain in the groin and hip

Acute strains

*______ _______ of the neck and upper back: - Etiology • Sudden turn of the head, forced flexion, extension, or rotation • Generally involves upper traps, scalenes, splenius capitis, and cervicis - Signs and symptoms • Localized pain and point tenderness, restricted motion, and reluctance to move the neck in any direction

Iliotibial (IT) band

*______ _______ stretch test - Test will often provoke pain in the contralateral PSIS area indicating an SI problem - Pressing downward on IT band - SI dysfunction can lead to a shortening of the IT band

Pinch grip

*______ _______ test •Pinch thumb and index finger together •Inability to touch fingers together indicates entrapment of anterior interosseous nerve between heads of pronator muscle

Piriformis Test (FAIR Test)

*______ _______: - Hip is internally rotated - Tightness or pain is indicative of piriformis tightness - When hip is pressed down there is burning sensation in leg (could pinch the sciatic nerve)

tommy john

*______ ________ procedure: taking palmaris longus muscle to put over UCL

Cubital tunnel

*______ ________ syndrome -Etiology •Pronounced cubital valgus may cause deep friction problem •Ulnar nerve dislocation •Traction injury from valgus force, irregularities with tunnel, subluxation of ulnar nerve due to lax impingement -Signs and symptoms •Pain medially which may be referred proximally or distally •Tenderness in cubital tunnel on palpation and hyperflexion •Intermittent paresthesia (tingling sensation) in 4th and 5th fingers

Breast injury

*______ ________: -Etiology •Constant uncontrolled movement (particularly in large-breasted women) •Stretching of Cooper's ligament (holds breasts upright) •Runner's and bicyclist's nipple

Muscle injuries

*______ ________: -Etiology •Muscles are subject to contusions and strains •Occur most often from direct blows or sudden torsion of the trunk (rotation or flexion) -Signs and symptoms •Pain occurs on active motions •Pain with inspiration and expiration, coughing, sneezing, and laughing

Distal phalangeal; Middle phalangeal; Proximal phalangeal

*______ _________ fracture: -Etiology •Crushing force -Signs and symptoms •Complaint of pain and swelling of distal phalanx •Subungual hematoma is often seen in this condition VS: *________ ________ fracture: -Etiology •Occurs from direct trauma or twist -Signs and symptoms •Pain and swelling with tenderness over middle phalanx •Possible deformity; X-ray will show bone displacement VS: *_______ __________ fracture: -Etiology •May be spiral and angular -Signs and symptoms •Complaint of pain, swelling, and deformity •Inspection reveals varying degrees of deformity

Liver

*______ contusion -Etiology •Blunt trauma to the right side of the rib cage •More susceptible if enlarged due to illness (hepatitis) -Signs and symptoms •Hemorrhaging and shock may present •May require immediate surgery

Tinel's

*______ sign: •Produced by tapping over transverse carpal ligament (on the flexor retinaculum) •Tingling and paresthesia over sensory distribution of the median nerve indicates presence of carpal tunnel syndrome

Slump

*_______ Test: - Monitor changes in pain as sequential changes in posture occur 1. Cervical spine flexion 2. Knee extension 3. Ankle dorsiflexion 4. Neck flexion released 5. Both legs extended - Assessment of neural tension

Cervical sprain

*_______ ______ (Whiplash) - Etiology • Generally the same mechanism as a strain, just more violent • Involves a snapping of the head and neck - compromising the anterior or posterior longitudinal ligament, the interspinous ligament and the supraspinous ligament - Signs and symptoms • Similar signs and symptoms to a strain - however, they last longer • Tenderness over the transverse and spinous processes • Pain will usually arise the day after the trauma (result of muscle spasm)

Slipped capital femoral

*_______ _______ _______ epiphysis: - Etiology • Found mostly in boys ages of 10-17 who are characteristically tall and thin or obese • May be growthhormone related • 25% of cases are seen in both hips and trauma accounts for 25% - Signs and symptoms : • Pain in groin that comes on over weeks or months • Hip and knee pain during passive and active motion • Limitations of abduction, flexion, medial rotation, and a limp

Glenohumeral joint sprain

*_______ _______ _________: -Etiology •Forced abduction and/or external rotation or a direct blow -Signs and symptoms •Pain during movement especially when recreating MOI •Decreased ROM and pain with palpation

Swan neck

*_______ _______ deformity and psuedoboutonniere deformity: -Etiology •Distal tear of volar plate may cause swan neck deformity; proximal tear may cause psuedoboutonniere deformity -Signs and symptoms •Pain and swelling with varying degrees of hyperextension •Tenderness over volar plate of PIP •Indication of volar plate tear = passive hyperextension

PIP dorsal; PIP palmar

*_______ _______ dislocation: -Etiology •Hyperextension that disrupts volar plate at middle phalanx -Signs and symptoms •Pain and swelling over PIP •Obvious deformity, disability, and possible avulsion VS: *_______ ______ dislocation: -Etiology •Caused by twist while digit is semiflexed -Signs and symptoms •Pain and swelling over PIP; point tenderness over dorsal side •Finger displays an angular or rotational deformity

Ober's test

*_______ _______: - Used to determine presence of contracted TFL or IT band - Patient's leg is extended and abducted - Thigh will remain in abducted position and will not fall into adduction (positive sign= leg falls into adduction)

Brachial plexus

*_______ ________ test: • Application of pressure to head, neck, and shoulders to recreate mechanism of injury • Lateral flexion of the neck with same side pain indicates a compression injury • Lateral flexion of the neck with opposite side pain indicates stretch or traction injury

rotator cuff

*________ _______ tear: •Occurs near insertion on greater tuberosity •Partial- or complete-thickness tear •Full-thickness tears usually occur in those athletes with a long history (generally does not occur in athletes under age 40) •Primary mechanism - Acute trauma or impingement •Involve supraspinatus or rupture of other rotator cuff tendons

Kidney stones

*_______ ________: -Etiology •Unknown cause •May be small (grain of sand), large (marble-sized), smooth, or jagged •May remain in kidney causing blockage and pressure in renal system •If breaks free and travels through urinary tract, it is very painful -Signs and symptoms •Sudden, painful, severe, and sharp pain initially •Referred pain in low back, flank, and groin •Nausea and vomiting •Skin is cool, clammy, pale, and sweaty •Burning with frequent urination and possible blood in urine *•In 80-85% of cases, smaller stones move through ureter, drop into the bladder, and come out in the urine

Cervical dislocation

*_______ ________: - Etiology • Usually the result of violent flexion and rotation of the head - Signs and symptoms • Considerable pain, numbness, weakness, or paralysis • Unilateral dislocation causes the neck to be tilted toward the dislocated side with extreme muscle tightness on the elongated side

Pronator teres

*_______ _________ syndrome -Etiology •Entrapment of median nerve -Proximal to the elbow joint -nerve passes between the superficial and deep heads of the muscle •May become trapped due to edema or muscle hypertrophy -Signs and symptoms •Sensory deficits - numbness, tingling, and pins and needles (digits 1-4) •Motor deficits - loss of flexion and opposition and weakness with pronation

Pronator teres

*_______ _________ syndrome test •Forearm pronation is resisted •Increased pain proximally over pronator teres indicates a positive test (median nerve)

Kidney contusion

*_______ _________: -Etiology •Susceptible to injury due to normal distention of blood •Result of an external force (dependent on force and angle) -Signs and symptoms •May display signs of shock, nausea, vomiting, rigidity of back muscles, and hematuria (blood in urine) •Referred pain (e.g. kidney is in pain at costovertebral angle posteriorly but radiating forward around the trunk)

Sternoclavicular sprain

*_______ _________: -Etiology: •Indirect force or a blunt trauma (may cause displacement) -Signs and symptoms: •Grade 1 - Pain and slight disability •Grade 2 - Pain, subluxation with deformity, swelling and point tenderness, and decreased ROM •Grade 3 - Gross deformity (dislocation), pain, swelling, and decreased ROM -Possibly life-threatening if dislocation takes place posteriorly

stress fractures

*_______ __________: - Etiology • Seen in distance runners - Repetitive cyclical forces from ground reaction force • More common in women than men • Common sites include inferior pubic ramus, femoral neck, and subtrochanteric area of femur - Signs and symptoms • Groin pain with aching sensation in thigh that increases with activity and decreases with rest • Standing on one leg may be impossible • Deep palpation results in point tenderness • May be caused by intense interval training or competitive racing

MCP

*_______ dislocation: -Etiology •Caused by twisting or shearing force -Signs and symptoms •Pain, swelling, and stiffness at MCP joint •Proximal phalanx is angulated at 60-90 degrees

Colles'

*_______ fracture: -Etiology •Occurs in lower end of radius or ulna •Mechanism of injury is falling on outstretched hand and forcing radius and ulna into hyperextension •Less common is the reverse Colles' fracture (Smith fracture) -Anterior displacement of distal fragment •Intraarticular fracture is referred to as a Barton fracture -Signs and symptoms •Forward displacement of radius causing visible deformity (dinner fork deformity) •When no deformity is present, injury can be passed off as bad sprain •Extensive bleeding and swelling •Tendons may be torn/avulsed, and there may be median nerve damage

Milgram

*_______ test: involves a bilateral straight-leg raise that increases intrathecal pressure placing pressure on the disk and nerve roots

FABER (patrick) and FADIR test

*_______ test: pain in bottom side of SI joint VS: *______: rotating and pushing downward to see if any pain in hip-lumbar spine with a positive test being increases in the low back pain

Patrick's Test

*________ ______ (FABER): - Detects pathological conditions of the hip and sacroiliac joint - Pain may be felt in the hip or sacroiliac joint - Separating the SI joint by pushing on the femur which stresses the posterior SI joint

hamstring muscle strains

*________ _______ ______: - Etiology: • Multiple theories of injury - Hamstring and quad contract together - Change in role from hip extender to knee flexor - Fatigue, posture, leg length discrepancy, lack of flexibility, and strength imbalances - Signs and symptoms • Muscle belly or point of attachment pain •Capillary hemorrhage, pain, loss of function, and possible discoloration •Grade 1 - Soreness during movement and point tenderness (<20% of fibers torn) • Grade 2 - Partial tear identified by sharp snap or tear, severe pain, and loss of function (<70% of fiber torn) • Grade 3 - Rupturing of tendinous or muscular tissue involving major hemorrhage and disability, edema, loss of function, ecchymosis, and palpable gap • >70% muscle fiber tearing

Ulnar collateral ligament

*________ _______ ________ injuries: -Etiology •Injured as the result of a valgus force from repetitive trauma •Can also result in ulnar nerve inflammation or wrist flexor tendinitis; overuse flexor/pronator strain, ligamentous sprains; elbow flexion contractures or increased instability -Signs and symptoms •Pain along medial aspect of elbow; tenderness over medial collateral ligament (MCL) •Associated paresthesia, positive Tinel's sign •Pain with valgus stress test at 20 degrees; possible endpoint laxity •X-ray may show hypertrophy of humeral condyle, posteromedial aspect of olecranon, marginal osteophytes; calcification within MCL; loose bodies in posterior compartment

Little League

*________ _______ elbow -Etiology •Caused by repetitive microtraumas that occur from throwing (not type of pitch but the amount of throwing) •May result in numerous disorders of growth in the pitching elbow •Linked to: -Accelerated apophyseal growth region and delay in medial epicondyle growth plate (growth plate is stunted and wont grow perpendicular) -Traction apophysitis with possible fragmentation of medial epicondylar apophysis -Signs and symptoms •Onset is slow; slight flexion contracture, including tight anterior joint capsule and weakness in triceps •Patient may complain of locking or catching sensation •Decreased ROM of forearm pronation and supination

Rib contusion

*________ _______: -Etiology •Blow to the rib cage can bruise ribs, musculature, or result in fracture -Signs and symptoms •Painful breathing (particularly if muscles are involved) •Point tenderness and pain with rib compression

Femoral Stress Fractures

*________ ________ Fractures: - Etiology: • Excessive downhill running or jumping activities • Often seen in endurance athletes - Signs and symptoms: • Persistent pain in thigh/groin • X-ray or bone scan will reveal fracture • Walk with antalgic gait (abduction lurch) • Positive Trendelenburg's sign

Gastroesophageal reflux disease

*________ ________ _______ (GERD) -Etiology •Reflux or backward flow of the acidic gastric contents into the esophagus (malfunctioning esophageal sphincter) •Result of a hiatal hernia (incidence increases with activity) •Repeated bouts can result in inflammation of lower esophagus (esophagitis) -Signs and symptoms •Heartburn-like retrosternal pain that is similar to angina pectoris sensation •Burning feeling with sour liquid taste in throat

Flexor digitorum profundus

*________ ________ ________ rupture (Jersey finger) -Etiology •Rupture of flexor digitorum profundus tendon from insertion on distal phalanx •Often occurs with ring finger when athlete tries to grab a jersey -Signs and symptoms •DIP cannot be flexed, finger remains extended •Pain and point tenderness over distal phalanx

•Biceps brachii

*________ ________ rupture: -Etiology •Result of a powerful contraction •Generally occurs near origin of muscle at bicipital groove -Signs and symptoms •Patient hears a resounding snap and feels sudden and intense pain •Protruding bulge may appear near middle of biceps •Definite weakness with elbow flexion and supination -tears at distal end

Osteitis pubis

*________ ________: - Etiology • Seen in distance runners and also in soccer, football, and wrestling • Repetitive stress on pubic symphysis and adjacent muscles - Signs and symptoms • Chronic pain and inflammation of groin • Point tenderness on pubic tubercle • Pain with running, sit-ups, and squats • Acute case may be the result of pressure from a bicycle seat

Wrist ganglion

*________ ________: -Etiology •Synovial cyst (herniation of joint capsule or synovial sheath of tendon) •Generally appears following wrist strain -Signs and symptoms •Generally appears on the back of the wrist •Occasional pain with lump at site •Pain increases with use •May feel soft, rubbery, or very hard

Lumbar vertebrae

*________ _________ fracture and dislocation: - Etiology • Compression fractures or fracture of the spinous or transverse processes • Compression fractures are usually the result of trunk hyperflexion or falling from a height • Fractures of the processes are generally the result of a direct blow - Signs and symptoms • Compression fractures will require X-rays for detection • Point tenderness over the affected area

Avascular necrosis

*________ _________: - Etiology • Result of temporary or permanent loss of blood supply to proximal femur • Can be caused by traumatic conditions (hip dislocation and disruption of circumflex artery) or nontraumatic circumstances (steroids, blood coagulation disorders, and excessive alcohol use compromising blood vessels) - Signs and symptoms: • Early stages - possibly no symptoms • Joint pain with weight bearing progressing to pain at times of rest • Pain gradually increases (mild to severe) particularly as bone collapse occurs • May limit ROM • Osteoarthritis may develop • Progression of symptoms can develop over the course of months to a year

Forearm splints

*________ _________: -Etiology •Forearm strain - Most come from severe static contraction -Signs and symptoms •Dull ache between extensors, which cross the posterior aspect of forearm •Weakness and pain with contraction •Point tenderness in interosseous membrane

Muscle strains

*________ _________: -Etiology •MOI is excessive resistive motion (falling on outstretched arm), repeated microtears that cause chronic injury •Rupture of distal biceps is the most common muscle rupture of the upper extremity -Signs and symptoms •Active or resistive motion produces pain; point tenderness in muscle, tendon, or myotendinous junction

O'Brien test

*________ _________: (Active compression test) -Patient flexes GH joint to 90 degrees and horizontally adducted 15 degrees from the sagittal plane -Downward pressure is applied with humerus fully internally rotated and externally rotated -If pain is present with internal rotation but decreases with external rotation and there is clicking = SLAP lesion -Pain in AC joint may indicate AC joint pathology

Chronic recurrent

*________ __________ instabilities: -Etiology •Traumatic, atraumatic, microtraumatic (repetitive use), congenital, or neuromuscular •As supporting tissue become more lax, mobility increases resulting in damage to other soft tissue structures -Signs and symptoms •Anterior - May have clicking or pain; complain of dead arm syndrome during cocking phase (when throwing); pain posteriorly; possible impingement; positive apprehension test •Posterior - Possible impingement, loss of internal rotation; crepitation; increased laxity; pain anteriorly and posteriorly •Multidirectional - Inferior laxity; positive sulcus sign; pain and clicking with arm at side; possible signs and symptoms associated with anterior and posterior instability

Scapular dyskinesis

*________ __________: -Etiology •Abnormal movement of the scapula •SICK scapula -Inferior medial scapular winging -Coracoid tenderness -Kinesis abnormalities of the scapula •Occurs because of repetitive use and often in the throwing athletes -Signs and symptoms •Affected shoulder tends to be held lower and is rolled forward (slouched) •Prominent inferior scapular border due to tight pectoralis major/minor, weak serratus anterior, and lower portion of trapezius •Posterior tipping may contribute to functional narrowing of subacromial space leading to pain when shoulder is abducted and externally rotated •Winging becomes more pronounced with fatigue and may contribute to impingement and cuff injury

Shoulder impingement

*________ __________: -Etiology •Mechanical compression of supraspinatus tendon, subacromial bursa, and long head of biceps tendon due to decreased space under coracoacromial arch •Seen in overhead repetitive activities •Exacerbating factors - Laxity and inflammation and postural malalignments -Kyphotic posture and rounded shoulders -Signs and symptoms •Diffuse pain; pain on palpation of subacromial space •In overhead, athletes' clinicians may see increased GH external rotation gain (ERG) and decreased glenohumeral internal rotation (GIRD)

quad contusion

*________ ___________: -Etiology: • Constantly exposed to traumatic blunt blow • Contusions usually develop as a result of severe impact • Extent of force and degree of thigh relaxation determine depth and functional disruption that occurs - Signs and symptoms: • Pain, transitory loss of function, and immediate effusion with palpable swollen area • Graded 1-4 = Superficial to deep with increasing loss of function (decreased ROM and strength)

Cervical disk

*________ _______injuries: - Etiology • Herniation that develops from an extruded posterolateral disk fragment or from degeneration of the disk • Mechanism of injury involves sustained repetitive cervical loading - Signs and symptoms • Neck pain with some restricted ROM • Radicular pain in the upper extremity and associated motor weakness

Trigger

*________ finger or thumb: -Etiology •Repeated motion of fingers may cause irritation, producing tenosynovitis •Inflammation of tendon sheath (extensor tendons of wrist, fingers and thumb, and abductor pollicis) •Thickening occurs within the sheath, forming a nodule that does not slide easily -Signs and symptoms •Resistance to reextension, produces snapping that is palpable, audible, and painful •Palpation produces pain and lump can be felt within tendon sheath

Bennett's

*________ fracture: -Etiology •Occurs at carpometacarpal joint of the thumb as a result of an axial and abduction force to the thumb -Signs and symptoms •CMC may appear to be deformed - X-ray will indicate fracture •Patient will complain of pain and swelling over the base of the thumb

Sternum

*________ fractures -Etiology •Result of high-impact blow to the chest •May also cause contusion to underlying cardiac muscles -Signs and symptoms •Point tenderness over the sternum •Pain with deep inspiration and forceful expiration •Signs of shock or weak rapid pulse may indicate more severe injuries

clavicular

*________ fractures: -Etiology: •Fall on the outstretched arm, fall on the tip of shoulder, or a direct impact •Occur primarily in middle 1/3 (greenstick fracture often occurs in young patients) -Signs and symptoms: •Generally presents with supporting of arm and head tilted toward injured side with chin turned away •Clavicle may appear lower •Palpation reveals pain, swelling, deformity, and point tenderness

Coccyx

*________ injuries - Etiology • Result of a direct impact which may be caused by forcibly sitting down, falling, or being kicked by an opponent - Signs and symptoms • Pain is often prolonged and at times chronic • May even cause irritation to the coccygeal plexus

Piriformis

*________ muscle test - A positive test indicates tightness or myofascial pain in that muscle - Can also be done seated with the hip and knee at 90 degrees - Resisting hip external rotation can also elicit pain if there is a problem with the piriformis

Allen's

*________ test can also be used -Patient is instructed to clench fist 3-4 times and to hold it on the final time -Pressure is applied to ulnar and radial arteries -Patient then opens hand (palm should be blanched) -One artery is released; if normal, the hand should fill immediately (both should be checked)

Hoovers

*________ test: unilateral straight-leg raise by cupping both hands on both heels and ask pt to lift leg—if there is pressure in the opposite heel that you told the pt to raise this indicates a positive test

Valgus/Varus

*________/______ and Glide stress tests: •Tests used to assess ligamentous integrity of joints in hands and fingers •Used to test collateral ligaments •Anterior and posterior glides are used to assess the joint capsule

Sciaticia/piriformis syndrome

*________/_______ ________: - Etiology • Hip and buttock pain is often diagnosed as sciatic nerve irritation •Sciatica - term used to describe any pain produced by irritation of the sciatic nerve - Many potential causes • Sciatic nerve can be irritated by a disk problem, direct trauma, or trauma from surrounding structures (i.e., piriformis muscle = piriformis syndrome) • Seen more in women than men • Cause typically attributed to a tight piriformis as the nerve passes underneath the muscle or anatomical variation -Symptoms and signs: - Must differentiate low back problems (disk disease) from piriformis syndrome as the cause • Determine whether the patient has low back pain with radiation into the extremity • Back pain is most likely midline, exacerbated by trunk flexion and relieved by rest • Coughing and straining may also increase back pain and possibly the radiation • Muscle weakness and sensory numbness may also be present - With piriformis syndrome, the patient might report a deep pain in the buttock without low back pain

Valgus/Varus

*________/_______ stress test •Assess injury to the medial and lateral collateral ligaments, respectively •Looking for gapping or complaint of pain

Contusion

*_________ (hip pointer): - Etiology • Contusion of iliac crest and abdominal musculature • Result of direct blow - Same MOI for iliac crest fracture and epiphyseal separation - Signs and symptoms: • Pain, spasm, and transitory paralysis of soft structures • Decreased rotation of trunk or thigh/hip flexion

Extensor tendon avulsion

*_________ _______ _______ (Mallet finger) -Etiology •Caused by a blow to tip of finger avulsing extensor tendon from insertion •Also referred to as baseball or basketball finger -Signs and symptoms •Pain at DIP; X-ray shows avulsed bone on dorsal proximal distal phalanx •Unable to extend distal end of finger (carrying at 30° angle)

Carpal tunnel syndrome

*_________ _______ ________: -Etiology •Compression of median nerve due to inflammation of tendons and sheaths of carpal tunnel •Result of repeated wrist flexion or direct trauma to anterior aspect of wrist -Signs and symptoms •Sensory and motor deficits (tingling, numbness, and paresthesia); weakness in thumb

heterotrophic ossification

*_________ _______: -Etiology: • Formation of ectopic bone following repeated blunt trauma (disruption of muscle fibers, capillaries, fibrous connective tissue, and periosteum) • Gradual deposit of calcium and bone formation • May be the result of improper thigh contusion treatment (too aggressive) - Signs and symptoms : • X-ray shows calcium deposit 2-6 weeks following injury • Pain, weakness, swelling, and decreased ROM • Tissue tension and point tenderness

Herniated disk

*_________ _______: - Etiology • Caused by abnormal stresses and degeneration due to use (forward bending and twisting) - Signs and symptoms • Symptoms are worse in the morning • Onset is sudden or gradual, and pain may increase after the athlete sits and then tries to resume activity • Forward bending and sitting increase pain, while back extension reduces pain • Straight-leg raise to 30 degrees is painful • Decreased muscle strength and tendon reflexes; Valsalva maneuver increases pain

Thoracic outlet compression

*_________ ________ ________: -Etiology •Compression of brachial plexus, subclavian artery and vein due to 1) decreased space between clavicle and first rib, 2) scalene compression, 3) compression by pectoralis minor muscle, or 4) presence of cervical rib -Signs and symptoms •Paresthesia and pain, sensation of cold, impaired circulation, muscle weakness, muscle atrophy, and radial nerve palsy •Positive anterior scalene test, costoclavicular test, and hyperabduction test -elevation of 1st rib to take pressure off -what testing measures should you use? Take a pulse

Shoulder bursitis

*_________ _________ -Etiology •Chronic inflammatory condition due to trauma or overuse - Subacromial bursa •Fibrosis and fluid buildup resulting in constant inflammation -Signs and symptoms •Pain with motion and tenderness during palpation in subacromial space; positive impingement tests

Lateral epicondylitis

*_________ _________ (Tennis elbow): -Etiology •Repetitive microtrauma to insertion of extensor muscles of lateral epicondyle •Tendinosis with degeneration of tendon without inflammation -Signs and symptoms •Aching pain in region of lateral epicondyle after activity •Pain worsens and weakness in wrist and hand develop •Elbow has decreased ROM; pain with resistive wrist extension

Forearm fractures

*_________ _________: -Etiology •Common in youth due to falls and direct blows •Rare to see fractures to ulna and radius simultaneously •Fracture in upper third may result in abduction deformity due to pull of pronator teres •Fracture in lower portion will remain relatively neutral •Older patients may experience greater soft-tissue damage and greater chance of paralysis due to Volkmann's contracture -Signs and symptoms •Audible pop or crack followed by moderate to severe pain, swelling, and disability •Edema and ecchymosis with possible crepitus

Wrist sprains

*_________ _________: -Etiology •Most common wrist injury •Arises from any abnormal, forced movement •Falling on hyperextended wrist or violent flexion or torsion •Multiple incidents may disrupt blood supply -Signs and symptoms •Pain, swelling, and difficulty with movement

Olecranon Bursitis

*_________ _________: -Etiology •Superficial location makes it extremely susceptible to injury (acute or chronic)—direct blow -Signs and symptoms •Pain, swelling, and point tenderness •Swelling will appear almost spontaneously and without usual pain and heat

Scapulohumeral rhythm

*_________ _________: -Movement of scapula relative to the humerus -Initial 30 degrees of glenohumeral abduction does not incorporate scapular motion (setting phase) -After the initial 30 degrees of abduction, there is a 2:1 ratio between glenohumeral and scapulothoracic joint motion (i.e. at 120 degrees of abduction, scapula is 60 degrees rotated upward

deQuervain's disease

*_________ __________ (Hoffman's disease) -Etiology •Stenosing tenosynovitis in thumb (extensor pollicis brevis and abductor pollicis longus) -These 2 muscles border the anatomical snuffbox •Constant wrist movement can be a source of irritation -Signs and symptoms •Aching pain, which may radiate into hand or forearm •Positive Finkelstein's test •Point tenderness and weakness during thumb extension and abduction; painful catching and snapping

Triangular fibrocartilage complex

*_________ __________ _________ (TFCC) injury: -Etiology •Violent twist or torque of the wrist •Often associated with sprain of UCL -Signs and symptoms •Pain along ulnar side of wrist, difficulty with wrist extension, possible clicking •Swelling is possible and may not be much initially

Bicipital tenosynovitis

*_________ ____________: -Etiology •Repetitive, overhead, and ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath -Signs and symptoms •Tenderness over bicipital groove, swelling, and crepitus due to inflammation •Pain when performing overhead throwing-type activities

Metacarpal what is a classic sign of a metacarpal fracture? A: knuckle malalignment

*_________ fracture: -Etiology •Direct axial force or compressive force •Fractures of the fifth metacarpal are associated with boxing or martial arts (boxer's fracture) -Signs and symptoms •Pain and swelling; possible angular or rotational deformity

Hamate

*_________ fracture: -Etiology •Occurs as a result of a fall or more commonly from contact while athlete is holding an implement -Signs and symptoms •Wrist pain and weakness and point tenderness •Pull of muscular attachment can cause nonunion

Cervical

*_________ fractures - Etiology • Generally an axial load with some degree of cervical flexion - Signs and symptoms • Neck point tenderness, restricted motion, cervical muscle spasm, cervical pain, pain in the chest and extremities, numbness in the trunk and/or limbs, weakness in the trunk and/or limbs, and loss of bladder and bowel control

humeral, Proximal, Epiphyseal

*_________ fractures - Remove from activity for 3-4 months *___________ fractures - Incapacitation 2-6 months *__________ fractures - Quick healing - Three weeks

scapular

*_________ fractures: -Etiology: •Result of direct impact or force transmitted up through humerus -Signs and symptoms: •Pain during shoulder movement as well as swelling and point tenderness

Kernig's

*_________ test: • Knees and hips flexed to 90 degrees • Passively extend knee - Causes pain in hamstring • Back pain may be a sign of nerve root irritation

Sciatica

*_________: - Etiology • Inflammatory condition of the sciatic nerve • Nerve root compression from intervertebral disk protrusion, structural irregularities within the intervertebral foramina, or tightness of the piriformis muscle - Signs and symptoms • Arises abruptly or gradually; produces sharp shooting pain, tingling, and numbness • Sensitive to palpation while straight-leg raises intensify the pain

Dislocated hip joint

*__________ ______ ________: - Etiology • Rarely occurs in sports • Result of traumatic force directed along the long axis of the femur (posterior dislocation with hip flexed and adducted and knee flexed) - Signs and symptoms • Flexed, adducted, and internally rotated hip • Palpation reveals displaced femoral head posteriorly • Serious pathology - Soft tissue, neurological damage, and possible fracture

Lunotriquetral ballotment

*__________ _________ test: -Stabilize lunate while sliding the triquetral anteriorly and posteriorly -Assess laxity, pain, and crepitus -Positive test indicates instability that often results in dislocation of the lunate

Trochanteric bursitis

*__________ __________: - Etiology: • Inflammation at the site where the gluteus medius inserts or the iliotibial (IT) band passes over the trochanter - Signs and symptoms: • Complaint of pain in lateral hip that may radiate down the leg • Palpation reveals tenderness over lateral aspect of greater trochanter • IT band and TFL tests should be performed

Medial epicondylitis

*__________ __________: -Etiology •Repeated forceful flexion of wrist and extreme valgus torque of elbow •May involve pronator teres, flexor carpi radialis and ulnaris, and palmaris longus tendons •Can be associated with ulnar nerve neuropathy -Signs and symptoms •Pain produced with forceful flexion or extension •Point tenderness and mild swelling

Madelung deformity

*__________ ___________: -Etiology •Developmental deformity of the wrist •Associated with changes in radius, ulna, and carpal bone -> results in palmar and ulnar wrist subluxations •Common in females •Carpals become wedged between radius and ulna following epiphyseal plate changes -Signs and symptoms •Bowing of radius and ulna evident on X-ray •Wrist pain and loss of forearm rotation •Palmar subluxation with prominence of radius and ulnar styloid processes

Acromioclavicular sprain

*__________ ___________: -Etiology •Result of direct blow (from any direction) or a upward force from humerus •Can be graded from 1-6 depending on severity -Signs and symptoms •Grade 1 - Point tenderness and pain with movement; no disruption of AC joint •Grade 2 - Tear or rupture of AC ligament, partial displacement of lateral end of clavicle; pain, point tenderness and decreased ROM (abduction/adduction) •Grade 3 - Rupture of AC and CC ligaments •Grade 4 - Posterior separation of clavicle •Grade 5 - Loss of AC and CC ligaments; tearing of deltoid and trapezius attachments; gross deformity, severe pain, and decreased ROM •Grade 6 - Displacement of clavicle behind the coracobrachialis

Dislocation (9/10 occurs posteriorly (anterior side is more stable))

*__________ of the elbow -Etiology •Caused by fall on outstretched hand with elbow extended or severe twist while flexed -Signs and symptoms •Swelling, severe pain, and disability •Complications with median and radial nerves and blood vessels •Often a radial head fracture is involved

Fractures

*__________ of the elbow -Etiology •Fall on flexed elbow or from a direct blow •Fracture can occur in any one or more of the bones •Fall on outstretched hand often fractures humerus above condyles or between condyles -Condylar fracture may result in gunstock deformity •Direct blow to olecranon or radial head may result in fracture -Signs and symptoms •May not result in visual deformity •Hemorrhaging, swelling, and muscle spasm

Costochondral

*__________ separation: -Etiology •Result of a direct blow to the anterolateral aspect of the rib cage -Signs and symptoms •Localized pain in region of costochondral junctions •Pain with movement and difficulty in breathing

Phalen's

*__________ test: -Test for carpal tunnel syndrome -Position is held for approximately one minute -If test is positive, pain will be produced in region of carpal tunnel

Finkelstein's

*__________ test: •Test for deQuervain's syndrome •Athlete makes a fist with thumb tucked inside •Wrist is ulnarly deviated •Positive sign is pain indicating stenosing tenosynovitis •Pain over carpal tunnel could indicate carpal tunnel syndrome *testing for pain associated with the extensor pollicus longus

Adductor/hip flexor (groin) strain

*__________/_____ ______ (groin) strain: - Etiology: • One of the more difficult problems to diagnose • Injury to one of the muscles in the regions (generally adductor longus) • Occurs from running , jumping, and twisting with hip external rotation or severe stretch - Signs and symptoms: • Sudden twinge or tearing during active movement • Produces pain, weakness, and internal hemorrhaging

Indigestion

*___________ (Dyspepsia) -Etiology •Some patients develop food idiosyncrasies that cause them distress after eating •Reactions before competition •Emotional stress, esophageal and stomach spasms, or inflammation of mucous linings in stomach and esophagus -Signs and symptoms •Increased HCl secretion, nausea, and flatulence (farting a lot)

Hemorrhoids

*___________ (Piles) -Etiology •Varicosities of the hemorrhoidal venous plexus of the anus •Constant straining or constipation may result in stretching of anal vessels, protrusion and bleeding, or a thrombus forming in the external veins -Signs and symptoms •Painful, nodular swellings near the anal sphincter •May cause slight bleeding and itching

adhesive capsulitis

*___________ _________ (frozen shoulder): -Etiology •Contracted and thickened joint capsule with little synovial fluid •Chronic inflammation with contracted inelastic rotator cuff muscles •Generalized pain with motions (active and passive) resulting in resistance of movement -Signs and symptoms •Pain in all directions and both with active and passive motion -extreme stiffness of the shoulder joint due to connective tissue built up with collagen (typically occurs in elderly)

Trendelenburg's test (this test is more dynamic and therefore typically the better test to use)

*___________ _________: - Iliac crest on unaffected side should be higher when standing on one leg - Test is positive when affected side is higher, indicating weak abductors (gluteus medius)

Gastrointestinal

*___________ bleeding -Etiology •Distance running, gastritis, iron-deficiency anemia, ingestion of aspirin or antiinflammatory agents, stress, bowel irritation, and colitis -Signs and symptoms •Abdominal pain, watery stool (with pus) dehydration, and intermittent fever (if colitis is involved)

Functional evaluation

*___________ evaluation -Range of motion in all movements of wrist and fingers should be assessed -Active, resistive, and passive motions should be assessed and compared bilaterally •Wrist - flexion, extension, radial and ulnar deviation •MCP joint - flexion and extension •PIP and DIP joints - flexion and extension •Fingers - abduction and adduction •MCP, PIP, and DIP of thumb - flexion and extension •Thumb - abduction, adduction, and opposition •Fifth finger - opposition

Scaphoid (scaphoid bone is hard to heal since there is poor blood supply)

*___________ fracture: -Etiology •Caused by force on outstretched hand, compressing scaphoid between radius and second row of carpal bones •Often fails to heal due to poor blood supply -Signs and symptoms •Swelling and severe pain in anatomical snuff box •Presents like wrist sprain •Pain with radial flexion

Contusion

*___________ of the forearm: -Etiology •Ulnar side receives majority of blows due to arm blocks •Can be acute or chronic •Result of direct contact or blow -Signs and symptoms •Pain, swelling, and hematoma •If repeated blows occur, heavy fibrosis and possibly bony callus could form within hematoma

Gamekeeper's

*___________ thumb: -Etiology •Sprain of ulnar collateral ligament ( UCL) of MCP joint of the thumb •Mechanism is a forceful abduction of proximal phalanx, occasionally combined with hyperextension -Signs and symptoms •Pain over UCL in addition to weak and painful pinch

Contusion

*____________ of upper arm -Etiology •Direct blow -Signs and symptoms •Transitory paralysis and inability to use extensor muscles of forearm (if radial nerve is impacted)

Hyperventilation

*____________: -Etiology •Rapid rate of ventilation due to anxiety-induced stress or asthma -Develop a decreased amount of carbon dioxide relative to the amount of oxygen -Signs and symptoms •Patient has difficulty getting air in and seems to struggle with breathing •Panic state with gasping and wheezing

Tendinitis

*____________: -Etiology •Repetitive pulling movements of (commonly) flexor carpi radialis and ulnaris; repetitive pressure on palms (cycling) can cause irritation of flexor digitorum •Primary cause is overuse of the wrist -Signs and symptoms •Pain on active use or passive stretching •Isometric resistance to involved tendon produces pain, weakness, or both

Tenosynovitis

*_____________: -Etiology •Cause of repetitive wrist accelerations and decelerations •Repetitive overuse of wrist tendons and sheaths -Signs and symptoms •Pain with use or pain in passive stretching •Tenderness and swelling over tendon

Appendicitis

*_____________: -Etiology •Inflammation of the vermiform appendix (chronic or acute) •Result of fecal blockage, lymph swelling, or carcinoid tumor •In early stages, it presents as a gastric complaint that gradually develops from red swollen vessel into a gangrenous structure that can rupture into bowels causing peritonitis -Signs and symptoms •Mild-to-severe pain in lower abdomen associated with nausea, vomiting, and low-grade fever •Pain may localize in lower right abdomen (McBurney's point)

Bowstring

*________test • Used to determine sciatic nerve involvement (similar to straight-leg raise test) • Leg (on affected side) is lifted until pain is felt • Knee is flexed to relieve pressure and popliteal fossa is palpated to elicit pain (along sciatic nerve) • To verify problem with nerve root, leg is lowered, ankle is dorsiflexed and neck is flexed. - Return of pain verifies nerve root pathology

AC joint instability

-Apply pressure in all four directions to determine stability (Clasp hands, put over shoulder and squeeze) •Take arm and horizontally adduct if there is a positive sign (it pinches them) this determines what injury/instability?

brachial and radial; Tinel's

-Circulatory and neurological function: •Pulse should be taken at ________ artery and ______ artery •Skin sensation should be checked - determine presence of nerve root compression or irritation in cervical or shoulder region *_______ sign: -Ulnar nerve test -Tap on ulnar nerve (in ulnar groove-i.e. 'funny bone') -Positive test is found when athlete complains of sensation along the forearm and hand

low

-Pale, cool, clammy skin indicates _____ blood pressure (BP)

1. Check ROM 2. Check neurological components (dermatome, myotome) 3. Do they have radiating pain? (if they don't—probably a muscle; if they do—probably an irritated nerve or compressed muscle-either vertebral body or nucleus pulposis)

-important questions to include when evaluating spine:

biceps femoris, semitendinosus, semimembranosus

3 hamstring muscles:

C5, C6, C7, C8, T1

Brachial plexus is what up of which nerves roots?

anterior to the sacrum

Body's center of gravity is located where

gliding

Carpometacarpal, Intercarpal joints, and wrist (radiocarpal) are what type of joint?

Obers is tightness at hip, Nobel's is at the knee

Difference between Nobel's test and Ober's?

hinge- contain collateral ligaments

IP joints and MCP joints are what type of joint?

nerve roots

In the Brachial Plexus, C5-T1 represents what part?

stick sports, like hockey

In what sports is a hamate hook fracture common?

1)Supraspinatus: I: greater tubercle A: abduction 2) Infraspinatus: I: greater tubercle A: external rotation & extension 3) Teres Minor: I: greater tubercle A: external rotation, extension, adduction 4) Subscapularis: I: lesser tubercle A: flexion & internal rotation

Insertion and Action of the 4 rotator cuff muscles:

Long Head of Biceps Supraspinatus Subacromial Bursa (i.e. contents of subacromial space)

List the 3 common anatomical structures that get pinched in an impingement syndrome with GH joint:

capillary refill

Pinching fingernails can also help detect circulatory problems- this phenomenon is also known as?

follow through phase

SLAP occurs most often in which throwing mechanics phase?

spondylolisthesis

Slipping of one vertebrae above or below another is referred to as _____________

Rennes test

Testing the Tensor Fasciae Latae and Iliotibial Band: * ______ ______: - Athlete stands with knee bent at 30-40 degrees - Positive response of fasciae latae tightness occurs when pain is felt at lateral femoral condyle

"Snapping Hip"

The "_______ _______" phenomenon: - Etiology • Common in young female dancers, gymnasts, and hurdlers • Habitual movement can predispose muscles around hip to become imbalanced • Manifested as: - IT band moving over greater trochanter resulting in trochanteric bursitis - Iliopsoas tendon moving over iliopectineal eminence - Iliofemoral ligament moving over femoral head - Long head of biceps femoris moving over ischial tuberosity • Extraarticular causes -> Hip ER and flexion • Related to structurally narrow pelvis, increased hip abduction, and limited lateral rotation • Intraarticular causes -> Loose bodies, labral tears, and joint subluxations - Signs and symptoms • Because of extraarticular causes, hip joint capsule, ligaments, and muscles become loosened and hip becomes unstable • Patients complain of snapping with severe pain and disability upon each snap

Phonophoresis

The application of ultrasound with a topical drug (i.e. cortisone) to facilitate transdermal drug delivery.

Pre-participation physical

____-______ ______ (PPP) exam for screening with the questions listed above (ask these 1st before echo or EKG): -History of heart murmurs -Chest pain during activity -Periods of fainting during exercise -Family history -Thickening of heart or history of Marfan's syndrome

Core stabilization

______ _________, dynamic abdominal bracing, and maintaining neutral position can be used to increase lumbo-pelvic hip stability

vomiting

________ results of some irritation, most often in the stomach

Marfan's

________ syndrome: Abnormality in connective tissue results in weakening of aorta and cardiac valves

Ulnar and Radial

_________ and _________arteries supply the hand -Two arterial arches (superficial and deep palmar arches)

Murphy's

_________ sign: when middle knuckle is depressed—lunate bone is subluxed

Neurological

__________ exam - Sensation testing: • If there is nerve root compression, sensation can be disrupted

flexion of elbow and supination of forearm, plus assists in radial deviation

action of brachioradialis?

protraction (upward rotation & lateral tilt)

action of serratus anterior?

upper= elevation of scapula lower= adduction

actions of the Trapezius (lower & upper):

-occur from a direct blow or falling on an outstretched hand

acute injuries of the elbow usually occur from what 2 things?

radial

all extensors of the forearm & fingers are innervated by what nerve?

median

all flexors of the forearm & fingers (except for two) are innervated by what nerve?

musculocutaneus

biceps brachii, coracobrachialis, brachialis are innervated by what nerve?

clavicle & scapula

bones of the shoulder girdle

scapula & humerus

bones of the shoulder joint

depression of 3 or more ribs together syncing into chest wall

clinical sign of flail chest?

3 -> 7 = bankart lesion 10 -> 2 = SLAP lesion (superior)

clock of axillary nerve:

lateral; medial

common extensor tendon via ______ epicondyle common flexor tendon via ________ epicondyle

1. Limited range of motion 2. Burning pain in extremity (pressure on nerve root)

compressing forces down onto lumbar disc (from obesity/height) -How to know when to refer pt to physician?

linea alba

connective tissue that connects both sides of the abdominal muscles together

viscera

connective tissue that separates internal organs

intervertebral discs

the _________ _____ consists of 2 parts: nucleus pulpolsis & annular fibrosis **Annulus Fibrosus -Dense fibrous tissue -X-pattern, able to compress -Ability to deform and change shape without damaging tissue -Best for compression (where the vertebral body sits on) **Nucleus Pulposus -Semi-gelatinous substance inside annulus -High water content- does not compress, but can shift position and change shape -Less stable structure (more jelly like)

iliopsoas

the _________ muscle is 1 joint; initiates knee flexion; could be the reason for back pain

flexor carpi ulnaris and flexor digitorum

the ulnar nerve innervates what 2 flexor muscles of the hand?

cause lower back pain (will cause the hips to rotate anteriorly)

tight hip flexors could cause pain where?

external rotation of hip

together, what action does the Gluteus Maximus & Piriformis perform?

radial

triceps are innervated by what nerve?

Neer's test and Hawkins-Kennedy test

what 2 tests can be used to assess impingement of soft-tissue structures? -Positive test is indicated by pain and grimace

1) Glenohumeral translation - Anterior and posterior stability -Translation of 1cm or greater is an indication of GH ligament instability and inadequacy of glenoid lip 2) Anterior and posterior drawer tests -Positive anterior and posterior drawer test indicates insufficiency of anterior and posterior joint capsule and labrum **Why are these not good test? Everyone will have a certain amount of laxity so it is a hard test to determine 3) Sulcus test: -depression of the shoulder

what 3 tests can be used to determine GH joint instability?

rotator cuff muscles + long head of the biceps tendon

what 5 muscles provide dynamic stability in the GH joint?

abduction of hip

what action does both the Gluteus Maximus & Medius perform?

active, passive, resistive *Active & Passive: •Flexion and extension •Abduction and adduction •Internal and external rotation *Muscle testing: •Muscles of the shoulder and those that serve as scapula stabilizers

what are the 3 different types of ROM to test?

deep circumflex femoral, deep femoral, and femoral arteries

what are the 3 main arteries of the thigh?

Posterior view anatomical position: Q1 (upper right): Liver, stomach, gallbladder, duodenum, right kidney Q2 (lower right): appendix, reproductive organs, right ureter Q3: (lower left): left ureter, reproductive organs Q4: (upper left): heart, stomach, pancreas, left kidney, spleen

what are the 4 abdominopelvic quadrants (move clockwise starting from upper right quadrant) and what organs do they contain?

•the right scapula, right shoulder, substernal area, and occasionally in left anterior side of the chest

what are the 4 referred pains with liver contusion?

A: wind up B: pre cock C: cocking D: acceleration E: follow through •Wind-up phase: -First movement until ball leaves gloved hand -Lead leg strides forward while both shoulders abduct, externally rotate, and horizontally abduct •Cocking phase: -Hands separate (achieve maximum external rotation) while lead foot comes in contact with ground •Acceleration: -Maximum external rotation until ball release (humerus abducts, horizontally abducts, and internally rotates) -Scapula elevates, abducts, and rotates upward •Deceleration phase: -Point from ball release until maximum shoulder internal rotation -Eccentric contraction of external rotators to decelerate humerus while rhomboids decelerate scapula •Follow-through phase: -End of motion when athlete is in a balanced position

what are the 5 stages during throwing mechanics?

borders: Acromion, Coracoid, Coracoacromial ligament contents: biceps brachii (long head), subacromial bursa, & rotator cuff muscles

what are the contents and borders of the subacromial space?

ischial tuberosity

what bone do we sit on that attaches to the hamstrings?

Fall on Out-Stretched Hand Anteriorly

what does FOOSHA stand for?

non-steroidal anti-inflammatory drugs

what does NSAIDS stand for

indicate tight hip flexors -> Thomas: AT will hold knee up to chest, positive sign if bottom leg (which is straight) is lifted up off table -> Kendalls: bottom leg from knee down is hanging off table, patient holds knee to chest, positive sign is if bottom leg pops upwards instead of remaining dangled

what does a positive Thomas & Kendall's test indicate? what is the difference between these 2 tests?

when there is an extra nerve on heart -HR is too fast so this nerve is removed

what is Wolff-Parkinson-White syndrome?

Gerdy's tubercle

what is the insertion point for IT band?

Did you slip on a wet surface? This strain is an eccentric muscle action

what is the key question to ask a patient with a quad/hamstring strain? what type of muscle action causes this strain?

hamstring muscle strain

what is the most common thigh injury?

pronator teres

what muscle has the highest propensity of entrapment of the median nerve?

Piriformis

what muscle is the prime mover for external rotation?

posterior

what portion of the disc is the weakest?

'acetabulum' which is the concave surface which fits the head of the femur into

what structure does the ilium, ischium, & pubis bones form? (concave)

IT band

what structure serves as the attachment for the tensor fascia lateral and greater aspect of the gluteus maximus

Shoulder abduction test

what test can be done to ensure that a positive cervical compression test/ Spurling's test were correct?

costal cartilage

what type of cartilage is between ribs?

ball-in-socket joint with intrinsic stability (moves through 3 plane-particularly during gait)

what type of joint is the hip?

ask patient to swallow because if it is posteriorly dislocated it could be blocking the trachea

when dealing with an SC joint dislocation, what question should you ask and why?

apply the ice with the knee flexed, after a few minutes flex the knee a little further, continuing icing and the process of moving the knee further into the flexion until trying to get the knee into full flexion

when icing a quad contusion how should you position the knee?

cervical: -Postural alignments (if shoulders are aligned) -head and neck alignment thoracic: -Pain in upper back and scapular region Facet joint involvement -With deep inspiration and chin tucked to chest

when observing spinal injuries you should look at:

fractured rib; costochondral

when palpating the thorax, anterior/posterior palpations indicated a fractured ______; transverse pressure assesses __________ junction

on the medial (ulnar) side on the outside of the wrist carpals

where can the triangular fibrocartilage be palpated? on the medial (ulnar) side on the outside of the wrist carpals

iliac crest

where does contusions of the hip occur?

rectus femoris- extends knee and flexes the hip

which muscle is the only quad muscle that crosses the hip? What is its action?

Active (since they must be able to move it on their own)

which of these 3 ROM tests is the best for testing the GH joint?

birth control increases BMD because some oral contraceptive pills containing progesterone can help bone density

why do females on birth control have a decreased risk of stress fractures?

compression, entrapment, and palsy

•Nerve ________, _________, and __________: -Etiology •Median and ulnar nerve compression •Result of direct trauma to nerves -Signs and symptoms •Sharp or burning pain associated with skin sensitivity or paresthesia •May result in benediction or bishop's deformity (damage to the ulnar nerve) or claw hand deformity (damage to both nerves) •Palsy of radial nerve produces drop wrist deformity, caused by paralysis of extensor muscles •Palsy of median nerve can cause ape hand (thumb pulled back in line with other fingers)

-Solid organ - Dull sound ('thud') -Hollow organ - Tympanic or resonant sound •Echo sound (if a thud sound this means there is fluid build up)

•Percussion (Place fingers on abdomen and strike with other hand) what sound should occur with solid organ? hollow organ?

-Limit the number of repetitions in throwing a baseball or in hitting a tennis ball -Ensure that the mechanics of the throwing or hitting techniques being used are correct -Select and use equipment that is appropriate for a specific skill level -Engage in routine stretching of the muscles in the elbow, forearm, and wrist to maintain flexibility/range of motion

•Strategies for reducing chronic injuries:

Tension pneumothorax

•________ __________: -Pleural sac on one side fills with air displacing the lung and heart and compressing the opposite lung -May cause shortness of breath, chest pain, absence of breath sounds, cyanosis, distention of neck veins, and deviated trachea

Apprehension; Relocation

•___________ test: used for anterior glenohumeral instability •___________ test: uses external rotation and posteriorly directed pressure to allow for increased external rotation

Pneumothorax

•___________: -Pleural cavity (outer cavity) becomes filled with air negatively pressurizing the cavity and causing a lung to collapse -Will produce pain, difficulty in breathing, and anoxia

Hemothorax

•_____________: -Tearing or puncturing of the lungs or pleural tissue -Painful breathing, dyspnea, coughing up frothy blood, and signs of shock -Blood fills up around the lung