EXS 301 Test #3

Special Tests

*if you suspect a fracture, you don't perform this* ...beginning in extension...the knee is passively flexed (normal=full ROM, one with swelling=restricted), active movement from flexion to extension (strong&painful=muscle strain, weak/pain free=indicates 3rd degree or partial rupture), muscle weakness against an isometric resistance may indicate nerve injury)

Acute Mountian Sickness

1 out of 3 people will experience this when making a jump of 7000-8000 feet. They will experience headache, nausea, vomiting, sleep disturbance, and dyspnea. Caused by brain disruption associated with sodium potassium imbalance resulting in fluid retention and cellular pressure changes.

Carbon Monoxide

Colorless, odorless gas. Reduces hemoglobins ability to transport oxygen and restricts release of oxygen to the tissue. Interferes with performance, and various psychomotor, behavioral, and attentional related activities.

Sickle Cell Trait Reaction

8-10% of African Americans have the "sickle cell trait" This is an abnormality in red blood cell hemoglobin structure. When hemoglobin is deozygenated, cells clump together causing blood cell to develop sickle shape making it easy to destroy. Causes an enlarged speel and could rupture at high altitudes.

Heat Rash (Prickly Heat)

Condition associated with red, raised rash, combined with prickling and sweat. Results in continous wet un-evaporated sweat. Contunally towling the body will help prevent this from happening, and generally localized areas covered in clothing.

Hyperthermia

AT's require knowledge and information concerning temperature, humidity, and weather to adequately make decisions regarding environmental dangers. This has caused a number of deaths over the past years, must manage heat stress appropriately and plan accordingly with coaching staff.

Tools for Customizing

Adhesives, adhesive tapes, heat source (to make foams), scissors, blades, knives, fastening materials, snaps, velco, rivets, laces.

Tibial Torsion

An angle that measures less than 15 degrees is an indication of this.

Osgood- Schlatter Disease

Apophysitis occuring at the tibial tubercle. Begins cartilaginous and develops a bony callus, enlarging the tuberce. Resolves with aging, common cause is repeated avulsion of the patellar tendon. signs include swelling, hemorrhaging and gradual degeneration of the apophysis due to impaired circulation, pain with kneeling, jumping, and running. management includes reduce stressful activity until union occurs, possible casting, ice, isometrics.

Girth Measurements

Changes in girth can occur due to atrophy swelling and conditioning. Must use circumferential measures to determine gains during the rehab process. Measurements should be taken at the joint line, the level of the tibial tubercle, belly of the gastronemius. Subjective reading (used to determine partients perception of pain)

Altitude

As the height of an event increases, maximum oxygen uptake decreases and results in a decrease in performance. Responses to this are a result of having fewer red blood cells than necessary to adquately capture available oxygen. To adapt you must go to the site before in order to get your body use to it, natives to US are typically going to be in better shape because their chest cavity is bigger.

Heat Syncope (Heat Collapse)

Associated with rapid fatigue and overexposure standing in heat for long periods of time. This is caused by perihperal vasodilation, or pooling of blood in extremities resulting in dizziness and fainting. Treat by placing athlete in cool environment, consuming fluids and laying down.

Posteriod Sag Test (Godfrey's Test)

Athlete is supine with both knees flexed at 90 degrees. lateral observation is required to determine extent of posteriod sag while comparing bilaterally.

People prone to Heat Related Illness

Athletes with large muscle mass, overweight athletes, death from stroke increases 4:1 as body weight increased, women are physiologically more efficient with regard body temperature regulation. People with poor fitness, history of heat illness, or young and elderly.

Legg Calve' Perethes Disease (Coxa Plana)

Avascular necrosis of the femoral head in child ages 4-10, trauma accounts for 25% of cases, articular cartilage becomes necrotic and flattens. Signs include pain in groin that can be referred to the abdomen or knee. Limping is also typical, varying onsets and may exhibit limited ROM. Management includes best rest to alleviate synovitis, brace to avoid direct weight bearing, with early treatment and the head may re-ossify and revascularize. Complications include that if its not treated early, will result in ill-shaped head and develop into osteoarthritis later in life.

Convective Heat Exchange

Body heat can be lost or gained depdning on circulation of medium

Joint Contusions

Caused by a blow to the muscles crossing the joint. Signs include it looks like a knee sprain, severe pain, loss of movement and signs of acute inflammation, swelling, discoloration, capsular damage. Management includes RICE and continue as long as there's swelling. Gradual progression into normal activity following return of ROM and padding for protection. If swelling does not resolve within a week, may require more rest

Quadriceps Muscle Strain

Caused by a sudden stretch, violent forceful contraction of hip and knee into flexion. Over stretching of the quadriceps. Signs include peripheral tear causes fewer symptoms than deeper tear, pain, point tenderness, spasm, loss of function, complete tear may leave patient with a disability, discomfort, deformity. Graded 1-3. Management includes RICE, NSAID's.

Adductor/Hip Flexor (Groin) Strain

Caused by an injury to one of the muscles in the regions (generally adductor longus) Occurs from running, jumping, twisting with hip external rotation or severe stretch. Signs include sudden twinge or tearing during active movement, produces pain, weakness, and internal hemorrhaging. Management includes RICE, NSAID's, determined exact muscle involved, rest is critical, restore normal ROM

Quadriceps Contusions

Caused by constantly being exposed to traumatic blunt blows, severe impact, extent of force and degree of thigh relaxation. Signs include pain, loss of function, immediate effusion with palpable swollen area. Graded 1-4. Management includes RICE, NSAID's and analgesics, crutches, follow up care, heat, massage.

Osteochondtritis Dessecans

Caused by partial or complete separation of articular cartilage and subchondral bone. Cause is unknown but may include blunt trauma, possible skeletal abnormalities. Signs include arching pain with recurrent swelling and possibly locking, possible qaud atrophy and point tenderness. Management includes rest and immobilization for children, surgery may be necessary in teenagers and adults.

Myositis Ossificans Traumatica

Caused by the formation of ectopic bone following repeated blunt trauma, gradual deposit of calcium and bone formation, may be the result of improper thigh contusion treatment. Signs include an x-ray that will show calcium deposit 2-6 weeks following injury, pain, weakness, swelling, decreased ROM. Management includes treatment, may require surgery

Trochanteris Bursitis

Caused by the inflammation at the site where the gluteus medius inserts or the IT-band passes over the trochanter. Signs include complaints of lateral hip pain that may radiate down the leg, palpation reveals tenderness over lateral aspect of greater tochanter. IT-band and TFL tests should be performed. Management includes RICE, NSAID's, phonophoresis if pain isn't reduces, runners should avoid inclines

Osteochondral Knee Fractures

Caused by the twisting, sudden cutting or direct blow, fractures of the cartilage and underlying bon varying in size and depth. Signs include you hear a snap and feeling of giving away, immediate swelling and considerable pain, diffuse, pain along joint line. Management includes treatment is dependent on stability of fracture, if stable the patient will be casted, if fragment is loose surgical reattachment will occur or removal. Rehab, ROM is typically initiated after surgery, return to activity after 3-6 months

Knee Plica

Caused from the irritation of the plica. Signs include possible history of knee pain/injury, recurrent episodes of painful pseudo-locking, possible snapping and popping, pain with stairs and squatting, little or no swelling, or no ligamentous laxity. Management includes treat with RICE, NSAID's, and if its recurrent surgery may be required.

Frostbite

Chillblains result from prolonged exposure causing redness and swelling, tingling pain in toes and fingers. Due to poor peripheral circulation. Superficial frosbite invovles only the skin, appears blue, may blister. Deep frostbite indicates frozen skin requiring hospitalization. Tissue will become blotchy and red, swollen, painful.

Athletic Pubalgia

Chronic pubic region pain caused by repetitive stress to pubic symphysis from kicking, twisting, or cutting. Signs include no presence of hernia, chronic pain during exertion, sharp and burning that laterally radiates into adductors and testicles. Management includes conservative treatment, massage, stretching after 1 week, 2 weeks=strengthening, 3-4weeks began running.

Sulfer Dioxide

Colorless gas that is a component of burning coal or petroleum. Causes increased resistance to air movement in and out of the lungs, decreased ability of lungs to rid themselves of foreign matter, shortness of breath, coughing, fatigue and increased susceptibility to lung diseases.

Bursitis

Comes from acute, chronic, or recurrent swelling. Prepatellar (continued kneeling), intrapatellar (overuse of patellar tendon) Signs include prepatellar bursistis may be localized swelling above knee that is ballotable. Swelling in popliteal fossa may indicate a Baker's cyst. Management include RICE and NSAID's, aspiration and steroid injection if chronic.

Radiant Heat Exchange

Comes from sunshine and will cause increase in temperature

Frost Nip

Common cold injurt that involves ears, nose, chin, fingers, and toes. occurs with high wind or/and severse cold. skin appears firm with cold painless areas that may peel and blister. treat with firm pressure, blowing warm air or hands in armpits. Do not rub.

The Snapping Hip Phenomenon

Common in young female dancers, gymnasts, hurdlers. Movement causes hips to become imbalanced. Related to a structurally narrow pelvis, increased hip abduction and limited lateral rotation. Signs include that due to extraarticular causes hip joint capsule ligaments, muscles become loosened and hip becomes unstable. Patient complains of snapping with severe pain and disability upon each snap. Management includes decreases pain and inflammation, move on to stretch and strengthen weak musculature in hip region.

The Knee

Complex joint that endures great amounts of trauma due to the extreme amounts of stress that are applied onto it. This is a hinge joint with a rotational component. Stability is primarily due to the ligaments, joint capsule, and muscles surrounding the joint. Designed for stability with weight bearing and mobility in locomotion.

Peroneal Nerve Contusion

Compression of peroneal nerve due to a direct blow. Signs include local pain and possible shooting nerve pain, numbness in cutaneous distribution of the nerve, added pressure may exacerbate condition. Generally resolves quickly. Management includes RICE and return to play once symptoms resolve and no weakness is present. Padding for fibular head is necessary for a few weeks.

Preventing Heat Illness

Consume fluids and stay cool.`

Contusion (Hip pointer)

Contusion of the iliac crest or abdominal musculature. Result of a direct blow. Signs include pain, spasm, decreased rotation of the trunk or thigh/hip flexion. Management includes RICE for 48 hours, NSAID's, bed rest 1-2 days. x-ray, ice massage, ultrasound, steroid injection

Decreasing ACL Injury

Focus on strength, neuromuscular control, balance. Series of different programs with address balance board training, landing strategies, plyometric training, and single leg performance.

Acute Patella Subluxation or Dislocation

Deceleration with simultaneous cutting in opposite direction. Quad pulls the patella out of alignment, some individuals may be predisposed, repetitive subluxation with stress medial restraints. Signs and symptoms include pain and swelling, restricted ROM, tenderness, sometimes total loss of function. Management includes reduction is performed by flexing the hip, moving patella medially and slowly extending the knee. Following reduction, immobilization for at least 4 weeks with use of crutches and isometric exercises during this period. After immobilization period, horseshoe pad with elastic wrap should be used to support the patella. muscle rehab focusing on muscle around the knee. possible surgery.

Main Arteries of the Thigh

Deep circumflex femoral, deep femoral, and femoral artery.

Assessing the Knee Joint

Determining the mechanism of injury to the knee is critical. Ask them their history (current injury/past injury), What position was your body in, did you hear/feel anything, did the knee collapse, did swelling occcur, where was the pain? Major complaint, when did you notice, does the knee lock or catch, is there severe pain, grinding...?

Foot Orthotics

Device used for correcting biomechanical problems that exist in foot and can eventually cause injury. Plastic, thermoplastic, rubber, leather and others are different types. Can also be customized by a doctor, athletic trainer, and physical therapist (more expensive)

Functional Discrepancy

Difference due to deformity that cannot be "fixed" Measurement is taken from umilicus to medial malleoulus.

Patellar Fracture

Direct or indirect trauma, semi-flexed position with forcible contraction. Signs include hemorrhaging and joint effusion with generalized swelling, indirect fractures may cause capsular tearing, separation of bone fragments and possible quad tendon tearing. Little bone separation with direct injury. Management includes x-ray necessary for confirmation of findings, RICE and splinting if fracture is suspected, refer and immobilize for 2-3 months.

Kinetic Chain

Directly affected by motions and forces occurring at the foot, ankle, lower leg, thigh, hip, pelvis, and spine. With the Kinetic Chain forces must be absorbed and distributed. If the body is unable to manage forces, breakdown of the system occurs.The knee is extremely susceptible to injuries resulting from absorption of forces.

Anterior Cruciate Ligament Test

Drawer test at 90 degrees of flexion. Tibia sliding forward from under the femur is considerd a positive sign (ACL). Should be performed with knee internally and externally to test integrity of joint capsule.

Hypothermia

Due to cold weather and nature of the sport. Problems arise when heat lost exceeds heat production generated by metabolism. Drop is core stimulates shivering but stops after temperature drops below 85-90 degrees. To prevent apparel geared for weather must prevent chilling, waterproof and windproof fabrics that allow passage of heat and sweat and allow movement. Layers and how you adjust them are key. Be aware of what is wrong with clothing, and the environment. Be aware of hydration levels.

Femoral Stress Fractures

Due to overstress, excessive downhill running or jumping activities, often seen in endurance athletes. Signs include persistent pain in thigh/groin, x-ray or bone scan will reveal fracture. Management includes prognosis will vary depending on location, fx lateral to femoral neck tend to be more complicated, shaft and medically located fractures tend to heal well with management.

Sprains of the Hip Joint

Due to substantial support, any unusual movement exceeding normal ROM may result in damage. Force from opponent/object or trunk forces over planted foot in opposite direction. Signs include signs of acute injury and inability to circumduct the hip, similar to S & S to stress fracture, pain in hip region with hip rotation increasing pain. Management includes x-ray or MRI should be performed to rule out fracture. RICE, NSAID's, crutches maybe, ROM is messes up until you're pain free.

Synthetic Turf

Durable, offer great consistency, usable with inclement weather, require less maintenance, offer greater performance in areas of speed and resilency. Resilient infill turf is the most recent and it's similar to grass.

Heat Stress

Extreme caution should be used when training in the heat, this is preventable. Athletes that rain under these extreme conditions are at risk, the body MUST be able to dissipate heat to maintain homeostasis. The elderly and young athletes are more likely to be affected by heat stress. Sometimes the problem could be due to the type of clothing used, and the equipment.

Acute Hyponatremia

Fluid/Electrolye disorder resulting in abnormally low concentration of sodium in the blood, caused by ingesting too much fluid before during and after practice. May result in too little sodium in diet or too much injested fluids over a period of prolonged exercise. Athletes that inhest large quanitites of water and sweat over several hours are at risk. Must maintian that balance in order to prevent. Signs include progessively worrsening headache, nausea, vomiting. Swelling of the hands and feet, low blood sodium.

Ozone

Formed by the action of sunlight on carbon based chemicals (hydrocarbons) in cominiation with Nitrogen Dioxides. Minimum activity levels-ozone will not impact, and higher intensity will have a negative impact on work output. May experience shortnes sof breath, coughing, chest tightness, pain with deep breathing, nausea, eye irritation, fatigue, lung irritation, lowered resistance to lung infection.

Slipped Capital Femoral Epiphysis

Found mostly in boys ages 10-17 who are characteristically tall and thin or obese. may be growth hormone related. 25% of the cases are seen in both hips. head slippage on x-ray appears posterior and inferior. Signs include 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 presents with a limp. Management includes with minor slippage, rest and non-weight bearing may prevent further slippage, major displacement requires surgery, if undetected or if surgery fails severe problems will result.

Patellar Tendinitis (Jumper's or Kicker's knee)

From jumping or kicking, placings lots of stress and strain on patellar or quadriceps tendon. sudden on repetitive extension. Signs include pain and tenderness at inferior pole of patella. 3 phases: pain after activity, pain during activity, pain during and after. Management includes ice, ultrasound, heat, exercise, tendon bracing, friction massage.

Avulsion Fractures and Apophysitis

From traction epihphysis (bone outgrowth) common sites include ischial tuberosity, AIIS and ASIS. Avulsions seen in sports with sudden accelerations and decelerations. Signs include sudden localized pain with limited movement. Pain, swelling, point tenderness, Muscle testing increases pain. Management includes x-ray, rice, nsaid's, crutch, 2-3 weeks of gradual stretching

Nitrogan Dioxide

Gas producsed throgh combustion (cars, power plants, home heaters, and gas stoves) factor is atmospheric reaction to generate ozone and acid rain. Can irriate the lungs, lower resistance to respiratory infection and may increase incidence of respiratory disease in children.

Soft Materials

Gauze (versatile, can be used for protection or absorbtion), cotton (cheapest and most widely used absorbent), adhestive felt, felt (matted wool fibers, pressed in a variety of thicknesses), foam

Illiotibial Band Friction Syndrome Runner's Knee or Cyclist's Knee)

General expression for repetitive/overuse conditions attributed to mal-allignment and structural asymmetries.Signs include IT band friction syndrome, Pes anserine tendinitis Bursistis. management includes correction of malalignments, ice before and after activity, utilize proper warm-up and stretching techniques, avoidance of aggravating activities, NSAID's

Acute femoral Fractures

Generally involves the shaft and requires a great deal of force, occurs in the middle third due to structure and point contact. Signs include pain, swelling, deformity, muscle guarding, hip is adducted, leg with fx may be shorter. Management includes treating for shock, verify neurovascular status, splint before moving, reduce following x-ray.

Circadisn Dysrthyhmia (Jet Lag)

Happens whenever you travel over several different time zones. Body adapts over time to the changes (Immediately, protein metabolism--over 8 days, body temperature---three weeks, adrenal hormones) Disrupts circadian rhythms and sleep-wake cycles. may cause fatigue, headaches, digestive disorder, changes in blood pressure, heart reate, hormona and endorcine releases, and bowl habits. To prevent, depart well rested, pre adjust to the changes.

Apley's Compression Test

Hard downward pressure is applied with rotation. Pain indicated a meniscal injury.

Observation of the Knee

Have them walk, half squat, go up and down stairs. Is there swelling, their leg alignment (genu valgum, genu varum, hyperextension, hyperflexion, patella alta and baja, patella rotated inward or outward. tibial torsion, femoral anteversion and retroversion.

Face Protection: Face Guard

Helps reduce the number of facial injuries. Number of concussions has increased beacuse the head is usually the most often used in initial contact in sports. Proper mounting of the mask must occur to assure that it's working properly. All mountings must be flush to the helmet. In hockey, this proctective gear is mandatory, and the opening must not allow passage of sticks or pucks.

Eye Protection

Highest percent of injuries in the sport are here on the face. Generally caused by blunt trauma. Glasses, cibtacts, eye and glasses guards.

Assessment of the Thigh

History: onset, previous history, what caused the injury, pain description, symmetry, size, skin color, texture...can they move the thigh?

Palpation of Swelling

Intra vs. Extracapsular swelling. Intracapsular may be referred to as joint effusion, swelling within the joint that is caused by synovial fluid and blood is a hemarthrosis. Extracapsular swelling tends to localize over the injured structure, may ultimately migrate down to foot and ankle.

IT band Friction Syndrome

Irritation at bands insertion- commonly seen in individuals that have genu varum or pronated feet

Posterior Drawer Test (posterior cruciate ligament tests)

Knee is flexed at 90 degrees and a posterior force is applied to determined translation posteriorly. Positive sign indicated a PCL deficient knee.

Flexion-Rotation Drawer Test

Knee is taken from a position of 15 degrees of flexion (tibia is subluxed anteriorly with femur externally rotated) Knee is moved into 30 degrees of flexion where tibia rotates posteriorly and femur internally rotates.

Q- Angle

Lines that bisect the patella relative to the ASIS and the tibial tubercle. Normal angle is 10 degrees for males, and 15 degrees for females. Elevated angles often lead to pathological conditions associated with improper patella tracking.

IIiotibal Track

Located laterally serving as the attachment for the tensor fascia lata and greater aspect of the gluteus maximum

Infra-patellar Fat Pad Injury

May become wedged between the tibia and patella. Irritated by chronic kneeling, pressure or trauma. Signs include capillary hemorrhaging and swelling, chronic irritation may lead to scarring and calcification. Pain below the patellar ligament, may display weakness. Management includes rest for irritating activities until inflammation has subsided, utilize therapeutic modalities for inflammation, heel life to prevent irritation during extension, hyperextension taping to prevent full extension.

Meniscal Lesions

Medial meniscus is more commonly injured to to ligamentous attachments and decreased mobility. Most common cause it rotary force with knee flexed or extended. Tears may be longitudinal, oblique, or transverse. Signs include effusion developing over 48-72 hours, joint line pain and loss of motion, intermittent locking and giving away, pain with squatting, portions may become detached causing locking or giving away within a joint. Management includes if the knee is not locked, but indications of a tear are present further diagnostic testing may be required. If locking occurs, anesthesia may be necessary to unlock the joint with possible surgery follow up. With surgery all efforts are made to preserve the meniscus. Repaired meniscus will cause you to be immobile for 12 weeks.

Dehydration

Mild dehydation occurs when 2% of body weight is lost in fluid. This will impair cardiovascular and thermoregulatory responses. Signs and symtoms include thirst, dizziness, dry mouth, irritability, excessive fatigue, and possible cramps. Must remove individual to a cool environment and begin rehydration.

Gradual Acclimation

Most effective method to avoiding heat stress. Involves becoming assuctomed to heat and exercising in the heat. Early pre-season training and graded intensity changes are recommended with progressive exposure over 7-10 day period. 80% of acclimatization can be achieved during first 5-6 days with 2 hour morning and afternoon practice sessions. Equipment restrictions may help athlete accomodate.

Face Protection: Ear Guards

Most sports do not use this type of face protection, however, wrestleing, water polo and boxing do use this in order to prevent ear irritation and the deformity of the ears.

Functional Anatomy of the Knee

Movement of the knee requires flexion, extension, rotation, and the arthrokinematic motions of rolling and gliding. Rotational component involves the "screw home mechainism", as the knee extends it externally rotates because the medial femoral condyle is larger than the lateral, provides increased stability to the knee, and popliteus "unlocks" the knee allowing knee to flex. Capsular ligaments are taut during full extension and relaxed with flexion (which allows rotation to occur). Deeper capsular ligaments remain taut to keep rotation in check. PCL prevents excessive internal rotation, and the ACL stops excessive internal rotation and stabilizes the knee in full extension and prevents hyperextension. Patella aids knee during extension, providing a mechanical advantage. ROM is 140 degrees.

Malignany Hyperthermia

Muscle disorder causing hypersensitivity to anesthesia and heat. Muscle biopsy is needed to help detect. Temperature will remain elevated 10-15 minutes following exercise. Athlete with condition should be disqualified from competition in hot, humid environments.

Functional Exam of Knee

Must assess walking, running, turning and cutting. Co-contraction test, vertical jump, single leg hop tests and the duck walk. Resistive strength testing. Tests should be performed at speed without limping or favoring injured limb. Use baseline for comparison if available.

Football Helmets

Must be protective against concussion force, NOCSAE develops the standards for these type of helmets. These helmets have an air or fluid-filled pocket to help absorb force. When fitting the helmet, your hair should be wet, and there must be snug fit (credit card check), there should be three fingers from the face and chin strap, and 2 finger width between the forehead and helmet.

Baseball Helmets

Must withstand high velocity impacts (catcher, hitter), research has indicated that the helmet does little to help dissipate energy of the ball. Possible solutions to helping this problem would be to add additional external padding. Helmet must carry NOCSAE stamp.

Metabolic Heat Production

Normal Metabolic function results in the production of heat, which will increase with the intensity of the exercise

NOCSAE Helmet Standards

Not a warranty, indicates that the helmet meets the requirements of performance tests when it was manufactured/or re-conditioned. Helmets need to undergo regular recertification and reconditioning.

Altitude Pulmonary Edema

Occurs from a jump from 9000-10000 feet. Lungs accumulate fluid in the alveolar walls forming pulmonary edema. Signs and symptoms include cough, headache, weakness, and occassionaly unconsciousness. Treat by moving the athlete to a lower altitude and providing oxygen.

Hip Labral Tear

Often occurs due to repetitive movements such as running or pivoting, results in degeneration or breakdown of the labrum. can also occur acutely due to a hip dislocation. Signs often include asymptomatic, may present with clicking, locking, stiffness, limited ROM, pain in through the groin and hip. management includes focus on hip ROM strength and stability, avoid painful movements, medication for pain

Heat Cramps

Painful muscle spasm (calf, abdominal) due to excessive water loss and electroltye imbalance. Occurs in individuals in good shape that overexert themselves. Profuse sweating results in water loss and electroltye imbalance which causes this. Prevent this by consuming fluids and maintaining electrolye balance, treat with fluid igestion and ligh stretching with ice massage. Return to play is unlikely due to continued cramping.

Patellar Exam

Palpation of the patella: must palpate around and under patella to determine points of pain. Patella grinding, compression, and apprehension tests (a series of glides and compressions are performed with the patella to determine integrity of patellar cartilage)

A- Angle

Patellar orientation to the tibial tubercle. Quantitative measure of the patellar realignment after rehab. An angle greater than 35 degrees is often correlated with patellofemoral pathomechanics.

Thessaly Test

Patient stands on one leg. tested with knee flexed to 5 degrees and 20 degrees. patient then rotates trunk and knee into internal and external rotation. First you do the text on the healthy side first for comparison. Positive test results in pain along the medial or lateral joint line.

Functional Anatomy of hip/groin

Pelvis moves in 3 planes throughout muscle function (anterior tilting changes degree of lumbar lordosis, lateral tilting changes degree of hip abduction) Hip is a true ball and socket joint with intrinsic stability, hip also moves in 3 planes

Prevention of Knee Injuries

Physical conditioning and Rehab: total body conditioning is required. Strength, flexibility, cardiovascular and muscular endurance, agility, speed and balance. Muscles around the joint must be conditioned to maximize stability.

Conductive Heat Exchange

Physical contact with objects resulting in heat loss or gain.

Sock fitting

Poorly fitted socks cause cause stress on the foot. They should be clean, dry, and without holes. Cotton/Poly blend are ligher and dry faster than regular cotton socks.

Functional Anatomy of the Thigh

Quadriceps insert in a common tendon to the proximal patella. Rectus femoris is the only quad muscle that crosses the hip (extends knee and flexes the hip) Hamstrings cross the knee joint posteriorly and all except the short head of the biceps crosses the hip. Bi-articulate muscles produce forces dependent upon position of both knee and hip. Position of the knee and hip during movement and MOI play important roles

Types of Knee Braces

Rehabilitative (widely used after surgery, allows controlled progressive immobilization, and its adjustable) Functional (used during and following rehab to provide functional support, ready-made and customized), Neoprene (with medial and lateral support, used by those that have sustained collateral ligametns injuries, some are also used to provide support in those that have patellofemoral conditions)

Lacrosse Helmets

Required for all male players. Womens only require protective eye guard. This helmet is made of hard plastic with a wire mesh face guard. Designed to help absorb repeated impact from hard hits.

Medial Collateral Ligament Sprain: Grade 1

Result of a severe blow from the lateral side (valgus force). Signs include little fiber tearing or stretching, stable valgus test, little or no joint effusion, some joint stiffness and point tenderness on lateral aspect, normal ROM. Management includes RICE for 24 hours, crutches maybe, follow up care, move from isometrics to bicycle riding and isokinetics, may require 3 weeks to recover.

Avascular Necrosis

Result of a temporary or permanent loss of blood supply to the proximal femur. Can be caused by the traumatic conditions (hip dislocation) Signs include joint pain with wear bearing progressing to pain in times of rest, pain gradually increases, may limit ROM. Management includes that you must be referred for an x-ray, mri, or ct scan. must work to improve use of joint, stop further damage and ensure survival of bone and joint.

Lateral Collateral Ligament Sprain

Result of a varus force, generally with the tibia internally rotated. If severe enough damage can also occur to the cruciate ligaments, meniscus, and produces bony fragments as well. Signs include pain and tenderness over LCL, swelling and effusion around LCL, joint laxity with varus testing, may cause irritation of the peroneal nerve. Management includes follows management of MCL injuries depending on the severity

Larson-Johnansson Disease

Result of excessive pulling on the inferior pole of the patella.signs include swelling, hemorrhaging and gradual degeneration of the apophysis due to impaired circulation. Pain with kneeling, jumping and running. Management includes reduce stressful activity until union occurs, possible casting, ice, isometrics.

Exertional Heat Exhaustion

Result of inadequate fluid replacement. Unable to sustain adequate cardiac output. Will exhibit signs of profuse sweating, pale skin, mildly elevated temperature, dizziness. may develop heat cramps or become faint/dizzy. Immediate treatment should be taken, by ingesting fluids, place in a cool environment, remove excess clothing. Most continue to monitor vital signs. Return to play, must be fully hydrated and be cleared by a physician. Can lead to stroke.

Patellofemoral Stress Syndrome

Result of lateral deviation of patella while tracking in femoral groove. Signs include tenderness of lateral facet of patella and swelling associated with irritation of synovium, dull ache in center of the knee, patellar compression will elicit pain and crepitus, apprehension when patella is forced laterally. Management includes correct imbalances (strength and flexibility), McConnell taping, lateral reticular release if conservative measures fail.

Apparent Discrepancy

Result of lateral pelvic tilt or from a flexion or adduction deformity.

Dislocated Hip

Result of traumatic force directed along the long axis of the femur. Signs include flexed, adducted and internally rotated hip, palpation reveals displaced femoral head posteriorly, seriously pathology. Management includes immediate medical care, contractors may further complicate reduction, 2 weeks immobilization and crutch use for at least one month.

Jerk Test

Reverses the direction of the pivot shift. Moves from position of flexion to extension. Without an ACL the tibia will sublux at 20 degrees of flexion.

Osteitis Pubis

Seen in distance runners and also in soccer, football, and wrestling. Repetitive stress on pubic symphysis and adjacent muscles. Signs include chronic pain and inflammation of the groin, point tenderness on pubic tubercle, pain with running, sit ups and squats, acute case may be the result of bicycle seat. Management includes rest, NSAID's and gradual return to play.

Stress Fractures

Seen in distance runners, repetitive cyclical forces from ground reaction force. More common in women. Common site include inferior pubic ramus, femoral neck, and subtrochanteric area of femur. Signs include 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. Management includes rest for 2-5 months, crutch walking, x ray, swimming

Exertional Heatstroke

Serious life-threatening condition with unknown specific cause. Characterized by sudden onset-sudden colapse, LOC, CNS dysfuncction, flushed hot skin, minimal sweating, strong rapid pulse, and breakdown of thermoregulatory mechanism. Drastic measures must be taken to help athlete, strip clothing, sponge with cool water, transport to hospital ASAP, cool first, transport second. athlete should avoid exercise for a minimum of one week and gradually return back to play.

Medial Collateral Ligament Sprain: Grade 3

Signs include complete tear of supporting ligaments, complete loss of medial stability, minimum to moderate swelling, immediate pain followed by ache, loss of motion due to effusion and hamstring guarding, positive valgus stress test. Management includes RICE. Limited mobilization

Anatomical Discrepancy

Shortening may be equal throughout limb or localized within the femur or lower leg. Measurement taken from medial malleolus to ASIS.

Medial Collateral Ligament Sprain: Grade 2

Signs include complete tear of deep capsular ligament and partial tear of the superficial layer of the MCL. No gross instability, slight swelling, moderate to severe joint tightness with decreased ROM, pain along medial aspect of knee. Management includes RICE for 48-72 hours, crutch until acute phase has resolved, possibly a brace

Losee's Test

Similar to flexion-reduction drawer test. Performedwhile you're lying on your side. Begings with knee at 45 degrees of flexion and external tibilal rotation. Knee is subluxed anteriorly. As the knee is extended it is reduced.

Chondromalacia Patella

Softening and deterioration of the articular cartilage. Undergoes 3 stages (swelling and softening of cartilage, fissure of softened cartilage, deformation of cartilage surface), often associated with abnormal tracking, abnormal patellar tracking may be due to genu valgum etc. Signs include pain with walking, running, stairs and squatting, possible recurrent swelling, grating sensation with flexion and extension, pain at inferior border during palpation. Management includes RICE, NSAID's, surgical possibilities

Particulate Matter

Solids found in the atmosphere (dust, pollen, molds, ashes, soot, aerosol), generated through wood burning, factors smokestacks, mining construction. Small enough to be inhaled and absorbed into the bloodstream or remain imbedded. Exposure to this matter may trigger asthma attacks, cause whizzing or coughing, respiratory irritation in people with chronic obstruction pulmonary lung disease (bronchitis),

Patellar Tendon Rupture

Sudden powerful quad contraction, generally does not occur unless a chronic inflammatory condition persists resulting in tissue degeneration, occur primarily at point of attachment. Signs include palpable defect, lack of knee extension, considerable swelling and pain. Management includes surgical repair if needed, proper conservative care of jumper's knee can minimize chances occurring, if steroids are being used, intense knee exercise should be avoided.

Main Veins in the thigh

Superficial great saphenous and the femoral vein

Patrick Test (FABER)

Test for hip and sacroiliac joint. Detects pathological conditions of the hip and SI joint, pain may be felt in the hip or SI joint,

Gaenslen's Test

Test for hip and sacroiliac joint. Test works to push SI joint into extension, test is positive if hyperextension on affected side increases pain.

Thomas Test

Test for hip contractures, tests for the hip flexor tightness

Kendall Test

Test used to test for hip flexor tightness, tests for rectus femoris tightness.

Renne's Test

Testing the tensor fasciea latea and iliotibial band. Athlete's stand with knee bent at 30-40 degrees, positive response of TFL tightness occurs when pain is felt at lateral femoral condyle.

Piriformis Test

Testing the tensor fasciea latea and iliotibial band. Hip is internally rotated, tightness or pain is indicative of piriformis tightness

Trendelenburg's Test

Testing the tensor fasciea latea and iliotibial band. Iliac crest on unaffected side should be higher when standing on one leg. test is positive when affected side is higher indicating weak abductors (glut medius)

Nobel's Test

Testing the tensor fasciea latea and iliotibial band. Lying supine the athlete's knee is flexed at 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.

Ely's Test

Testing the tensor fasciea latea and iliotibial band. Used to assess tightness of rectus femoris, patient is prone, with pelvis stabilized and knee on affected side if flexed. If hip on that side extends as the knee is flexed, rectus femoris is tight.

Ober's Test

Testing the tensor fasciea latea and iliotibial band. Used to determine presence of contracted TFL or IT-band, patient's leg is extended and abducted, thigh will remain in abducted position, not falling into adduction.

assessment of the hip and pelvis

The bodies center of gravity is located anterior to the sacrum. Injuries to the hip or pelvis cause major disability in the lower limbs, and trunk.

Fluid and Electrolyte Replacement

The body requires 2.5L of water daily when engaged in minimal activity. Adults will typically lose 1.5L per hour, and a 1-2% drop in body weight. If this is ignored, dehydration sets in. Prevent this through hydration, don't ignore thirst, generally only 50% is ever replaced and should be repalced before exercise. Athletes should always have access to water.

Fascia

The fascia lata femoris is part of the deep fascia that invests the thigh musculature. Thick anteriorly, laterally and posteriorly, however its thin on the medial side.

Football Shoulder Pads

There are two types of this pad: Cantilvered (typically bulkier and used by those engaged in blocking and tackling), and non-cantilevered (do not restrict motion..quarterback and recievers). The rules of fitting these pads are the width of the shoulders must be measured, the inside of the pad should cover the tip of the shoulder in line with lateral aspect of the shoulder. Epaulets and cups must cover the deltoid and allow motion. Neck opening must allow athlete to raise arms over head without pads sliding forward and back. With spilt clavicle pads, channel for the top of the shoulder must be in proper position.

Non-Yielding Materials

Thermoomoldable plastics (used in orthotics, braces, spints and for shielding body parts, cassting, support for foot, protect contusions) Heat Foaming (heat cant be molded) and heat plastic foams. Casting Materials (fiberglass is the material of choice, helps produce hardening)

Sports Bra

These are here to help give athletic support to women. Most designed to minimize excessive vertical and horizontal movements that occur with running and jumping. To be effective, they must hold the breasts to the chest, and help prevent stretching of the coopers ligament. The different types available are compressive (which bind the breasts to the chest wall, recommended for medium size breast), support (heavy duty with additional upward support for larger breasts), and lightweight elastic (compression and support for people with smaller breasts)

Using Sports Drinks

These drinks are more effective than just replacing fluids with water. Flavoring results in increased desire to conume and it helps replace fluids with electrolytes. Optimal CHO level is 14g per 8 ounces of water, more CHO reults in slower absorbtion.

Ice Hockey Helmets

These helmets must withstand high velocity impacts and high mass low velocity impacts.This helmet will disperse force over a large area and decelerate forces that would act on the head. Helmets must be approved by the Canadian Standards Association.

Face Protection: Mouth Guards

These help prevent dental injuries if you're using the appropriate customized mouth guard. Help protect teeth, minimize lip lacerations, absorb shock of chin blows, and prevent concussions. This should fit comfortably and not block any airways. 3 types: Stock, commercial (formed by submersion in water), and custom (fabricated from dental mold)

Cycling Helmets

These type of helmets are designed to protect the head from ONE single impact. Many states require the use of these helmets, especially in adolescents.

Preventing thigh/groin/pelvic Injuries

Thigh must have max strangth, endurance, and extensibility against strain While muscle function is critical to perform dynamic activities, it's critical for providing base of support with pelvis for whole body motion. Maintain strength and flexibility in region.

Leg Length Discepancy

This can be anatomical of functional. Anatomical differences can potentially cause problems in all weight bearing joints, functional differences acn be caused by pelvic rotations or mal-alignment of the spine.

Hamstring Muscle Strain

This is the most common thigh injury. Comes from when the hamstring and quad contract together, change in role from hip extender to knee flexor, fatigue, posture, lack of flexibility. Signs include muscle belly or point of attachment pain, capillary hemorrhage, loss of function and possible discoloration. Grades 1-3. Management includes RICE, NSAID's.

Face Proctection: Throat Projection

This is used to prevent laryngitracheal injuries, while they are uncommon, they can be fatal. Baseball catchers, lacrosse goalies, and ice hockey goalies are at most risk.

Evaporative Heat Loss

This is where the sweat glands allow water transport to surface. Evaporation of water typically takes heat with it. When radiant heat and environment temperature are higher than the body temperature, loss of heath through evaportation is key. You typically lose 1 quart of water per hour for up to 2 hours. Relative humidity of 65% impairs evaporation, and relative humidity of 75% stops evaporation.

Trunk and Thorax Protection

This protection is essential in many sports. Must help protect regions that are exposed to the impact of forces (external genitalia, bony protuberances, shoulders, ribs, and spine) Typically what baseball catchers will be seen wearing and hockey goalies as well.

Wet Bulb Globe Temperature Index

This provides an objective measure for determining precautions concerning particpation in the hot. There are different thermometer readings: dry bulb (standard mercury temp), wet bulb (thermometer with wet gauze that is swung around in air), black bulb (black casing that measures radiant heat)

Hydration

This should begin 24 hours prior to whichever activity they are engaging in. Urine should be a light yellow color, and dark urine is an indication of dehydration. They should consume fluid at regular intervals (17-20 fl oz or sports drink 2-3 hours prior to activity, and 7-10 oz 15-20 minutes before exercise.

Anterior Cruciate Ligament Sprain

Tibia externally rotated and valgus force at the knee, may be linked to inability to decelerate valgus and rotational stresses. May also involve injuries elsewhere around the knee. Signs include you experience a pop with severe pain and disability, positive anterior drawer and lachman's test, rapid swelling at the joint line, other ACL test may also be positive. Management includes RICE, arthroscopy may be necessary, could lead to major instability in incidence of high performance, without surgery joint degeneration may result, age/activity may factor into surgical option. Surgery would involve joint reconstruction.

Sciatic Nerve Complex

Tibial an common paroneal are given rise from the sacral plexus, which forms the largest nerve in the body, which is this

Shoe Selection

Toe box: (1/2-3/4 inch of space from toe to front of shoe), Sole (helps provide shock absorbtion and durability), heel counter (prevents medial and leteral roll of the foot), shoe uppers (top of the shoe made with combo of materials designed for appropriate ventilation, drying and support), shank (part of the sole between the heel and metatarsal heads), last (form on which shoe is built, may be straight, semi curved or curved), arch support (durable but soft and supporttive to foot), price (may be worth the extra investment)

Femoral Anteversion and Retroversion

Total rotation of the hip equals about 100 degrees, if the hip rotates greater than 70 degrees internally, this may exist.

Apley's Distraction Test

Traction is applied with rotation. Pain will occur if there is damage to the capsule or ligaments. No pain will occur if it is meniscal.

Smog

Type of air pollution. Combination of carbon monoxide, sulfur dioxide, and particulate matter.

Photochemical Haze

Type of air pollution. Nitrogen dioxide and stagnant air acted on by sunlight to produce ozone

Tests for Knee Stability

Use endpoint feel to determind stability. MRI may also be necessary for assessment. Classification of joint instabilit y(knee laxity includes both straight and rotary instability), translation regers to the glide of tibial plateau relative to the femoral condyles, as the damage to stabilization strctures increases, laxity and translation also increase.

Heel Cups

Used for a variety of conditions including plantar fasciitis, heel spurs, achilles tendonitis, and heel bursitis. Hard plastic or spongy rubber used to help compress fat pad, providing more cushion during weight bearing.

Pivot Shift Test

Used to determine anterolateral rotary instability. Position starts with the knee extrended and leg internally rotated. The thigh and knee are then flexed with a valgus stress applied to the knee. Reduction of the tibial plateau (produces a clunk) is a positive sign of this test.

McMurray's Meniscal Test

Used to determine displaceable meniscal tear. Leg is moved into flexion and extension while the knee is interally and externally rotated in conjunction with valgus and varus stressing. A positive test is found when clicking and popping are felt.

High Altitude Cerebral Edema (HACE)

Usually occurs in conjunction with other life threatening conditions that can lead to coma or death. Occurs in about 1% of people adjusting to altitudes above 9000 feet. Result of increased cerebral edema due to increased cerebral blood flow, which is caused by increased permeability of cerebral endothelium when exposed to hypoxia. Signs include severe, persistant headache with may precede mental dysfunction, neurological abnormalities.

Collateral Ligament Stress Tests

Valgus vs. Varus. Used to asses the integrity of the MCL and LCL. Testing at 0 degrees incorporates capsular testing while testing at 30 degrees of flexion isloates the ligaments.

Shoe fitting

When doing this you should always measure both feet because there can sometimes be a slight difference. Do this fitting at the end of the day due to the fact that there is an increase in volume due to weighg bearing. The shoe should be snug, but should have ample movements of the toes and foot.

Lachman Drawer Test

Will not forcehe knee into painful flexion immediately after injurt. Reducsed hamstring involvement. at 30 degrees of flexion an attempt is made to translate the tibia anteriorly on the femur. A positive test indicates damace to the ACL.

External Rotation Recurvatum Test

With the athlete supine, the leg is lifted by the great toe. If the tibia externalyl rotates and slides posteriorly there may be a PCL injury and damage to the posterolaterial corner of the capsule.

Posterior Cruciate Ligament Sprain

You're most at risk for this whenever you're at 90 degrees of flexion. Fall on a bent knee is the most common cause, can also be damaged as a result of a rotational force. Sometimes referred to as a 'dashboard injury" Signs include you feel a pop in the back of the knee, tenderness and relatively little swelling in the popliteal fossa, laxity with posterior sag test. Management includes RICE, non-operative rehab.

Knee Joint Rehab

general body conditioning, weight bearing, knee joint mobilization, flexibility, muscular strength, neuromuscular control, bracing,

Pes Anserine tendinitis

result of excessive genu valgum and weak vastus medialis. often occurs due to running with one leg higher than the other.

Measuring Leg Length Discrepancy

with inactive individual, different of more than 1 inch may produce symptoms. Active individuals may experience problems with as little as 3mm. can cause stress to lower limbs, hips, pelvis, or low back.