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?