Term
|
Definition
| Lacerations, bumps, bruises |
|
|
Term
| Intra-Cranial Tissues (Meninges) |
|
Definition
Dura Mater- Outermost, thick, fibrous and highly vascular
Arachnoid Mater: middle layer, less dense and avascular
Pia Mater: Innermost layer; thin, delicate,highly vascular
Sub-arachnoid space – CSF (CSF cushions the CNS from external forces) |
|
|
Term
|
Definition
| Dura Mater- Outermost, thick, fibrous and highly vascular |
|
|
Term
|
Definition
| Arachnoid Mater: middle layer, less dense and avascular |
|
|
Term
|
Definition
| Pia Mater: Innermost layer; thin, delicate,highly vascular |
|
|
Term
|
Definition
| Sub-arachnoid space – CSF (CSF cushions the CNS from external forces) |
|
|
Term
|
Definition
At the base of the brain
-Auto-regulatory functions(primitive brain)
-Reticular activating system
-regulates wakefulness
Controls primitive functions: Hunger, breathing, heart |
|
|
Term
| Cerebrum (Cerebral cortex) |
|
Definition
-Higher Centers of control
-Memory, emotions and reasoning (esp short term memory) |
|
|
Term
| Cerebellum (little brain) |
|
Definition
-Organizational Skills
-Movement, thought process and speech |
|
|
Term
Concussion: Clinical Definition
Statistic on high school athletes |
|
Definition
“clinical syndrome characterized by
immediate and transient impairment of
neurologic function secondary to
mechanical forces”
1 in 5(20%) high school athletes have sustained a concussion annually
You see immediate impairment: dizzy, blurred vision, can't remember things
But its transient, meaning it goes away |
|
|
Term
| Concussion Mechanisms of Injury |
|
Definition
-Contact (blunt force) and non-contact (whiplash)
-Acceleration/deceleration of brain
forceful impact against the skull; these are compressive forces
-Twisting (rotational forces) of brain stem
axial and angular; shearing and tensile forces
-Contre-coup
symptoms arise on side opposite the blow
-Threshold force on brain to cause concussion?
70Gs in brain w/o previous concussion
threshold drops with each subsequent concussion
repeated impacts (as opposed to one single impact) |
|
|
Term
| What Mechanism causes most concussions |
|
Definition
| Rotational and specifically angular rotation causes most concussions |
|
|
Term
| Concussion Mechanism: Angular |
|
Definition
-Angular rotational force
-Stress is applied to the midbrain region
-Impairment of axonal pathways between brain stem and higher centers (cortex) |
|
|
Term
T/F?
A concussion can be diagnosed with an MRI |
|
Definition
False
You cannot see a concussion on an MRI |
|
|
Term
| Pathophysiology of a Concussion |
|
Definition
Mechanical damage to axons (microscopic damage to axons)
-Impaired signaling between brain
centers
-Decrease cerebral brain function--
ischemia and hypoxia
-Secondary neuronal damage
-Normal metabolic and cognitive
function returns in 7-10days post-
injury |
|
|
Term
|
Definition
This is when you can determine the impact/severity of the concusison
-Residual or persistant signs and symptoms days, weeks,
sometimes months after concussion from unresolved brain
tissue damage
More likely to suffer repeat concussion if
previous injury is not fully healed!
-b/c of unresolved tissue damage
Need to wait until a person is a-symptomatic for a week before they can RTP |
|
|
Term
| How long must a person with a concussion be a-symptomatic before they can RTP |
|
Definition
May return to play after one week of being asymptomatic
If you have three concussions in a season, your season is done |
|
|
Term
| How do you prevent and Care for a concussion? |
|
Definition
Prevention:
-Equipment
-helmet, mouthpiece
or guard
-Tackling techniques
-no spearing
-Termination from sport
participation
-Recurrence
Care:
-Assess/Recognize
-Monitor condition
-Protect athlete
-Referral |
|
|
Term
| What are the three domains of concussion assessment |
|
Definition
1. Cognitive
-Concentration, focus and attention, Memory and recall deficits
2. Affective (behavioral)
-Emotional responses, anger and depression, lethargy,sleeping problems, irritability
3. Somatic (physical)
-Headache, nausea, sensitivity to light/noise, visual
impairments
-Psychomotor skills, balance deficits
-Exertional- symptom stress test (provokes symptoms) |
|
|
Term
| Primary signs of Concussion |
|
Definition
1. Loss of Consciousness
2. Post-Traumatic Amnesia
Retrograde(before injury)
Anterograde(can't form new memory)
3. Altered Mental Status
-Confusion
-Disorientation |
|
|
Term
| Secondary signs of concussion |
|
Definition
-Headache(persistent)
-Emotional outbursts
-laughter, crying
-Dizziness/unsteadiness
-Blurred or double vision
-pupillary response
-Sensitivity to light(photophobia)
and sound
-Psychomotor disturbances
-Abnormal vital signs
-Tinnitus
-Nausea
-Shock |
|
|
Term
| How do Cantu guidelines differ from other diagnostic criteria? |
|
Definition
Cantu guidelines are used in diagnosing concussions
In others loss of consciousness was the big symptom to look for, in Cantu they look for amnesia |
|
|
Term
| Assessment of Concussion (Primary and Secondary Survey) |
|
Definition
Primary survey (on-field or court)
-CNS involvment (look for 3 primary signs)
-Vital Signs
Secondary survey (sideline or courtside)
-HOPS
-Re-assess in training room
-Follow up daily
(typically jump right to secondary survey) |
|
|
Term
|
Definition
Level of consciousness
-Altered mental state; confusion
Cognitive function – check for amnesia, attentiveness, concentration
-memory recall tests
Psychomotor tests (subjective and instrumented)
-Balanace and Hand-eye coordination
Somatic symptoms
-Sensitivity to light and sound
Exertional tests
-reproduce sypmtoms
Visual/pupillary response tests – PERRLA
Sensitivity to light and sound |
|
|
Term
| What are the two psychomotor tests for concussion assessment |
|
Definition
Finger-to-nose test
Romberg's Test
Romberg's sign swaying of the body or falling when the eyes are closed while standing with the feet close together |
|
|
Term
| Treatment of a concussion |
|
Definition
Monitor for deterioration of symptoms
-headache, LOC, dizziness, amnesia
Tylenol for headache (not NSAIDS)
RTP guidelines
-Cognitive rest
-avoid over-stimulating brain for 24-48 hours |
|
|
Term
|
Definition
Track PCSS until asymptomatic
Need cognitive rest
Allow additional period of time (e.g. 1
week) for healing of damaged neural
tissue
Use of return-to-play (RTP) guidelines |
|
|
Term
|
Definition
Loss of auto-regulatory function of CNS
Catastrophic form of concussion
Repeat concussion before resolution of symptoms or recovery from initial concussion
-Very rare occurence
-Vasodilation of arterioles with rapid increase
in CBF
-Rapid increase ICP causes brain tissue
(temporal lobes) to herniate through base of
skull(foramen magnum) with corressponding
failure in brainstem function
-respiratory arrest |
|
|
Term
| Mortality/morbidity of Second impact syndrome |
|
Definition
50% mortality rate, 100% morbidity (permanent damage with issues down the line)
IT IS COMPLETELY PREVENTABLE |
|
|
Term
| Signs and symptoms of second impact syndrome |
|
Definition
Collapse w/in sec/min
Semi- to unconscious
-RAS
Rapid pupillary dilation,loss of eye movement
Respiratory failure |
|
|
Term
| Long term complications of concussions |
|
Definition
Cumulative effects
-Higher risk for repeat concussions (lowered
threshold); after 1 (2x), after 3 (3x)
-Irreversible brain damage (degeneration)
Repeat concussions
-every concussion lowers threshold
Degeneration of brain tissue (Chronic traumatic encephalopathy (CTE))
“Dementia Pugilistica”
-irreversible brain damage
-early onset alzheimers
-clinical depression |
|
|
Term
| Chronic traumatic encephalopathy (CTE) |
|
Definition
Degeneration of brain tissue
A long term complication of concussion |
|
|
Term
| Acute Subdural Hematoma(ASDH) |
|
Definition
Forceful blows to the head cause damage to
bridging veins and capillaries
effusion (oozing) of blood between the dura and the arachnoid mater
-Increass intracranial pressure(ICP) and produces symptoms (gradual onset)
-lucid interval
-Progressive headache, deterioration of mental status and psychomotor function
YOU CAN SEE ASDH ON NEURAL IMAGING TESTS!!!! Unlike concussions, an MRI will show you a subdural hematoma. Concussions are microtraumatic to axons, subdural hematoma is macrotraumatic |
|
|
Term
|
Definition
Epidermal hematoma(EDH) - rapid hemorrhage
-Artery/arterioles (middle meningeal artery)
-Secondary to fractured skull
Between the skull and the dura
More lethal than acute subdural hematoma |
|
|
Term
| Intracranial Lesions: Lucid Interval |
|
Definition
temporary improvement in patient's condition after concussion, after which the condition deteriorates
-Time period b/t concussive episode and on-set of symptoms of SDH(sub-dural hematoma)
Lucid interval usually indicates bleeding within the brain |
|
|
Term
| Which can be seen on neural imaging tests? Concussions or Acute Subdural Hematoma |
|
Definition
| YOU CAN SEE ASDH ON NEURAL IMAGING TESTS!!!! Unlike concussions, an MRI will show you a subdural hematoma. Concussions are microtraumatic to axons, subdural hematoma is macrotraumatic |
|
|
Term
|
Definition
Ecchymosis at base of skull (mastoid process)
-discoloration behind ear
Indicates intracranial bleeding |
|
|
Term
| What are the different Cranio-facial Fractures? |
|
Definition
Fractures of the
face/base of skull
Cribiform plate
Eye orbit
Nasal
Zygomatic arch
(cheek)
Maxilla (LeFort)
Mandible
Lots of injuries to this area because they're small, fragile and stick out.
These injuries are dangerous because they're very close to the brain |
|
|
Term
| Nasal Trauma/Fracture injuries |
|
Definition
-Trauma nasal and septal caritlage
-Epistaxis(nosebleed)
-Deformity-deviated septum
-Breathing problems
-Impaired sense of smell
Bones will heal but cartilage does not |
|
|
Term
| What is the most commonly fractured facial bone? (and third most common fracture in body behind collarbone and wrist) |
|
Definition
| Nose is most frequently fractured facial bone and third most common bone fracture (behind collarbone and wrist) |
|
|
Term
|
Definition
Wafer thin sheet of perforated bone(ethmoid) through which the olfactory nerves pass on their journey from the nasal mucosa to the olfactory bulbs
CSF leakeage = Rhinorrhea
-Disrupt lining of brain(meninges)
-Sinusitis, meningitis
-Sense of smell
CSF leaks out of nose; Halo test: testing if CSF is in blood, blood absorbs into gauze but CSF forms halo around it |
|
|
Term
|
Definition
| CSF leakage out of the nose |
|
|
Term
| Orbital “Blow out” Fracture |
|
Definition
Blunt force causing increased pressure in socket or bottom rim
-Fx of infra-orbital plate
-Contents drop into maxillary sinus
-X-ray/CT examination
-Loss of eye movement or fixed gaze-ocular muscle entrapment
-Periorbital ecchymosis(black eye) |
|
|
Term
| Fixed Stare is indicative of what? |
|
Definition
|
|
Term
| Where do contents of eye drop after orbital blowout fracture |
|
Definition
|
|
Term
| 2nd most common facial fracture |
|
Definition
Zygomatic Arch "Tripod"
MOI(mechanism of injury): direct blow
Prominent bone arch, forms part of eye socket (made up of maxilla, arch and lateral orbital rim) |
|
|
Term
| Face Fractures: Le Fort I, II, III |
|
Definition
I: Horizontal (least severe)
-across maxilla
II: Pyramidal
-maxilla, orbital rim and nasal bridge
III: Transverse (most severe)
-Zygomatic arch, eye socket, nasal bridge
-May involve other facial bones |
|
|
Term
| Mandibular Fracture (types and prevelance) |
|
Definition
Body (30-40%)
Angle (25-31%)
Body fractures are more common |
|
|
Term
Which sport causes most eye injuries?
Sports are responsible for what % of eye injuries |
|
Definition
Basketball has most eye injuries compared to other sports
-Sports are responsible for 42% of all eye injuries |
|
|
Term
| What are the different types of eye injuries? |
|
Definition
Extra-occular (most injuries are extra-occular)
- Peri-orbital ecchymosis(contusion) “black eye”
- Edema into tissue spaces
Intra-occular
-subconjuctival hemorrhage
-Corneal abrasion
-Hyphema
(in order of severity) |
|
|
Term
|
Definition
Peri-orbital ecchymosis
"Black eye" |
|
|
Term
| Subconjunctival Hemorrhage |
|
Definition
Intra-occular eye injury
Hemorrhage of small vessels b/t conjunctiva and sclera
-Red eye
-Rule out more serious eye injury |
|
|
Term
|
Definition
Intra-occular eye injury
Foreign body, friction or rubbing on cornea
Irritation of epithelium
fluorescein dye luminescense
typically you'll get eye drops or an eye patch |
|
|
Term
|
Definition
Very Serious intra-occular eye injury
Damage to iris
Hemorrhage into anterior chamber (lower portion)
Accumulation of blood
-increases intra-ocular pressure
-Loss of visual field
-Diplopia(double vsion)
-Physician referral is warranted!!
-Secondary bleeding!!!!
-Bed rest
-Permanent visual loss
-corneal staining
Main worry is secondary bleeding, if it continues then it can stain the cornea and cause loss of vision |
|
|
Term
|
Definition
|
|
Term
|
Definition
Cauliflower Ear
-Separates cartilage from perichondrium
-Cartilage dies(necrotic) and folds over
(scars) into clumps (hence cauliflower)
-Ossification of cartilage can result
-Acute- ice, aspirate and compression splint
-Associated with hearing loss |
|
|
Term
|
Definition
1. Fractured (chipped)
2. Avulsion (knocked out)
3. Displaced (subluxed)
Caused by direct blows to mouth |
|
|
Term
|
Definition
Broken Crown/neck
-Save broken portion
-Stabilize portion in mouth
-Pulp exposed?
-Immediately transport to dental
facility |
|
|
Term
|
Definition
Entire tooth knocked out (rupture of periodontal ligament and blood vessels/nerves)
If possible re-implant tooth
If unable to re-implant:
-Save broken portion
-Stabilize portion in mouth
-Pulp exposed?
-Immediately transport to dental
facility |
|
|
Term
|
Definition
Tooth in socket wrong position
Extruded or laterally displaced
Re-position tooth
Stabilize
Intruded (worst case scenario)
Do nothing - transport |
|
|
Term
|
Definition
Atlas
Articulates with occipital bone |
|
|
Term
|
Definition
|
|
Term
| Which ligaments provide cervical stability |
|
Definition
1.Posterior longitudinal ligament
2.Ligamentum Flavum
3. Interspinal and supraspinal
4. Intervertebral discs |
|
|
Term
| Since _____, less than ____ players/year suffer permanent spinal cord injuries. This is because |
|
Definition
Since 1977, less than 10 players a year suffer from permanent spinal cord injuries
1976 NCAA barred spearing |
|
|
Term
| Predisposing risk factors to cervical spine injuries |
|
Definition
-Cervical or spinal stenosis (narrowing of spinal canal
-Weak musculature
-Long, thin neck
-Previous neck injury
-Poor tackling technique
-Biggest preventable risk factor |
|
|
Term
| Cervical or spinal stenosis |
|
Definition
(narrowing of
spinal canal |
|
|
Term
| Cervical spine injuries: MOI |
|
Definition
Hyperflexion, hyperextension, rotation,
lateral flexion, and axial loading
Axial loading is most common mechanism for catastrophic injury |
|
|
Term
| Prevention of cervical spine injuries |
|
Definition
1. Proper coaching techniques concerning butt-blocking and
tackling (spearing)
2. Strength and conditioning programs aimed at the cervical
spine
3. Proper protection during contact
-Helmet, shoulder pads, collar, matting |
|
|
Term
|
Definition
-Rigid must be used in suspected C-spine injuries
Rigid = possible Cervical spine injury
Soft = sternocleidomastoid sprain |
|
|
Term
| What are the types of cervical spine injuries? |
|
Definition
1.Strain/Sprain (most common)
Neck strains rarely involve nerve damage
Strains generally more painful than serious
2.Fracture/Dislocation
Severe injuries involve fractures that are displaced
3.Brachial plexus dysfunction
Spinal nerve |
|
|
Term
|
Definition
| MOI: hyperflexion, extension(jammed), rotation |
|
|
Term
|
Definition
Abnormal posturing or wry neck
Happens during neck sprain/strain |
|
|
Term
| 1st step in treating cervical/lumbar spine strain/sprain |
|
Definition
Break pain-spasm-pain cycle
-ice is primary modality b/c
it numbs area and slows
nerve conduction, less pain = less spasm |
|
|
Term
|
Definition
Sternocleidomastoid (SCM)
You would use a soft brace on this injury
because it relieves pain, but theres no need for rigid brace because theres no risk of bone displacement |
|
|
Term
|
Definition
C1 (Jefferson or burst)
-Atlas
-Axial loading
-Comminuting fracture, pieces break off
-Displacement into spinal canal
-Use a hard brace with a halo |
|
|
Term
|
Definition
C2 (hangman's)
-Axis
-Bilateral (sides)-pedicle
-Forced extension "whiplash" with compression |
|
|
Term
|
Definition
-Critical area C3, C4, C5 keep body alive;
invervates phrenic nerve which controls diaphragm
-Phrenic nerve innervates diagphram |
|
|
Term
| Complete vs Incomplete Spinal cord injuries |
|
Definition
Complete: Function below the neurologic level is lost
Incomplete: Some sensation and movement below the level is retained
(athletic injuries usually incomplete) |
|
|
Term
|
Definition
C1 and C2
Quadriplegia or tetraplegia (full or partial) |
|
|
Term
|
Definition
|
|
Term
| Injuries to Brachial Plexus |
|
Definition
-Brachial plexus injuries (AKA burner or stinger) can produce significant, but transient, symptoms
S/S: Immediate shooting pain down arm/neck, quickly regain function
MOI: stretch or compression of nerve at the level of the divisions or cords
High rate of recurrence |
|
|
Term
Initial treatment guideline of spine injuries
Do and Do not: |
|
Definition
Do:
-always assume a neck injury
-Immobilize head
Do not:
-Remove the helmet (or shoulder pads)!!! (you can cause more harm)
-Move athlete
-Use ammonia capsules (causes people to move head)
-Rush through secondary survey (rule out pain, paralysis, etc.) |
|
|
Term
| Main muscle group of the lumbar spine |
|
Definition
|
|
Term
| What prevents abnormal extension of the spine |
|
Definition
|
|
Term
| Major ligaments of cervical/lumbar spine |
|
Definition
Anterior/posterior longitudinal
Interspinal
Supraspinal |
|
|
Term
| Facet joints and Vertebral discs are made of what |
|
Definition
|
|
Term
|
Definition
Biggest spinal nerve in body
Goes L4-L5
Innervates thigh and lower leg |
|
|
Term
|
Definition
Made of fibrocartilage,collagen, proteoglycans, and water
Consists of out annulus fibrosis
Fibrous (increase collagen)
-Contains nucleus
-Lamellae (15-25 concentric sheets) (rings)
Inner nucleus pulposis |
|
|
Term
|
Definition
Made of hyline cartilage
Connect vertebra to disc, provide blood an nutrients |
|
|
Term
| What are the MOI for lumbar sprains |
|
Definition
-Weak core
-Forceful contraction (in a bad position)
-Poor lifting techniques
-Overstretching
Usually a combination of all |
|
|
Term
| Signs/symptoms of lumbar strain |
|
Definition
Local muscle spasm (Just like cervical spine, the most common sign of an injury is spasm; must break pain-spasm cycle)
Pain
Acute postural abnormalities associated with recent trauma |
|
|
Term
|
Definition
Spondylogenic
Spondylolysis - Uni-lateral, one sided issue. Spine is stable
Exact cause is unknown -may be congenital
Spondylolisthesis- bilateral fracture, spine is not stable |
|
|
Term
|
Definition
Spondylolysis and spondylolistheses
if scotty dog is decapitated youb have a complete fracture: Spondylolisthesis |
|
|
Term
| Management of lumbar injuries |
|
Definition
CONSERVATIVE MANAGEMENT!!!!
Core stregthening
Lumbar bracing, for posture not stability
surgical repair is always last resort |
|
|
Term
|
Definition
Concentric or circumference tears(fissures)- layers separate
Radial tears develop
Dehydration and loss of disc height and joint space
-Leads to bulging of nucleus
pulposis
-"Jelly donut" |
|
|
Term
|
Definition
Lumbar = problems (L4-L5, L5-
S1)
4 stages of disc herniation:
Bulge
Protrusion (prolapse)
Extrusion
Sequestration |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Extrusion and sequestration |
|
|
Term
| Nucleus typically deviates in what directions |
|
Definition
| posteriorly and laterally |
|
|
Term
| Straight leg raise with dorsiflexion |
|
Definition
Special test for disc herniation
sensory deficits
weakness |
|
|
Term
| What injury may warrant an epidural injection in the acute care |
|
Definition
|
|
Term
|
Definition
“Wallet in the back pocket” Syndrome
Pressure on sciatic nerve
S/S:
Sciatica – radiating pain
Point tender over piriformis |
|
|
Term
|
Definition
| Compression of nerve, occurs in piriformis syndrome |
|
|
Term
| How do you stretch piriformis |
|
Definition
|
|
Term
|
Definition
1. Skeletal: Spondyloisthesis
2. Discogenic: Herniation
3. Muscular: Piriformis syndrome |
|
|
Term
| Which area of the spine is the least mobile |
|
Definition
| Thoracic spine is less mobile than lumbar or cervical |
|
|
Term
|
Definition
|
|
Term
|
Definition
-Fracture of two or more ribs in more than one place
-Mobile segment
-Paradoxical breathing
-as rib cage expands, mobile segment doesn't move appears to go in, opposite when exhale |
|
|
Term
|
Definition
1. Pulmonary contusion (bruised lung)
-Hematoma in lung tissue (collection of blood/bleeding w/in tissue)
-Blood in sputum(cough up blood)
(these injuries typically are not life threatening)
2. Pneumothorax (punctured lung)
-Hematoma in lung tissue (collection of blood/bleeding w/in tissue)
-Blood in sputum(cough up blood)
(these injuries typically are not life threatening) |
|
|
Term
|
Definition
-Extreme case
-Continued air pressure in cavity compresses heart and opposite lung
-Diminished heart and lung function
-Potentially catastrophic if not detected/treated |
|
|
Term
| Signs and symptoms of pneumothroax |
|
Definition
Dyspnea
Coughing up sputum or blood
Cyanosis of lips and nail beds
Failure of chest to expand (Asymmetrical breathing)
Loss of breath sounds |
|
|
Term
|
Definition
Electrical issue
Sends heart in ventricular fibrilation
High fatality rate
AED within 3-5 min |
|
|
Term
|
Definition
Hypertrophic Cardiomyopathy (HCM)
-Structural issue (congenital)
-Englarged heart and muscular wall impairs cardiac output |
|
|
Term
|
Definition
Electrical issue between SA and AV node
Congenital; abnormal heart rythm
Causes atrial or ventrical fibrilation |
|
|
Term
| Which abdominal organs are most susceptible to injury |
|
Definition
Solid organs, because they don't give like hollow organs (GI tract)
-Liver
-Kidney
-Spleen |
|
|
Term
| Abdominal Injuries: Liver |
|
Definition
Susceptible to blunt trauma
Diseases such as hepatitis make liver more vulnerable
Heavy consumption of alcohol and/or use of steroids enlarges the liver |
|
|
Term
| Abdominal Injuries: Kidneys |
|
Definition
Susceptible to blunt trauma directed at the back of the torso
(lumbar area)
May also be injured as a result of heat stroke
Be alert for hematuria (educate the athlete)
Dehydration puts strain on kidneys |
|
|
Term
|
Definition
most common abdominal injury in contact sports
Linked to Mono
Spleen is susceptible to blows in the LUQ
(back)
Serves as a reservoir for RBCs, immune and
lymphatic systems (filters blood)
Be on the alert for a Kehr’s sign
Mononucleosis -- MUST be cleared by a
physician to return to participation |
|
|
Term
| S & S: Intra-abdominal Injury |
|
Definition
Vital signs
Decrease in BP
shock
-Rebound tenderness
-Rigid abdomen
-Referred pain
-Nausea and Vomiting
-Hematuria (indicates trauma to kidney) |
|
|
Term
| Catastrophic injuries of abdomin and thorax |
|
Definition
Catastrophic:
-Commtio cordis
-Hypertrophic cardiac myopathy(HCM)
-Spleen injury (ruptured spleen)
-Pneumothorax
-Cadiac arrythmias
-Intra-abdominal hemorrhage
-Acute appendisitis |
|
|
Term
| Articulations of shoulder |
|
Definition
Articulations:
1. Scapulo Thoracic (ST)
2. Gleno Humeral (GH) (commonly referred to as shoulder joint)
3. Acromio Clavicular (AC)
4. Sterno Clavicular (SC) |
|
|
Term
| Shoulder is what type of complex |
|
Definition
|
|
Term
|
Definition
SITS:
-Supraspinatus (abduction of arm)
-Infraspinatus(externally rotates)
-Teres Minor(externerally rotates)
-Subscapularis
Stabilize GH joint (compressor) and initiate movement |
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Term
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Definition
Fall on Outstretched Hand (FOOSH)
Major MOI for shoulder-related injuries
AC/SC joint and clavicle |
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Term
| Signs/Symptoms of AC Injury |
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Definition
-Obvious deformity- separation
-scapula droops downward exposing
clavicle
-Point tenderness over AC Joint
-Reaching across the body to touch the
opposite shoulder is painful
-Weakness during arm movements
MOI: fall on elbow, point of shoulder-
force transmitted to AC joint |
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Term
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Definition
Sling-and-swathe
Figure of 8
Referral for X-ray |
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Term
| Labrum is involved in what injuries |
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Definition
Glenohumeral:
Bankart and SLAP lesion |
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Term
| Depth (concavity) & Compression: |
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Definition
Depth and compression give you a very stable joint
The greater depth of the socket, the greater stability |
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Term
| Which joint is most mobile but least stable |
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Definition
Glenohumeral
Golf ball on tee |
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Term
| Seal balancing a ball on its nose |
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Definition
Scapula must position & reposition to
maintain stability |
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Term
| Capsulo-ligamentous Disruption |
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Definition
Sprain - ligament damage with no displacement
Dislocation/subluxation- ligament and labral damage causing displacement |
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Term
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Definition
Most common capsulo-ligamentus disruption
High five position
Position
Abduction
External Rotation
With a force into
horizontal extension
and ER
Humeral head is
forced anterior
against capsule
Usually results in bankart lesion |
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Term
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Definition
Humeral head chip fracture
Glenohumeral injury |
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Term
Where do Bankart and SLAP lesions tear?
What is there main difference |
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Definition
-Bankart Lesion- 12:00 to 3:00 o'clock
-SLAP lesion- 10:00 to 1:00 o'clock
Bankart occurs with anterior dislocation
SLAP is a peel back; occurs with throwing motion |
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Term
| Special tests for joint stability |
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Definition
Apprehension/Relocation (good)
Manual Laxity (bad) |
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Term
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Definition
Rotator Cuff Strains
Most strains affect the supraspinatus tendon
Acute is from sudden tensile force
-eccentric loading causing macrotrauma
Chronic is from the "braking force" of throwing
-Eccentric loading causing microtrauma
Tears at middle 1/3 of tendon |
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Term
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Definition
Strain is from tensile forces
Impingement is from compression and shear forces |
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Term
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Definition
Tendon is ‘squeezed’ between
coraco-acromial arch and
humeral head
Overhead activity decreases
sub-acromial space
Dynamic stability
Forces cause microtrauma to
tendon |
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Term
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Definition
Point tenderness over tendon
“Painful arc” or pain during arm abduction
Limited ROM & stiffness
Strength loss (weakness)- Drop arm test, Empty can, etc.
Persistent, dull-aching pain
Nocturnal pain |
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Term
| 4 key tests to diagnose a rotator cuff impingement or strain |
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Definition
-Painful arc
-Drop arm
-Neer sign
-Empty/full can |
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Term
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Definition
"crowded house"
3 Levels of Compression
-Scalene muscle: between ant & middle
-1st rib and clavicle(costoclavicular syndrome)
-Pectoralis minor muscle
Lifting weights, occupational lifting
-overdeveloped or tight neck or shoulder muscles |
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Term
| Signs & Symptoms of Thoracic Outlet Syndrome |
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Definition
-Numbness and tingling into hand during repetitive overhead
activity
-Management:
-stretching program of neck and shoulder girdle muscles
-easily remidied
-Usually occurs in people who lift weights often |
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Term
| Special Test for Thoracic Outlet syndrome |
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Definition
Upper limb tension test- Neural
Adson’s maneuver - Vascular (good test)
Roos- Vascular (bad test)
Check pulse and changes in pulse
strength, rhythm, rate |
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Term
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Definition
-Hinge joint
-flexion/extension |
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Term
| Proximal radio-ulnar joint |
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Definition
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Term
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Definition
-Ulnar(medial) collateral (injured most in sports)
-Annular supports radial head
-Radial(lateral) collateral
-Interosseous membrane |
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Term
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Definition
MOI: :
Falling either on a flexed or fully extended arm
Hyperextension
Valgus force: outward angulation of distal segment
-Sprain on UCL
S/S:
-point tenderness
-pain during hyperextension |
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Term
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Definition
Elbow: Valgus “Overload” Stress
-Weight bearing or non-weight bearing (throwing)
-Acute vs. Chronic (overuse)
-Medial = distraction or tensile forces on UCL
-Lateral:
-Compression and shear forces
b/t radial head and capitellum
-Causes erosion of articular
surfaces |
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Term
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Definition
Tommy john surgery is the surgery done to repair ulnar collateral ligament (use wrist tendon; pulmeris longis)
Frank Jobe was the first surgeon to do the surgery
James Andrews now does all repairs for baseball/football players |
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Term
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Definition
Elbow Injuries: Medial Epicondylitis
Medial epicondyle is larger than lateral
-attachment of wrist FLEXORS
MOI: overuse
S/S:
-Point tender over epicondyle
-weakness of grip
-stiffness
little league or golfers elbow |
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Term
| Elbow Injuries: Lateral Epicondylitis |
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Definition
Attachment of the wrist extensors
Overuse MOI – repetitive stress
S/S:
-point tender over epicondyle
-stiffness
-weakness of grip
-chronic soreness
Tennis elbow |
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Term
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Definition
| Management of lateral epicondylitis injuries |
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Term
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Definition
Scaphoid
Lunate
Triqueirium
Pisiform
Trapezium
Trapezoid
Capitate
Hamate |
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Term
| What hand bone is fractured most? |
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Definition
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Term
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Definition
Wrist: Colles’ Fracture
Distal radius – growth plate region
MOI: FOOSH – wrist extended
Silver fork deformity |
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Term
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Definition
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Term
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Definition
Distal radius
MOI: FOOSH – wrist flexed
"garden spade" deformity |
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Term
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Definition
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Term
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Definition
What is it?
-Inflammation of median nerve or,
-Increased fluid pressure in tunnel that compresses median nerve
-Wrist flexion increases symptoms
MEDIAN NEUROPATHY |
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Term
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Definition
MOI – overuse in awkward hand
positions
-Gripping or vibration stimulus
-Keyboard operator or typist
(dental hygenists have highest
rates) |
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Term
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Definition
Median nerve inervates thumb, index and middle finger
Affected in carpal tunnel |
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Term
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Definition
Conservative
-Exerceises for forearm muscle
-Wrist brace (night)
-best management option
Surgical
-Release of transverse carpal ligament
-Poor outcome |
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Term
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Definition
Most commonly fractured carpal bone
MOI: FOOSH with wrist EXTENDED
Annatomical snuff box |
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Term
| Complication of scaphoid fracture |
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Definition
Non-union fracture: bones don't reunite
Avascular necrosis: proximal segment fails to heal and becomes necrotic |
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Term
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Definition
Tunnel of Guyon: (Pisiform and hook of hamate) Ulnar nerve runs through
MOI: Compression
S/S: Tingling, numbness and weakness of grip
seen in cyclists and weight lifters |
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Term
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Definition
Base of 1st metacarpal
Carpo-metacarpal (CMC) joint of thumb
MOI: axial loading with slight flexion (trying to catch a ball or tackle)
Fracture and dislocation |
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Term
| Which hand injury must have surgical repair? |
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Definition
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Term
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Definition
MOI:
-Valgus force to hyper-abducted thumb (ski pole injury)
-Sprains or ruptures UCL
Signs/symptoms:
Pain over the area of the ulnar collateral
ligament
-Snapping or popping at the time of injury
-Swelling of the MCP(meta-carpal phalyngeal) joint
-Inability to move thumb and grip tightly
using the thumb |
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Term
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Definition
Complication of Gamekeepers thumb
Distal attachment becomes avulsed and displaced
-Interposing aponeurosis prevents re-attachment of torn ends
-Impairs healing
Impairs grasping(prehension) |
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Term
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Definition
MOI: "Jamming" tip of finger with forced flexion
S/S:
-Avulsion fx off distal phalanx
-extensor tendon
-Deformity
-extension lag (30 degrees) |
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