Sports Medicine (Musc system) – Flashcards

1. Acute - Macrotrauma (Usually seen in contact sports) 2. Overuse - Microtrauma (Usually seen in non-contact sports)

- Athletic Trainers (usually first-line in care) - Physical Therapits - Dentists (especially for hockey) - Primary Care providers - Orthopedists - Nutritionalists - Psychologists - Parents/coaches

a gatekeeper, he opens the gate to other specialties (ortho, derm, psych...etc.) as needed. They are no longer the sole providers of care.

Pre-participation physicals, Mgmt of on-field injuries, plans for rehab, return to play criteria checklists, prophylaxis for injury, prevention and mgmt. of injurys, counseling for all types of injuries, and management of coaches and parents

One athlete participation in one practice or game in which there is a possibility of injury.

- During a scheduled practice or game - Requires medical attention - The injury restricts the athlete from finishing the practice or from future practice/games

- Recommendation for changes in equipment - Recommendations for rule changes - Recommendation for environment changes

Men's Hockey Gymnastics Football

Knee and ankle are most common sites of injury in men and women

1. Single physician - Good for small #'s, allows a more intimate and personable approach 2. Team approach with stations - Good for large #'s, sites for ENT, EKG, Ortho, Resp...etc., each doc fills out his portion of the form and sends them on

- Determine any underlying condition that would restrict participation - ID and eval any potential problems (i.e. old injuries) - Fulfill legal and insurance requirements - Establish Rapport - Provide counseling to athlete - Establish a baseline medical record (look at ROM, cardiac, resp...etc.)

The PPP should be done 4-6 weeks before competition, then annually after that for maintenance and tracking. The purpose of the PPP is to provide clearance to play. Ensuring that the athletes condition doesn't put them at risk for injury or illness by playing

1. Cleared without restriction 2. Cleared after completing additional eval or rehab for a specific injury or illness (used if they find a cardiac condition as an example) 3. Not cleared for participation in a specific sport

- Experience of the physician (if they feel this is not as serious at it would appear) - Informed athlete or parent (they know the risks and still wish to play) - Written consent and legal waiver - Legal counsel

They are ergogenic (any external influences that can be determined to enhance performance in high-intensity exercises), and will increase the athletes performance in an unfair manner

DeHydroEpiAndrosterone (DHEA) is an anti-aging/Anti-obesity drug. It can increase the risk of uterine and prostate CA, as well as cause Hirsutism, gynecomastia, liver disease, and virilization. Since it is now marketed as a dietary supplement it is not regulated by the FDA Some other banned substances: Androstendione - Testosterone precursor Creatine - Increases Phosphocreatine in muscle, increasing ATP formation Beta-Hydroxy or Beta-MethylButyrate - Increases muscle mass and recovery after exercise

EPO is a natural hormone secreted by the kidney, causing increased RBC production. Darbepoetin (Aransep) - Has a similar action, but 3x longer half life

Nutritional or herbal medicines are not regulated by the FDA, lack a quality control, and there is no assurance of safety in use.

- Less likely to have teen pregnancy - Less likely to be in an abusive relationship - More likely to finish HS and go to college

- Females have increased % body fat - 30-50% less upperbody strength vs men - Lower RBC count then men (ha ha ha ha.....periods) - Women have a wider pelvis and an external rotation alignment of lower extremities (>Q angle) vs. males - They are more flexible then guys.....yea they are!

Knee is the most dramatic differences between sexes. - ACL is 4.9x higher in females vs males - Collateral Ligament is 2.5x higher in females vs. males - Meniscus injury is 1.9x higher in females - Increased risk of patellofemoral syndrome (due to ligamentous laxity and lateral tracking of patella) - Females are also at an increased risk for stress fractures - Poor nutrition and eating disorders are higher in females (gymnasts and ballet dancers) - They can also suffer menstrual irregularities

60% of females in sports may have an eating disorder, the risk is 10x greater in females

Drive to excel at any cost Subjective sports judging (gymnastics, ice skating...etc) Revealing clothing

Anorexia Nervosa is the refusal to maintain minimal body weight for height (<85% of normal). They will have an intense fear of weight gain and a disturbed body image. S&S: Amenorrhea, Fat & muscle loss, dry hair and skin, Lanugo (a very soft fine hair on the skin), Cold discolored extremities, decreased body temp, lightheadedness, and bradycardia

Recurrent binge eating within any 2 hr period. They will over eat (suffering a sense of lost control), and then cause compensatory vomiting, abuse laxatives, fast and over exercise, and will have a negative self-image.

Amenorrhea Disorders of eating Osteoporosis

Amenorrhea - Absence of menarche by age 16 (however secondary sex characteristics are present) Oligomenorrhea - Cycles that last over 36 days, so they will be irregular Secondary Amenorrhea - Absence of 3 or more consecutive cycles

There can be an increase in skeletal demineralization, predisposing the athlete to stress fx's Infertility Increased risk of uterine CA

Treatment is based on age: - If less than 3 years since menarche: Decrease exercise and increase rest - If more than 3 years since menarche: Low dose oral contraceptives

There is a 4x greater risk for females vs males (however, men can still get it) Exercise has little effect on bone mass (although it normally will increase it) Often associated with anemia The decrease in estrogen caused by exercise causes osteoporosis and menstrual problems

In most cases women can safely continue to exercise, some of the concerns are: - Effect of elevated maternal temp on fetus - Effect of exercise on blood flow to fetus - Effect on weight of fetus

- Maternal HR should not exceed 140 bpm - Strenuous activity should not exceed 15 min - No prone position after 4th month - Avoid vasalva maneuver - Increase caloric intake - Maternal core temp should not exceed 38⁰ C

The 2 groups of risk factors are: 1. Host related (Risks from the young athlete themselves) - Growth of tissues, growth spurts, Gender, anatomical malalignment, conditioning, psych, pre-existing conditions 2. Environment related - Training error, technique error, coaching, equipment, playing surface, drugs/supplements, nutrition, weather, and parents.

Little league shoulder - An injury at the proximal humerus epiphysis (a microfracture and widening) Look at red box Due to the ligaments being stronger then the bone, dislocation is less frequent, but does occur on occasion. It will typically be an anterior dislocation, potentially tearing the anterior labrum

Little League elbow is caused by excessive acceleration and deceleration of the arm. This will cause: - Medial epicondylar apophysistis - Lateral joint compression - Osteochondritis Dessicans (OCD) of the capitellum (between radial head and humerus) These can all progress to an Avulsion of the Medial epicondyle

Seen a lot in gymnasts and/or weight lifters wrists It is caused by dorsal impaction of the radiocarpal joint (due to excessive dorsiflexion under load). They will present with a shortened and deformed/bowed distal radius.

Almost ½ of all low back pn in young athletes is due to to Spondylolysis, due to repetitive hyperextension. - Usually at L5 - Related to diving, volleyball, soccer, dance, skating, and gymnastics They may also suffer from Juvenile Herniated Nucleus Pulposis. The NP is likely to herniate into the endplate as well as posterolateral too. Frequently the Ligamentum Flavum will hypertrophy as well due to an inflammatory response from the HNP.

1. Snapping Hip - Due to tight Ilipsoas which grinds on or gets caught on ilipectineal line. This is felt during external rotation. 2. Snapping Ileotibial Tract - Due to Tensor Fascia Lata and iliotibial muscle getting caught up on the Greater trochanter Treatment for both is: Rest, Ice, Meds, Therapy, and stretching. If this doesn't help, then surgery

Osgood-Schlatter disease is inflammation of the Tibial Apophysis (where the patellar tendon attaches). Jumpers knee is the opposite of Osgood-Schlatters, It presents with pain at the inferior pole of the patella (where the patella-tibial tendon attaches). Discoid Meniscus is a disc shaped meniscus (instead of a normal C shaped) on the lateral articular condyle. It is typically asymptomatic, However, since it is thicker, and still avascular, it is more prone to tears. Osteochondritis Dessicans is necrosis of subchondral bone below articular cartilage. It can be a closed lesion, where the necrotic bone has not broken thru the articular cartilage Or an open, where it has penetrated the cartilage and there is now an open lesion, and possibly a loose body in the knee.

Sever's apophysistis is inflammation of the calcaneal apophysis, where the Achilles tendon attaches. It will present with pain and tenderness over the heel area that increases with walking, running or jumping.

Osteochondritis Dessicans of the talus, is when the subchondral bone is injured or becomes ischemic and then dies off. It can eventually wear its way thru the cartilage into the joint space. This typically occurs on the medial side of the mortise joint.

Tillaux fractures occur due to asymmetric closure of the distal tibial physis. Part of the lateral malleolus ligament complex will pull off a piece from the tibia, but the fx only extends in 2 planes (horizontal and sagittal).

Caused by the same problem as Tillaux Fxs, but this time the ligament pulls off a fragment which extends in all 3 planes (Horizontal, sagittal, and coronal)

Kohler's disease is AVN of the navicular bone

Frieberg's disease is AVN of the 2nd metatarsal head

Muscle strains are stretched induced injuries, and are 30% of typical sports medicine cases. Dx: Acute onset of muscle soreness, usually during an unaccustomed exercise, and is accompanied by weakness and easy fatigueability. Typically occurs at the Muscular-Tendinous Junction. There is an increased incidence when fatigued (late in a training session) Pathogenesis: There will be a pronounced local inflammatory response (1-2 days post injury) By the 7th day there will be fibrous tissue replacement of injured tissue Prophylaxis for muscle strains: Warm up with flexibility exercises Pre-exercise stretching (increases viscoelastic property of muscle prior to exercise).

Rest Ice Compression Elevation Avoid NSAIDs, this removes the inflammatory process, which is needed for healing. So you stop the healing process.

Overuse injuries are related to microtrauma, and nearly ½ of all sports injuries are related to overuse Treatment of overuse injuries are: Rest NSAIDs PT for rehab Counseling

Intrinsic Risk Factors: - Age - Strength - Flexibility - Previous Injury Extrinsic Risk Factors: - Equipment in use - Playing surfaces - Sport specific

Pain that is brought on by exercise but is decreased with rest (like Shin splints). This is most common in the lower leg. Caused by the fascia not accommodating increased blood flow and swelling. Can lead to classical compartment syndrome (and the 4 P's)

During microtrauma of tendons, there may not be an inflammation, instead a degeneration which causes a fibrous metaplasia and calcification. It will cause the Type I collagen to be replaced by type II

- Cryotherapy (cold packs, ice massage) - Heat - Sonotherapy (ultrasound) - Pulsed Electrical Stim - Transcutaneous Nerve Stim - Iontophoresis and Phonophoresis (helps with drug uptake) - Massage - Muscle stim (to prevent atrophy of immobilized muscles) - Isokinetic exercise (Isometrics) - Active and passive exercise and stretching

- Athlete down from contact and not moving - Athlete down from contact and moving - Athlete down without contact (MOST SERIOUS) - Athlete down but moving to sidelines under own power

Congenital anomalies Hypertrophic Cardiomyopathies CAD Marfan's syndrome - Can have aortic rupture Myocarditis - Strep infection can travel to heart

60-80% of all athletes have RBCs, albumin, and casts in their urine. This is non-trauma related Renal injuries can lead to blood in the urine - Contusions to kidneys - Bleeding inside the peri-renal capsule - Parenchymal laceration of the kidney - Deep Parenchymal injury or vascular injury. Also be aware that pain over LUQ should be suspected of splenic rupture, as it can have massive blood loss and lead to shock and death.

Concussion (most common) Post concussion syndrome Second impact syndrome

An alteration of cerebral function caused by a direct or indirect (rotational) force transmitted to the head resulting in one or more of the following acute signs: - LOC - Cognitive dysfxn (retrograde amnesia and short term memory loss) - Tinnitis - Blurred vision - HA - Difficulty concentrating - N/V - Photophobia - Balance disturbance - Excessive sleep - Depression The pathophysiology of a concussion is: Disruption of neurons cell membrane and stretching of axons Opening of K+ channels causing increase in extracellular K+ (disrupting normal fxn) Release of excitatory AA's, and influx of Ca2+ into neuron that can cause cell injury or death. Eventually cerebral blood flow decreases.

Post-concussion syndrome is when the symptoms of concussion continue for weeks, months, or possibly a year after the event. It is due to continued neurotransmitter dysfxn. They will still have: HA, slowed reflexes, impaired memory and concentration, depression, and excessive sleep.

An athlete who sustained an initial head injury and returns to play while still symptomatic, and sustains a secondary head injury. They will have a loss of cerebral autoregulation (temp, bp...etc) Cerebral vascular congestion Increased ICP which can lead to herniation

Always assume severe head injury and cervical fracture Assess ABCs Immobilize on a long spine board with a C-Collar Transport to medical facility ASAP

Assume cervical injury Assess alertness and orientation Assess pn and tenderness on head Active ROM of extremities Asses DTR's and any Focal deficits

C-spine injuries are 75% of all fatal injuries and 10-15% of all football injuries. It is caused by impact on top of the head with a slightly flexed neck. This increases load on cervical spine and increases chance of injury. The types of C-spine injuries are: - Nerve root or brachial plexus injuries - Acute cervical strains or sprains - Intervertebral disc injuries - Cervical Fxs and dislocations - Cervical Stenosis

Nerve root or brachial plexus injuries are also referred to as "Stingers" or "Burners". Usually caused by a player who uses their shoulder to tackle and causes a brachial plexus stretch injury. Should go away in 2-10 minutes, or up to 24 hrs

Heat Cramps: - Mildest form Painful muscle cramps and spasms that occur during or after intense exercise and sweating in heat, mild fever of less than 102. Treatment: move to a cool place, fan patient, give a cool sports drink, and stretch cramped muscles Heat Exhaustion: More severe than heat cramps. Caused by a loss of water and electrolytes (due to excessive sweating). Pt will have muscle cramps,N/V, and a fever over 102. Body is unable to keep up with the heat and cool itself. Treatment: Move to a cool place, expose the body, fan patient, give cool sports drink, if no improvement may need cool IV. Heat Stroke: Most severe form of heat illness, occurs when the bodys heat regulation system is overwhelmed. IT IS LIFE THREATENING. Pt will have high fever over 104 and will be dry (NO SWEAT!!!!). They will be confused, lethargic, and be in a stupor. They can have seizures, coma and lead to death Treatment: Move to a cool place, call 911, remove excess clothing and drench with cool water and fan skin, use ice packs or ice bags if possible in pits and groin, if awake give cool fluids PO, IV saline, and monitor urine output.