kushner Sports med

quickster2008's version from 2016-01-14 06:08


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blisters are generally the result of ? stressshear/frictional
list the mechanical causes of blisterswet socks, seams in shoegear/socks, poor fit of shoe gear allowing sliding, wrinkles in socks, gait abnormalities
tennis toe could best be described assubunqual hematoma
What is the mechanism behind the development of "tennis toe?"Tennis toes results from the free end of the toenail catching in the tocbox as the toot slides forward in the shoe, ie. low toe box, or long nail, or distal phalanx extensus, or foot sliding forward for various reasons.
In acute "hyperflexion" injuries of the hallux in athletes, which soft tissue structures would be most likely to be injured?Dorsal capsular structures, EHL tendon which may also produce an avulsion injury at the EHL tendon insertion into the dorsal aspeet o f the distal phalanx.
The mechanism of "turf toe" generally involve which forces?Axial compression and dorsiflexion at the 1st metatarsophalangeal joint.
What are some common associated physical findings with hallux limitus in athletes may include?Increases hallux abductus interphalangeus angle, hyperextension of the hallux IPJ, keratoma under the IPJ of the hallux, dystrophic hallux nail from catching in the toebox, subungual exostosis due to dorsal distal phalangeal pressure (secondary to hyperextension at the IPJ).
List 3 methods of conservative treatment for hallux limitus/rigidus which can be used in athletes.Morton's extension, rigid sole rocker bottom shoe
The common mechanical denominator in functional hallux limitus isDorsiflexion, elevation ofthe 1st ray (metatarsus primus elevatus) with resulting dorsal 1st MPJ jamming and eventual joint destruction and bony proliferation.
Where is the most common location of metatarsal stress fracture occurring in the central raysDistal metaphyseal-diaphyseal junction.
A common mechanical factor in the development of abductor hallucis muscle strain occurring in a runner may beHypermobility ofthe 1,I ray requiring the abductor hallucis to overwork in attempt to try to stabilize the 151 rayon the ground/supporting surface.
In acute hyperextension injuries of the 1st MPJ, which structures ofthe 1st MPJ are most likely to be injured?Plantar 1st MPJ capsular sprain/rupture, dorsal 1st MPJ joint jamming (base of proximal phalanx, head of 1st met), possible avulsion fracture of sesamoids.
List 4 mechanical etiologies of sesamoiditis as occurs in athletes.Piantartlexed Isl ray. Excessive STJ pronation with 151 ray dorsiflexion and eversion, exposing tibial sesamoid. Equinus, uncompensated, partially compensated.Forefoot contact activities. Foot type, i.e. Rigid cavus.


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The most common cause of haHucal sesamoid fracture in athletes involvesForceful landing on the forefoot with the hallux dorsiflexed, tensing the sesamoid apparatus, either "exposing" the sesamoids to compression injury or increasing tension on the sesamoids resulting in avulsion.
List the causes of neuroma (perineural fibroma) seen in athletes.Enlarged metatarsal head; piling of metatarsal heads (ie supinated foot); excessive pronation with dorsiflexion, eversion and abduction o f the forefoot against the lateral side o f the shoe resulting in crowding o f the metatarsal heads; dorsiflexed digits with an altered MPJ axis ofrotation; depressed metatarsal heads (unequal levels); decreased forefoot cushion (shoes or fat pad); tight shoes in forefoot.
List the biomechanicallstructural defects, which may result in a Navicular stress fracture.Abnormal spring ligament function.Abnormal posterior tibial tendon function. Excessive subtalar and midtarsal joint pronation. Short Isl metatarsal, long 2nd metatarsal.Pes planus. Navicular compression between talus and cuneiforms.
What is the most common location and orientation for Navicular stress fracture is?In the central J/3rd (middle l/3fd) of the Navicular, oriented on the sagittal plane beginning at the Talonavicular joint, extending distally.
What is the basic pathomechanical factor leading to the development of a Navicular stress fracture?There is a retrograde force back through the 2nd metatarsal to the intermediate cuneiform, to the central 1/3 ofthe Navicular. The Navicular, as the "keystone" of the arch is impinged between the forefoot distally and the Talus proximally, focusing stress on the Navicular, resulting in stress fracture.
Describe the appearance of a Navicular stress fracture as would be seen on MRI.Decreased signal intensity in the Navicular (central) on T I weighted images and increased signal intensity on T2 and STIR due to inflammatory edema.
What is the most important treatment concept in Navicular stress fracture is?The patient should be non-weight bearing initially whether casted or surgically fixated.
Os Tibiale Externum syndrome in athletes primarily involves dysfunction of which tendon?Posterior Tibial.
List/describe shoe abnormalities or inadequacies which may contribute to Posterior Tibial tendonitis.Low durometer midsole. Weak/short heel counter. Lateral midsole flare. Excessive sole flexibility. Excessive room in heel area allowing excessive motion within shoe.
List the biomechanical causes of anterior tibial tendonitis as may be seen in the athlete.Excessive STJ pronation with forefoot varus; equinus with weak anterior muscle (muscle imbalance); heavy heel strikers (rapid slapping of forefoot requiring tibialis anterior to work harder to decelerate the forefoot plantarflexion; tight tibialis anterior.
Describe the mechanism of functional tarsal tunnel syndrome.Subtalar joint pronation/eversion produces traction on the posterior tibial nerve as well as retinacular tightening producing compression on the nerve.
How are anterior process fractures of the calcaneus are classified?Rowe type IC fracture.
What is the mechanism for anterior process calcaneal fractures occurring in athletes?Mechanical inversion stress wilh adduction o f the forefootlmidfoot and a plantarflexed foot.
List injuries which occur at or around the calcaneocuboid joint.Anterior process fracture o f the calcaneus. Bifurcate ligament sprain. Rupture o f the Extensor Digitorum Brevis muscle. Cuboid Peroneal Syndrome (subluxcd cuboid). Compression fracture ofthe cuboid.
Which portion of the bifurcate ligament is usually sprained?The calcaneocuboid portion.
What are the differential diagnoses in an athlete complaining of heel pain?Heel Spur Syndrome; Plantar fasciitis; Calcaneal Stress fracture; Entrapment of Isl branch of the lateral plantar nerve (Baxter's nerve); Inferior calcaneal bursitis; Plantar fascial rupture; Calcaneal neoplasm; Fat Pad failure of the heel; Sero-negative/sero-positive arthritis; Secondary to acute trauma; Medial calcaneal nerve neuritis.
Describe the typical appearance of a Calcaneal stress fracture.Sclerotic fracture line from anterior to the tubercles, extending posterior and superior, minimal to no periosteal reaction, blurringtbluntingldisruption o f the calcaneal trabeculae. The fracture line is generally nearly perpendicular to the primary compression trabeculae, suggesting a "compression" factor and resulting in the sclerotic appearance of the fracture line.
Calcaneal stress fractures are generally the result of which forces?Primarily compression, secondarily tension.
Sever's disease could best be described asa traction apophysitis
What are the common mechanical abnormalities associated with Sever's disease?Excessive pronation; Equinus.What are the pathomechanics which frequently lead to Haglund's deformity?Excessive motion of the rearfoot, primarily frontal, seeondarily sagittal i.e. Due to rearfoot varus, forefoot valgus, plantarllexed 1st ray, etc.


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Radiographic findings seen in Haglunds deformity may includeHigh Calcaneal inclination angle; High Fowler and Phillip angle (>70 deg). Posterior-superior calcaneus above parallel pitch lines.
List 3 mechanical etiologies of Hallux Limitus/Rigidus.: Hypermobile I" ray (excessive STJ pronation, short 1sl ray). Dorsillexed 1st ray. (metatarsus primus elevatus, congenital or acquired). Long 1sl ray. Trauma/DJD
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List radiographic findings which may be seen with Hallux Iimitus.asymmetrical jt space narrowing, marginal osteophytes, subchondral cysts, subchondral sclerosis, long or short 1st MT, metatarsus primus elevatus, elevated HAI angle
What are the different varieties of Freiberg's Infraction type 1?type 1-MT head dies but heals by replacement
What are the different varieties of Freiberg's Infraction type 2head collapses but articular surface remains, +/- peripheral osteophytes
What are the different varieties of Freiberg's Infraction type 3head collapses with articular cartilage loosening, joint destroyed
What are the different varieties of Freiberg's Infraction type 4multiple heads involved
Describe the usual mechanisms in acute subluxed cuboid/cuboperoneal syndrome.: Post ankle sprain with the cuboid forced plantar and medial.
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Describe the usual mechanisms in chronic subluxed cuboid/cuboperoneal syndrome.Excessive lateral stress due to rearfoot varus, cavus foot, short limb compensations, equinus.
Chronic extrinsic stress, dorsiflexing forefootlmidfoot, ie. standing on rung ofladder for prolonged periods.
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In subluxed cuboid syndrome, how is the Cuboid believed to move?plantar and medial


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Ligamentous structures most commonly involved in Sinus Tarsi Syndrome includeInterosseous talo-calcanealligament. Cervical ligament.
Soft tissue impingement of the ankle usually occurs in which areasAnterolaterally and posteromedially.
The mechanism of anterior bony impingement of the ankle generally involves: Forceful dorsit1exion jamming trauma, i.e. Jump and land forcing the foot in a rapid dorsiflexed position or rapid explosive starts/push offwith the foot in a dorsit1exed position.
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How does posterior leg muscle tone contribute to the development of anterior ankle impingement syndrome?Iflow tone/strength in the posterior muscle group, rapid dorsiflexion of the ankle cannot be counteracted/decelerated as effectively, resulting in anterior jamming.
What is Ferkel's phenomenon?Soft tissue cause of anterolateral ankle impingement from scarlfibrosis and synovitis in anterolateral ankle gutter, usually post-traumatic (post sprain).
What is Basset's ligament?
A slip of the anterior tibiotlbular ligament, abnormally coursing down the lateral malleolus to the lateral border of the talus, resulting in impingement syndrome ofthe ligament between the talus and tlbula.
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What is the mechanism involved in posterior bony impingement of the ankle?The posterior tubercle, primarily posterolateral tubercle/process (Stieda's Process) becomes impinged between the posterior lip of the tibia and the superior surface of the calcaneus at the posterior edge ofihe posterior subtalar joint facet when the ankle is plantarflexed.
Soft tissue posterior ankle impingement often involves which structures?Flexor Hallucis Longus tendon, posterior capsule and synovium.
What classification system is used in osteochondral fractures of the Talar dome and how is the fracture staged?


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What are the typical differences between medial and lateral osteochondral fractures of the talus?Medial fractures tend to be deeper, more cup shaped, secondary to compression force. Lateral fractures tend to be shallower, more wafer shaped and generally secondary to shear forces.
Lateral Talar process fractures in the athlete generally tend to be due to The ankle is forcefully dorsiflexed and inverted with weight bearing forces becoming concentrated on the lateral processofthetalus. Thedownwardforceofthetalusiscounteractedbythestablepositionofthecalcaneuswhich transmits vertical ground reactive forces to the lateral talar process.
What are the two most common mechanisms resulting in a posterior talar process fracture seen in the athlete?Forced dorsiflexion of the foot and ankle, avulsing the posterior process by ligamentous attachment; or extreme plantarflexion, ie. Sliding injury in baseball, where the posterior process is compressed between the posterior lip of the tibia superiorly driving downward and the posterior calcaneus inferiorly driving upward, shearing off the posterior process of the talus.
The mechanism most commonly involved in traumatic subluxation of the peroneal tendons is:Forceful, resisted dorsiflexion and eversion ofthe ankle, i.e. Such as eversion/dorsiflexion ofthe foot against the rigidity ofa ski boot.
When the peroneal tendons traumatically dislocate, besides possible injury to the peroneal tendons, which other structures are injured allowing the subluxation/dislocation?
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The superior Peroneal retinaculum which may avulse a small strip o f periosteum from the posterior surface o f the lateral malleolus or produce an avulsion fracture from the posterior surface ofthe lateral malleolus which may be seen on an ankle mortise view or a medial oblique radiograph ofthe ankle.
What are "shin splints?": An overuse, musculotendinous intlammatory condition orthe shin region excluding injury to bone or of vascular etiology.
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What are the types of shin splints?Anterior, Posterior and Lateral depending on the muscle compartments or individual muscles involved.
What are some mechanical precipitating factors leading to the development of shin splints?


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What are the different types of Posterior shin splints?Posterior tibiallSoleal shin splints which usually occur in the mid to lower Tibial along the posterior medial ridge, FHL shin splints which tend to be at the distal end of the Tibia along the posterior medial ridge and FDL shin splints which tend to be more proximal along the posterior medial ridge ofthe Tibia.
How can running shoes contribute to the development of Posterior TibiallSoleal shin splints?Factors in the running shoe which would allow the foot to excessively pronate would contribute to the development of Posterior Tibial/Soleal shin splints, i.e., wide flared heels (particularly lateral flare), low durometer midsole, weak: counter, lack of medial shoe support, poor counter-midsole junction, etc.


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What are some mechanical precipitating factors leading to the development of shin splints?Biomechanical faults (depending on the fault, different muscles/groups are involved).
-Muscle imbalances (weakness, tightness, improper ratios).
-Early in training/beginning training/resuming training after a period of inactivity, etc. Change in training schedule (ie. Increased effort = duration, stress, frequency, etc.). Change in training methods.
Changes in surfaces. Changes in shoegear.


Changes in surfaces. Changes in shoegear.