ppe 486 test 3

throat protection

Laryngotracheal injuries, while uncommon can be fatal Baseball catchers, lacrosse goalies, and ice hockey goalies are most at risk Should be mandatory in these sports

muscles of abdomen

-Rectus abdominis -External oblique -Internal oblique -Transverse abdominis

elbow protective taping and bracing

-Should be continued until full strength and flexibility have been restored -Chronic conditions usually cause gradual debilitation of surrounding soft tissue •Must restore maximum state of conditioning w/out encouraging post-injury aggravation

humeral fractures management

-Signs and Symptoms •Pain, swelling, point tenderness, decreased ROM -Management •Immediate application of splint, treat for shock and refer -Humeral fractures- remove from activity for 3-4 months -Proximal fracture - incapacitation 2-6 months -Epiphyseal fracture - quick healing - 3 weeks

torsion testical

-Torsion of spermatic cord from a direct blow or coughing or vomiting acute testicular pain, nausea, vomiting, and inflammation immediate referral

tinel's sign for elbow

-Ulnar nerve test -Tap on ulnar nerve (in ulnar groove) -Positive test is found when athlete complains of sensation along the forearm and hand

shoulder joint mobilization

-Used to re-establish appropriate joint arthrokinematics -Used w/ joint capsule tightness

hollow organs of abdomen

-Vessels -Tubes -Stomach -Intestines -Gall bladder -Urinary bladder

elbow functional progressions

-Will enhance healing and performance •PNF, swimming, pulley machines and rubber tubing •to simulate sports activities -Should include steps •Warm-up •Gradual build up to activity, becoming increasingly more difficult

limiting factors

1.Aging •Muscle atrophy •Neural atrophy •Increase tissue stiffness •Tissue dehydration 2.Immobilization •Shortened - decrease in fiber length •Lengthened - increase in length - short lived •Muscle Atrophy •Weaken cartilage - needs stress and movement

3 areas of flexibility

1.Corrective •Correct posture, Imbalances, Dysfunctions 2.Active •Improve soft tissue extensibility •Reciprocal inhibition - Agonists vs antagonists •I.e bicep curl - biceps brachii contracts to create elbow flexion, triceps resists and is stretched 3.Functional •Optimal neuromuscular control throughout FULL ROM - *while performing functional movements •I.e. - full depth and perfect form w/ back squat

importance of flexibility

1.Decreased risk of injury 2.Prevent muscular imbalances 3.Correct existing muscular imbalances 4.Improve posture 5.Improve strength, joint ROM, and power

thoracic cage

12 pairs of ribs sternum coastal cartilage external intercostals internal intercostals diaphragm

postmenstrual and postovulatory phase

2) What phase of the menstrual cycle did females have the highest level of performance?

athletes and cancer patients

2. Are there certain demographics that dry needling and acupuncture works better on, whether it be based on age, specific sport, race, or gender?

keep consistent healthy habits

3. Are there any pre/post or during suggestions to make the effects of acupuncture more successful, in terms of hydration, sleep, or other self care?

tools for customizing equipment

Adhesives (glues and cements) Adhesive tapes Heat Source (used to form thermomoldable plastics/foams) Shaping Tools (scissors, blades, knives) Fastening material (variety of devices including snaps, Velcro, rivets, laces

no

Are there negative side effects to dry needling and acupuncture that would outweigh the supposed benefits?

yes

Can you treat tarsal tunnel syndrome? If so, what treatments?

yes, OTC medications, therapy, surgery

Can you treat tarsal tunnel syndrome? If so, what treatments?

2 types shoulder pads

Cantilevered - bulkier and used by those engaged in blocking and tackling Non-cantilevered - do not restrict motion (quarterback and receivers)

types of sports bras

Compressive (bind breasts to chest wall - recommended for medium size breast) Support (heavy duty with additional upward support for larger breasts) Lightweight elastic (compression and support not as critical for smaller breasts)

cycling helmets

Designed to protect head during one single impact Many states require the use of cycling helmets Especially in adolescents

head protection

Direct collision sports require head protection due to impacts, forces, velocities and implements

yes

Does functional testing show that patellofemoral pain syndrome patients have a lower strength capacity?

no

Does ulnar nerve dislocation cause neuropathy?

trunk and thorax protection

Essential in many sports Must protect regions that are exposed to the impact of forces External genitalia and bony protuberances (shoulders, ribs, and spine) While equipment may provide armor it may also be used as an implement Question must be asked concerning necessity of equipment and its role in producing trauma

5 categories face protection

Face guard/mask, mouth, ear, eye, and neck

during flexion

Generally, when does ulnar nerve dislocation occur?

soccer headgear

Headband with piece of foam Marketed to reduce concussions from heading a ball Data is LIMITED

eye protection

Highest percentage of eye injuries are sports related Generally blunt trauma

hard

How difficult would it be to obtain and staff seasoned acupuncturists to work on staff for teams and at schools?

compression on posterior tibial nerve

How is tarsal tunnel syndrome caused?

blinding patients

In any experiment where the placebo effect and psychologically influenced results play a large part in the accuracy of the experiment how does one ensure exactitude?

many

Is a Hill-Sachs lesion usually an isolated injury, or in conjunction with many?

yes

Is addressing hip flexor flexibility important in reducing pain from patellofemoral disorder?

yes

Is tarsal tunnel syndrome preventable?

standard concerns for equipment

Material durability Who is setting standards Manufacturing Testing Methods Requirements for use Must be in place relative to maintenance A number of groups and agencies are involved in standardizing sports equipment and facilities

glasses

May slip on sweat, become bent, fog, detract from peripheral vision or be difficult to wear with headgear Properly fitting glasses can provide adequate protection Polycarbonate: Virtually unbreakable and safest Lens should be case hardened to cause crumbling; not splintering on contact (disadvantage = increased weight) May have polarizing/tinting ability (void in NCAA FB) Plastic lenses: lightweight and scratch resistant with coating

mouth guards

Most dental injuries can be prevented with appropriate customized intraoral mouth guards Protect teeth, minimize lip lacerations, absorb shock of chin blows Should fit comfortably, not impede speech or breathing Should extend back as far as last molar Constructed of flexible resilient material formed to fit teeth and upper jaw Do not cut down mouth guard as it voids warranty for dental protection and could become dislodged and disrupt breathing

baseball and softball batting helmets

Must withstand high velocity impacts Research has indicated that helmet does little to dissipate energy of ball Possible solutions? Add additional external padding Improve helmet's suspension Helmet must still carry NOCSAE stamp (similar to football label)

football helmets

NOCSAE develop standards for certification Must be protective against "concussive" force Must be certified, may not always be fail-safe Athletes and parents must be aware of inherent risks Each helmet must have visible exterior warning label Athlete must be aware of risks and what label indicates

equipment reconditioning and recertification

National Operating Committee on Standards for Athletic Equipment (NOCSAE) established voluntary testing standards in an effort to reduce head injuries Established Minimum Helmet Standard for: Football Baseball Softball Lacrosse Considers type of helmet and amount of and intensity of usage

thigh and upper leg

Necessary in collision sports Pads slip into ready made uniform pockets Customized pads may need to be held in place with tape and/or wraps Neoprene sleeves can also be used for support of injuries

eye and glasses guards

Necessary in sports with fast moving projectiles Athletes not wearing glasses should wear closed eye guards to protect orbital cavity While eye guards afford great protection, they can limit vision Polycarbonate eye shield have been developed for numerous pieces of head gear

NOCSAE helmet standard

Not a warranty Indicates that helmet met requirements of performance tests when manufactured/re-conditioned

off-shelf vs custom protective equipment

Off-the-shelf equipment Pre-made and packaged Can be used immediately ○Neoprene sleeves, inserts, ankle braces May pose problem relative to sizing and fit Customized equipment Constructed according to the individual Specifically sized and designed for protective and supportive needs

contacts

Pros: part of the eye, can be tinted Cons: cost, corneal irritation

lacrosse helmets

Required for men's lacrosse Absorbs repeated impact from a hard, high-velocity projectile Four-point buckling system

hips and buttocks

Required in collision and high-velocity sports Boxing, snow skiers, equestrians, jockeys, and water skiers Girdle and belt types

lower extremity protective equipment

Socks Poorly fit socks can cause abnormal stress on the foot Should be clean, dry and w/out holes Different types for different activities Composition ○Cotton can be bulky ○Cotton/poly blend are lighter and dry faster

groin and genitalia

Sports involving high velocity projectiles Require cup protection for male and female participants Stock item that fits into jockstrap or athletic supporter

3 types mouth guards

Stock Commercial (formed following submersion in water) Custom (fabricated from dental mold) Mandated use in high school and collegiate levels

muscles of rotator cuff

Supraspinatus (most commonly injured) Infraspinatus Teres Minor Suprascapularis

corrective flexibility

self myofascial release, static stretch, neuromuscular stretching (PNF)

meniscus

shock absorption and knee support

no, nonoperative treatment options should be exhausted first

should treatment automatically be operative management?

LUQ contains

stomach, left kidney, spleen, colon, pancreas

ulnar and radial arteries

supply the hand with blood and nerves uTwo arterial arches (superficial and deep palmar arches)

drop arm test

supraspinatus muscle weakness •Used to determine tears of rotator cuff (primarily the supraspinatus) •Athlete abducts shoulder and gradually lowers to starting position •Inability to lower arm slowly and controlled will indicate torn supraspinatus

Neer's test

test for shoulder impingement and assesing soft tissues, positive test indicated by pain and grimace

hawkins-kennedy test

test for shoulder impingement and assesing soft tissues, positive test indicated by pain and grimace

lungs

trachea, branches into left and right bronchi branched further into clusters of air sacs (alveoli)

neurogenic reflex

trauma triggers___________, •Trauma à inflammation/chemical reaction à pain à muscle spasm • •Spasm - protect nerve but... • •Alter length-tension relationship/force-couple relationships •Alter movement patterns à create muscle imbalances

allens test

uAthlete instructed to clench fist 3-4 times, holding it on the final time uPressure applied to ulnar and radial arteries uAthlete then opens hand (palm should be blanched) uOne artery is released and should fill immediately (both should be checked)

fingernail deformities

uChanges in normal appearance of the fingernail can be indicative of a number of different diseases uScaling or ridging = psoriasis uRidging and poor development = hyperthyroidism uClubbing and cyanosis = congenital heart disorders or chronic respiratory disease uSpooning or depression = chronic alcoholism or vitamin deficiency

sprains of interphalangeal joints of fingers

uEtiology uCan include collateral ligament, volar plate, extensor slip tears uOccurs w/ axial loading or valgus/varus stresses uSigns and Symptoms uPain, swelling, point tenderness, instability uValgus and varus tests may be possible uManagement uRICE, X-ray examination and possible splinting uSplint at 30-40 degrees of flexion for 10 days uIf sprain is to the DIP, splinting for a few days in full extension may assist healing process uTaping can be used for support

wrist tenosynovitis

uEtiology uCause of repetitive wrist accelerations and decelerations uRepetitive overuse of wrist tendons and sheaths uSigns and Symptoms uPain w/ use or pain in passive stretching uTenderness and swelling over tendon uManagement uAcute pain and inflammation treated w/ ice massage 4x daily for first 48-72 hours, NSAID's and rest uWhen swelling has subsided, ROM is promoted w/ contrast bath uUltrasound and phonphoresis can be used uProgress as tolerated when pain free and FULL ROM

scaphoid fracture

uEtiology uCaused by force on outstretched hand, compressing scaphoid between radius and second row of carpal bones uOften fails to heal due to poor blood supply uSigns and Symptoms uSwelling, severe pain in anatomical snuff box uPresents like wrist sprain uPain w/ radial flexion uManagement uMust be splinted and referred for X-ray prior to casting uImmobilization lasts 6 weeks and is followed by strengthening and protective tape uWrist requires protection against impact loading for 3 additional months

PIP palmer dislocation

uEtiology uCaused by twist while it is semiflexed uSigns and Symptoms uPain and swelling over PIP; point tenderness over dorsal side uFinger displays angular or rotational deformity uManagement uTreat w/ RICE, splinting and analgesics followed by reduction uSplint in full extension for 4-5 weeks after which it is protected for 6-8 weeks during activity

MCP dislocation

uEtiology uCaused by twisting or shearing force uSigns and Symptoms uPain, swelling and stiffness at MCP joint uProximal phalanx is angulated at 60-90 degrees uManagement uRICE, splinting following reduction uBuddy taping and given early ROM following splinting

carpal tunnel syndrome

uEtiology uCompression of median nerve due to inflammation of tendons and sheaths of carpal tunnel uSigns and Symptoms uSensory and motor deficits (tingling, numbness and paresthesia); weakness in thumb uManagement uConservative treatment - rest, immobilization, NSAID's uIf symptoms persist, corticosteroid injection may be necessary or surgical decompression of transverse carpal ligament

distal phalangeal fracture

uEtiology uCrushing force uSigns and Symptoms uComplaint of pain and swelling of distal phalanx uSubungual hematoma is often seen in this condition uManagement uRICE and analgesics are given uProtective splint is applied as a means for pain relief uSubungual hematoma is drained

metacarpal fracture

uEtiology uDirect axial force or compressive force uFractures of the 5th metacarpal are associated w/ boxing or martial arts (boxer's fracture) uSigns and Symptoms uPain and swelling; possible angular or rotational deformity uManagement uRICE, analgesics are given followed by X-ray examinations uDeformity is reduced, followed by splinting - 4 weeks of splinting after which ROM is carried out

dislocation of lunate bone

uEtiology uForceful hyperextension or fall on outstretched hand uSigns and Symptoms uPain, swelling, and difficulty executing wrist and finger flexion uNumbness/paralysis of flexor muscles due to pressure on median nerve uManagement uTreat as acute, and sent to physician for reduction uIf not recognized, bone deterioration could occur, requiring surgical removal uUsual recovery is 1-2 months

PIP dorsal dislocation

uEtiology uHyperextension that disrupts volar plate at middle phalanx uSigns and Symptoms uPain and swelling over PIP uObvious deformity, disability and possible avulsion uManagement uTreated w/ RICE, splinting and analgesics followed by reduction uAfter reduction, finger is splinted at 20-30 degrees of flexion for 3 weeks -- followed by buddy taping

proximal phalangeal fracture

uEtiology uMay be spiral or angular uSigns and Symptoms uComplaint of pain, swelling, deformity uInspection reveals varying degrees of deformity uManagement uRICE and analgesics are given as needed uFracture stability is maintained by immobilization of the wrist in slight extension, MCP in 70 degrees of flexion and buddy taping

wrist sprains

uEtiology uMost common wrist injury uArises from any abnormal, forced movement uFalling on hyperextended wrist, violent flexion or torsion uMultiple incidents may disrupt blood supply uSigns and Symptoms uPain, swelling and difficulty w/ movement

dupuytren's contracture

uEtiology uNodules develop in palmer aponeurosis, limiting finger extension - ultimately causing flexion deformity uSigns and Symptoms uOften develops in 4th or 5th finger (flexion deformity) uManagement uTissue nodules must be removed as they can ultimately interfere w/ normal hand function

hamate fracture

uEtiology uOccurs as a result of a fall or more commonly from contact while athlete is holding an implement uSigns and Symptoms uWrist pain and weakness, along w/ point tenderness uPull of muscular attachment can cause non-union uManagement uCasting wrist and thumb is treatment of choice uHook of hamate can be protected w/ doughnut pad to take pressure off area

middle phalangeal fracture

uEtiology uOccurs from direct trauma or twist uSigns and Symptoms uPain and swelling w/ tenderness over middle phalanx uPossible deformity; X-ray will show bone displacement uManagement uRICE and analgesics uNo deformity - buddy tape w/ thermoplastic splint for activity uDeformity - immobilization for 3-4 weeks and a protective splint for an additional 9-10 weeks during activity

sprains, dislocations, and fractures of phalanges

uEtiology uPhalanges are prone to sprains caused by direct blows or twisting uMOI is also similar to that which causes fractures and dislocations uSigns and Symptoms uRecognition primarily occurs through history uSprain symptoms - pain, sever swelling and hemorrhaging

trigger finger or thumb

uEtiology uRepeated motion of fingers may cause irritation, producing tenosynovitis uInflammation of tendon sheath (extensor tendons of wrist, fingers and thumb, abductor pollicis) uThickening occurs w/in the sheath and, forming a nodule that does not slide easily uSigns and Symptoms uResistance to re-extension, produces snapping that is palpable, audible and painful uPalpation produces pain and lump can be felt w/in tendon sheath uManagement uSame treatment as de Quervain's disease -- if unsuccessful, injection and splinting are last options

wrist tendinitis

uEtiology uRepetitive pulling movements of (commonly) flexor carpi radialis and ulnaris; repetitive pressure on palms (cycling) can cause irritation of flexor digitorum uPrimary cause is overuse of the wrist uSigns and Symptoms uPain on active use or passive stretching uIsometric resistance to involved tendon produces pain, weakness or both uManagement uAcute pain and inflammation treated w/ ice massage 4x daily for first 48-72 hours, NSAID's and rest uWhen swelling has subsided, ROM is promoted w/ contrast bath uonce swelling and pain subsided start high rep, low resistance weights

contusion and pressure injuries of hand and fingers

uEtiology uResult of blow or compression of bones w/in hand and fingers uSigns and Symptoms uPain and swelling of soft tissue uManagement uCold compression until hemorrhaging has ceased uFollow w/ gradual warming - soreness may still be present -- padding may also be necessary uBruising of distal phalanx can result in subungual hematoma - extremely painful due to build-up of pressure under nail uPressure must be released once hemorrhaging has ceased

boutonniere deformity

uEtiology uRupture of extensor tendon dorsal to the middle phalanxForces DIP joint into extension and PIP into flexion uSigns and Symptoms uSevere pain, obvious deformity and inability to extend DIP joint uSwelling, point tenderness uManagement uCold application, followed by splinting uSplinting must be continued for 5-8 weeks uAthlete is encouraged to flex distal phalanx

jersey finger

uEtiology uRupture of flexor digitorum profundus tendon from insertion on distal phalanx uOften occurs w/ ring finger when athlete tries to grab a jersey uSigns and Symptoms uDIP can not be flexed, finger remains extended uPain and point tenderness over distal phalanx uManagement uMust be surgically repaired uRehab requires 12 weeks and there is often poor gliding of tendon, w/ possibility of rerupture

gamekeeper's thumb

uEtiology uSprain of UCL of MCP joint of the thumb uMechanism is forceful abduction of proximal phalanx occasionally combined w/ hyperextension uSigns and Symptoms uPain over UCL in addition to weak and painful pinch uManagement uImmediate follow-up must occur uIf instability exists, athlete should be referred to orthopedist uIf stable, X-ray should be performed to rule out fracture uThumb splint should be applied for protection for 3 weeks or until pain free uSplint should extend from wrist to end of thumb in neutral position uThumb spica should be used following splinting for support

wrist ganglion

uEtiology uSynovial cyst (herniation of joint capsule or synovial sheath of tendon) uGenerally appears following wrist strain uSigns and Symptoms uAppear on back of wrist generally uOccasional pain w/ lump at site uPain increases w/ use uMay feel soft, rubbery or very hard uManagement uOld method was to first break down the swelling through distal pressure and then apply pressure pad to encourage healing uNew approach includes aspiration, chemical cauterization w/ subsequent pressure from pad uUltrasound can be used to reduce size uSurgical removal is most effective way

wrist return to activity

uGrip strength must be equal bilaterally, full range of motion and dexterity uThumb has unique strength requirements uManual resistance can be instituted to strengthen major motions; intrinsic muscles can be strengthened w/ rubber band

wrist neuromuscular control

uHand and fingers require restoration of dexterity uPinching, fine motor activities (buttoning buttons, tying shoes, and picking up small objects) uCustomized bracing, splints and taping techniques are available to protect the injured wrist and hand

wrist circulatory and neurological evaluation

uHands should be felt for temperature uCold hands indicate decreased circulation uPinching fingernails can also help detect circulatory problems (capillary refill) allen's test uHand's neurological functioning should also be tested (sensation and motor functioning)

wrist sprains mangement

uManagement uRefer to physician for X-ray if severe uRICE, splint and analgesics uHave athlete begin strengthening soon after injury uTape for support can benefit healing and prevent further injury

wrist nerve compression, entrapment, palsy

uNerve Compression, Entrapment, Palsy uEtiology uMedian and ulnar nerve compression most common uDirect trauma to nervesSigns and Symptoms uSharp or burning pain associated w/ skin sensitivity or paresthesia uMay result in benediction/ bishop's deformity u(damage to the ulnar nerve) or claw hand deformity (damage to both nerves) uPalsy of radial nerve produces drop wrist deformity caused by paralysis of extensor muscles uPalsy of median nerve can cause ape hand (thumb pulled back in line w/ other fingers) uManagement uChronic entrapment may cause irreversible damage uSurgical decompression may be necessary

wrist observation

uObservation uPostural deviations uIs the part held still, stiff or protected? uWrist or hand swollen or discolored? uGeneral attitude uWhat movements can be performed fully and rhythmically? uThumb to finger touching uColor of nailbeds

tinel's sign for wrist

uProduced by tapping over transverse carpal ligament uTingling, paresthesia over sensory distribution of the median nerve indicates presence of carpal tunnel syndrome

wrist functional evaluation

uRange of motion in all movements of wrist and fingers should be assessed uActive, resistive and passive motions should be assessed and compared bilaterally for wrist: flexion, extension, radial and ulnar deviation

wrist bony palpation

uScaphoid uTrapezoid uTrapezium uLunate uCapitate uTriquetral uPisiform uHamate (hook) uMetacarpals 1-5 uProximal, middle and distal phalanges of the fingers uProximal and distal phalanges of the thumb

lunotriquetral ballotment test

uStabilize lunate while sliding the triquetral anteriorly and posteriorly uAssessing laxity, pain and crepitus uPositive test indicates instability that often results in dislocation of the lunate

phalen's test

uTest for carpal tunnel syndrome uPosition is held for approximately one minute uIf test is positive, pain will be produced I region of carpal tunnel

finklestein's test

uTest for de Quervain's syndrome uAthlete makes a fist w/ thumb tucked inside uWrist is ulnar deviated uPositive sign is pain indicating stenosising tenosynovitis uPain over carpal tunnel could indicate carpal tunnel syndrome

valgus/varus and glide stress tests

uTests used to assess ligamentous integrity of joints in hands and fingers uValgus and varus tests are used to test collateral ligaments uAnterior and posterior glides are used to assess the joint capsule

wrist soft tissue palpation

uTriangular fibrocartilage uLigaments of the carpals uCarpometacarpal joints and ligaments uMetacarpophylangeal joints and ligaments uProximal and distal interphylangeal joints and ligaments uFlexor carpi radialis uFlexor carpi ulnaris uLumbricale muscle uFlexor digitorum superficialis and profundus uPalmer interossi uFlexor pollicis longus and brevis uAbductor pollicis brevis uOpponens pollicis uOpponens digiti minimi uExtensor carpi radialis longus and brevis uExtensor carpi ulnaris uExtensor digitorum uExtensor indicis uExtensor digiti minimi uDorsal interossi uExtensor pollicis brevis and longusAbductor pollicis longus

3 major nerves of wrist

uUlnar, median and radial

apprehension test

used for anterior glenhumeral instability

relocation test

uses external rotation and anterior pressure to allow for increased external rotation

heavy menstrual bleeding

what is HMB?

glenhumeral joint

what joint does labrum surround?

associated with multiple other shoulder problems

why are SLAP injuries difficult to assess?

different anatomical structures and past activities

why is patient history so important when determining labral tears?

throwing mechanics

wind up phase, cocking phase, acceleration, deceleration, follow-through phase

helmet fitting

}When fitting head/hair should be wet to simulate sweat }Follow manufacturer's directions }Must routinely check fit ◦Snug fit (credit card test) ◦With change in altitude, bladder helmets must be rechecked ◦Chin straps (2, 4, or 6 snap systems) ◦Jaw pads are essential (prevent lateral rocking) }Certification is of no avail if helmet is not fit and maintained

elbow, wrist, and hand protection

}While the elbow is less commonly injured it is susceptible to instability, contusions, and muscle strain } }A variety of products are available to protect the elbow }Wrist, hand and finger injuries are often trivialized but can be functionally disabling } }Susceptible to fracture, dislocation, ligament sprains and muscle strains } }Gloves and splints are available for protection and immobilization

stretch reflex

•A motor response in the spinal cord that results whena muscle is stretched quickly • •Muscle spindle contracts à afferent fibers stimulated à tension increases in muscle • •Protection - GTO inhibition reacts - allows adaptation in new range

valgus/varus stress test

•Assess injury to the medial and lateral collateral ligaments, respectively •Looking for gapping or complaint of pain

elbow soft tissue palpation

•Biceps brachii •Brachialis •Brachioradialis •Pronator teres •Triceps •Supinator •Wrist flexors and extensors

skeletal system

•Boney anatomy •Alignment •Restrictions •Joint arthrokinematics •Glide, roll, slide, etc

clavicular fracture management

•Closed reduction - sling and swathe, immobilize w/ figure 8 brace for 6-8 weeks •Removal of brace should be followed w/ joint mobes, isometrics and use of a sling for 3-4 weeks

elbow functional anatomy

•Complex that allows for flexion, extension, pronation and supination -145 degrees of flexion and 90 degrees of supination and pronation •Bony limitations, ligamentous support and muscular stability at the elbow help to protect it from overuse and traumatic injuries •Elbow demonstrates a carrying angle due to distal projection of humerus -Normal in females is 10-15 degrees, males 5 degrees •Critical link in kinetic chain of upper extremity

medial and lateral epicondylitis test

•Elbow flexed to 45 degrees and wrist extension or flexion is resisted •Pain at lateral or medial epicondyle, respectively indicates a positive test

pronator teres syndrome test

•Forearm pronation is resisted •Increased pain proximally over pronator teres indicates a positive test

test for glenhumeral instability

•Glenohumeral Translation - anterior and posterior stability, apprehension test

grades of acromioclavicular sprain

•Grade 1 - point tenderness and pain w/ 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 dislocation of clavicle •Grade 5 - loss of AC and CC ligaments; tearing of deltoid and trapezius attachments; gross deformity, severe pain, decreased ROM •Grade 6 - displacement of clavicle behind the coracobrachialis

elbow bony palpation

•Humerus •Medial and lateral epicondyles •Olecranon process •Radial head •Radius •Ulna •Medial and lateral collateral ligaments •Annular ligament

acromioclavicular sprain management

•Ice, stabilization, referral to physician •Grades 1-3 (non-operative) will require 3-4 days and 2 weeks of immobilization respectively •Grades 4-6 will require surgery •Aggressive rehab is required w/ all grades -Joint mobilizations, flexibility exercises, & strengthening should occur immediately -Progress as athlete is able to tolerate w/out pain and swelling -Padding and protection may be required until pain-free ROM returns

neuroanatomy

•Nerves affected by: •Muscle imbalances •Joint dysfunctions •Posture •Acute Injury

elbow observations

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

rotator cuff tear

•Occurs near insertion on greater tuberosity •Partial or complete thickness tear •Full thickness tears usually occur in those athletes w/ a long history (generally does not occur in athlete under age 40) •Primary mechanism - acute trauma or impingement •Involve supraspinatus or rupture of other rotator cuff tendons -Management •Analgesics, electrical stimulation for pain, NSAID's and ultrasound for inflammation •Restore appropriate mechanics and strengthen rotator cuff to depress and compress humeral head to restore space •Strengthen lower extremity and trunk to reduce stress on shoulder •Stage III and IV cases may require immobilization and rest and potentially surgery

abdomen injuries

•Only comprise of 10% of sports injuries •Can require long recovery •Can be life threatening

elbow functional evaluation

•Pain and weakness are evaluated through AROM, PROM and RROM -Flexion, extension, pronation and supination -ROM of pronation and supination are particularly noted

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

prevention of shoulder injuries

•Proper physical conditioning is key •Develop body and specific regions relative to sport •Strengthen through a full ROM •Warm-up should be used before explosive arm movements are attempted •Contact and collision sport athletes should receive proper instruction on falling •Protective equipment •Mechanics versus overuse injuries

elbow circulatory and neurological function

•Pulse should be taken at brachial artery and radial artery •Skin sensation should be checked - determine presence of nerve root compression or irritation in cervical or shoulder region

acute subluxations and dislocations management

•RICE and reduction by a physician •Immobilize following reduction for 3 weeks •Perform isometrics while in sling •Progress to resistance exercises as pain allows •Return to play when athlete has regained 20% of body weight when tested for internal and external rotation •Protective bracing

dislocation of elbow management

•Refer for reduction •Neurological and vascular fxn must be assessed prior to and following reduction •Physician should reduce - immediately •Immobilization following reduction in flexion for 3 weeks •Hand grip and shoulder exercises should be used while immobilized •Following initial healing, heat and passive exercise can be used to regain full ROM •Massage and joint movement that are too strenuous should be avoided before complete healing due to high probability of myositis ossificans •ROM and strengthening should be performed and initiated by athlete (forced stretching should be avoided

acute subluxations and dislocations signs and symptoms

•Signs and Symptoms Anterior dislocation - flattened deltoid, prominent humeral head in axilla; arm carried in slight abduction and external rotation; moderate pain and disability Posterior dislocation - severe pain and disability; arm carried in adduction and internal rotation; prominent acromion and coracoid process; limited external rotation and elevation

prevention of internal injuries

•Strengthening of abdomen and thorax •Empty hollow organs before competition: Stomach/bladder appropriate equipment

test for capsular 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

dynamic stretching

•Use the muscle's own force production and momentum and go through a complete ROM •i.e. prisoner's squats, plank + thoracic rotation

active flexibility

•Using agonists to move through muscles ROM •Creates antagonist RECIPROCAL Inhibition •Relaxation of antagonist •Perform 1-2 sec hold of 5-10 reps • •I.e. Tin soldiers, lateral lunges, etc.

test for serratus anterior weakness

•Wall push-up - looking for winging scapula •Could indicate injury to long thoracic nerve

test for sternocalvicular joint instability

•With athlete seated, pressure is applied to the SC joint anteriorly, superiorly and inferiorly to determine stability or pain associated w/ a joint sprain

test fo biceps irritation

•Yergason's test and Speed's test utilized to determine pain and possible subluxation of biceps tendon •Ludington's test used to assess possible rupture of biceps (feel for contraction while alternating contractions of each biceps)

sarcomere

•contractile element of muscle ("Crossbridge") •Length of sarcomeres determines tension produced •Full stretched = greatest tension/potential for full contraction à power

SLAP lesion

•defect in superior labrum that begins posteriorly and extends anteriorly impacting attachment of long head of biceps on labrum

static stretch

•low force LONG duration •Potential DECREASED muscle spindle activity

self myofascial release

•relieves trigger points, fascial adhesions •Foam roll •Lacrosse ball •Theragun

muscle spindles

•sensory organs of muscles •Sensitive to changes in LENGTH and rate of LENGTH change •Innervated by neural system

face guard/mask

○Reducded # of facial injuries ○# of concussions and neck injuries has increased - head is most often used in initial contact ○Variety of options: sport, manufacturer ○Proper mounting of the mask must occur with no additional attachments that would invalidate the manufacturer's warranty ○All mountings must be flush to the helmet

neoprene knee brace

◦(w/ medial and lateral support) Used by those that have sustained collateral ligament injuries Some are also used to provide support in those that have patellofemoral conditions

ankle support

◦Alone or with tape -- they are increasingly popular ◦Significant debate over efficacy ◦Little or no impact on performance ◦Compared to tape: the device will not loosen significantly with use ◦Research also looking at impact on proprioceptive effects

foot orthotics

◦Device for correcting biomechanical problems that exist in foot that can cause injury ◦ ◦Plastic, thermoplastic, rubber, sorbethane, leather support or ready-made products ◦ ◦Can also be customized by physician, podiatrist, athletic trainer or physical therapist More expensive

off the shelf foot pads

◦General public use, not designed for athletic use ◦With adequate funding, provides advantage of saving time ◦Manufactured for numerous structural conditions ◦Commonly used before customized devices are made

shoe selection

◦Number of options for multiple activities ◦Guidelines for selection Toe Box - space for toes (1/2 to 3/4 inch of space from toes to front of shoe) Sole - provide shock absorption and durable Heel Counter - prevents medial and lateral roll of foot Shoe Uppers - top of shoe made with combination of materials, designed for appropriate ventilation, drying and support Arch Support - durable but soft and supportive to foot Price- due to impact on performance and injury prevention, may be worth the extra investment

shin and lower leg

◦Often overlooked ◦Commercially marketed, hard molded shin guards are used in field hockey and soccer

sports bras

◦Significant effort has been made to develop athletic support for women ◦Minimize vertical and horizontal movements ◦Should hold breasts to chest - prevent stretching of Cooper's ligament ◦Improper fit - rubbing and abrading of skin and nipples

thorax and rib protection

◦Thorax protectors and rib belts ◦Protect against external forces ◦Air-inflated interconnected cylinders (jacket design)

heel cups

◦Used for a variety of conditions: 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 or lift of heel

flexibility

The normal extensibility of all soft tissues to allow full range of motion of a joint and optimum neuromuscular efficiency throughout all functional movements

convex

The patella is what on its anterior surface?

false

True or false a meniscal transplant is a long-term solution for knee pain?

false

True or false a meniscal transplant is targeted for an older audience?

true

True or false the tissue in a meniscal transplant comes from a human cadaver?

false

True/False: Female athletes with symptoms of anxiety, depression, or both injured themselves just as much as male athletes with symptoms did during the season.

ice hockey helmets

Undergone extensive testing in an effort to upgrade and standardize Must withstand high velocity impacts and high-mass-low-velocity impacts Helmet will disperse force over large area and decelerate forces that would act on head (energy absorption liner) Helmets must be approved by Canadian Standards Association or Hockey Equipment Certification Council

functional knee brace

Used during and following rehab to provide functional support Ready-made and customized

dynamic splints

Used for injuries in hands and fingers Provides long duration tension on healing structures Combination of thermomoldable plastic, elastic and Velcro

knee braces

Used prophylactically to prevent injuries to MCL Efficacy debated May positively influence joint position sense

ear guards

Wrestling, water polo, and boxing use to reduce irritation Most helmets built protection in

if equipment results in injury

______________due to defect or inadequacy for intended use manufacturer is liable

increasing amount of litigation

__________regarding equipment Must foresee all uses and misuses and warn user against ANY potential risks inherent in equipment use and misuse

dynamic stability

ability of rotator cuff and long head of biceps provide

special tests of shoulder

active vs passive flexion/extenion abduction/adduction internal/external rotation

golgi tendon organ

aka GTO mechanoreceptors located within the musculotendinous junction •Sensitive to changes in TENSION and rate of TENSION change

neuromuscular stretching

aka Peripheral Neuromuscular facilitation - PNF •Contracting musculature to relax it throughout the muscles ROM •i.e. Hamstring straight leg raise - patient supine, leg raised to end range, push leg down into clinician (about 25% effort) for 3-6 seconds, relax, and move leg further into end range

triangular fibrocartilage complex injury

aka TFCC Etiology Occurs through forced hyperextension, falling on outstretched hand Often associated w/ sprain of UCL Signs and Symptoms Pain along ulnar side of wrist, difficulty w/ wrist extension Swelling is possible, not much initially Athlete may not report injury immediately Management Referred to physician for treatment

frozen shoulder

aka adhesive capsulitis -Etiology •Contracted and thickened joint capsule w/ little synovial fluid •Chronic inflammation w/ contracted inelastic rotator cuff muscles •Generalized pain w/ motions (active and passive) resulting in resistance of movement -Signs and Symptoms •Pain in all directions both w/ active and passive motion -Management •Aggressive joint mobilizations and stretching of tight musculature •Electric stim for pain and ultrasound for deep heating

anterior scalene syndrome

aka adson's test, -Compression of subclavian artery by scalenes is assessed -Disappearance of pulse while athlete turns toward extended arm and takes a breath indicates a positive test

hyperabduction syndrome test

aka allen's test, -Used to assess if pressure from pectoralis minor is compressing brachial plexus and subclavian artery

mallet finger

aka baseball/basketball finger uEtiology uCaused by a blow that contacts tip of finger avulsing extensor tendon from insertion uSigns and Symptoms uPain at DIP; X-ray shows avulsed bone on dorsal proximal distal phalanx uUnable to extend distal end of finger (carrying at 30 degree angle) uPoint tenderness at sight of injury uManagement uRICE and splinting for 6-8 weeks

de quervain's disease

aka hoffman's disease uEtiology uStenosing tenosynovitis in thumb (extensor pollicis brevis and abductor pollicis longus uConstant wrist movement can be a source of irritation uSigns and Symptoms uAching pain, which may radiate into hand or forearm uPositive Finklestein's test uPoint tenderness and weakness during thumb extension and abduction; painful catching and snapping

de quervain's disease management

aka hoffman's disease uManagement uImmobilization, rest, cryotherapy and NSAID's uUltrasound and ice are also beneficial uSometimes may see a physician for an injection.

costoclavicular syndrome test

aka roo's test, -Compression of artery between clavicle and first rib -Test is positive if after opening and closing hands for 3 minutes, strength or circulation decreases -Test is also positive if while in military brace position, head is turned in opposite direction and pulse disappears

lateral epicondylitis

aka tennis elbow -Etiology •Repetitive microtrauma to insertion of extensor muscles of lateral epicondyle -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 w/ resistive wrist extension

lateral epicondylitis management

aka tennis elbow -Management •RICE, NSAID's and analgesics •ROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motions •Mobilization and stretching in pain free ranges •Use of a counter force or neoprene sleeve •Mechanics training

tests for thoracic outlet compression

anterior scalene syndrome (adson's test), costoclavicular syndrome test (Roo's test), hyperabduction syndrome test (Allen test), sensation testing

RLQ contains

appendix, colon, small intestine, ureter, major vein and artery to right leg

possible complications of shoulder dislocation

bankart lesion, hill sachs lesion, SLAP lesion, brachial nerves and vessels compromised, rotator cuff injuries, bicipital tendon subluxation and transverse ligament rupture

rib contusions

blow to rib cage sharp pain when breathing x-ray needed, self limiting-rest most important

infectious mononucleosis

can cause spleen enlargement

hill sachs lesion

caused by compression of cancellous bone against anterior glenoid rim

LLQ contains

colon, small intestine, ureter, major vein and artery to left leg

supraspinatus

compresses the head while the other rotato cuff muscles depress the humeral head during overhead motion

yes

do a majority of female athletes have a history of iron supplementation?

yes

does functional testing show that patellofemoral pain syndrome patients have lower strength capacity?

kidney contusion

external force applied usually to posterior -Signs of shock, nausea, vomiting, rigidity of the back muscles and blood in urine refer to physician

avoid litigation

follow specific use instructions of equipment exactly If the athletic trainer's modification results in injury, the ATC and the institution are subject to a lawsuit

opposition

functional evaluation for 5th finger

flexion and extension

functional evaluation for MCP joint, PIP and DIP joints, thumb

abduction and adduction

functional evaluation for fingers and thumb (also do opposition for thumb)

rehabilitation of elbow

general body conditioning, flexibility, joint mobilizations, strengthening: -Achieved through low-resistance, high-repetition exercises - must be pain free -Shoulder and grip exercises should also be performed -Continuous passive motion units followed by dynamic splinting is ideal following surgery -Isometrics can be used while elbow is immobilized -PNF and isokinetics are useful in early and intermediate active stages of rehab -A graded program w/ tubing, weights or manual resistance should be included -Closed kinetic chain activities should also be incorporated - assist in both static and dynamic stability to the elbow -Proprioceptive training should also incorporated

wrist, hand, fingers rehabilitation

general body conditioning, joint mobilizations, flexibility, strength: uExercises should not aggravate condition or disrupt healing process uA variety of exercises are available for strength (wrist and hand)

shoulder

great degree of mobility and limited stability

Mcburney's point

halfway between belly button and point of anterior superior iliac spine

liver contusion

hard blow to right side of rib cage - referred pain just below the right scapula, right shoulder, and substernal area hemorrage and shock

regular recertification

helmets should undergo____________________and reconditioning Will allow equipment to meet necessary standards for multiple seasons

sternum fracture

high impact blow to the chest (more likely car accidents than athletics) point tenderness, exacerbated with deep inspiration or expiration monitor vitals

rib fracture

highest incidence in collision sports direct or indirect trauama overuse (rowing) possible crepitus protection for collision sports

12-16 weeks

how long is the rehab for meniscal transplant

before every session

how often should athletes be screened for physical symptoms?

about 1/3

how prevalent is HMB in elite athletes?

appendicitis

inflammation of appendix acute or chronic mistaken for common gastric complaints mild to severe pain in lower abdomen fever surgery

labrum

like a suction cup or washer that connects ball to the T

RUQ contains

liver, right kidney, gall bladder, colon, pancreas

if equipment if modified

modifier becomes liable

scaoulohumeral rythm

movement of scapula relative to humerus, initial 30 degree of glenhumeral abduction does not incorporate scapular motion first 30 degrees, scapula doesn't move 30-90 degree scapula starts to move (abducts and upward rotate 1 degree for every 2 degrees humerus elevates) 90+ scapula moves in 1 to 1 ratio with humerus

control the capsule

muscle contract dynamically to

Palmaris longus muscle

not everyone has this muscel tendon in their wrist, flexor

monitor vital signs

observation of internal injuries swelling, tight muscles, body position, hold ing chest wall

costochondritis

overuse (rowing) or direct blow pain on either side of sternum or lower anterior ribs or pain with breathing or coughing ice, possible injection for treatment

bankart lesion

permanent anterior defect of labrum

glenhumeral and scapulothoracic

physical assessment of SLAP injuries must always begin with assessing what two ranges of motion

general body conditioning

rehab technique -Maintain cardiovascular endurance through cycling, running and walking

immobilization of shoulder

rehab technique -Will vary depending on injury -Isometrics can be performed during immobilization -Time in brace or splint are injury specific -ROM and strengthening are dictated by healing

types of braces

rehabilitative, functional, neoprene

injury to spleen

relatively uncommon •From a fall or a direct blow to left upper quadrant -Abdominal ridgity, nausea, vomiting Kher's sign

flat glenoid

round humeral head articulates with

empty can test

-90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal abduction -Downward pressure is applied -Weakness and pain are assessed bilaterally

deceleration phase

-Ball release until max shoulder internal rotation -Eccentric contraction of ext. rotators to decelerate humerus while rhomboids decelerate scapula

return to activity for shoulder

-Based on pre-established criteria -Functional performance testing -Object measures of strength and performance

elbow return to activity

-Can re-engage in activity when criteria has successfully been completed -ROM w/in normal limits, strength should be equal w/ no complaint of pain -Return should progress with use of restrictions in an effort to objectively measure activity progression

flexibility

-Codman's pendulum exercises and sawing motions should begin early -Progress to active assisted ROM in pain free range (cardinal planes) -Should be performed in conjunction w/ rotator cuff and scapula strengthening exercises

follow-through phase

-End of motion when athlete is in a balanced position

volkmann's contracture

-Etiology •Associate w/ humeral supracondylar fractures, causing muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm •Can become permanent -Signs and Symptoms •Pain in forearm - increased w/ passive extension of fingers •Pain is followed by cessation of brachial and radial pulses, coldness in arm •Decreased motion -Management •Remove elastic wraps or casts •Close monitoring must occur

little league elbow

-Etiology •Caused by repetitive microtraumas that occur from throwing (not type of pitch) •May result in numerous disorders of growth in the pitching elbow -Signs and Symptoms •Onset is slow; slight flexion contracture, including tight anterior joint capsule and weakness in triceps •Athlete may complain of locking or catching sensation •Decreased ROM or forearm pronation and supination

shoulder bursitis

-Etiology •Chronic inflammatory condition due to trauma or overuse - subacromial bursa •Fibrosis, fluid build-up resulting in constant inflammation -Signs and Symptoms •Pain w/ motion and tenderness during palpation in subacromial space; positive impingement tests -Management •Cold, ultrasound and NSAID's to reduce inflammation •Remove mechanisms precipitating condition •Maintain full ROM to reduce chances of contractures and adhesions from forming

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 pec. minor -4) presence of cervical rib -Signs and Symptoms •Paresthesia and pain, sensation of cold, impaired circulation, muscle weakness, muscle atrophy and radial nerve palsy -Management •Conservative treatment - correct anatomical condition through stretching (pec minor and scalenes) and strengthening (trapezius, rhomboids, serratus anterior, erector spinae)

contusion of upper arm

-Etiology •Direct blow -Signs and Symptoms •Transitory paralysis and inability to use extensor muscles of forearm -Management •RICE for at least 24 hours •Provide protection to contused area to prevent repeated episodes that could cause myositis ossificans •Maintain ROM

fractures of 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 ulna or radius may cause radial head fracture as well -Signs and Symptoms •May not result in visual deformity •Hemorrhaging, swelling, muscle spasm

clavicular fractures

-Etiology •Fall on outstretched arm, fall on tip of shoulder or direct impact •Occur primarily in middle third (greenstick fracture often occurs in young athletes) -Signs and Symptoms •Generally presents w/ supporting of arm, head tilted towards injured side w/ chin turned away •Clavicle may appear lower •Palpation reveals pain, swelling, deformity and point tenderness

glenhumeral joint sprain

-Etiology •Forced abduction and/or external rotation • a direct blow -Signs and Symptoms •Pain during movement especially when re-creating MOI •Decreased ROM and pain w/ palpation -Management •RICE for 24-48 hours; sling •After hemorrhaging subsides, cryotherapy, ultrasound and massage can be used along w/ passive and active exercise to regain full ROM •When full ROM achieved w/out pain, resistance exercises can be initiated •Must be aware of potential development of chronic conditions

dislocation of elbow

-Etiology •High incidence in sports caused by fall on outstretched hand w/ elbow extended or severe twist while flexed •Bones can be displaced backward, forward, or laterally •Distinguishable from fracture because lateral and medial epicondyles are normally aligned w/ shaft of humerus -Signs and Symptoms •Swelling, severe pain, disability •Complications w/ median and radial nerves and blood vessels •Often a radial head fracture is involved

humeral fractures

-Etiology •Humeral shaft fractures occur as a result of -a direct blow - fall on outstretched arm •Proximal fractures occur due to -direct blow -Dislocation -fall on outstretched arm -May pose danger to nerve and blood supply •Epiphyseal fractures are more common in young athletes - -occur due to direct blow or indirect blow travelling along long axis of humerus

elbow osteochondritis dissecans

-Etiology •Impairment of blood supply to anterior surface resulting in degeneration of articular cartilage, creating loose bodies •Repetitive microtrauma in movements of elbow rotation, extension, valgus stress causing compression of the radial head ad shearing of the radiocapitular joint •Seen in young athletes involved in throwing motion •Panner's disease in incidents of children age <10 -Signs and Symptoms •Sudden pain, locking; range usually returns in a few days •Swelling, pain at radiohumeral joint, creptitus, decreased ROM (full extension); grating w/ pronation and supination •X-ray may show flattening and crater of capitulum w/ loose bodies

sternoclavicular sprain

-Etiology •Indirect force, blunt trauma (may cause displacement) -Signs and Symptoms •Grade 1 - pain and slight disability •Grade 2 - pain, subluxation w/ deformity, swelling and point tenderness and decreased ROM •Grade 3 - gross deformity (dislocation), pain, swelling, decreased ROM -Possibly life-threatening if dislocates posteriorly -Management •RICE, reduction if necessary •Immobilize for 3-5 weeks followed by graded reconditioning

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 MCL •Associated paresthesia, positive Tinel's sign •Pain w/ valgus stress test at 20 degrees; possible end-point laxity •X-ray may show hypertrophy of humeral condyle, posteromedial aspect of olecranon, marginal osteophytes; calcification w/in MCL; loose bodies in posterior compartment

elbow strain

-Etiology •MOI is excessive resistive motion (falling on outstretched arm), repeated microtears that cause chronic injury •Rupture of distal biceps is most common muscle rupture of the upper extremity -Signs and Symptoms •Active or resistive motion produces pain; point tenderness in muscle, tendon, or lower part of muscle belly -Management •RICE and sling in severe cases •Follow-up w/ cryotherapy, ultrasound and exercise •If severe loss of function encountered - should be referred for X-ray (rule out avulsion or epiphyseal fx

shoulder impingement syndrome

-Etiology •Mechanical compression of supraspinatus tendon, subacromial bursa and long head of biceps tendon due to decreased space under coracoacromial arch •Seen in over head repetitive activities •Exacerbating factors - laxity and inflammation, postural mal-alignments -kyphotic posture, rounded shoulders -Signs and Symptoms •Diffuse pain, pain on palpation of subacromial space •Decreased strength of external rotators compared to internal rotators; tightness in posterior and inferior capsule •Positive impingement and empty can tests

cubital tunnel syndrome

-Etiology •Pronounced cubital valgus may cause deep friction problem •Ulnar nerve dislocation •Traction injury from valgus force, irregularities w/ tunnel, subluxation of ulnar nerve due to lax impingement, or progressive compression of ligament on the nerve -Signs and Symptoms •Pain medially which may be referred proximally or distally •Tenderness in cubital tunnel on palpation and hyperflexion •Intermittent paresthesia in 4th and 5th fingers

medial epicondylitis

-Etiology •Repeated forceful flexion of wrist and extreme valgus torque of elbow -Signs and Symptoms •Pain produced w/ forceful flexion or extension •Point tenderness and mild swelling •Passive movement of wrist seldom elicits pain, but active movement does -Management •Sling, rest, cryotherapy or heat through ultrasound •Analgesic and NSAID's •Curvilinear brace below elbow to reduce elbow stressing •Severe cases may require splinting and complete rest for 7-10 days

bicepital tenosynovitis

-Etiology •Repetitive overhead athlete - ballistic activity that involves repeated stretching of biceps tendon causing irritation to the tendon and sheath -Signs and Symptoms •Tenderness over bicipital groove, swelling, crepitus due to inflammation •Pain when performing overhead activities -Management •Rest, ice and ultrasound to treat inflammation •NSAID's •Gradual program of strengthening and stretching

biceps brachii rupture

-Etiology •Result of a powerful contraction •Generally occurs near origin of muscle at bicipital groove -Signs and Symptoms •Athlete 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 -Management •Ice for hemorrhaging, place arm in sling and refer to athlete •Athletes will require surgery •Older individual will be able to rely on brachialis which serves as primary elbow flexor

acromioclavicular sprain

-Etiology •Result of direct blow (from any direction), upward force from humerus, •Can be graded from 1-6 depending on severity

scapular fractures

-Etiology •Result of direct impact • force transmitted up through humerus -Signs and Symptoms •Pain during shoulder movement as well as swelling and point tenderness -Management •Sling immediately and follow-up w/ X-ray •Use sling for 3 weeks w/ overhead strengthening beginning at week 1

acute subluxations and dislocations

-Etiology •Subluxation involves excessive translation of humeral head w/out complete separation from joint •Anterior dislocation is the result of an anterior force on the shoulder, forced abduction and external rotation •Posterior dislocation occurs due to forced adduction and internal rotation or falling on an extended and internally rotated shoulder

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 w/out usual pain and heat -Management •In acute conditions, compression for at least 1 hour •Chronic cases require superficial therapy primarily involving compression •If swelling fails to resolve, aspiration may be necessary •Can be padded in order to return to competition

chronic recurrent instabilities

-Etiology •Traumatic, atraumatic, microtraumatic (repetitive use), congenital and 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 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 w/ arm at side; possible signs and symptoms associated w/ anterior and posterior instability

elbow 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) -Management •Treat w/ RICE immediately for at least 24 hours •If severe, refer for X-ray to determine presence of fracture

hyperventilation

-Excessively rapid rate of ventilation gradually decreased amount of Carbon dioxide in blood anxiety and asthma slow breathing in nose and out of mouth, paper bag

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 max. external rotation) while lead foot comes in contact w/ ground

adonis complex

Which term has been coined to describe symptoms of body image issues in men?

rehabilitative knee brace

Widely used following surgery Allows controlled progressive immobilization Adjustable

rules of fitting football shoulder pads

Width of shoulders must be measured (AC to AC) Inside of pad should cover tip of shoulder in line with lateral aspect of shoulder Epaulets and cups must cover deltoid and allow motion Neck opening must allow athlete to raise arms over head w/out pads sliding forward and back With split clavicle pads, channel for top of shoulder must be in proper position

fractures of elbow management

-Management •Decrease ROM, neurovascular status must be monitored •Surgery is used to stabilize adult unstable fracture, followed by early ROM exercises •Stable fractures do not require surgery -Removable splints are used for 6-8 weeks

little league elbow management

-Management •RICE, NSAID's and analgesics •Throwing stops until pain resolved and full ROM is regained •Gentle stretching and triceps strengthening •Throwing under supervision w/ good technique to prevent recurrence

cubital tunnel syndrome mangement

-Management •Rest, immobilization for 2 weeks w/ NSAID's •Splinting or surgical decompression or transposition of subluxating nerve may be necessary •Athlete must avoid hyperflexion and valgus stresses

acceleration phase

-Max external rotation until ball release (humerus adducts, horizontally adducts and internally rotates) -Scapula elevates and abducts and rotates upward

elbow history

-Past history -Mechanism of injury -When and where does it hurt? -Motions that increase or decrease pain -Type of, quality of, duration of, pain? -Sounds or feelings? -How long were you disabled? -Swelling? -Previous treatments?

tension pneumothorax

-Pleural cavity becomes filled with air and displaces the lung and the heart toward the opposite side which compresses the opposite lung -Shortness of breath, chest pain on side of injury, absence of breath sounds, cyanosis, distention of neck veins, •The neck veins may deviate away from side of injury medical attention necessary

pneumothorax

-Pleural cavity is filled with air through an opening in chest -As the pleural cavity fills with air the lung on that side collapses -Pain, shortness of breath, anxiety, diminished breath sounds. medical attention is necessary

hemothorax

-Presence of blood in pleural cavity -Caused by violent blow or compression of chest -Difficulty breathing, pain, and cyanosis -Coughing up blood, shock •MEDICAL ATTENTION IS NECESSARY

cognitive-behavioral approach

What is the best treatment for male athletes who suffer from eating disorders?

frequency of dislocation

What is the incidence of HSL directly proportional to?

load and shift test

What is the name of the manual test typically used to identify a Hill-Sachs lesion or a glenoid defect?

quadriceps patella mechanism

What is the primary stabilizer of the patella?

psychological treatment and education on effective coping strategies

What is the recommended treatment for athletes who screen positive for anxiety and/or depressive symptoms?

snapping

What kind of noise is associated with ulnar nerve dislocation?

knee flexion and quadriceps loading

What knee conditions are associated with pain from patellofemoral disorder?

MPFL

What ligament is most important for patellar stability?

CT

What method of imaging is typically considered the "gold standard" in predicting bone loss?

25

What percent of knee injuries comprise from patellofemoral disorders?

82

What percent success rate has there been in treating anterior knee pain with physical rehabilitation programs?

premenstrual and menstrual phase

What phase of the menstrual cycle shows high levels of lactate concentration?

ring and pinky finger

What two fingers are affected by ulnar nerve dislocation?

neuromuscular control

-Must regain appropriate firing sequence for specific muscles -Biofeedback can be used to regain control -Proprioception -Closed kinetic chain exercises will be required in gymnasts, wrestlers and weight lifters •Emphasize co-contraction muscle activity -OKC and CKC are necessary in complete rehab plan

functional progressions

-Incorporation of sports specific skills -Strengthening that involves PNF patterns (resembles throwing) -Gradual and progressive increase in angular velocities

solid organs of abdomen

-Kidneys -Spleen -Liver -Pancreas -Adrenal glands

elbow osteochondritis dissecans management

-Management •Activity restriction for 6-12 weeks; NSAID's •Splint and cast applied for cases of extensive deterioration •If repeated locking occurs, loose bodies are removed surgically

ulnar collateral ligament injuries management

-Management •Conservative treatment begins w/ RICE and NSAID's •W/ resolution, strengthening should be performed; analysis of the throwing motion (if applicable) •Surgical intervention may be necessary (Tommy John procedure) -Throwing athlete can return to activity 22-26 weeks post surgery

chronic recurrent instabilities management

-Management •Conservative treatment involves extensive strengthening (rotator cuff and scapula stabilizers) •Avoid joint mobilizations and flexibility exercises •Various harnesses and restraints can be used to limit motion •Surgical stabilization may be required to improve function and comfort •Strengthening should be continued for a reasonable time before surgery is opted for

ely's test, ober's test, thomas test

What are some tests used to measure muscle flexibility associated with PFPS?

pain, numbness, tingling

What are symptoms of tarsal tunnel syndrome?

medial epicondyle

What bone does the ulnar nerve anteriorly slip over during dislocation?

lateral reticulum release of the patella

What is a common surgical procedure for the alleviation of patellofemoral pain syndrome?

immobilization and physical therapy

What is an example of a conservative treatment method for HSL?