Test 3
Auricular Hematoma
Description: "cauliflower ear"; pooling of blood between the skin and the cartilage separates the two and this deprives the cartilage of its source of nutrition; may scare with time if not properly taken care of Causes: repeated episodes of shearing forces to the external ear Signs & Symptoms: pain in the external and middle ear, accompanied by ecchymosis and swelling of the auricle, palpation reveals tenderness and a "boggy" feeling Treatment: a small needle is used to aspirate the hematoma; more extreme excision may be needed if the fluid is within the cartilage; chronic injury may require surgical intervention
Cerebral Contusion
Description: a bruise of the brain tissue Causes: often caused by a blow to the head; coup - injured at the spot of impact, countercoup - injured opposite the area of impact Signs & Symptoms: depend on the severity of the injury, ranging from minor to severe; individuals may experience a headache; confusion; sleepiness; dizziness; loss of consciousness; nausea and vomiting; seizures; and difficulty with coordination and movement; they may also have difficulty with memory, vision, speech, hearing, managing emotions, and thinking; signs depend on the contusion's location in the brain Treatment: prevent swelling, although surgery may be necessary to reduce it
Multidirectional Shoulder Instability
Description: a combination of two or more unidirectional instabilities Causes: result from overuse or due to associated shoulder injuries Signs & Symptoms: congenital MDI - generalized hyperlaxity of the shoulders and other joints and have no history of trauma; acquired MDI - typically participate in overhead activities that impose repetitive microtrauma, symptomatic with activities and present with less laxity than with congenital MDI Treatment: generally focuses on conservative treatment with an emphasis on retraining and strengthening the scapular stabilizers and rotator cuff
Spondylolysis
Description: a defect in the pars interarticularis, the area of the verterbral arch between the inferior and superior articular facets Causes: reptetitive stresses Signs & Symptoms: pain in the lumbar spine, possibly radiating into the buttock region and upper thigh region; pain may increase with activity and subside with rest Treatment: depends on severity, rehab focuses on strengthening the surrounding musculature and focusing on proper posture and body mechanics; lumbar brace may be used
Slater-Harris Epiphyseal Plate Fracture
Description: a fracture of the epiphyseal plate or growth plate of the involved bone Causes: direct trauma, such as a direct blow, or indirect trauma, such as a FOOSH injury Signs & Symptoms: pain, swelling, deformity, ecchymosis, decreased ROM Treatment: immobilize and refer; *important to properly reduce due to the involvement of the growth plate
Sciatica
Description: a nondescript general term for any inflammation involving the sciatic nerve, does not describe the actual condition that is insulting the nerve and causing inflammation Signs & Symptoms: pain with movement, on palpation, radiating pain, decreased ROM Causes: lumbar disc herniation, SI joint dysfunction, piriformis muscle spasm, scar tissue formation around the nerve root, nerve root inflammation, spinal stenosis, synovial cysts, cancerous or noncancerous tumors, and other disease states Treatment: treat the underlying conditions
Post-concussion Syndrome
Description: a number of cognitive impairments following a cerebral concussion Causes: occur following a cerebral concussion as a result of altered neurotransmitter function Signs & Symptoms: decreased attention span, trouble concentrating, impaired memory, and irritability over both the short and long term; exercise may cause headaches, dizziness, and premature fatigue; long-term consequences include balance disruptions, decreased cognitive performance, and emotional depression Treatment: cognitive rest, possibly including reduced (or no) schoolwork or screen time and no exertion during ADL's is often indicated; athlete should not return to competition until after symptoms have resolved
Volkmann's Contracture
Description: a permanent shortening of forearm muscles, usually resulting from injury, that gives rise to a claw-like deformity of the hand, fingers, and wrist; it is more common in children Causes: caused from primary injury Signs & Symptoms: pain, pallor, pulselessness, paresthesia, paralysis, firmness the tissue in the hand, induration of wrist and forearm muscles Treatment: removal of the dressing, splint or cast; treatment depends on the severity and may include rehab, stretching, strengthening, or possible surgery
Primary Headache
headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medicines, dehydration, or hormone changes
Hypermobile Facet Joint
increase in mobility at the involved facet joint
Coup injury
injury occurs at the point of contact; getting hit by a hockey puck while the head is stationary
Countrecoup injury
injury occurs opposite the point of impact; hitting had on the group
Secondary Headache
related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection
Splint with the PIP and DIP in extension
Boutonniere Deformity
Concussion
Description: a subset of mild traumatic brain injury; a complex pathophysiological process affecting the brain induced by biomechanical forces; may be marked by direct of indirect trauma Causes: direct or indirect trauma (coup or countercoup) Signs & Symptoms: dizziness, tinnitus, nausea, memory loss, and motor impairment (symptoms occur along a continuum ranging from no disruption to total disruption) Treatment: remove from participation, cognitive rest, and once symptoms subside a progressive RTP protocol is completed prior to returning to activity
De Quervain Tenosynovitis
Description: a tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons, which are encased by a fibrous sheath having a common synovial lining; most common in women between the ages of 20 and 40 Causes: repetitive stresses cause the compartment to become inflamed, which result in a thickening and narrowing of the tendon's sheath; history of repetitive motions usually involving radial deviation Signs & Symptoms: pain is located at the radial styloid process and dorsum of the thumb and radiates proximally into the forearm, swelling may be located over the styloid process and thenar eminence, radial and ulnar deviation result in pain as do flexion, extension, and abduction of the thumb Treatment: corticosteroid injections, rest, ice, splinting, and surgery to release the sheaths depending on the severity
Malignant Brain Edema
Description: accumulation of fluid within the intracellular or extracellular spaces of the brain Causes: brain trauma or indirect trauma to the brain from ischemic stroke, cencer, meningitis, or encephalitis Signs & Symptoms: symptoms include nausea, vomiting, blurred vision, faintness, and in severe cases, seizures and coma; if brain herniation occurs, respiratory symptoms or respiratory arrest can also occur due to compression of the respiratory centers in the pons and medulla oblongata Treatment: treatment approaches can include osmotherapy using mannitol, diuretics to decrease fluid volume, corticosteroids to suppress the immune system, hypertonic saline, and surgical decompression to allow the brain tissue room to swell without compressive injury
Brachial Plexus Stretch
Description: acute trauma to the brachial plexus often referred to as a "stinger" or a "burner" Causes: a traction force placed on the brachial plexus or an impingement of the cervical nerve roots through extension and lateral flexion to the side Signs & Symptoms: immediate pain often reported as "burning" or an "electrical shock" radiating through the upper extremity, involved arm will often be hanging to the side limply or the person may be shaking the hand and arm in an attempt to regain feeling, often decreased strength with MMT of the muscles innervated by the associated nerves, reflexes may be altered Treatment: head held in a position to relieve stress on the brachial plexus, ice may help relieve pain and muscle spasm, if symptoms persist the individual should be seen by a physician
Adhesive Capsulitis
Description: affects individuals primarily ages 40 to 70 years old and is more common in women; painful shoulder condition associated with a loss of ROM in all planes Causes: no identifiable causes; individuals with diabetes are at an increased risk for developing this condition Signs & Symptoms: (*four stage progression) pain at night; pain referred to deltoid; severe night pain and stiffness, profound stiffness and pain at the end-range of motion, profound stiffness with minimal pain Treatment: usually resolves on its own after a period of several months to years, oral steroids, steroid injections, manipulation under anesthesia, nerve blocks, and ROM exercises and joint mobilization
Prolapsed Disc
Description: also known as a disk herniation Causes: Signs & Symptoms: pain, radiation pain, numbness, tinging, weakness Treatment: conservative, treatment, possible surgery based on the patients symptoms
Epidural Hematoma
Description: arterial bleeding between the dura mater and the skull results in the rapid formation of a hematoma Causes: a blow to the head that jars the brain Signs & Symptoms: onset occur within hours following injury; athlete may be briefly unconscious and may show signs of a mild concussion, athlete progresses through a lucid period; individual quickly becomes disoriented, displays abnormal behavior, and complains of or displays drowsiness; a headache of increasing intensity may be reported; symptoms of cranial nerve involvement will be displayed Treatment: immediate referral and medial intervention including hospitalization and possible surgery to reduce intracranial pressure
Orbital Hematoma
Description: bleeding in the skin around the eye; also known as raccoon eyes or a black eye Causes: usually caused by direct trauma to the orbital area Signs & Symptoms: pain around area of ecchymosis, swelling, possible deformity or fracture Treatment: many require no treatment, ice and pain killers may be used; rule out concussion or fracture
Subconjunctival Hemorrhage
Description: bleeding underneath the conjunctiva Causes: sudden, severe cough, hypertension, blood thinners, eye trauma, head injury Signs & Symptoms: sudden bright red coloring below the conjunctiva Treatment: self-limiting and typically requires no treatment; artificial tears may be used
Hymphema
Description: blood in the anterior chamber of the eye Causes: blunt eye trauma causing a tear in the ciliary body; less frequently they occur spontaneously Signs & Symptoms: increase in intraocular pressure, visible ecchymosis, possible difficulty seeing Care: patching and shielding the eye with immediate referral to an emergency room
Biceps Contusion
Description: bruising of the biceps brachii muscle of the upper arm Mechanism: typically caused by a direct blow to the area Signs & Symptoms: pain during or after the impact, decreased ROM, swelling, tenderness on palpation Treatment: apply ice, compression wrap, pad when returning to play; *watch for development of myositis ossificans
Perilunate Dislocation
Description: carpal bones are stripped away from the lunat Causes: limits of the wrist and hand extension are exceeded the scaphoid bone strikes the radius, rupturing the palmar interosseous ligaments connecting the scaphoid to the lunate - as the force continues, the distal carpal row is stripped away from the lunate, the lunate then rests dorsally relative to the other carpals Signs & Symptoms: pain along the palmar or dorsal aspect of the wrist that limits ROM, a bulge may be visible on the palmar or dorsal aspect of the hand proximal to the third metacarpal, possible paresthesia in the middle finger Treatment: surgical repair
AC Sprain
Description: commonly referred to as "separated shoulder"; more common in men; sprain of the AC ligament and/or the conoid and trapezoid segments of the coracoclavicular ligaments results in instability or dislocation of the joint Causes: most commonly occurs from a direct force on tip of the shoulder such as falling on the acromion with the arm at the side, FOOSH Signs & Symptoms: pain is primarily located over the superior anterior shoulder, anterolateral neck, and anterolateral deltoid, noticeable displacement of the clavicle from the acromion process (step deformity), distal clavicle may depress and elevate, pain with most movements Treatment: conservative management consisting of immobilization, NSAIDs, and strengthening exercises, depending on severity, surgery may be necessary
Cauda Equina Syndrome
Description: damage to the cauda equine causes loss of function of the lumbar plexus of the spinal canal below the terminal end of the spinal cord Signs & Symptoms: bilateral leg pain, absent deep tendon reflexes, changes in bowel and bladder function Causes: herniated disk, tumor, infection, fracture, or narrowing of the spinal canal Treatment: surgery to remove the material that is pressing on the nerves
Spndylolisthesis
Description: defects in both the pars interarticularis result in the separation of the vertebrae into two uniquely identifiable structure and resulting spinal instability; fixation between the affected vertebrae and the one below it is lost; superior vertebrae slides forward on the inferior resulting in a palpable step off deformity Causes: repetitive hyperextension and rotation or forceful hyperextension and rotation Treatment: depends on severity, rehab focuses on strengthening the surrounding musculature and focusing on proper posture and body mechanics; lumbar brace may be used
Swan Neck Deformity
Description: deformity of the finger with the PIP in hyperextension and the DIP in flexion Causes: stretching of the volar plate at PIP joint; intrinsic tightness; collateral ligament contracture; DIP laxity Signs & Symptoms: Treatment: extension block splint (figure 8 or murphy ring); surgery depending on the severity of the condition
Temporomandibular Joint Dislocation
Description: dislocation of the jaw, or subluxation of the jaw (mandible) from the skull Causes: blow of sufficient force, such as a punch, that moves the mandible laterally Signs & Symptoms: pain, malignment of the teeth, impaired jaw movement Care: immobilize with a Philadelphia collar and the refer for immediate management
Retinal Detachment
Description: disorder of the eye in which the retina separates from the underneath layer Causes: tear in the retina allowing fluid to get behind it or short-sightedness, a forceful sneeze Signs & Symptoms: flashes of light, increase in floaters, ring of floaters or hairs, straight lines, curtain over the eye, loss of central vision Treatment: immediate referral and surgery will be needed
Cubital Tunnel Syndrome
Description: entrapment of the ulnar nerve as it becomes irritated and compressed within the cubital tunnel of the elbow Causes: overuse is a common cause of this injury; constant leaning on the elbow, direct trauma to the elbow Signs & Symptoms: tingling and numbness radiating down the arm and the fingers, weakness in grip strength, and wasting away of muscles in severe cases Treatment: avoid aggravating activities, maintain good posture, stretch and strengthening
Epiphyseal Fracture (Clavicle)
Description: fracture involving the epiphysis or growth plate of the clavicle; common in children Causes: occur from direct or indirect trauma Signs & Symptoms: pain, swelling, deformity, decreased ROM, pain on palpation, ecchymosis, decreased strength and weakness Treatment: recognize, immobilize, and refer; surgery is often needed to repair the injury; time in a figure-8 brace
Cervical Fracture
Description: fracture of any of the cervical bones Cause: typically caused by an axial load to the head with hyperflexion Signs & Symptoms: weakness or inability to move, decreased or absent sensation, pain at fracture site, possible posturing, possible cardiac and respiratory involvement Treatment: immobilize and refer
Bennett's Fracture
Description: fracture of the base of the first metacarpal that extend into the articular surface Causes: direct force on the first metacarpal while it is hyperadducted and flexed (punching with thumb in hand) Signs & Symptoms: dorsally or laterally displaced first metacarpal bone, pain, swelling, bruising, decreased thumb ROM Treatment: internal fixation
Humeral Fracture
Description: fracture of the bone of the upper arm Causes: direct or indirect trauma to the humerus Signs & Symptoms: pain, swelling, deformity, decreased ROM, pain on palpation, ecchymosis, decreased strength and weakness Treatment: immobilize and refer; often casted, depending on the severity they may need surgery; *important to watch out for myositis ossificans
Orbital Fracture
Description: fracture of the bony orbit of the eye Cause: a blow to the orbital rim or periorbital region Signs & Symptoms: infraorbital ecchymosis, enopthalmos, vertical dystopia, possible hymphema Treatment: shield the affected eye and refer (may need to cover the other eye was well in order to prevent the patient from moving the injured eye in association.
Zygomatic Complex Fracture
Description: fracture of the cheek bone(s) Causes: direct blows to the cheek and inferior periorbital area Signs & Symptoms: pain, discoloration, and possible depression of the zygomatic arch at the site of injury; possible malaignment of the eyes with displaced fractures, increased pain with attempted eye movements, pain on palpation, occasionally a step off deformity may be noted Treatment: referral to a physician for a definitive diagnosis and treatment
Clavicular Fracture
Description: fracture of the clavicle (*typically along the distal 2/3rds of the clavicle) Causes: direct trauma to the clavicle (direct blow), FOOSH injury Signs & Symptoms: deformity, swelling, ecchymosis, pain on palpation, crepitus Treatment: immobilize and refer
Spinal Stenosis
Description: narrowing of the spinal canal or intervertebral foramen Causes: most often results from degeneration associated with aging and collapse of the disc space Signs & Symptoms: increased stress to the facet joints and subsequent osteophyte formation Signs & Symptoms: bilateral buttock or leg pain, absence of pain when seated, improvement of symptoms when bending forward, and a wide-based gait Treatment: NSAIDs and core-strengthening exercises, surgical intervention may be necessary
Hamate Fracture
Description: fracture of the hamate bone which functions as a point of muscular attachment for the flexor digiti minimi and the opponens digiti minimi and the point of attachment for the transverse carpal ligament and the pisohamate ligament Cause: hook of the hamate fractures - occur following falls on an outstretched arm, or more commonly, as a result of trauma to the palm when playing racquet sports or baseball or golf; body of the hamate fracture - an axial load applied to the fourth or fifth metacarpal and frequently occurs concurrently with a metacarpal fracture Signs & Symptoms: sharp pain dorsally and/or volarly in the ulnar palmar and wrist region, welling in the hythenar eminence, tenderness duing firm palpation of the hamate, pain with movement of the fifth finger and pain with passive movement of the fifth finger Treatment: immobilization with the wrist in slight flexion and fourth and fifth MCP joint fully flexed; surgical excision
Nose Fracture
Description: fracture of the nasal bone(s) and possible injury to related structures Causes: direct blow to the nose; associated with multiple trauma to the face and head Signs & Symptoms: epistaxis, possible deformity, edema, suborbital ecchymosis Treatment: ice, stabilize, and refer; open or closed reduction; possible surgery
Skull Fracture
Description: fracture of the skull Causes: typically caused by direct trauma to the skull Signs & Symptoms: pain, ecchymosis, deformity, swelling, concussive symptoms Treatment: immediate referral to a physician
Tooth Fracture
Description: fracture of the tooth classified by the region of the fracture (cervical third, middle third, or apical third) Causes: direct blow to the mouth, fracture of the mandible, TMJ injury Signs & Symptoms: pain, aching, malaligned jaw, pain when breathing in Care: proper management of the tooth in order to possible save it
Subdural Hematoma
Description: hematoma function between the brain and dura mater; usually involves venous bleeding Causes: blow to the head that jars the brain Signs & Symptoms: symptoms present hours, days, and even weeks after the initial trauma; athletes are very lucid (even to the point of displaying no signs of trauma), as blood begins to accumulate they begin to develop headaches, clouding consciousness, impairment of cognitive, behavioral, and motor ability Treatment: medical intervention including hospitalization and possible surgery to reduce intracranial pressure
Cranial Neuralgia
Description: inflammation of a nerve in the head or face including serve sharp or throbbing pain Causes: inflammation of a nerve in the neck or face Signs &Symptoms: severe throbbing and shooting pain Treatment: anticonvulsents, antidepressants, and surgery may be needed
Bursitis
Description: inflammation of the bursa between the acromion, humerus, and tendons of the shoulder muscles Causes: repetitive stresses placed on the bursa usually from microtrauma of the adjacent structures (especially the supraspinatus tendon) Signs & Symptoms: pain along the anterior shoulder, night pain, decreased movement, swelling, redness, pain on palpation Treatment: avoid aggravating activities, NSAIDs, local modalities, improve posture and biomechanics; if conservative measures do not help, surgery may be needed
Olecranon Bursitis
Description: inflammation of the bursa between the olecranon process of the elbow and the skin over the joint Causes: direct trauma to the elbow, constant pressure on the joint (leaning on your elbows a lot), underlying medical conditions (gout, rheumatoid arthritis, or kidney failure) may also lead to this condition Signs & Symptoms: swelling, possible pain, possible infection, redness, warmth, decreased joint motion Care: avoid irritating activities, pad and protect, oral NSAIDs, fluid may need to be aspirated, if an infection is present the fluid should be drained and precaution should be taken to make sure the infection does not spread or develop into sepsis
Lateral Epicondylitis
Description: inflammation or repetitive stresses at the lateral epicondyle irritates the common attachment of the wrist extensor group Causes: overuse syndrome involving repeated, forceful wrist extension; radial deviation, supination, or grasping in an overhand position; repeated eccentric loading of the wrist extensor muscles Signs & Symptoms: swelling and pain on palpation of the area, active wrist extension results in pain, pain during passive stretching, decreased grip strength, possible nerve involvement Care: avoid aggravating activities, oral NSAIDs, stretching and strengthening of the musculature surrounding the elbow, "tennis elbow" straps may help relieve pain and symptoms; proper body mechanics should also be enforced
Medial Epicondylitis
Description: inflammation or repetitive stresses at the medial epicondyle irritate the common flexor muscle group Causes: repeated, forceful flexion or pronation of the wrist (or both); repeated activities that eccentrically load the medial elbow muscles *throwing Signs & Symptoms: point tenderness a the origin of the pronator teres, flexor carpi radialis, palmaris longus, and flexor carpi ulnaris tendon on the medial epicondyle; grip strength may be markedly reduced Treatment: avoid aggravating activities, stretch and strengthen the associated musculature, work on proper body mechanics
Otitis Media
Description: inflammatory diseases of the middle ear Causes: dysfunction of the Eustachian tube typically from a sinus infection or deformity leading to an inflammation and an infection Signs & Symptoms: An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there often are accompanying symptoms like cough and nasal discharge Treatment: oral and topical pain killers, antibiotics, and tympanostomy tubes
Tooth Avulsion
Description: intact tooth is displaced from the alveolar process and may represent a medical emergency Causes: direct blow, mandibular fracture, TMJ injury Signs & Symptoms: deformity, pain, bleeding Care: rinse with saline or water and store in the socket if possible, store in a tooth saver system, or store in a glass of fresh whole milk
Lunate Dislocation
Description: lunate dissociates from its contiguous carpals Causes: high-energy forced hyperextension of the wrist and hand resulting in its displacement either dorsally or palmarly Signs & Symptoms: pain along the palmar or dorsal aspect of the wrist that limits ROM, a bulge may be visible on the palmar or dorsal aspect of the hand proximal to the third metacarpal, possible paresthesia in the middle finger, third knuckle is level with the other knuckles Treatment: closed reduction, wrist immobilization for 6 to 8 weeks, possible pinning if the reduction is lost
splint the palmar surface of the wrist and hand
Metacarpal fracture
Shoulder Impingement
Description: occurs when there is decreased space through which the rotator cuff tendons pass under the coracoacromial arch, the muscles then become inflamed, which then causes the tendons to enlarge, and this further decreases the subacromial space Causes: structural cause (hooked acromion) encroaches on the subacromial space, weakness, laxity, fatigue, motion restriction, or a combination of these factors can contribute to a decrease in the subacromial space; common overuse injury in overhead sports Signs & Symptoms: pain during overhead motions, reduced pain with the GH joint is maintained in slight abduction, aching feeling in the shoulder Treatment: strengthening the involved musculature, restore scapular kinematics, improve thoracic extension mobility, stretching, and activity modification; surgical intervention may be necessary in extreme cases
Intracerebral Hematoma
Description: occurs within the cerebrum itself
Trigger Finger
Description: painful condition that causes the fingers or thumb to catch or lock when bent Causes: tendons become inflamed; prolonged irritation of the tendon sheath can produce scarring and thickening that impede the tendon's motion and when this happens, bending the finger or thumb can pull the inflamed tendon through a narrowed tendon sheath, making it snap or pop; repeated movement or forceful use of the finger or thumb Signs & Symptoms: soreness at the base of the finger or thumb; painful clicking, snapping, or popping while the finger or thumb is extended; finger or thumb may become locked Treatment: splint the finger, NSAIDS, surgery may be necessary if the injury does not improve
Shoulder Subluxation
Description: partial dislocation of the humerus from the GH joint Causes: FOOSH injury, abduction with external rotation, axial load on the arm during internal rotation, and a traction force on the arm Signs & Symptoms: pain, deformity, discoloration, decreased strength and ROM, inability to move the arm Treatment: immobilize and refer for further evaluation; following eval. working on strengthening the surrounding musculature to help prevent recurrent subluxation and work on posture
Elbow Neuropathy
Description: peripheral nerves in the elbow, which emanate from the brachial plexus, can be compromised secondary to chronic entrapment, repetitive tension, or trauma Causes: compression, traction, or inflammation of the nerve Signs & Symptoms: ulnar nerve - pain at the medial aspect of the elbow and forearm, radial nerve - proximal dorsal forearm, wrist extensor region, median nerve - pain at the anterior (ventral) forearm; numbness or paresthesia radiating into the nerve patterns Treatment: managed by identifying and alleviating the underlying cause of compression or tension; surgical intervention is often needed; stretching and soft tissue mobilization
Scapular Dyskinesis
Description: poor scapular function, which may include abnormal motion, position, or stability Causes: common inthose with shoulder conditions that include: rotator cuff pathology, GH instability, AC joint injury, and adhesive capsulitis; increase in activity Signs & Symptoms: pain may be localized over the coracoid process, pectoralis minor, superior and medial borders of the scapula, AC joint, posterior-lateral GH joint line, or subacromial space, muscle spasm may be palpated or reported Treatment: varies depending on the levels of activity, dysfunction, and associated pathology, discontinue aggravating activities until more normal control is restored, local modalities and manual therapy, increasing flexibility and appreciation of scapular position and control
Boutonniere Deformity
Description: position of the finger is extension of the DIP and MCP joints and flexion of the PIP joint Causes: occur as a result of a rupture of the central extensor tendon or secondary to the progression of osteoarthritis or rheumatoid arthritis; rupture of the central extensor tendon causes the lateral bands to slip palmarly on each side of the PIP joint, changing its line of pull on the joint from that of an extensor to one of a flexor Signs & Symptoms: pain occurs on the dorsal aspect of the PIP joint and a visible boutonniere deformity, PIP cannot be actively extended (but can be passively moved to its normal position) Treatment: splinted with the PIP and DIP joints in extension
Scalp Wound
Description: puncture, laceration, or tear in the skin at the scalp Causes: typically caused by direct trauma Signs & Symptoms: bleeding, pain, swelling, deformity, possible concussion, possible skull fx Treatment: control bleeding, evaluate for concussion, and refer to a physician for care and further evalutation
Tooth Luxation
Description: ranges from a tooth being avulsed from the socket to its being driven into the bone; a subtle dislocation is not always recognized; intruded tooth is depressed into the alveolar process; an extruded tooth is partially withdrawn from the socket Causes: typically caused by a direct blow to the mouth; may occur in conjunction with a mandible fracture or a TMJ dislocation Signs & Symptoms: pain, bleeding, pain with breathing in, deformity, possible swelling Care: immediate referral
Anterior Shoulder Instability
Description: results from laxity of the anterior stabilizing structures of the GH joint such as the middle GH ligament and the anterior band of the inferior GH ligament Causes: acquired through repetitive overload (overuse injury) or the result of an acute episode of subluxation or dislocation Signs & Symptoms: possible flattened deltoid, possible atrophy of the rotator cuff, tenderness of the anterior GH joint, diffuse ache during ADL's, unstable sensation with abduction and external rotation Treatment: brief period of immobilization, gradual strengthening of anterior dynamic stabilizers, surgery to repair Bankart lesion and augment the GH ligaments may be necessary (associated with patient's return to desired activity level)
Posterior Shoulder Instability
Description: results from laxity of the posterior stabilizing structures of the GH joint Causes: acutely - most often occurs when the humerus is flexed and internally rotated while a longitudinal force is placed through the arm, repetitive forces that force the humeral head posteriorly, or repetitive forces that distract the posterior GH joint surfaces Signs & Symptoms: pain with maneuvers that require horizontal adduction and positions that load the posterior joint Treatments: conservative treatment is generally the first line of intervention for those with posterior instability, rehab emphasizes restoration strength and endurance of the infraspinatus muscle; surgical management is considered in the presence of a posterior labral tear
Tympanic Membrane Rupture
Description: rupture of the ear drum Causes: sudden change of air pressure caused by blunt trauma or by a decreased ability to regulate inner ear pressure secondary to infection or direct trauma (sticking a sharp object in the ear) Signs & Symptoms: visible reddish-brown cerumen, decreased hearing, pain, tinnitus Treatment: referral to a physician for further examination, pain medications and antibiotics may be prescribed
Mandibular Fracture
Description: second most common type of facial fracture Causes: result from a high-velocity impact to the jaw Signs & Symptoms: pain in the jaw that is increased by opening and closing the mouth, difficulty or discrepancies with jaw movement, crepitus may be felt during palpation typically result in malocclusion of the jaw and teeth Treatment: referral to a physician
Scaculolunate Disassociation
Description: significant ligamentous wrist injury; there is disruption of the scapholunate ligament with resultant instability; condition may also be known as "rotary subluxation of the scaphoid" Causes: commonly results from trauma Signs & Symptoms: pain localized over the dorsal scapholunate region; pain is increased with dorsiflexion Treatment: surgical repair or reconstruction of the scapholunate interosseous ligament is normally required to prevent long-term complications
Forearm Splints
Description: similar to shin splints in the lower leg, but occurs less commonly; microtrauma to muscular attachments of the bone, and more specifically, the periosteum of the bone Causes: repetitive use of the wrist, contracting the wrist extensor (or flexor) muscles Signs & Symptoms: dull pain in the forearm, pain is minor initially but increases as activity progresses, pain on the dorsal aspect of the hand and forearm, weakness in the wrist extensor muscles, pain with resisted wrist extension Treatment: avoid aggravating activities, ice and compression to help with swelling, stretching and strengthening of the involved musculature, and a gradual return to play
Myositis Ossificans
Description: small growth of bone within the muscle Causes: complication of not treating a contusion properly Signs & Symptoms: pain in the muscle particularly during exercise. The athlete will have a restricted range of movement in the leg and a hard lump may be felt deep in the muscle Treatment: conservative treatment or surgery to remove the bone growth
SC Dislocation
Description: sprain of the ligaments at the SC joint Causes: typically caused by an indirect mechanism such as falling on an outstretched hand Signs & Symptoms: pain during joint play movements, protraction and retraction of the scapula can reproduce pain, deformity, swelling, pain on palpation, ecchymosis Treatment: closed reduction with the patient sedated, immobilization in a figure 8 brace, strengthening of surrounding musculature, and a progressive return to play; *posterior
SC Sprain
Description: sprain of the ligaments at the SC joint Causes: typically caused by an indirect mechanism such as falling on an outstretched hand Signs & Symptoms: pain during joint play movements, protraction and retraction of the scapula can reproduce pain, deformity, swelling, pain on palpation, ecchymosis Treatment: closed reduction with the patient sedated, immobilization in a figure 8 brace, strengthening of surrounding musculature, and a progressive return to play; *posterior
Second Impact Syndrome
Description: sustaining a second concussion while the individual is still symptomatic from an earlier concussion Causes: another direct blow to the head or impact that causes a second concussion Signs & Symptoms: initial symptoms of a concussion but then they quickly collapse into a semicomatose state, impairment of the cranial nerves (especially of the eye) can be noted, and eventually disruption of the phrenic nerve leading to respiratory distress Treatment: intubation of the athlete and then induced hyperventilation
SLAP Lesion
Description: tears of the superior aspect of the glenoid labrum that extend anteriorly and posteriorly to the biceps insertion Causes: overuse (common with repetitive motions such as overhead throwing); tension of the LHBT during the follow through phase of pitching, compression and inferior traction mechanisms, LHBT contacting the rotator cuff while in the cocked phase, tendon torsion Signs & Symptoms: pain between the AC joint and the coracoid process during overhead arm movement that is relieved by rest, feeling of "dead arm", loss of control and decreased velocity when throwing Treatment: symptomatic tears require surgical intervention; contraction of the biceps tendon and other torsion forces should be controlled for 6 to 8 weeks following surgery
Bicep Brachii Rupture
Description: tendon and its aponeurosis degrades with time, ultimately resulting in a spontaneous rupture of the tendon, often occurring in the hypovascular zone between the proximal and distal blood supply; most involve the avulsion of the bicipital tuberosity; commonly occur in males older than 40 Causes: eccentric loading of the biceps brachii when the elbow is flexed to 90 degrees Signs & Symptoms: patient reports and immediate pain and the sensation of a "pop" within the elbow, loss of are strength during elbow flexion and forearm supination, swelling and ecchymosis around the cubital fossa, palpable defect of the tendon, ROM is WNL, strength during MMT is notably decreased with elbow flexion and supination Treatments: surgical repair following with rehabilitation consisting of progressive return of the elbow extension combined with passive elbow flexion with minimal immobilization; full ROM is expected in 8 weeks and strengthening exercises are then integrated
Little League Elbow
Description: tension buildup in young baseball pitchers results in an avulsion of the common tendon from its attachment site; fragmentation of the medial epicondyle are commonly detected Causes: excessive number of pitches thrown; overuse leads to the beginning of the condition Signs & Symptoms: similar to medial epicondalgia; swelling, pain/tenderness upon palpation of the medial epicondyle and the common flexor muscles, decreased ROM, reduced grip strength
Shoulder Dislocation
Description: the humeral head dislocates from its position within the labrum; can occur anterior, posterior, inferior, or superior; *anterior is most common Causes: FOOSH, direct blow to the shoulder, distraction force on the arm Signs & Symptoms: immediate pain, swelling, deformity, inability to move the arm, feeling like the GH joint is "locked-up; possible numbness and tingling and even decreased circulation if there is neurovascular involvement Treatment: joint needs to be reduced immediately; arm/shoulder should be immobilized and the patient should be referred immediately; closed reduction or an open reduction depending on severity and time following the injury, patient then progresses through a rehab
Thoracic Outlet Compression Syndrome
Description: thoracic outlet is comprised of the interscalene triangle, the costoclavicular space, and the subcoracoid space, which is covered by the pectoralis minor muscle; compression of these structure results in this condition Causes: pressure on the trunks and medial cord of the brachial plexus, the subclavian artery, or the subclavian vein (neurovascular bundle) Signs & Symptoms: dramatic vascular engorgement to mild, intermittent symptoms associated with sustained posture; may be neurological or vascular in nature; neurological symptoms generally occur along the distribution of the medial cord of the brachial plexus; vascular symptoms may include decreased blood flow, edema in the distal upper extremity and thrombophlebitis if left untreated Treatment: depends on the structure involved and the location of entrapment; arterial TOS may warrant surgical intervention; venous TOS may warrant thrombolytic therapy; neurological TOS is generally managed conservatively with initial interventions targeting atypical postures and reducing overhead movements and positions
TFCC
Description: trauma or repeated insult tot he TFCC and the UCL can result in permanent disability of the wrist if left unrecognized and untreated; athletes who compete in sports that place the upper extremity in a closed kinetic chain are at an increased risk of injury; positive ulnar variance is a predisposing condition Causes: repeated loading, such as during gymnastics maneuvers and weight lifting, may cause degeneration of the TFCC, especially in those with positive ulnar variance; may also be injured secondary to dorsally displaced fractures of the radius Signs & Symptoms: pain when bearing weight on the arms as with pushing up from a chair, pain over the TFCC during palpation Treatment: depends on the location of the tear and the underlying causes; small, acute tears may be treated conservatively with short-arm case or volar splints; if conservative management is unsuccessful or it the tear is in a vascular zone or is unstable, surgical management is indication; with positive ulnar variance the ulna may need to be shortened
Volar Plate Avulsion
Description: type of avulsion injury. The volar plate of the proximal interphalangeal (PIP) joint is vulnerable hyperextension injury as either an ligamentous or intra-articular fracture. Causes: commonly caused by a hyperextension injury Signs & Symptoms: pain, weakness, ecchymosis, swelling, deformity Treatment: finger splinting and possible surgical intervention
Splint with the DIP in flexion
Jersey Finger
Splint with the DIP in extension
Mallet Finger
Splint in the position found
Phalanx fracture
Splint in the position found
Unreduced Dislocation
Disc Extrusion
a disc extrusion occurs when the outer part of the spinal disc ruptures, allowing the inner, gelatinous part of the disc to squeeze out. Disc extrusions can occur with the ligaments in tact, or damaged
Disc Sequestration/nerve root impingement
a disc sequestration occurs when the center, gelatinous portion of the disc is not only squeezed out, but also separated from the main part of the disc
Disk Protrusion
commonly called a disc bulge, a disc protrusion occurs with the spinal disc and the associated ligaments remain in tact, but form an outpouching that can press against the nerves
Hypomobile Facet Joint
decrease in mobility at the involved facet joint