Kushner sports2

quickster2008's version from 2016-01-14 06:19


Question Answer
What are some mechanisms contributing to the development of anterior shin splints?
Which types of sports/activities are most likely to produce lateral shin splints involving the Peroneal musculature? Sports/activities requiring lateral mobility, multidirectional and/or eversional type motion.
What are some typical radiographic findings seen in tibial stress fracture?Periosteal reaction. cortical hypertrophy, endosteal canal narrowing due to endosteal reaction, possible lucent fracture line. Early radiographs may be negative and may require Tc99 bone scan (hot spot) or MRI (dee. signal intensity of endosteal canal on Tl and increased signal intensity of endosteal canal on T2 and/or STIR).
What is the most common location of Tibial Stress fractures in runners?Middle to lower 1/3 of the Tibia along thc posterior medial tibial ridge.
What is the most common location of Fibular stress fractures?Most occur in the distal If.. of the fibula, in adults about 4-6 em. Superior to the medial malleolus.
What are the pathomechanics behind the development of "Chronic Compartment Syndrome" of the leg?A higher than normal, increased resting compartment pressure due to a tight fascial bag around a particular muscle or group of muscles. With exercise, blood flow to the muscular compartment increases, increasing volume of an already tight compartment resulting in a pathologic elevation of intercompartmental pressure resulting in ischemic type symptoms. While this is not a surgical emergency (differing from acute compartment syndrome), elective fasciotomy may reduce or eliminate the problem.
What is "Tennis Leg?"Anacuteposteriorcalfstrain,usuallythemedialheadoftheGastrocnemiusorpossiblytheSoleus. Previously thought to be a rupture of the Plantaris tendon.
What is the usual mechanism resulting in "Tennis Leg?"Usually occurs in a fatigued/fatiguing Gastroc/Soleus. The muscle is eccentrically loaded/stretched as body weight moves forward over the foot/leg. This is followed by a forceful, sudden contraction ofthe Gastroc/Soleus resulting in strain o f the involved muscle.
What is the "Q Angle?"This is the quadriceps angle or relationship ofthe line ofpull ofthe quads to the line ofpull ofthe patellar tendon. It is formed by a linc connecting the ASIS to the midpoint/center of the patellar intersecting with a line from the midpoint/eenter of the patella to the tibial tubercle. The normal angle is between 10-18 degrees and is abnormal if either too high or too low.
Pathologicany, what does the Q Angle reflect?Tracking ofthe Patella in the intercondylar notch ofthe Femur. An abnormal Q angle suggests the possibility of abnormal Patellar tracking and a possible mechanical cause for Patellofemoral Pain Syndrome.
What is the "common denominator" in Patellofemoral Pain Syndrome?Abnormal, increased Patellofemoral contact pressures.
When the Patella subluxes or dislocates, which direction does tbis usually occur?Laterally.
Wben evaluating muscle activity and strength in chronic Patellar subluxation and Patellofemoral Pain Syndrome, which muscle frequently appears weak and atropbic?The Vastus Medialis Obliquis (Part ofthe Quads).
In evaluating a knee, what is the "Panic" or "Apprehension Sign?"When attempting to sublux the Patella laterally to evaluate the mobility ofthe Patella, the patient will respond with panic or apprehension and may respond by withdrawing, contracting the quads, etc. to avoid the discomfort previously experienced with Patellar subluxation or laxity.
What is "Clark's Test" and when is it used?This is a test to evaluate the status (inflammation/irregularity, etc) ofthe retropatellar surface as a cause of retropatellar pain in Patellofemoral Pain Syndrome and Chondromalacia. The Patella is distracted and held distally following which the quads are contracted. The Patella is thereby forced against the femoral condyles which may produce pain and crepitation associated with retropatellar surface inflammation, irregularity, etc. The exam should be performed with the knee mildly flexed as compared to fully extended to avoid trapping redundant synovium between the Patella and Femur which would also produce pain and a false positive finding.
In Plica Syndrome of the knee, symptoms generally occur in which area of the knee?Peripatellarly, usually over the medial/superior-medial area of the adjacent femoral condyle.
What are some of the typical pathomechanics which may result in Plica Syndrome of the knee?Direct blow to the knee. High intensity flexion/extension activities. Excessive/abnormal pronation stretching the plica due to tibial rotation and valgus stress at the knee. In any case, the plica, a band of redundant tissue which usually resorbs following birth, but in this case remains, becomes thickened, fibrotic and inelastic due to inflammation and hence resulting in pain.
List the differential diagnoses in patients with suspected Patellofemoral Pain Syndrome.Chondromalacia Patellae; Plica Syndrome. Meniscal injury. Chronic Patellar Subluxation. Synovitis. Fat Pad Entrapment Syndrome (infrapatellar fat pad) = Bursitis.
List the possible mechanical etiologies resulting in Patellar tendonitis in athletes.Excessive jumping activities. Tight hamstrings (quads have to work harder to extend knee). Tight quads (tendon becomes stretched with activities involving excessive knee flexion). Excessive midstance knee flexion, i.e., long leg compensation. Under striding.
What is Osgood-Schlatter's Disease?Traction apophysitis of the tibial tubercle due to excessive tension of the Patellar tendon. Occurs most commonly between 10-15 years of age in young athletes involved in jumping sports or activities requiring increased tension on the Patellar tendon.
Pes Anserine tendonitis involves inflammation of which muscular insertions?Sartorius; Gracilis; Semitendinosus.
What is the usual mechanism behind the development of IT (iliotibial) Band Syndrome?With knee flexion and extension, the IT band snaps or rubs back and forth over the lateral femoral condyle. The repetitive "friction" results in inflammation and pain and, hence, the name ITB "Friction" Syndrome.
What might be some mechanical etiologies of ITB Syndrome?Tight IT band; Cavus foot (shock dissipation in ITB); Excessive ITB stress/fatigue (hills/sloped or crested roads); Varus deformities (genu varum, tibial varum, rearfoot varus, compensation for short limb, etc.); Excessive internal tibial rotation which tightens ITB, (ie. Excessive pronation, long limb compensation.)
What test evaluates the tightness of the IT Band?The "Ober" test. Lying on the opposite side of the leg being tested, the medial side of the knee being tested should be able to reach the table with minimal to no resistance. Restriction ofthe medial side from reaching the exam table may be due to tightness of the IT Band on the lateral side of the limb.
What are the usual mechanical causes of Popliteus Muscle Syndrome seen in a runner?Exeessive downhill running, displacing the femur anteriorly on the tibia stressing the Popliteus which limits anterior displacement of the femur on the tibia; Factors which result in excessive external tibial rotation; Factors which result in excessive internal femoral rotation (the Popliteus internally rotates the tibia and prevents anterior displaeement of the Femur on the Tibia. Therefore, anything that excessively externally rotates the Tibia, excessively internally rotates the Femur or produces excessive anterior displacement stress of the Femur may stress the Popliteus).
The discomfort in Popliteus Muscle Syndrome would occur in which area of the knee'?Poslero lateral.
Most chronic problems involving the Achilles tendon occur within 2-6 cm superior to the Calcaneal insertion. Why does this frequently occur in this area? This is an area of reduced vascularity or the so called "watershed" area which makes this area vulnerable to injury and with a reduced healing potential.
What is the relationship of excessive, abnormal pronation to chronic Achilles tendonitis?Bowstringing of the Achilles tendon as the foot pronates, tightening the medial side of the tendon. - Torque or "wringing" effect of the tendon. The tibia remains internally rotated in the pronated foot while the knee is extending in midstance and propulsion producing a conflicting torque force on the tendon. The wringing effect may also cause tendon "blanching" and cycl ic periods of further reduced vascularity. - In the foot with compensatory pronation due to equinus, the Achilles tendon is tight (reduced flexibility) increasing the tension within the tendon.
What is the usual appearance of the runner with chronic Achilles tendonitis?Most often male (approximately 80%), average age around 40.
How does foot strike contribute to the development of chronic Achilles tendonitis?In readoot strikers, there is a higher vibration resonance within the tendon which is also under higher eccentric tension at heel strike. In midfoot strikers, there is a resulting increased eccentric muscle decelerator activity as the heel is eccentrically lowered to the ground following heel strike. Both situations may increase tension within the Achilles tendon.
What is the "Thompson Test?" This is a manual test used to evaluate the integrity of the Achilles tendon. The calf is squeezed (Gastroc/Soleus only, avoiding squeezing of the deep posterior muscle group). Plantarnexion of the foot suggest at least a partially intactAchillestendon. AbsenceofplantarflexionofthefootsuggestsdiscontinuityoftheAchillestendon.
What are some manual tests used to evaluate the integrity of the ligamentous structures of the ankle following acute ankle injury?Anterior drawer (pull test) to evaluate the Anterior Talofibular ligament. Calcaneal inversion (Talar Tilt) to evaluate the Calcaneofibular ligament when it is positioned parallel to the long axis of the leg. Eversion stress test to evaluatetheintegrityoftheSuperficialDeltoid. ExternalrotationtesttoevaluatetheintegrityoftheDeepDeltoid fibers. Dorsiflexion and external rotation to evaluate the Tibiofibular ligaments.
To what does the Salter-Harris classification refer?The epiphyseal plate in children.
What is the weakest zone in the epiphyseal plate, or plane of cleavage in most epiphyseal plate fractures in children?The Zone ofProvisional Calcification
Describe the 5 main forms of epiphyseal plate fractures. S-H I: Fracture only through the plate without epiphyseal or metaphyseal involvement. S-H II: Fracture along the plate with a projection out through the metaphysis producing a metaphyseal spike ("Thurston-Holland Sign"). S-H III: Fracture through the joint surface, longitudinally through the epiphysis to the plate and then transversely out through the epiphyseal plate. S-H IV: Fracture through the joint surface, longitudinally through the epiphysis, across the plate and terminating out through the metaphysis. S-H V: Compression injury of the epiphyseal plate, partial or complete.
The classical description of a Jones fracture of the 5th metatarsal is: A transversely oriented fracture line distal to the styloid process o f the 5th metatarsal in the proximal portion o f the bone.
In Subluxed Cuboid Syndrome, there may be an associated tendonitis of which tendon?The Peroneus Longus.
Describe the mechanical etiologies of extensor tendonitis as may be seen in the athlete.Weak Tibialis Anterior with extensor substitution; compression from underlying bony prominence; excessive dorsiflexion activities (extensor assist); "step on" injury ofthe forefoot/midfoot.
In a "saddle bone" deformity in an athlete (lst met-medial cuneiform dorsal exostosis), clinical symptoms and complaints are most frequently the result of what?Compression o f soft tissue structures (tendon, nerve, etc.) between the dorsal exostosis and the extrinsic pressure from the shoe, resulting in the development of symptoms.
What is the usual mechanism behind the development of retrocalcaneal bursitis in the athlete?Pressure between the posterior-superior bursal surface of the calcaneus and the Achilles tendon with resulting inflammation of the bursa with swelling and pain. This may be due to an enlargement of the posterior surface of the calcaneus (Haglund's deformity), an abnormal position of the calcaneus (high Calcaneal Inclination angle with the bursal surface pushed against the Achilles tendon), extrinsic pressure from the counter of the shoe over the area of the bursal surface, and possibly rotational motion of the calcaneus with frictional pressure created in the area of the retrocalcaneal bursa. This is besides other systemic causes such as sero-negative and sero-positive arthropathies whieh are only incidental to the athlete.