Injury Prevention Exam 3 Ch 15 , 16

Front 1

What are 3 types of ankle sprains?

Back 1

Inversion Sprain

Eversion Sprain

High Ankle Sprain

Front 2

Treatment for Achilles tendinitis

Back 2

•Anti-inflammatory medications •Agressive stretching

•Reducing tendon stretch by structural faults

(Orthotics, Mechanics, Flexibility).

Front 3

Causes of Medial Tibial Stress Syndrome

(Shin Splints)

Back 3

•Stress Fracture

•Muscle Strains

•Repetitive Microtrauma

•Weak Muscles

•Improper Footwear

Front 4

Causes of Medial Tibial Stress Syndrome

(Shin Splints)

Back 4

•Training Errors

• Varus Foot

•Tight Heel Cord

•Pronated Feet

•Forefoot Supination

Front 5

Achilles Tendon stretching (Preventing Injury)

Back 5

A tight heel cord may limit dorsiflexion and may predispose athlete to ankle injury

Should routinely stretch before and after practice

Stretching should be performed with knee extended and flexed 15-30 degrees

Front 6

Strength Training

(Preventing Injury)

Back 6

Static and dynamic joint stability is important in prevention injury

Develop a balance in strength throughout the range

Front 7

Neuromuscular Control Training

(Preventing Injury)

Back 7

Can be enhanced by training in controlled activities on uneven surfaces or a balance board

Front 8

Footwear (Preventing Injury)

Back 8

Can be an important factor in reducing injury

Shoes should not be used in activities they were not made for

Front 9

Preventive Taping and Orthoses

Back 9

Tape can provide some prophylactic protection

However, improperly applied tape can disrupt normal biomechanical function and cause injury

Lace-Up braces have even been found to be effective in controlling ankle motion

Front 10

History

Back 10

Past HistoryMechanism of injuryWhen does it hurt?Type of, quality of, duration of pain?Sounds or feelings?How long were you disabled?Swelling?Previous Treatments?

Front 11

Observations

Back 11

Postural deviations? Genu Valgum (Knock Kneed) or Genu Varum (Bow Legged)? Is there difficulty with walking? Deformities, asymmetries or swelling?

Front 12

Observations

Back 12

Color and texture of skin, heat, redness? Patient in obvious pain? Is a range of motion normal?

Front 13

Palpation

Back 13

Begin with bony landmarks and progress to soft tissue Attempt to locate areas of deformity, swelling and localized tenderness

Front 14

Percussion/bump and Compression tests (Special Test - Lower Leg)

Back 14

Used when fracture is suspected

Percussion test is a blow to the tibia, fibula or heel to create vibratory force that resonates w/in fracture causing pain

Compression test involves compression of the tibia and fibula either above or below site of concern

Front 15

Anterior drawer test(Ankle Stability Tests)

Back 15

Used to determine damage to anterior talofibular ligament primarily and other lateral ligament secondarily A positive test occurs when foot slides forward and/ or makes a clunking sound as it reaches the end point

Front 16

Talar tilt test or Inversion/Eversion Stress Test

Back 16

A test performed to determine extent of inversion or eversion injuries With foot at 90 degrees calcaneus is inverted and excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligaments If the calcaneus is everted, the deltoid ligament is tested

Front 17

Functional Tests(While weight Bearing)

Back 17

Walk on toes (Plantar Flexion)Walk on heels (Dorsiflexion)Hops on both anklesHops on injured ankle alone

Front 18

Functional Tests(While weight Bearing)

Back 18

Start and stop joggingStart and stop runningChange direction rapidlyRun figure eightsSport specific tests

Front 19

Ankle Injuries: Sprains

Back 19

Single most common injury in athletics caused by sudden inversion or eversion moments

Front 20

Inversion Sprains

Back 20

Most common and result in injury to the lateral ligaments Anterior talofibular ligament is injured with inversion, plantar flexion and internal rotation Occasionally the force is great enough for an avulsion fracture to occur w/ the lateral malleolus

Front 21

Inversion Sprains

Back 21

The foot is forcefully inverted or occurs when the foot comes into contact w/ uneven surfaces

Front 22

Eversion Ankle Sprains -Etiolog(5-10% of all Sprains)

Back 22

Bony protection and ligament strength decreases likelihood of injury

Eversion force resulting in damage to deltoid and possibly fx of the fibula

Deltoid can also be impinged and contused with inversion sprains

Front 23

Syndesmotic Sprain -Etiology

Back 23

(High Ankle Sprain)

Injury to the distal tibiofemoral joint (anterior/posterior tibiofibular ligament) Torn w/increased external rotation or dorsiflexion

Injured in conjunction w/ medial and lateral ligaments

May require extensive period of time in order to return to play

Front 24

Grade 1 Ankle Sprains

Back 24

•Mild pain and disability; weight bearing is minimally impaired; point tenderness over ligaments and no laxity.

Front 25

Grade 2 Ankle Sprain

Back 25

•Feel or hear pop or snap; moderate pain w/difficulty bearing weight; tenderness and edema

•Positive talar tilt and anterior drawer tests

•Possible tearing of the anterior talofibular and calcaneofibular ligaments

Front 26

Grade 3 Ankle Sprains

Back 26

•Severe pain, swelling, hemarthrosis, discoloration

•Unable to bear weight

•Positive talar tilt and anterior drawer

•Instability due to complete ligamentous rupture

Front 27

Ankle Fracture/Dislocations

Back 27

•Cause of Injury:

Number of mechanisms-often similar to those seen in ankle sprains

•Signs of Injury:

Swelling and pain may be extreme with possible deformity

Front 28

Ankle Fracture/Dislocations (Treatment)

Back 28

•Splint and refer to physician for

X-ray and examination

•RICE to control hemmorrhaging and swelling

•Once swelling is reduced, a walking cast brace may be applied, w/ immobilization lasting 6-8 weeks

•Rehabilitation is similar to that of ankle sprains once range of motion is normal

Front 29

Tibial and Fibular Fracture

Back 29

Causes:

•Result of direct blow or indirect trauma

•Fibular fractures seen with Tibial fractures or as the result of direct Trauma

Front 30

Tibial and Fibular Fractures

Back 30

S/S

•Pain,swelling, soft tissue insult

•Leg will appear hard and swollen

(Volkman's contracture)

•Deformity -May be open or closed

Front 31

Tibial and Fibular Fractures (Treatment)

Back 31

Care:

•Immediate treatment should include splinting to immobilize and ice, followed by medical referral

•Restricted weight bearing for weeks/months depending on severity

Front 32

Stress Fracture of Tibia or Fibula

Back 32

Cause:

•Common overuse condition, particularly in those with structural and biomechanical insufficiencies

•Result of repetitive loading during training and conditioning

Front 33

Stress Fracture of Tibia or Fibula

Back 33

S/S:

•Pain with activity

•Pain more intense after exercise than before

•Point tenderness, difficult to discern bone and soft tissue pain

•Bone scan results

(stress fracture vs. periostitis)

Front 34

Stress Fracture of Tibia or Fibula

(Treatment)

Back 34

•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 wks athlete can gradually return to activity

•Biomechanics must be addressed

Front 35

Acute Patellar Subluxation or Dislocation

Back 35

Cause:

•Deceleration w/ simultaneous cutting in opposite direction (Valgus force at knee)

•Quad pulls the patella out of alignment

•Some athletes may be predisposed to injury

Front 36

Acute Patella Subluxation or Dislocation

Back 36

Cause:

•Repetitive subluxation will impose stress to medial restraints

•More commonly seen in female athletes

Front 37

Acute Patella Subluxation or Dislocation

Back 37

S/S:

•W/ subluxation, pain and swelling, restricted ROM, palpable tenderness over adductor tubercle

•Dislocations result in total loss of function

•First time dislocation = assume fx

Front 38

Acute Patella Subluxation or Dislocation

Back 38

Care:

•Immobilize and refer to physician for reduction

•Ice around the joint

•Following reduction, immobilization for at least 4 weeks w/ use of crutches

Front 39

Acute Patella Subluxation or Dislocation

Back 39

Care:

•After immobilization period, horseshoe pad w/ elastic wrap should be used to support patella

•Muscle rehab focusing on muscle around the knee, thigh and hip are key (straight leg raises are optimal for the knee)

Front 40

Osgood-Schlatter Disease and Larsen-Johansson Disease

Back 40

Cause:

•An apophysitis occurring at the tibial tubercle

-Result of repeated pulling by

tendon

-Begins cartilagenous and develops a bony callus, enlarging the tubercle

•Resolves w/ ageing

Front 41

Osgood-Schlatter Disease and Larsen-Johansson Disease

Back 41

S/S:

•Both elicit swelling, hemmorrhaging and gradual degeneration of the apophysis due to impaired circulation

•Pain with activity and tenderness over anterior proximal tibial tubercle

Front 42

Osgood-Schlatter Disease and Larsen-Johansson Disease

Back 42

Care:

Conservative:

•Reduce stressful activity until union occurs (6-12 months)

•Padding may be necessary for protection

•Possible casting, ice before and after activity

•Isometerics

Front 43

Functional and Prophylactic Knee Braces

Back 43

•Used to prevent and reduce severity of knee injuries

•Provide degree of support to unstable knee

•Can be custom molded and designed to control rotational forces and tibial translation

Front 44

Shin Splints

Back 44

Medial Tibial Stress Syndrome

Front 45

Patellar Tendonitis

Back 45

Jumpers or Kickers Knee

Front 46

Shin Contusion

Back 46

Cause:

•Direct blow to lower leg (impacting periosteum anteriorly)

Front 47

Iliotibial Band Friction Syndrome

Back 47

Runner's Knee