Sports Medicine

Fibular films The combination of an eversion or external rotation mechanism with potential deltoid ligament injury warrants evaluation for proximal fibular or a Maissoneuve fracture. In addition to careful palpation along the fibula, radiographs of the fibula should be obtained, since the fracture will be missed on standard ankle films.

A 19-year-old basketball player complains of ankle pain after an eversion-type injury. There is tenderness and swelling over the deltoid ligament. Which of the following radiographs should be obtained in addition to standard ankle films?

benign, fracture at the fifth metatarsal base is an extra-articular fracture of the tuberosity or styloid process (the bulge of the fifth metatarsal that is easily palpated over the lateral edge of the foot). Treat wth a walking cast for 2-3 weeks However, surgical treatment has been recommended if either displacement of greater than three millimeters occurs, or greater than 30% of the metatarsal cuboid joint articulation is involved.

A dancer' fracture or pseudo-Jones fracture is?

Peroneal tendon dislocation Peroneal tendon dislocation or subluxation may be misdiagnosed, as ankle sprain or may occur concomitantly with ankle sprains or fractures. The mechanism of injury usually is forced dorsiflexion with reflex contraction of the peroneal muscles, resulting in avulsion of the retinaculum and anterior displacement of the peroneal tendons. Peroneal tendon dislocation causes sudden pain and a snapping sensation over the posterolateral ankle associated with weakness of eversion. A characteristic finding on the physical examination is tenderness and swelling over the lateral retromalleolar area. Dislocated tendons also may be palpable near the inferior tip of the lateral malleolus. Inability to evert the foot against resistance when the foot is in dorsiflexion is diagnostic.

A snapping sensation over the posterolateral ankle is indicative of?

navicular tuberosity

According to the Ottawa Foot Rules, radiographs of the foot are recommended when physical examination reveals pain upon palpation of:

thenar eminence https://www.youtube.com/watch?v=vlwAoKpSI7s

After a median nerve injury at the wrist, the muscles of the ??? eminence will gradually atrophy (loss of recurrent nerve), and the hand eventually looks flattened and "apelike".

Lateral malleolar fracture below the tibiotalar joint line. A fracture of the fibula below the tibiotalar joint (Weber A fracture) is considered extra-articular. All other ankle fractures are potentially unstable and require orthopedic consultation for possible surgery.

An ankle fracture that can be managed on an outpatient basis with close orthopedic follow-up:

an intra-articular fracture at the base of the thumb metacarpal (just distal to wrist, visually still part of the hand) combined with a dislocation or subluxation of the carpal-metacarpal joint. This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint. accompanied by pain and weakness of the pinch grasp. Characteristic signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb. The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.

Bennett's thumb is?

Botounniere's deformity is caused by a disruption of the central tendon (an extensor tendon) over the proximal interphalangeal (PIP) area. long swan neck This leads to an unopposed flexor digitorum superficialis at the PIP, which now locks the PIP joint into flexion. Eventually, the lateral bands (which normally act as auxilliary extensors) displace volarly (opposite to their displacement in the swan neck deformity), and thereby change from being extensors to flexors of the PIP joint. In addition, the extensor hood retracts proximally, causing extension of both the MCP and DIP joints (skipping the rigidly flexed PIP joint). The resulting tendon imbalance leads to the so-called boutonniere (buttonhole) deformity. Although open injuries of the central tendon may cause an acute boutonniere deformity, it usually is the result of a closed athletic injury, in which the initial central tendon injury was not recognized

Botounniere's deformity is

alignment of the second metatarsal with middle cuneiform bone The first 4 metatarsals should each line up with their respective tarsal articulation along their medial edge on anteroposterior and oblique radiographic views.

Evaluation of which aspect of plain films of the foot is critical to assessing for Lisfranc's injury? (is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus) Lisfranc injuries are rare because tremendous energy is required to disrupt the joint. Most are incurred in motor vehicle crashes or sports in which the foot remains fixed (equestrian sports, wind surfing).

Buddy taping to adjacent toe splinting the injured toe to an adjacent toe with adhesive tape.

For a nondisplaced fracture of the distal phalanx, what is the best management of this injury?

weakness or absence of flexion of the index finger's middle and distal phalanges (PIP and DIP joints), the middle finger's distal phalanx (DIP joint) and the thumb (IP joint). https://www.youtube.com/watch?v=vlwAoKpSI7s

Injury to the median nerve in the upper forearm or at the elbow usually results in neurological compromise of the forearm digitorum muscles, which leads to??? weakness or absence of flexion of the index finger's middle and distal phalanges (PIP and DIP joints), the middle finger's distal phalanx (DIP joint) and the thumb (IP joint).

Both of these fractures involve the base of the 5th metatarsal but are treated very differently. A Pseudo-Jones fracture is an avulsion fracture of the proximal tuberosity tip of the 5th metatarsal caused by lateral ankle strain. It occurs at the insertion site of the peroneus brevis tendon and typically enters the tarsometatarsal joint rather than the intermetatarsal joint. Patients with a dancer's fracture should be discharged with a hard soled shoe and directed to weight bear as tolerated until symptoms improve.

It is important to be able to tell the difference between a Jones fracture (displayed above) and a Pseudo-Jones fracture (Dancer's fracture).

median This is usually due to laceration or compression via the carpal tunnel. https://www.youtube.com/watch?v=vlwAoKpSI7s

On its long course from the neck to the hand, the median or radial nerve is most frequently injured at the wrist?

Today, skiing is the most common cause of this injury.

Pearl: The term gamekeeper was coined to describe the occupational hazard of Scottish gamekeepers who damaged their thumbs by a repeated maneuver involving twisting the necks of hares.

valgus but radiographs should be obtained before the joint is stressed. Complete ruptures are more frequently accompanied by injuries that are visible on x-ray (avulsed dorsal capsule and volar plate and other injuries). A bony avulsion from the insertion of the UCL into the proximal phalanx, an associated condylar fracture, or proximal phalanx volar subluxation with radial deviation all point towards a complete UCL rupture. X-rays alone are not sufficient to distinguish a sprain from a tear.

Proper valgus or varus stressing during the clinical examination is the key to differentiating complete from partial ruptures.

a comminuted fracture of the base of the thumb metacarpal (same location as Bennett's thumb, but a different fracture).

Rolando's fracture is?

ulnar Skier's thumb (also known as gamekeeper's thumb): ulnar collateral ligament sprain or tear at its insertion into proximal phalanx of the thumb (where the thumb separates from the hand to become an individual digit). Besides the collateral ligament injury, associated injuries of the dorsal capsule and volar plate are common if the ligament is completely severed but rare if the ligament is "only" sprained.

Skier's thumb: ulnar or radial collateral ligament sprain or tear at its insertion into proximal phalanx

delayed complication of poorly healed mallet finger (avulsion of extensor tendon from base of distal phalanx). This abnormality develops when the lateral bands gradually contract during the healing process so that they move dorsally and proximally, which results in increased extension forces on the PIP joint that lock the PIP joint into extension.

Swan neck deformity is? "mallet finger"

Yes, a complete tear requires surgery and if delayed may need complete fusion of the joint. Incomplete ruptures or sprains can be managed with a 4-week period of immobilization in a thumb spica cast; full recovery is the rule. Volar base avulsion fractures may be associated with an UCL sprain, but partial ligamentous disruption alone is more common in the context of a sprain. Complete ligamentous tears require surgical repair because in nearly two thirds of patients, the adductor pollicis becomes interposed between the superficial proximal portion and the deep distal portion of the ligament and interferes with healing. In these two thirds of patients, chronically non-healing gamekeeper's thumbs may later require an arthrodesis (bony fusion!) of the MCP thumb joint, which leaves the patient with a significant disability.

T or F A complete tear of the ulnar collateral ligament should be differentiated from a sprain.

Absence of passive plantarflexion of the foot by squeezing the calf muscles...Achilles tendon rupture.

The Thompson test is?

Absence of passive plantarflexion of the foot by squeezing the calf muscles Diagnosis of Achilles tendon rupture is primarily clinical. The classic maneuver for assessing Achilles tendon rupture is Thompson's test, where squeezing the calf muscles with the knee flexed at 90 degrees fails to elicit plantarflexion. Beware: Active plantarflexion can be present because of the action of the tibialis posterior muscle. Only rarely can a defect be palpated, but if one is present, then this is an even more specific sign.

The most helpful test in establishing a diagnosis of Achilles tendon rupture?

Median Intact opposition of the thumb to the little finger is a quick test that requires flexion and abduction (yes, aBduction!) and thus indicates an intact distal median nerve (more specifically - an intact recurrent motor nerve to the thenar muscles). https://www.youtube.com/watch?v=vlwAoKpSI7s

The radial or median nerve can be tested by opposition of the thumb and index finger?

radial

Ulnar collateral ligament (UCL) injury, otherwise known as gamekeeper's or skier's thumb, is usually due to forced radial or ulnar deviation or abduction at the metacarpal-phalangeal joint of the thumb.

distal fibula. The fractures are below (Weber A), at (Weber B), or above (Weber C) the tibiotalar joint. Only Weber A fibular fractures can be treated conservatively. The other 2 types typically require surgery or at least an urgent orthopedic consult.

Weber A, B, and C is a classification system for fractures of the ???

The Ottawa Foot Rules state that a foot radiographic series is required if there is pain in the midfoot region with any of the following findings: bone tenderness at the navicular bone, or bone tenderness at the base of the fifth metatarsal, or inability to bear weight for at least 4 steps both immediately after the injury and at the time of evaluation The Ottawa Foot Rules are validated clinical decision rules designed to help clinicians save time and money by avoiding unnecessary radiographs of the midfoot. They have a sensitivity approaching 100% in detecting midfoot zone fractures. They should not be relied upon in children, pregnant women, patients with diabetes, or injuries over 10 days old.

What are the Ottawa Foot Rules?

A Jones fracture goes through the diaphysis of the metatarsal just distal (at least 15 mm) to the proximal tuberosity and typically involves the 4th /5th intermetatarsal joint. The fracture results from a complex combination of forces generated when a load is applied to the lateral forefoot in the absence of inversion. The Jones fracture lies in a vascular watershed area and therefore has a propensity towards non-union and chronic pain.

What is a Jones fracture?

perineural fibrosis of the intermetatarsal plantar digital nerve. The second-to-third or third-to-fourth intermetatarsal spaces are commonly affected. The pain of Morton's neuroma is reproduced when structures of the affected interspace are pinched or when the metatarsal heads are compressed together. Thus, pain may occur intermittently with tight-fitting footwear (rock-climbing shoes, ski boots). Crepitus or a nodule may be palpable. For cases that do not respond to conservative therapy (roomier shoes, custom shoe inserts, NSAIDS or corticosteroid injections), treatment usually involves surgical excision or neurolysis.

What is a Morton's neuroma?

The Apley grind test or Apley test is used to evaluate individuals for problems in the meniscus of the knee.

What is the Apley grind test?

median nerve The boundaries are the carpal bones and the flexor retinaculum. In addition to the medial nerve, the carpal tunnel contains nine tendons: the flexor pollicis longus, the four flexor digitorum superficialis and the four flexor digitorum profundus. https://www.youtube.com/watch?v=vlwAoKpSI7s

What nerve runs through the carpal tunnel?

thumb, index, middle and half of the third digit https://www.youtube.com/watch?v=vlwAoKpSI7s

What part of the hand experiences numbness with CTS?

Only rarely can a defect be palpated, but if one is present, then this is an even more specific sign.

With an achilles tendon rupture, how frequent is it you can palpate the rupture