Anatomy and Rehabilitation of Musculoskeletal Injuries: A Comprehensive Guide, Quizzes of Kinesiology

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hip pointer pathomechanics

subcutaneous contusion with possible muscle tearing at origins/insertions no immediate concern- pain and swelling iwll ultimately impact athlete's mobility fracture may be associated with injury TERM 2

hip pointer injury mechanism

DEFINITION 2 result of direct blow to iliac crest or ASIS must differentiate between hip pointer and abdominal strain TERM 3

hip pointer rehab concerns

DEFINITION 3 must rule out fx with xrays tx must be promt in order to limit severe pain and loss of trunk motion RICE, anti inflammatory drugs, and modalities for pain and swelling ROM and strengthening (include trunk) TERM 4

grade 1 hip pointer and rehab progression

DEFINITION 4 normal gait, pain on palpation, full ROM of trunk no loss of activity TERM 5

grade 2 hip pointer and rehab progression

DEFINITION 5 moderate to severe pain on palpation, swelling, and abnormal gait (short wing phase), decreased hip ROM miss 5-14 days

grade 3 hip pointer and rehab progression

pain on palpation, swelling and discoloration, restricted gait, decreased ROM And trunk motion miss 2-3 weeks. should progress through strengthening exdercises if pain free after intial 2 days of RICE and active ROM TERM 7

criteria for return after hip pointer

DEFINITION 7 full trunk ROM performance of sport-specific activity padding for protection during rehabilitation and RTP TERM 8

pathomechanics of injury to ASIS and AIIS

DEFINITION 8 contusion to apophysitis severe pain with disabiltiy should be assessed iwth xray (rule out avulsion) TERM 9

MOI for ASIS and AIIS

DEFINITION 9 sartorius and rectus femoris attachment violent, forceful passive stretch of hip into extension violent, forcefull active contraction into hip flexion TERM 10

rehab concerns and progression with ASIS

and AIIS

DEFINITION 10 should follow same gildelines as hip pointer after avulsion is rules out

PSIS contusion pathomechanics

must differentiate form vertebral fracture and possible internal organ injury avulsion fractures are usally rare while injury is often painful it usually does not cause diability TERM 12

PSIS contusion MOI and rehab concerns

DEFINITION 12 caused by direct blow or fall pain on palpation wtih swelling, possibly althered gait (choppy steps) possible postural disruption (forward flexion) severe cases may require 3 days rest prior to return to competition TERM 13

piriformis syndrome pathomechanics

DEFINITION 13 sciatic nerve may be irritated in conjuction with LBP possibly a traumatic injury- related to sciatic nerve passaged beneath priirofrmis piriformis irritation is more common inwomen tight musculature is often associated with syndrome HS injury can result in nerve or ischial bursa irritation sciatic nerve disruption may occur in conjuction with posterior dislocation of femoral head TERM 14

MOI piriformis syndrome

DEFINITION 14 most common cause is direct blow to buttocks also asscoiated iwth nerve irritation due to piriformis tightness/piercing TERM 15

rehab concerns - piriformis syndrome

DEFINITION 15 must rule out disk disease stretches indicated for sciatica may be conrraindicated for disk disease determine if athlete has LBP with irritation into extremityy or just nerve irritation- sciatica with piriformis syndrome, must assess gait ( reduced heel striek, foot flat landing, stride shortening, flexed knee to decrease nerve stretch) altered hip ROM due to pain

about groin injuries

full understanding of biomechanics, anatomy, and MOI are necessary to assess groin injuries could be a number of possible causes iwth respect to pain must consider abdominal, hip joint, lumbosacral and pelvic ocnditions when asessing groin injuries TERM 17

groin and hip flexor strain pathomechanics

DEFINITION 17 injury to muscles (generally adductor muscles) in adn around the groin region pain that develops (moderate to severe) that cna become disabling chronic strain can cause bleeding and result in development of myositis ossificans TERM 18

groin and hip flexor strain MOI And rehab

concerns

DEFINITION 18 result of overextending or ER the hip foreceful contraction into flexion and IR must differentiate between hip flexor and adductor strain monitor gait and pelvic motion during ambulation pain and swelling must be controlled as they will greatly limit the reocery process TERM 19

groin and hip flexor strain rehab and RTP

criteria for grade 1

DEFINITION 19 w/ a grade 1- gentle stretching can begin immediately progress to some progresive strengthening exercises (exmpahises adduction and hip flexion, PNF exercises should also be incorporated) time out form competition may be limited functionally oriented training should be incorporated (slide board, plyometrics, and sport specific drills) TERM 20

groin and hip flexor strain rehab and RTP for

grade 1

DEFINITION 20 should begin with immediate, gentle and pain free AROM exercises ice and stretch position wth iliopsoas involvement- decrease pain and spasm isometrics and gait retrainign should be incorporated as pain allows

osteitis pubis pathomechanics

pain i nregion of pubic symphysis dificult to determien injury unless complain of direct trauma contact is rendered pubic pain can also be caused by inferior ramus fx or groin strain often seen in athletes that make repetitive changes in drection (overuse) (soccer and football) TERM 22

osteitis pubis MOI

DEFINITION 22 repetitive stress on pubic symphysis caused by muscle attachment direct trauma or contact s/s will develop gradually TERM 23

osteitis pubis reahb concerns

DEFINITION 23 must rule out hernia and other medical conditoins (refer) xrasy may take 406 weeks to show anything significant athlete will have pain with running, sit ups and squats (lower ab pain, radiation to inner thigh, pain on palpation) altered gait due to pain prevent shearing motios and focos on core stabilization progress of CKC to OCK may occur due stabilization TERM 24

rehab progrssiona dn RTP for osteitis pubis

DEFINITION 24 rest and NSAIDs early on for pain and to limit shear forces acting on pelvis intiate pain-free adductor stretching and core stablization traing as pain allows OKC hip exercsises can be used early on when tolerated stabilization shyould be focused on to limit shear forces CKC maty be more comfy due to pelvic stabilization involved return may take from 3-5 days, to 3 weeks to 306 month return to plyometrics and functional drills will be dpeendent on pain TERM 25

quadriceps contusion pathomechanics

DEFINITION 25 direct blow to area can causemuscle compression wth femur blow to anterior surface is generally more severe than a blow to lateral surface lack of aggressive treatment can lead to mosistis ossificans s/s include pain, swelling, loss of function

MOI quad contusion

direct blow to involved area graded oncdiiton TERM 27

grade 1 rehab concerns and condition- quad

contusion

DEFINITION 27 require immediate RIC until all s/s are absent light stretching should begn almost immediately strengthening hsould be initiated on second day and continue to progress TERM 28

grade 2 rehab concerns and progression -

quad contusion

DEFINITION 28 treat conservatively with crutches suggested until normal gait is re-established RICE and modality use for pain and inflammatoin should continue gradual progression from isometric exercises (day 3) to stretching within the active range (3-5) to light exercise and conintued stretching suggested say 7-10 additional stre s tching and progressive restisnance traingin. look at slides.... TERM 29

snapping hip syndrome pathomechanics

DEFINITION 29 usually secondary to excesssive repetitive movements common in dancers, gymnasts, hurlders, sprinters primary cause is due to muscle imbalance between HF and HE TERM 30

cause of snapping in snapping hip syndrome

DEFINITION 30 IT band snaps over greater troc. and//or iliopsoas tendon over the iliopectineal eminence. snapping is generally felt with HF and ER

rehab concerns and tx of snapping hip

usually see the hip joint/capsule/muscles become loosened and allow jt to become unstable first step is to reduce pain and inflammation (ice,nsaids, US) second step is to restore ROM and regain strength (very important to peform strength analysis to determine where muscle imbalance is) strengthening program: entire hip, especially hip extensors and IR and ER groups Stretching: focus on hip flexors RTP: reume jogging in 305 days and light sport specific drills TERM 32

pathomechanics of distal radius

fractures

DEFINITION 32 simiple extra-articular, non-displaced fractures tend to heal without incident ( full or near full recovery) more involved fractures (intra-articular, comminuted) full return may not be as likely if volar tilt of radius is disrupted could lead to alterations in fuction disruption of normal anatomic lenght of radius TERM 33

distal radius fracture- what could happen if

volar tilt of radius is disrupted?

DEFINITION 33 mid carpal instability decreased strength increased ulnar loading dysfunctional distal radioulnar joint TERM 34

distal radius fracture- what happens if there is

a disruption of normal anatomical length

DEFINITION 34 possible distal radioulnar joint problems decreased mobility decreased power will require repair via external fixaiton TERM 35

MOI of distal radius

fracture

DEFINITION 35 FOOSH

rehab concerns with distal radius

fractures

early and proper reduction/immobilizaiton early ROM to non-involved joints is critical (prevent atrophy and aid in muscle pumping) complications of carpal tunnel possible tendon rupture (extensor pollicis longus_ TERM 37

rehab progression of distal radius

fractures

DEFINITION 37 early mobilization of unaffected joints- above and below inury after immobilization is complete wrist ROM must begin putty exercises can be used 1-2 weeks following immobilization begin AROM immediately (focus on wrist, not finger motion) PROM- start dependent on physician preference Work on pronationa nd supination (apply force at radius, not hand) TERM 38

criteria for return with distal radius

fracture

DEFINITION 38 non-displaced fracture may be able to return 2-3 weeks following initial injury with protection (should exhibit early sins of healing and no pain) with ORIF athlete may be able to return to play after 3 weeks (should be able to go without protection at 6 weeks) with displaced fracture, athlete will probably be out of competition for 6 weeks return to competition will also be dependent on sport and position TERM 39

wrist sprain

pathomechanics

DEFINITION 39 minor trauma to wrist diagnosis of exclusion TERM 40

wrist sprain

MOI

DEFINITION 40 result of fall or landing on outstretched hand twisting motion some impact ( striking ground with club) carrying things that are too heavy

wrist sprain rehab

concerns

rule out more serious injury pain, swelling management, ROM and strengthening. TERM 42

wrist sprain rehab

progression

DEFINITION 42 may require some immbolixaiton rollowing decrease in pain and swelling return of ROM and strength is essetial progression of exercises similar ot distal radius fracture scenario may require joint mobilizations to enhance arthrokinematics TERM 43

wrist sprain criteria for

return

DEFINITION 43 when comfotable taping may be necessary for support and decreased pain TERM 44

carpal tunnel pathomechanics

DEFINITION 44 compression of median nerve decreased space due to tenodn inflammation excessive wrist flexion and extensio present with neuroloogical signs and symptoms TERM 45

MOI carpal tunnel

DEFINITION 45 sustained girp and repetitive action of thrower and racket discomfort due to tenosynovitis pressure due to lipoma, diabetes or pegnancy may be result of acute trauma as well painters, seamtsress

Carpal Tunnel Rehab

Concerns

Conservative Symptomatic Treatment Rest, NSAIDs, task modificaiton splinting and rest (decreased ROM And inflammation) soft tissue work to relieve adhesions and improve symptoms carpal tunnel release requires wound care, soft tissue massage and ROM exercises tendon gliding- comprehensive approach wrist ROM will also require attention TERM 47

carpal tunnel rehab progression

DEFINITION 47 involves grip strength- avoid symptom aggravation introduce exercses 2-4 pweeks post surgery maintain upper body conditioning TERM 48

criteria for RTP carpal tunnel

DEFINITION 48 can continue to play with carpal tunnel may need to modify in order to continue to perform base activity level on symptoms athlete typically able to return to play following suture removal if surgery is rquired rarely necessary in athletes surgery- 2-3 mos TERM 49

ganglion cyst pathology

DEFINITION 49 etiology is unclear synovial cyst arising from synovial lining most commonly on dorsal aspect of hand treatable with primarily via aspiration some cases require surgery TERM 50

ganglion cyst MOI

DEFINITION 50 most often result of repeated wrist hyperextension pain is indication for treatment

ganglion cyst rehab concerns

rehab generally not required following aspiration surgical instances may require work on ROM, strengthening and scar management TERM 52

ganglion cyst rehab progression

DEFINITION 52 following excision and regaining ROM Stregntehning may be performed grip strength, wrist flexion and extension TERM 53

RTP criteria- ganglion cyst

DEFINITION 53 activity limited by pain if asymptomatic, athlete can participate if symptomatic, aspiration can occur with immediate RTP in instances of surgical excision, return generally occurs within 10 days (following suture removal) TERM 54

Boxers fracture pathomechanics

DEFINITION 54 fracture of 5th metacarpal nexk perfect anatomic reuction is not necessary (due to high level of mobility) increased angulation may result in imbalance of the intrinsic/extrinsic hand muscles clawing or mass in palm TERM 55

MOI boxers fracture

DEFINITION 55 often result of contact against an object with closed fist

Boxers fracture rehab concerns

skin integrity proper immobilization, pain and edema control (involved and uninvolved joints) ORIF- active motion can begin within 72 hours of procedure immobilizaiton options TERM 57

boxers fracture rehab progression

DEFINITION 57 uninvolved joints ROM should be maintained during splinting after 4 weeks of splinting, MCP ROM Should begin at 4-6 weeks, gentle resistance may begin with intcreasing intensity by week 6 TERM 58

boxers fracture RTP criteria

DEFINITION 58 signs of fracture healing stalbe, no pain with movement 3-4 weeks with protection always dependent on sport, position, an dathlete TERM 59

dequervain's tenosynovitis and tendinits

pathomechanics

DEFINITION 59 inflammation in first dorsal compartment (abductor polliciis longus and extensor pollicus brevis) aggravated by wrist radial and ulnar devation, flexion, abduction, adduction, and extension of the thumb TERM 60

Dequervains MOI

DEFINITION 60 caused by overuse weakness or poor body mechanics/posture repeated wrist radial and ulnar deviation occasionally result of direct blow

Dequervains Rehab concerns

rule out fracture or ligament injury if result of direct blow or fall on outstretched hand assess mechanics (poor shoulder strength/mechanics) treat pain and swelling- remove aggravating activities splinting and immobilization TERM 62

dequervains rehab progression

DEFINITION 62 NSAID's and modalities for pain immobilization pain-free stretching should begin immediately with decreased pain strengthening exercises can begin (begin with isometrics and move to gravity dependent/light weight exercises, then weight bearing and plyometrics) lots of stretching splinting is only to help inflammation stregnthen so dont use accessory muscles TERM 63

Ulnar collateral Ligament sprain

(gamekeeper's thumb) pathomechanics

DEFINITION 63 stretching or tearing of UCL (grade 3 will require surgery) be aware of disrupted stability (may require surgery depending on angulation) stener's lesion TERM 64

stener's lesion

DEFINITION 64 aponeurosis of add. pollicus. becomes interposed between ruptured UCL of thumb and insertion at base of prox. phal. TERM 65

UCL sprain

MOI

DEFINITION 65 torsional load applied to thumb forced abduction or fall on outstretched hand

UCL sprain rehab

concerns

early diagnosis and treatment are critical ( avoid instances of chronic instability, weakness and arthritis sequelae immobilization (spica) for grade 1 and 2 injuries surgical care followed by immobilization avoid radial stresses on thumb condition of uninvolved joints gutter splint from DIP through wrist to distal aspect of forearm TERM 67

UCL sprain rehab

progression

DEFINITION 67 following 5-6 weeks of protective splinting, AROM exercises for flexion and extension begin putty exercises for strength for 2-6 weeks following immobiliation TERM 68

UCL sprain RTP

criteria

DEFINITION 68 legnth of time determined by sport, position, and thumb involvement in sport possible splinting and taping options pain should be reduced and strength should be sufficient for return with surgical interventio- time loss minimum of 2 weeks depends on how long immobilzed TERM 69

Finger Joint Dislocation pathomechanics

DEFINITION 69 MCP dorsal or palmar dislocations ( hyperextension moment with rotation) reduction PIP dislocation more common than DIP, usually volar (generally associated with fracture) Incident of injury PIP vs DIP (dorsal vs volar) xray should be taken prior to reduction (assess possibility of fracture) open v closed reduction splint during all non playing times and buddy tape with biggest finger during play time TERM 70

finger joint dislocation MOI

DEFINITION 70 hyperextension force or compresive load force

finger joint dislocaiton rehab concerns

possible fracture involvement surgical intervention ROM concnerns pain, swelling, stiffness or loss of reduction TERM 72

finger joint dislocation RTP criteria

DEFINITION 72 dependent on complexity of injury dependent on sport and position played must involve input from all associated with injury repair play without protection generally by weeks 10- avoid early return due to chance of re-injury some protective taping may be applied early for protection TERM 73

MCP dislocation RTP criteria

DEFINITION 73 with support can return almost immediately if simple with surgical intervention athlete will be out a minimum of 2-3 weeks TERM 74

PIP dislocation RTP criteria

DEFINITION 74 without fracture and with appropriate protection can return almost immediately if more severe injury, time will increase iwth relation to sport TERM 75

DIP dislocation RTP criteria

DEFINITION 75 simple- may return immediately with appropriate protection fracture/surgical- 10 days with protection following suture removal

mallet finger pathomechanics

avulsion of terminal extensor tendon with or without fracture may require ORIF depending on severity cant extend DIP joint TERM 77

mallet finger MOI

DEFINITION 77 forced DIP flexion while held in extension TERM 78

mallet finger rehab concerns

DEFINITION 78 few concerns splinting and immobilization will be requried immediately following injury (6-8 weeks ) (neutral to slight hyperextensio) maintain ROM in non-injured joints TERM 79

mallet finger rehab progression

DEFINITION 79 after 6-8 weeks of splinting, ROM exercises can begin (night splinting may continue for 2 weeks) do not attempt to passively flex finger for 4 weeks blocked DIP exercises are important TERM 80

mallet finger RTP criteria

DEFINITION 80 permitted immediately if appropriate splinting occurs if unable to participate due to rules associated with activity, athlete will be out for 6-8 weeks leave nail bed out for cap refill

boutonniere deformity pathomechanics

PIP flexion with DIP extension interruption of central slip lateral slippage of extensor muscles when flexed deformity is present, injury becomes difficult to treat TERM 82

boutonniere deformity MOI

DEFINITION 82 extended finger is forcibly flexed TERM 83

boutonniere deformity rehab concerns

DEFINITION 83 early and proper diagnosis appropriate splinting ( full extension , splint modificatind ue to changes in swelling) avoid passive PIP flexion following splint removal be aware that injury will present as PIP flexion contracture initially prior to DIP hyperextension TERM 84

boutonniere RTP criteria

DEFINITION 84 return to activity when finger is comfortable affected finger must be splinted in full exnteion if sport does not allow for splinting of digits, ahtlete iwll be out for 8 weeks TERM 85

Cspine pain prevalence

DEFINITION 85 15% of population

what plays a vital role in cspine

posture TERM 87

roles of cpsine musculature

DEFINITION 87 isometric function dynamic function relationship to shoulders TERM 88

isometric function of cspine musculature

DEFINITION 88 posture stabilization TERM 89

dynamic function of cspine musculature

DEFINITION 89 position head for better sensory input proprioception sight, hearing, olfaction, etc TERM 90

cpsine musculature relationship to soulders

DEFINITION 90 elevaiton inspiration

common cspine injuries

trigger points cervical strain joint restriction (facets) cervical instability disc pathology radicular pain cervicogenic headache TERM 92

cspine

postures

DEFINITION 92 forward head /rounded shoulders anterior stiffness/tightness posterior muscles overactive to counteract chest breather= hyperactive accessory muscles TERM 93

cspine and modalities

DEFINITION 93 efficacy of modalities in isolation not very good, but significantly imiproves when used in combination with other treatments (manual therapy and exercise) TENS, IFC, Combo TERM 94

clinical prediction rule for factors for using

traction on cpsine

DEFINITION 94 peripheralization with mobility testing (C4-C7) age >

• cervical distraction
• upper limb tension test
• shoulder abduction test (79.2% success with 3 factors/ 94.8% success with 4 factors)BUT conflicting studies suggesting traction no better than manual therapy and exercise when treating chronic and/or radicular pain TERM 95

thoracic manipulation

DEFINITION 95 also has a clinical prediciton rule but hasnt been validated with research do show consistent long and short-term improvements in pain and neck disability

therapeutic exercise and cspine pain

an effective treatment for cspine pain- often combnied with manual therapy TERM 97

examples of cspine

exercises

DEFINITION 97 chin tuck maneuver chin tuck with bladder t band resistance prone tuck with retraction BTE TERM 98

progression of chin tuck with bladder

exercise

DEFINITION 98 increase pressure head elevated off table add movements: elbow flex/ext, shoulder ER/IR, shoulder abd/flex/ext, scap protract/depress/elevat, shoulder pnf move off table TERM 99

what is TRX?

DEFINITION 99 randy Hetrick, Navy Seal, developed in 2004 goal was to stay mission fit on the road workout system that leverages gravity and your body weight to perform various exercises allows you to manipulate how difficult exercises are by adjusting body position to add or decrease resistance TERM 100

TRX target Audience

DEFINITION 100 Tailored to individuals of all ages and activity levels from sedentary populations to the elite athlete MLB teams, UCF fighters, olympic cyclists, and runners, military personnel

TRX goals

total body core stability strength flexibility muscular endurance coordination and body awareness TERM 102

TRX scope

DEFINITION 102 uses body weight and resistance with gravity to create superior muscle balance, core strength, joint stability and mobility helping prevent injury and increase performance gives you a successful and sustainable method to allow you to achieve your best no matter what fitness level you may be at TRX training is versatile that anyone anywhere can use it anytime to exercise and improve fitness in life TERM 103

TRX content

DEFINITION 103 12 week training program for strength as well as cardio goals designed for growth and progressively gets more challenging each week can change any exercise each ewek to make it easier or more difficult to suit fitness needs 2 different strength workouts designed to be performed 2x per week cardio training involves skill rainig, speed training tempo work and longer runs TERM 104

TRX set

up

DEFINITION 104 secure to a solid anchor ; foot cradles 3" off ground when fully lenghtening using the door anchor with door that opens away adjust the length leg spotting not a pully offset foot position (rocking from back to front foot preventing rubbing (gap between strap and arm) TERM 105

vector resistance

DEFINITION 105 change in working angle and center of gravity increase difficulty by steepening the angle of starting position

principle of instability

controlling center of gravity over base of support to affect intensity TERM 107

pendulum principle

DEFINITION 107 only applies to suspended exercises when heels or toes are in the TRX (Ex crunch) increase difficulty by moving away from the anchor (neutral) TERM 108

video exercise library for

TRX

DEFINITION 108 gives modifications; ways to make it more difficult using basic concepts suspended lunge single leg squat sprinter's start tricep press side plank "y" deltoid raise TERM 109

TRX facilitation criteria

DEFINITION 109 versatility of TRX trainer allows you to perform each exercise at a level that is appropriate for your fitness level with simple changes in body position TERM 110

TRX modifications

DEFINITION 110 still useful with injured or weaker limbs can be used single-limbed body position can be adjusted to acquire most comfortable or least painful positions

TRX strengths

total body workout all fitness levels set up anywhere durable and light weight adjustable length TERM 112

weaknesses

DEFINITION 112 cost body positioning to begin exercise can sometimes be difficult TERM 113

recommendations for TRX use

DEFINITION 113 ability ot maintain body weight proper body position (readjust body position before continuing an exercise) ensure proper equipement set up