Prevention and Care of Injuries Exam 4
Eliminate offending activity, Discontinue stress inducing activity 14 days, Use crutch for walking, Weight bearing may return when pain subsides, After pain free for 2 weeks athlete can gradually return to activity, Biomechanics must be addressed
Treatment of fractures and stress fractures in the lower leg and ankle
walking (forward, backward, straight line, curve) and process to jogging (straight, curve, uphill, downhill), running (forward, backward), and then sprinting (Straight, curve, large figure eight, small figure eight, zig-zag, carioca)
What are examples of functional tests for the knee?
the femur and the patella, the femur and the fibula and the tibia and the fibula
What are the support structures of the knee, such as the articulations?
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What are the support structures of the knee, such as the muscles?
knee extension
What is the function of the Quad group? Hamstring group?
inversion and eversion
What movements that take place in the subtalar joint?
plantar-flexion and dorsiflexion
What movements that take place in the talocrural joint?
hamstrings, popliteus, gastrocnemius, and gracilis
What muscles help with tibial rotation?
treatment of shin contusions
a compressive wrap along with ice and elevation should be applied immediately to minimize swelling. occasionally a physician may decide to aspire the hematoma
medial tibial stress syndrome
a condition that involves increasing pain specifically at the distal two-thirds of the posterior medial aspect of the tibia
Myositis ossificans
a severe blow or repeated blows to the thigh, usually the quadriceps muscle, can cause ectopic bone formation within the muscle.
Chrondramalacia
a softening and deterioration of the articular cartilage on the posterior surface of the patella. the exact cause of this is unknown but it is often related to either abnormal movement of the patella within the femoral groove or to overuse
signs of achilles tendon rupture
athletes may feel or hear a pop and feel as if they have been kicked in the back of the leg. Plantarflexing the ankle will be painful and limited but still possible with the assistance of the tibialis posterior and the peroneals. A palpable defect will be noted along the length of the tendon. The athlete will require the use of crutches to continue ambulation without an obvious limp
signs of tendonitis
athletes who develop this are likely to complain of pain with both active movement and passive stretching; swelling around the area of the tendon caused by inflammation of the tendon; crepitus on movement; and stiffness and pain following periods of inactivity but particularly in the morning
lateral collateral ligamant (LCL)
attached to the lateral condyle of the femur and to the head of the fibula. Resists varus forces that are applied to the medial surface of the knee. Tightest during knee extension but relaxed during flexion
medial collateral ligament (MCL)
attaches above the joint line on the medial condyle of the femur and inserts well below the joint line on the tibia. Its major purpose is to protect the knee form valgus forces that are applied to the lateral surface of the joint and to resist external tibial rotation.
treatment of achilles tendonitis
generally takes a long time to resolve; it is important to create a proper healing environment by limiting or restricting the activity that caused the inflammation. Aggressive stretching of the achilles tendon complex, inserting a heel lift under the calcaneus, using taping techniques to provide support to the achilles tendon, and using anti-inflammatory medication have all been recommended as treatments
hip pointer
iliac crest contusion occurs most often in contact sports; results from a blow to the inadequately protected iliac crest; one of the most handicapping injuries in sports. a direct impact to the unprotected iliac crest causes a severe pinching action to the soft tissue of that region
treatment of thigh contusions
immediate action includes compression by elastic bandage with the knee flexed to minimize the loss in range of motion for the first 12 hours. this places the quad in a stretch position and also helps to compress the injured area. PRICE
tendonitis
inflammation of the tendons surrounding the ankle joint is a common problems in athletes. may result from one specific cause or from a collection of mechanisms including faulty foot mechanics, inappropriate or poor footwear that can create fault foot mechanics, acute trauma to the tendon, tightness in the heel cord complex, or training errors
Achilles tendonitis
inflammatory condition that occurs because of repetitive stresses and strains placed on the achilles tendon such as running or jumping activities
Jumper's knee
jumping, kicking, or running may place extreme tension on the knee extensor muscle complex. as a result of either a single acute injury, or, more commonly, repetitive injuries, patellar tendinits occurs in the patellar or quadriceps tendon
eversion ankle sprain
less common largely because of the bony and ligamentous anatomy. These may involve an avulsion fracture of the tibia before the deltoid ligament tears. These sprains may take longer to heal.
hip sprain
may occur as a result of a violent twist, either produced through an impact force delivered by another participant or by forceful contact with another object or sustained in a situation in which the foot is firmly planted and the trunk is forced in an opposing direction
inversion ankle sprain
most common and often results in injury to the lateral ligaments.
lachman's test
most commonly used test for checking the integrity of the ACL. The test is administered by positioning the knee in approximately 30 degrees of flexion with the athlete lying on their back. One hand of the examiner stabilizes the leg by grasping the distal end of the thigh, and the other hand grasps the proximal aspect of the tibia, attempting to move it anteriorly.
PCL sprain
most likely to be injured when the knee is hyperflexed from falling with full weight on the anterior aspect of the bent knee with the foot in plantar flexion
acute femoral fracture
occur most often in the shaft rather than at the bone ends and are almost always caused by a great force, such as falling from a height or being hit directly by another participant. a fracture in the shaft most often takes place in the middle third of the bone because of the anatomical curve at this point and because the majority of direct blows are sustained in this area.
acute compartment syndrome
occurs secondary to direct trauma to the area, such as being kicked in the anterior aspect of the lower leg; considered to be a medical emergency because of the possibility of compression of arterial and nerve supply, which could result in additional injury to structures distal to the compartment
acute exertional compartment syndrome
occurs without any precipitating trauma and can evolve with minimal to moderate activity.
anterior cruciate ligament (ACL)
prevents the femur from moving posteriorly during weight bearing. It also stabilizes the tibia against excessive internal rotation and serves as a secondary stabilizer when there is injury to the collateral ligaments.
posterior cruciate ligament (PCL)
prevents the femur from sliding forward during weight bearing
quad group
rectus femoris, and the vastus medialis, intermedialis, and lateralis
Shape, characteristics, and functions of the menisci
shaped like bowls, thicker on the outside border and thinner on the inside; they lie on top of the flat tibial plateau and function to make the rounded femoral condyles fit better on the flat tibial plateau, thus increasing stability of the joint
high ankle sprain
the anterior and posterior tibiofibular ligament and the distal portion of the interosseous membrane holding the tibia and fibular together are torn with forced hyperdorsiflexion and external rotation of the foot as when twisting on a planted foot. sprains of these ligaments are extremely hard to treat and often take months to heal
signs of achilles tendonitis
the athlete often complains of generalized pain and stiffness about the achilles tendon just proximal to the calcaneal insertion; often begins with a gradual onset over time; symptoms may progress to morning stiffness and discomfort with walking after periods of prolonged sitting. tendon may be warm and painful to palpation, and if the inflammation persists, the tendon may thicken
piriformis syndrome
the sciatic nerve, which is dislocated either under the piriformis muscle or actually piercing the piriformis muscle itself, is compressed or irritated by tightness or spasm of this muscle. This can often mimic another condition called sciatica, and is often misdiagnosed
avulsion fractures
the tearing away of a body part from its point of attachment. occurs when a tendon that attaches a muscle to a bone pulls part of the bone away after sudden, forceful contraction of that muscle.
the superficial portion and the deep portion
there are two parts to the MCL: what are they?
MCL and LCL
these ligaments function to stabilize the knee against the side to side (valgus/varus) forces at the knee joint
valgus stress test
these tests are intended to reveal laxity of the medial and lateral collateral ligaments. The athlete lies supine with the leg extended. To test the medial collateal ligament, _______ is applied with the knee fully extended and at 30 degrees of flexion.
Osgood-Schlatter
this disease is a condition common to the rapidly growing immature adolescent's knee. the most commonly accepted cause is the repeated pull of the patellar tendon at the tibial tubercle on the front of the tibia.
achilles tendon rupture
this injury may range from a grade 1 strain of the muscle to complete rupture of the tendon. A tight achilles tendon is prone to strain, particularly of the gastrocnemius muscle. This injury is usually caused by a sudden, forceful plantarflexion of the ankle. more common in athletes older than 30
hip dislocation
this rarely occurs in sports; caused by traumatic force along the long axis of the femur or by the athlete falling on his or her side.
varus stress test
to test the lateral collateral ligament, the examiner holds the ankle firmly with one hand while placing the other over the medial joint line. The examiner then places a ________ force laterally in an attempt to open the lateral side of the knee
apley's compression test
used to direct a meniscus tear. it is performed with the athlete lying face down and the affected leg flexed to 90 degrees. While stabilizing the thing, a hard downward pressure is applied to the leg. The leg is then rotated back and forth. If pain results, a meniscal injury may have occurred
acute fracture of the pelvis
usually occurs as the result of a direct trauma; athlete responds to this injury with severe pain, loss of function, and shock
knee flexion
what is the function of the Hamstring group?
effective physical conditioning, rehabilitation, and skill development, as well as shoe type
what ways can you prevent knee injuries?
sublaxtions and dislocations
when an athlete plants the foot, decelerates, and simultaneously cuts in an opposite direction from the weight-bearing foot, the thigh rotates internally while the lower leg rotates externally, causing a medially directed valgus force at the knee
tendon, sheath or paratenon
Tendonitis commonly affects what soft tissue?
femur, acetabulum
The thigh is composed of what structures?
acute compartment syndrome acute exertional compartment syndrome chronic compartment syndrome
What are the different types of syndromes?
contusions and sprains
What are the most common sports injury to the thigh
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What are the support structures of the knee, such as the joint capsule?
chronic compartment syndrome
activity related in that the symptoms arise rather consistently at a certain point in the activity. Usually occurs during running and jumping activities, and symptoms cease when activity stops
stress fracture of the femur
females who are amenorrheic are particularly vulnerable to these as are those with female athlete triad.
LCL sprain
most often occurs either as a result of a laterally directed varus force from the medial side or from internal rotation of the tibia.
MCL sprain
most often occurs either as a result of a medially directed valgus force from the lateral side or from external rotation of the tibia
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How do sprains differ by symptoms and on exam?
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Prevention theories of injury reduction to the hip, thigh, groin area
shin splints
another name for medial tibial stress syndrome
ACL sprain
common in sports; occurs more in females than in males; most likely to occur with deceleration, rotation, and valgus stress to the knee.
hamstring group
biceps femoris, semitendinosus, and semimembranosus
stress fracture of the pelvis
can be produced by repetitive abnormal overuse forces. tend to occur during intensive training or competitive racing
limit swelling, PRICE
early treatment of an ankle or lower leg injury?
direct fracture
involves little bone separation
treatment of tendonitis
techniques that reduce or eliminate inflammation, including rest, therapeutic modalities, and anti inflammatory medications, or tapping the foot may also be helpful in reducing stress
coccyx, sacrum, femur, pelvic bone (ilium, ischium, pubis)
Bones that make up the pelvic girdle?
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Functions of the hip, structure of the hip, thigh, groin - What muscles make the movement happen. Hip flexion, hip extension, abduction, adduction, internal and external rotation
Anterior compartment: Dorsiflexion Lateral compartment: Eversion Superficial Posterior compartment: plantar-flexion Deep Posterior compartment: inversion
The lower leg is divided into 4 compartments: What are they? List each movement the compartment is responsible for.
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Treatment and limitations of specific injuries listed in the presentation
reducing lower leg injuries
achilles tendon stretching, strengthening key muscles, improving neuromuscular control, choosing proper footwear, and proper taping and bracing
treatment of achilles tendon rupture
after this injury, the question of surgical repair versus cast immobilization arises. Surgical repair of the tendon is recommended to allow the athlete to return to previous levels of activity. surgical repair of the achilles tendon may require a period of immobilization for 6 to 8 weeks to allow for proper tendon healing.
shin contusion
because of the absence of muscular or adipose padding, force is not dissipated and the periosteum receives the impact delivered to the shin. These occur frequently in soccer
fracture of the patella
can be caused by either direct or indirect trauma; most of these are the result of indirect trauma in which a severe pull of the patellar tendon occurs against the femur when the knee is semiflexed.
signs of a fracture of the patella
causes hemorrhage, resulting in generalized swelling.
indirect fracture
causes tearing of the joint capsule, separation of the bone fragments, and possible tearing of the quad tendon.
compartment syndrome
conditions in which increased pressure within one of the four compartments of the lower leg causes compression of muscular and neurovascular structures within that compartment
groin strain
overextension of the groin musculature may result in this. Running, jumping, and twisting with external rotation can produce such injuries. this are very likely to occur in the early part of the season
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Mechanisms of injury for specific muscles and/or joints
Anterior tibiofibular ligament posterior tibiofibular ligaments Deltoid ligament Lateral collateral ligament Calcneofibular ligament
Name the ligaments of the ankle.
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Injuries to the surrounding structures of the knee, different pathology than just the ligaments