p.20
Muscle Injury Types and Treatments
Who is most commonly affected by avulsion fractures?
Young adults or children.
p.9
Stress Fractures in Athletes
What is a high-risk factor for stress fractures in female athletes?
Certain risk factors such as low bone density, menstrual irregularities, and inadequate nutrition.
p.10
Knee Anatomy and Ligament Injuries
What are the two types of stabilizers for the knee joint?
Dynamic stabilizers (tendons/muscles) and static stabilizers (ligaments ± meniscus).
p.1
Soft Tissue Injuries Overview
What are the main types of soft tissue injuries?
Muscle, tendon, knee, shoulder, and ankle injuries.
p.6
Knee Anatomy and Ligament Injuries
What are the components of the knee extensor mechanism?
Quadriceps tendon and Patellar tendon.
p.20
Muscle Injury Types and Treatments
What is an avulsion fracture?
An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What is the primary treatment for a torn Anterior Cruciate Ligament (ACL)?
Reconstruction, as torn ACLs do not heal.
p.19
Initial Management of Ankle Sprains
What defines a Grade III ankle sprain?
Complete disruption of the lateral ligamentous complex with significant swelling and instability.
p.20
Muscle Injury Types and Treatments
What happens to the tendon in an avulsion fracture?
The tendon remains intact while the bone is broken.
p.17
Meniscus Injuries and Management
How can bucket handle tears be identified?
Through imaging techniques such as MRI.
p.10
Knee Anatomy and Ligament Injuries
What is the function of the lateral collateral ligament?
Prevents varus deformities.
p.14
Anterior Cruciate Ligament (ACL) Injuries
What is the most common mechanism of injury for a PCL injury?
A direct blow to the proximal aspect of the tibia.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What is a notable difference in ACL injury prevalence between genders?
Females are 2-4 times more likely to suffer ACL injuries than males.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What is a common characteristic of swelling in ACL injuries?
Immediate swelling (hemarthrosis) is noted within 1-2 days of the injury.
p.14
Knee Anatomy and Ligament Injuries
What is the main function of the Medial Collateral Ligament (MCL)?
To resist valgus and external rotation loads.
p.5
Tendon Injuries and Tendinopathies
What surgical treatment is considered for Patellar Tendinopathy?
Excision of abnormal tendon tissue and longitudinal tenotomies after failed conservative treatment for at least 3-6 months.
p.14
Knee Anatomy and Ligament Injuries
What is the mainstay of treatment for isolated MCL injuries?
Conservative treatment, including crutches, PRICE, and anti-inflammatory medication.
p.14
Knee Anatomy and Ligament Injuries
When is surgical treatment indicated for MCL injuries?
Very rarely, if conservative treatment fails and there is a complete tear associated with other ligament injuries.
p.2
Muscle Injury Types and Treatments
What are the clinical features of a muscle strain?
Immediate pain, localized tenderness, +/- swelling, and pain/weakness with resisted contraction.
p.1
Initial Management of Ankle Sprains
What does the acronym PRICE stand for in injury management?
Protect, Rest, Ice, Compression, Elevation.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What is the primary function of the Anterior Cruciate Ligament (ACL)?
Prevents anterior translation of the tibia relative to the femur.
p.17
Meniscus Injuries and Management
Why is early detection of a bucket handle tear important?
To prevent further joint damage and to plan appropriate treatment.
p.5
Tendon Injuries and Tendinopathies
Why are corticosteroid injections administered around the tendon sheath?
To prevent weakness and tendon rupture.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What type of graft is commonly used in ACL reconstruction surgery?
Autograft from the patellar tendon or hamstring tendon.
p.18
Knee Anatomy and Ligament Injuries
What is a limb-threatening injury associated with knee dislocation?
Vascular injury, particularly to the popliteal artery or peroneal nerve.
p.16
Meniscus Injuries and Management
What is the first choice of surgical intervention for meniscus tears?
Repair whenever possible.
p.16
Meniscus Injuries and Management
What is the risk associated with partial meniscectomy?
Increased risk of osteoarthritis progression.
p.12
Anterior Cruciate Ligament (ACL) Injuries
What is the significance of tibial spine/eminence avulsion?
It is associated with ACL injuries.
p.15
Meniscus Injuries and Management
What is a common procedure for treating meniscus injuries?
Arthroscopic partial meniscectomy.
p.5
Tendon Injuries and Tendinopathies
What is the primary goal of treating Patellar Tendinopathy?
To reduce pain and return function.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What type of treatment is appropriate for asymptomatic patients with partial ACL injuries?
Nonsurgical treatment, which includes rehabilitation and activity modification.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What is a key component of nonsurgical treatment for ACL injuries?
Rehabilitation to strengthen hamstrings and quadriceps, along with proprioceptive training.
p.1
Muscle Injury Types and Treatments
What are the types of muscle contractions mentioned?
Shortening, lengthening, and no change of length.
p.18
Knee Anatomy and Ligament Injuries
Why is proper physical examination important in knee dislocations?
Most patients present with no dislocation due to spontaneous reduction.
p.4
Tendon Injuries and Tendinopathies
What symptoms are associated with Medial Epicondylosis (golfer’s elbow)?
Pain when flexing the wrist, pain extending from the elbow to the pinky, a weak grip, and pain when shaking hands.
p.8
Stress Fractures in Athletes
What is the recommended treatment for low-risk stress fractures?
Conservative treatment with rest and gradual reintroduction of activity.
p.4
Tendon Injuries and Tendinopathies
What are the signs of Quadriceps Tendinopathy?
Swelling around the quad tendon, sensitivity to touch, warmth or burning pain, and stiffness in the knee in the morning.
p.2
Muscle Injury Types and Treatments
What is a muscle strain?
The most common muscle injury in sports, often due to overuse or improper use.
p.3
Complications of Muscle and Tendon Injuries
How is scar tissue formed inside a muscle?
The space between ruptured muscle fibers fills with blood that clots and is gradually converted into connective tissue, forming scar tissue.
p.15
Meniscus Injuries and Management
What is the most important function of the meniscus?
Load-sharing across the knee joint by increasing contact area and decreasing contact stress.
p.9
Stress Fractures in Athletes
What can contribute to a female athlete's risk of stress fractures?
Low bone density and inadequate nutrition.
p.19
Initial Management of Ankle Sprains
What is the most common type of ankle sprain?
Lateral sprains, accounting for 85% of all ankle sprains.
p.17
Meniscus Injuries and Management
What imaging modality is most commonly used for diagnosing bucket handle tears?
Magnetic Resonance Imaging (MRI).
p.13
Anterior Cruciate Ligament (ACL) Injuries
Why is ACL reconstruction preferred over repair?
Repair has poor healing outcomes, while reconstruction replaces the ligament with a new one.
p.16
Meniscus Injuries and Management
Which tests may produce a palpable audible click with localized tenderness in meniscal pathology?
McMurray and Apley tests.
p.6
Knee Anatomy and Ligament Injuries
At what age is patellar tendon rupture more common?
In individuals under 40 years old.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What is the recommended treatment for older patients with ACL injuries who are asymptomatic?
Conservative treatment, as they are unlikely to participate in sports.
p.6
Knee Anatomy and Ligament Injuries
What is the abnormal finding in the Thompson test for Achilles tendon rupture?
Lack of plantar flexion when squeezing the calf.
p.2
Muscle Injury Types and Treatments
What is a muscle contusion?
An injury caused by a non-penetrating blunt force resulting in hematoma and inflammation.
p.3
Complications of Muscle and Tendon Injuries
What is a rare infection associated with muscle injuries?
Pyomyositis caused by S. aureus.
p.1
Initial Management of Ankle Sprains
What is a common initial management step for an ankle sprain?
Stop using the injured limb and pad to protect it.
p.7
Stress Fractures in Athletes
What are stress fractures?
Injuries that occur with overuse in the setting of normal bone mineral density (BMD).
p.19
Initial Management of Ankle Sprains
What characterizes a Grade II ankle sprain?
Moderate injury with partial tear, localized swelling, and possible mild laxity.
p.1
Muscle Injury Types and Treatments
What is the goal of the prevention of recurrent injury protocol?
To protect the limb, minimize swelling, decrease inflammation, and decrease pain.
p.8
Stress Fractures in Athletes
What causes stress fractures?
Intense and repetitive exercise without adequate rest.
p.19
Initial Management of Ankle Sprains
What are the surgical indications for ankle sprains?
When nonsurgical treatment fails to control symptoms for grade III ankle instability.
p.16
Meniscus Injuries and Management
When is surgical intervention indicated for meniscus tears?
If there are mechanical symptoms, failure of conservative treatment, or a locked knee.
p.15
Knee Anatomy and Ligament Injuries
How common are LCL injuries compared to MCL injuries?
LCL injuries are less common than MCL injuries.
p.3
Complications of Muscle and Tendon Injuries
Why do muscles heal by scar formation?
Muscles do not have the ability to regenerate, leading to fibrosis and permanent weakness.
p.8
Stress Fractures in Athletes
What is a common cause of insufficiency fractures?
Reduced bone mineral density and elastic resistance.
p.3
Complications of Muscle and Tendon Injuries
What is Myositis Ossificans?
Bone formation (calcification) within muscle secondary to blunt trauma.
p.2
Delayed Onset Muscle Soreness (DOMS)
What is Delayed Onset Muscle Soreness (DOMS)?
Muscular pain that occurs 1-3 days after vigorous exercise, primarily associated with eccentric loading.
p.3
Complications of Muscle and Tendon Injuries
What is the treatment for muscle laceration?
Irrigation and debridement followed by suture repair of the fascia, if possible.
p.17
Meniscus Injuries and Management
What is a bucket handle tear?
A type of meniscus tear that resembles a handle of a bucket.
p.10
Knee Anatomy and Ligament Injuries
What does the anterior cruciate ligament (ACL) prevent?
Anterior tibial translation over the femur.
p.10
Knee Anatomy and Ligament Injuries
What are common types of knee ligament injuries?
ACL, MCL, LCL, PCL injuries.
p.12
Anterior Cruciate Ligament (ACL) Injuries
How is an Anterior Cruciate Ligament (ACL) injury primarily diagnosed?
Mainly diagnosed by H&E; investigations are usually not needed.
p.8
Stress Fractures in Athletes
What happens to bone resorption and formation in stress fractures?
Bone resorption exceeds bone formation.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What can cause instability in patients after the initial pain and swelling have resolved?
The ligament did not heal, leading to intermittent episodes of instability.
p.14
Knee Anatomy and Ligament Injuries
What is the typical mechanism of injury for an MCL injury?
A direct blow to the lateral aspect of the knee.
p.6
Knee Anatomy and Ligament Injuries
What does patella baja indicate?
Quadriceps tendon rupture.
p.2
Muscle Injury Types and Treatments
What is the primary treatment method for muscle injuries?
Conservative treatment including RICE, analgesia, and immobilization.
p.8
Stress Fractures in Athletes
What is the treatment protocol for high-risk stress fractures?
Immediate non-weight bearing cast immobilization and possibly surgical intervention if nonoperative treatment fails.
p.2
Muscle Injury Types and Treatments
What typically causes muscle tears?
Excessive tensile force (eccentric load) leading to overstraining of myofibers.
p.3
Complications of Muscle and Tendon Injuries
What are late clinical features of Myositis Ossificans?
Painless swelling with decreased range of motion.
p.9
Stress Fractures in Athletes
Who is at high risk for stress fractures?
Female athletes with specific risk factors.
p.7
Muscle Injury Types and Treatments
What is an avulsion injury?
A piece of bone attached to a ligament or tendon breaks away from the main part of the bone.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What is a common symptom of ACL injuries in the acute phase?
Pain, swelling, and instability.
p.1
Muscle Injury Types and Treatments
What should be done during the acute phase of a muscle injury?
Immobilize in maximum muscle length position and apply the PRICE protocol.
p.6
Knee Anatomy and Ligament Injuries
Which tendon rupture is more common, patellar or Achilles?
Achilles tendon rupture is more common than patellar tendon rupture.
p.6
Knee Anatomy and Ligament Injuries
What are the predisposing factors for tendon ruptures?
Steroid use, chronic disease, tendinopathy, and fluoroquinolone antibiotics like Ciprofloxacin.
p.19
Initial Management of Ankle Sprains
What is the initial treatment for an ankle sprain?
RICE (Rest, Ice, Compression, Elevation) and functional treatment.
p.4
Tendon Injuries and Tendinopathies
What are the two main types of tendon injuries?
Overuse tendinopathies and tendon rupture.
p.13
Anterior Cruciate Ligament (ACL) Injuries
Why do ACL injuries have poor healing?
Because the ACL is an intracapsular ligament with low blood supply.
p.2
Muscle Injury Types and Treatments
What are the three types of muscle contractions?
Contraction, elongation (eccentric), and isometric.
p.6
Knee Anatomy and Ligament Injuries
What is the most common occurrence of Achilles tendon rupture?
During sporting activities.
p.6
Knee Anatomy and Ligament Injuries
What sensation do patients often report during an Achilles tendon rupture?
A 'pop' or the sensation of being kicked in the heel.
p.4
Tendon Injuries and Tendinopathies
What symptoms indicate De Quervain’s disease?
Pain and swelling near the base of the thumb, difficulty moving the thumb and wrist, and a 'sticking' sensation in the thumb.
p.3
Complications of Muscle and Tendon Injuries
Who is at high risk for complications like compartment syndrome?
Patients with bleeding disorders, such as hemophilic patients.
p.15
Meniscus Injuries and Management
How do meniscus tears differ in middle-aged and older adults?
They can occur from squatting or falling due to degenerative changes in the meniscus cartilage.
p.19
Initial Management of Ankle Sprains
What is the classification of a mild ankle sprain?
Grade I: Mild injury with no ligamentous disruption, mild swelling, and no laxity.
p.14
Anterior Cruciate Ligament (ACL) Injuries
What is the primary function of the Posterior Cruciate Ligament (PCL)?
To restrain posterior tibial translation in the intact knee.
p.5
Tendon Injuries and Tendinopathies
What are some conservative treatment methods for Patellar Tendinopathy?
Rest, physiotherapy (stretching and eccentric strengthening), corticosteroid injections, ice, analgesics, orthotics, and braces.
p.13
Anterior Cruciate Ligament (ACL) Injuries
When is surgical treatment recommended for ACL injuries?
For athletes wishing to return to cutting and pivoting sports or for individuals in physically demanding occupations.
p.2
Muscle Injury Types and Treatments
What types of muscles are most at risk for injury?
Muscles whose origin and insertion cross two joints.
p.18
Knee Anatomy and Ligament Injuries
Which ligaments are typically injured in a knee dislocation?
ACL, PCL, and one of the collateral ligaments.
p.18
Knee Anatomy and Ligament Injuries
What should be considered a spontaneously reduced knee dislocation?
A bicruciate injury (ACL+PCL) or a multiligament knee injury involving three or more ligaments.
p.13
Anterior Cruciate Ligament (ACL) Injuries
What is the role of ACL sports braces?
They have not been shown to prevent abnormal anterior tibial translation.
p.8
Stress Fractures in Athletes
What differentiates the treatment for compression side and tension side fractures?
The treatment is totally different based on the type of side affected.
p.4
Tendon Injuries and Tendinopathies
What are the symptoms of Achilles Tendinopathy?
Increasing pain at the back of the leg or heel, stiffness in the tendon, swelling and tenderness at the ankle, and crepitus when moving the ankle.
p.2
Muscle Injury Types and Treatments
What are the common regions involved in muscle contusions?
Quadriceps and Brachialis muscles.
p.2
Muscle Injury Types and Treatments
What are the grades of muscle tears?
Grade 1: Mild, Grade 2: Partial tear, Grade 3: Complete tear.
p.1
Initial Management of Ankle Sprains
What is the purpose of applying a supportive bandage?
To help relieve swelling, control damage, and prevent further injury.
p.19
Initial Management of Ankle Sprains
What is a high ankle sprain?
A syndesmosis injury, accounting for 1-10% of all ankle sprains.
p.18
Knee Anatomy and Ligament Injuries
What is the common cause of multiligament knee injuries?
High-energy trauma, low-energy trauma in obese patients.
p.19
Initial Management of Ankle Sprains
What role does proprioceptive training play in ankle sprain recovery?
It is important as proprioception is often affected in ankle injuries.
p.4
Tendon Injuries and Tendinopathies
What are the symptoms of Rotator Cuff Tendinopathy?
Pain and swelling in the front of the shoulder, pain triggered by arm movement, a clicking sound, and stiffness.
p.16
Meniscus Injuries and Management
What are some nonsurgical management options for meniscus tears?
Ice, NSAIDs, and physical therapy for range of motion and strengthening.
p.5
Tendon Injuries and Tendinopathies
What factors contribute to the development of tendinopathies?
Repeated mechanical loading and hypovascularity of the tendon.
p.8
Stress Fractures in Athletes
What are the characteristics of high-risk stress fractures?
They can become complete fractures and often occur in bones with tension and compression sides.
p.15
Knee Anatomy and Ligament Injuries
What is the typical mechanism of injury for LCL injuries?
Varus strain, often resulting from motor vehicle accidents and athletic injuries.
p.18
Knee Anatomy and Ligament Injuries
What is the first step in managing a knee dislocation?
Emergent closed reduction and splinting or bracing.
p.15
Meniscus Injuries and Management
What are common causes of meniscus injuries in adolescents?
Twisting injuries or changes in direction, often during weight-bearing activities.
p.17
Meniscus Injuries and Management
What are the typical imaging findings of a bucket handle tear?
A displaced meniscal fragment that appears as a 'handle' on imaging.
p.16
Meniscus Injuries and Management
What are common findings during the physical examination of meniscus tears?
Small joint effusions and joint line tenderness with palpation.
p.10
Knee Anatomy and Ligament Injuries
What is the role of the posterior cruciate ligament (PCL)?
Prevents posterior tibial translation over the femur.
p.4
Tendon Injuries and Tendinopathies
What is the primary function of tendons?
To transfer force from muscle to bone to produce joint motion.
p.10
Knee Anatomy and Ligament Injuries
What is a significant concern associated with knee dislocation?
It is considered a red flag.
p.8
Stress Fractures in Athletes
What is the progression from microfractures to stress fractures?
Microfractures can lead to stress fractures with continued intense exercise.
p.11
Anterior Cruciate Ligament (ACL) Injuries
What is the mechanism of injury for most ACL injuries?
Cutting or pivoting movements.
p.4
Tendon Injuries and Tendinopathies
What are the symptoms of Hamstring Tendinopathy?
Pain near the knee joint radiating up the thigh, swelling in or around the knee or thigh, especially with repetitive activity.
p.12
Anterior Cruciate Ligament (ACL) Injuries
What is a common complication of ACL disruptions?
Injuries to other ligaments, such as MCL sprains.
p.12
Anterior Cruciate Ligament (ACL) Injuries
What is a kissing bone contusion lesion?
Bone contusions where there is edema on both surfaces of the joint.
p.3
Complications of Muscle and Tendon Injuries
How long after an injury does Myositis Ossificans become apparent?
Approximately 2 to 4 weeks post-injury.
p.14
Anterior Cruciate Ligament (ACL) Injuries
What is a common scenario that leads to a PCL injury in athletes?
A fall onto the flexed knee with the foot in plantar flexion.
p.14
Anterior Cruciate Ligament (ACL) Injuries
What are the treatment options for a PCL injury?
Non-operative treatment is preferred unless there is a combined ligament injury or symptomatic grade 3, which may require PCL reconstruction.
p.7
Stress Fractures in Athletes
What are common symptoms of stress fractures?
Insidious onset of pain worsened by impact activity and alleviated by rest.
p.6
Knee Anatomy and Ligament Injuries
What is the most significant clinical sign of a tendon rupture?
Inability to perform active knee extension.
p.4
Tendon Injuries and Tendinopathies
What characterizes Lateral Epicondylosis (tennis elbow)?
Tenderness on the outside of the elbow, morning stiffness, persistent aching, and worsened pain when grasping objects.
p.15
Knee Anatomy and Ligament Injuries
What is the primary function of the Lateral Collateral Ligament (LCL)?
The LCL is the primary restraint to varus stress at 5° and 25° of knee flexion.
p.12
Anterior Cruciate Ligament (ACL) Injuries
What causes the 'pop' sound in an ACL tear?
The impact between the tibial and femoral condyles.
p.3
Complications of Muscle and Tendon Injuries
What is a major complication of muscle injuries?
Scar formation and muscle weakness.
p.18
Knee Anatomy and Ligament Injuries
What should be done if pulses remain abnormal after reduction of a knee dislocation?
Immediate vascular surgery consultation with intraoperative exploration.
p.16
Meniscus Injuries and Management
What is the sensitivity of the Thessaly test for meniscus injuries?
89% for medial meniscus (MM) and 92% for lateral meniscus (LM).
p.7
Stress Fractures in Athletes
What is a critical factor for the early diagnosis of stress fractures?
A high index of suspicion.
p.6
Knee Anatomy and Ligament Injuries
At what age is quadriceps tendon rupture more common?
In individuals over 40 years old.
p.5
Tendon Injuries and Tendinopathies
What is the difference between tendinopathy and tendonitis?
Tendinopathy involves degeneration, not inflammation, as confirmed by biopsy.
p.18
Knee Anatomy and Ligament Injuries
What is the significance of the ankle-brachial index (ABI) in knee dislocation?
An ABI of less than 0.90 is considered abnormal and may indicate vascular injury.
p.5
Tendon Injuries and Tendinopathies
What are some other modalities used in the treatment of Patellar Tendinopathy?
Ultrasound (U/S), extracorporeal shockwave therapy (ESWT), iontophoresis, and phonophoresis.
p.15
Meniscus Injuries and Management
What is the anatomy of the menisci?
The menisci are crescent-shaped with a triangular appearance on cross-section; the lateral meniscus covers 84% of the condyle surface, while the medial meniscus covers 64%.
p.18
Knee Anatomy and Ligament Injuries
What should be done post-reduction to confirm knee reduction?
Post-reduction radiographs should be taken.
p.3
Complications of Muscle and Tendon Injuries
What is the recommended management for Myositis Ossificans?
Conservative management unless it is large, then surgical excision may be necessary.
p.3
Complications of Muscle and Tendon Injuries
What are early clinical features of Myositis Ossificans?
Pain, swelling, decreased range of motion, erythema, warmth, induration, and tenderness.
p.3
Complications of Muscle and Tendon Injuries
What is Rhabdomyolysis?
Skeletal muscle necrosis that can occur due to crush injuries, leading to myoglobin in circulation and renal impairment.
p.15
Meniscus Injuries and Management
What symptoms are associated with acute meniscus tears?
An effusion may develop slowly hours after injury, with localized pain to the joint line and mechanical symptoms like locking or catching.
