Bridgewater College



Athletic Injuries and Conditions Project 2015Gina TolomeiNovember 23, 2015Section 1: General Musculoskeletal Disorders & Inflammatory ConditionsArthritisDefinition: The inflammation of the jointsEtiology/Mechanism: Osteoarthritis is one form of arthritis. It is the wear and tear to the cartilage surrounding the joint. This can cause bone damage over a period of time, leading to pain and restricted movement.Signs and Symptoms: PainStiffnessSwelling/inflammation of joints, tendons, ligaments, and bonesRednessDecreased range of motionFatigueMuscle weaknessJoint degenerationManagement: Medications (NSAIDs and corticosteroids)Exercises (walking, swimming, cycling)Surgery (joint replacement and joint fusion)Differential Diagnosis: Lyme diseaseRheumatoid arthritisInfectionReferences: "Arthritis." Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 30 Aug. 2015.O'Connor, Bob, Richard Budgett, Christine Wells, and Jerry Lewis. Sports Injuries and Illnesses: TheirPrevention and Treatment. Ramsbury, Marlborough, Wiltshire: Crowood. 1998. 116-117. Print.Starkey, C., & Brown, S. (2015). Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 88-90.EnthesitisDefinition: Inflammation at the tendon/muscle attachment. It is the connection between muscle tissues and bone fragments, where it can cause inflammation or even calcification and fibrosisEtiology/Mechanism: caused by joint disease and is a main sign of spondyloarthritisSigns and Symptoms:Soreness and inflammation of heel, as well as toes and fingertipsSoreness and/or swelling of knee, pelvis and upper bodyManagement:MethotrexateNSAIDsTNF blockersDifferential Diagnosis:Achilles tendonitisRheumatoid arthritisOsteoarthritisReactive arthritisDiffuse idiopathic skeletal hyperostosisReferences: . Enthesitis | Types, Pain, Symptoms and Treatments. 2015. 5 Sept. 2015.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010.138. Print.EpiphysitisDefinition: inflammation of the epiphysis, which is the end of a long bone. Etiology/Mechanism: most common in infants, affecting the hip, shoulder, and kneeSigns and Symptoms:Management:Differential Diagnosis:References:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 52. Print.Fibrositis (Fibromyalgia)Definition: a chronic noninflammatory condition Etiology/Mechanism: cause still remains unknown; disturbed sleep pattern, along with extreme weight gain, injury, emotional trauma, withdrawal from medication, or a sudden stopping of exercising.Signs and Symptoms:Severe musculoskeletal pain, mostly located in neck and lower backSleep disturbancesFatigueDepressionManagement:Educating the patientCounselingExercisingBetter sleeping habitsMedications (antidepressants, muscle relaxants, NSAIDs, other neurological medications)Chiropractic treatmentsAcupunctureDifferential Diagnosis:DepressionChronic fatigue syndromeMyofascial pain syndromeHypothyroidismRheumatoid arthritisReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 324-325. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010.201. Print.LymphangitisDefinition: an inflammation of the lymphatic channelsEtiology/Mechanism: streptococcal bacteria is one of the most common causesSigns and Symptoms:Deep reddening of skinWarmthLymphandentitisRaised border over affected areaChillsHigh feverModerate painSwellingManagement:Hospitalization, along with taking vitalsThe affected area has to be elevated, warm, as well as compressed moistureAntibioticsFluid intakeDifferential Diagnosis:Myositis CellulitisReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 917. Print. “Lymphangitis: MedlinePlus Medical Encyclopedia.” U.S. National Library of Medicine. U.S. National Library of Medicine. Web. 13 Nov. 2015.LymphadenitisDefinition: inflammation of one’s lymph nodesEtiology/Mechanism: caused by an infection such as strep throat, measles, ear infections, abscessed tooth, mononucleosis, and HIV.Signs and Symptoms:Pain and tenderness in lymph nodesSwelling of lymph nodesManagement:If the swollen lymph nodes are caused by an infection, the most common treatment is antibioticsIf it’s due to an immune disorder, the treatment is based off of that disorderIf it’s due to cancer, depending on the type, treatment options could be surgery, radiation, or chemotherapyDifferential Diagnosis:Strep throatEar infectionMeaslesReferences: “Swollen lymph nodes.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 12Sept. 2015.MyositisDefinition: inflammation of connective tissue within muscleEtiology/Mechanism: possible causes include infection, injury, certain medications, exercise, and chronic diseaseSigns and Symptoms:Muscle weaknessTiredness and fatigueTrouble climbing stairs, standing from a seated position, or reaching upDifficulty swallowingManagement:MedicationsPhysical therapySupplements Differential Diagnosis:Lymphangitis References: Learn About Myositis - TMA - The Myositis Association. 1 March 2015. Web. 12 Sept. 2015.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2000. 672. Print.Myositis OssificansDefinition: a buildup of calcium deposits from repeated blowsEtiology/Mechanism: the same area of the body that has been bruised over and over by repeated blows; genetic formation of abnormal tissueSigns and Symptoms:SwellingWarmthPain at injury siteManagement:Protection – some sort of padding to help eliminate more blows to the areRest – allows the calcium to be reabsorbedDifferential Diagnosis:ContusionTear tumor (osteosarcoma)Exostosis References: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). NewYork, NY: McGraw-Hill Companies, Inc, 2014. 251. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia,PA: F.A. Davis Company, 2015. 82. Print.NeuritisDefinition: the inflammation of a nerveEtiology/Mechanism: Many forces that have been repeated for a period of timeSigns and Symptoms:PainTenderness Minor nerve problemsParalysisManagement:Refer to a physicianDifferential Diagnosis:Plexitis References: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). NewYork, NY: McGraw-Hill Companies, Inc, 2014. 261. Print.The Editors of Encyclopedia Britannica. “Neuritis (pathology).” Encyclopedia Britannica Online. Encyclopedia Britannica. Web. 13 Nov. 2015.OsteomyelitisDefinition: an infection caused by bacteria or a fungus eventually affecting the boneEtiology/Mechanism: caused by a staphylococcus bacteria and can enter through the bloodstream, a nearby infection, and direct contaminationSigns and Symptoms:Fever or chillsIrritabilityPain in are of infectionSwellingWarmthRednessManagement:MedicationsSurgeryHyperbaric oxygen therapy Differential Diagnosis:GoutStress fractureCellulitisReactive bone marrow edemaReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 418-419. Print. “Osteomyelitis.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 6 Sept. 2015.Periostitis (Medial Tibial Stress Syndrome)Definition: inflammation of the periosteum of tibiaEtiology/Mechanism: excessive pronation or prolonged pronation of foot, causing eccentric contraction of soleusSigns and Symptoms:Dull pain begins during workout, may change to sharp and penetratingPain feels better when resting, but may reoccur hours after activityPoint tenderness along distal posteromedial tibial borderPain aggravated with active plantar flexionManagement:5-7 days restModalities (NSAIDs, heel pads, casting, crutches, activity modification)Pain-free stretchingDifferential Diagnosis:Stress fractureAchilles tendon strain/sprainReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 114. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 510. Print.RadiculitisDefinition: radiating pain along spinal nerve root that causes inflammationEtiology/Mechanism: pressure on spinal nerveSigns and Symptoms:Pain radiating along involved nerveManagement:Refer to physicianDifferential Diagnosis:Spinal strains/sprainReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 125. Print.“Radiculitis – Radiculitis Treatment – Bonati Spine Institute.” Bonati Spine Institute. Web. 13 Nov. 2015. SynovitisDefinition: congestion in the active joint with edemaEtiology/Mechanism: when the joint has been injured multiple times or even the joint could be improperly managedSigns and Symptoms:Restricted movementsGrindingCracklingSwellingManagement:Differential Diagnosis:References: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 399. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). NewYork, NY: McGraw-Hill Companies, Inc, 2014. 254. Print.Section 2: HeadCerebral ConcussionDefinition: blow to the head, causing altered mental statusEtiology/Mechanism: a direct blow to the headSigns and Symptoms:HeadacheNauseaVomiting Loss of consciousnessMemory lossDizzinessBalance problemsFatigueTrouble sleepingDrowsinessSensitivity to light or noiseBlurred visionDifficulty rememberingDifficulty concentratingManagement:Remove from participationEvaluationsShould not return to play until no longer experiencing symptomsRestDifferential Diagnosis:Subdural hematomaEpidural hematomaIntracerebral hemorrhageSecond-impact syndromeSkull fractureReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 36. Print.Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 559-562. Print.Epidural HematomaDefinition: bleeding in brain above the dura matter, usually arterial bleedingEtiology/Mechanism: direct blow to side of head and almost always associated with a skull fractureSigns and Symptoms:Loss of consciousness at time of injuryFeels relatively normal at first, then within 10-20 minutes a decline in mental statusIncreased headacheDrowsinessNausea and vomitingDecreased level of consciousnessDilated pupil on side on hematomaContralateral weaknessDecerebrate postureManagement:Activate EMSMaintain ABC’sAssess vitalsTreat for shockSurgery is needed to decompress hematoma and control arterial bleedingDifferential Diagnosis:Skull fractureSubdural hematomaCerebral contusionReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 52. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 185-186. Print.Migraine HeadacheDefinition: severe, unilateral headache lasting 4-72 hoursEtiology/Mechanism: Not sure of exact causeTriggers includeAspartameCaffeineMonosodium glutamateNicotineNitratesAlcoholCheeseChocolateMissed mealsPerfumeRed grapesToo much/too little sleepStressBright lightsStrong odorsChange in altitudeSigns and Symptoms:PhotophobiaPhonophobiaNauseaVomitingDizzinessManagement:Over-the-counter drugs (ibuprofen, naproxen, caffeine, NSAIDs)Stress reductionDifferential Diagnosis:HeadacheReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 96. Print.Anderson, M., Parr, G., Hall, S. Foundations of Athletic Training: Prevention, Assessment, and Management (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2009. 730-733. Print.Malignant Brain Edema SyndromeDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Post-Concussion SyndromeDefinition: symptoms following a mild head injury that ends up lasting for weeks to months after the concussionEtiology/Mechanism: occurs within the first 7-10 days and go away within 3 months, however it could last for a year or moreSigns and Symptoms:HeadachesDizzinessFatigueIrritabilityAnxiety and depressionInsomniaLoss of concentration and memoryNoise and light sensitivityManagement:Medications for migraines or headaches, as well as for depression and anxietyCognitive therapy to help with possible memory and thinking problemsDifferential Diagnosis:ConcussionReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 119. Print.“Post-concussion syndrome.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web.7 Sept. 2015. Scalp LacerationDefinition: jagged cut on scalpEtiology/Mechanism: caused by blunt or penetration traumaSigns and Symptoms:Complains of being hit in the headExcessive bleedingManagement:Control bleedingPrevent contaminationAssess for possible skull fractureIce and pressure bandage to control hemorrhage and edemaRefer to physician if not improved in 24 hoursDifferential Diagnosis:AbrasionsFacial fractureReferences:Anderson, M., Parr, G., Hall, S. Foundations of Athletic Training: Prevention, Assessment, and Management (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2009. 232. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010.138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 824. Print.Second Impact SyndromeDefinition: a head injury occurs when the symptoms of the previous head injury has not been resolvedEtiology/Mechanism: direct blow to the head a second time while still having symptoms from first blow Signs and Symptoms:Similar symptoms to concussionMay appeared stunnedAs vascular engorgement within cranium increases intracranial pressure, brain stem becomes compromisedAthlete collapses with rapidly dilated pupils, progressing to loss of eye movement, coma, respiratory failureManagement:On the field= removal of helmet or pads to allow for intubation, transport to emergency roomMay have to go in surgically to decompressDifferential Diagnosis:Subdural hematomaEpidural hematomaIntracerebral hemorrhageConcussionSkull fractureReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 135. Print.Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 566. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 190. Print.Skull FractureDefinition: fracture to skull bone; types include linear, comminuted, depressed, or basilarEtiology/Mechanism: severe blow to headSigns and Symptoms:Visible deformityDeep laceration or severe bruise to scalpPalpable depression or crepitusUnequal pupilsDiscoloration under eyes (Raccoon eye’s) or behind ear (Battle’s sign)Bleeding or CSF from nose and/or earLoss of smellLoss of sight or major vision disturbancesUnconsciousness from more than 2 minutes after direct traumaManagement:Immediate managements= transported in reclining position, any open wounds should be covered with sterile gauze bandageSurgery to fixed displaced bones (if any)Postinjury/postoperative= treat occipital and basilar condyle fractures with cervical collar, bed rest, then modified activityMedications (aspirin, ibuprofen, acetaminophen, etc.) for painDifferential Diagnosis:Subdural hematomaEpidural hematomaIntracerebral hemorrhageConcussionSecond-impact syndromeReferences:Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 567-568. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 183-184. Print.Subdural HematomaDefinition: bleeding in the brain below the dura matter, usually venous bleeding; can be acute or chronic, and simple or complicatedEtiology/Mechanism: acceleration forces of head, rather than an impact of forceSigns and Symptoms:AcuteBleeding associated with cortical arterial bleedingRapid loss of consciousnessChronicBleeding from cerebral veins/s may not become apparent for hours, days, or weeks after injurySimpleLess likely to be rendered unconsciousSeldom demonstrate deterioration in level of consciousnessComplicated Rapid accumulation of bloodIntracerebral swelling leading to increased intracranial pressureKnocked out and remains unconsciousPupillary dilation and retinal changes on affected sideReduced pulseGradual increase in blood pressureVomiting Dysnea Management:Activate EMSMaintain ABC’sAssess vitalsTreat for shockSurgical drainage of hematomaDifferential Diagnosis:Epidural hematomaCerebral contusionReferences:Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 142. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 186. Print.Section 3: FaceFacial LacerationDefinition: cut on faceEtiology/Mechanism: tearing of tissue due to traumaSigns and Symptoms:PainSubstantial bleedingObvious tearing of epidermis, dermis, and subcutaneous layer of skinManagement:Referred to physician for suturing or Steri-stripsClean before suturing to prevent infectionSystemic antibiotics and tetanus prophylaxis may be necessaryDifferential Diagnosis:Facial fractureAbrasionReferences:Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book,1996. 68. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 826. Print.Maxilla FractureDefinition: fracture to maxilla bone; may involve separation of palate, extend into nasal region, or complete craniofacial dissociationEtiology/Mechanism: direct impact to upper jawSigns and Symptoms:Maxilla may be mobile, giving a longer face appearanceNasal bleedingEcchymosis in cheek or buccal regionMalocclusionNasal deformityFlattening and splaying of naso-orbital regionManagement:Maintaining airwayPlace in forward sitting position to allow drainage of saliva and bloodIce pack over area to control swelling, do not add pressure or compressionRefer immediately to physicianDifferential Diagnosis:Nasal fractureOrbital blowout fractureReferences:Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 198-199. Print.Mandibular FractureDefinition: direct blow to mandibleEtiology/Mechanism: blunt trauma to jaw on anterior or lateral aspectsSigns and Symptoms:SwellingImproper alignment of teethDifficulty opening mouthPain with biting down or not able to bite downIntraoral bleedingChewing is limitedCrepitus with palpationManagement:NSAIDs or narcotic analgesics for painDisplaced fractures need to be reduced by jaws wired together for 4-6 weeks or putting in plates and screwsNondisplaced fractures need to be observed and have a diet of soft foodsDifferential Diagnosis:TMJ sprain or dislocationTooth fractureReferences: Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 586-588. Print.Temporomandibular Joint DislocationDefinition: TMJ muscles are relaxed and there is a lateral blow to mandibleEtiology/Mechanism: direct blow to move mandible laterally, sneezing, eating, or when mouth is widely openSigns and Symptoms:Pain when opening and closing mouthMay be unable to open and close mouthMalocclusion of teethCrepitus with palpationDeformity of fracture siteManagement:Reduce dislocationNSAIDs or narcotic analgesics for painAfter reduction, restricted from opening mouth widely for 2 monthsDifferential Diagnosis:Mandibular fractureReferences: Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 588-589. Print.Temporomandibular Joint DysfunctionDefinition: encompasses pain, decreased range of motion, audible noises, and pain when opening and closing mouthEtiology/Mechanism: blow received on point of chin or across jawSigns and Symptoms:Jaw painPossible clicking at jointMouth may open and close asymmetricallyMay meet mechanical block during range of motionPalpation may detect tenderness, crepitus or clickingManagement:Over-the-counter anti-inflammatory medicationsMoist heatFocusing on normal biomechanicsInjected or oral corticosteroids (possible)Mouthguard-type splintsChronic or unrelenting cases may require surgeryDifferential Diagnosis:Mandibular fractureReferences: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 843-844. Print.Zygoma FractureDefinition: force to the cheekbone, causing a fracture to zygomatic boneEtiology/Mechanism: direct blow to faceSigns and Symptoms:Bruising at impact siteDepression of zygomatic boneEye in downward slantManagement: Ice pack over area to control swelling, but avoid pressure and compressionReferred immediately to physicianCan be reduced surgicallyDifferential Diagnosis:Orbital fractureMalar fractureMandible fractureFacial contusion References: Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 580-582. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2000. 198. Print.Section 4: EarAuricular HematomaDefinition: inflammation of external ear caused by repeated friction; also known as “Cauliflower Ear”Etiology/Mechanism: single or repeated trauma to external ear, resulting in subcutaneous hematomaSigns and Symptoms:SwellingRedness of ear and possibly ear canalEcchymosis Hearing and balance may be impairedManagement:Small needle is used to drain hematomaOnce drained, ear should be casted with pieces of plaster casting materials or gauze and flexible collodion to prevent further fluid accumulationProphylactic antibiotics to reduce chance of infectionChronic may require surgeryDifferential Diagnosis:noneReferences: Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 16. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 832-834. Print.Impacted CerumenDefinition: wax in ear canalEtiology/Mechanism: excessive wax build up in external auditory canalSigns and Symptoms:Loss of hearingTinnitusPossible painManagement:Refer to physicianDifferential Diagnosis:Otitis externaReferences:Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 58. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 301. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Otitis ExternaDefinition: the inflammation or infection of external auditory canal (outer ear) and tympanic membrane; also known as “Swimmer’s Ear”Etiology/Mechanism: patients with smaller inner ear canals, patients with ear canals that slope downward, patients who are swimmers or who are apart of other water sports, and patients who excessively clean their ears can have otitis externaSigns and Symptoms:PainItchingBurning with possible drainageScaling or crustingInflammation outside ear canalManagement:Apply ear drops (3-4 times daily)Oral analgesics for painDifferential Diagnosis:Acute otitis mediaImpacted cerumenCellulitisRupture tympanic membraneReferences: Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 109. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 300-301. Print.Otitis MediaDefinition: inflammation of the middle earEtiology/Mechanism: caused by nose and throat infectionSigns and Symptoms:Otalgia (ear ache)FeverFeeling of fullness in earDizzinessTinnitusHeadacheDiminished hearingManagement:Amoxicillin Differential Diagnosis:Otitis externaTemporomandibular joint (TMJ) dsyfunctionReferences: Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 109. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 301-302. Print.Tympanic Membrane RuptureDefinition: a tear to the eardrum of earEtiology/Mechanism: sudden change in air pressure by a blunt trauma or infection and even sticking objects in ears (e.g. cotton swabs) can cause the membrane to ruptureSigns and Symptoms:Audible whistling soundsDecreased hearingPurulent fluid or bleeding from earMay be painlessOtoscope may reveal redness and perforationManagement:Small ruptureCan heal itselfOver-the-counter analgesics for painIf caused by infection, drying agent drops and oral antibioticsInstruct to prevent water from entering (during showering and swimming)Large ruptureSurgical procedure involving graft of surgical paper, fat, muscle or other material to help repairDifferential Diagnosis:Otitis mediaOtitis externaImpacted cerumenInfectious myringitisReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 302-303. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 835. Print.Section 5: EyeConjunctivitisDefinition: inflammation of the conjunctiva; also known as “Pink Eye”Etiology/Mechanism: can be caused by bacteria, viruses, allergies or dry eye; response to a corneal injury or irritationSigns and Symptoms:RednessBurningItchingTearingIrritationForeign body sensation Management:Topical antibiotic eye drops or ointmentsAllergic conjunctivitis: over-the-counter topical ophthalmic antihistamine or decongestant productsDifferential Diagnosis:Viral conjunctivitisBacterial conjunctivitisAllergic conjunctivitisReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 272-273. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 836. Print.Corneal AbrasionDefinition: a scratch on the surface of cornea, causing a defect in the epithelium Etiology/Mechanism: direct trauma with a foreign objectSigns and Symptoms:Feeling of something in eye (foreign body sensation)Decreased visionTearingSensitivity to lightBlepharospasm (abnormal blinking)Reactive conjunctivitis Management:Lubrication with artificial tearsTopical antibiotic drop or ointmentTopical nonsteroidal inflammatory drop for painEye patch for 24-48 hours to prevent rubbing of eyelid over abrasionBandage contact lens= soft contact lens that protects from movements of eyelidDifferential Diagnosis:Foreign body stuck in eyeConjunctivitis References: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 274-276. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 836-837. Print.Corneal LacerationDefinition: laceration to cornea of eyeEtiology/Mechanism: caused by sharp objects (fingernail, darts, skate blades, broken glass)Signs and Symptoms: Decreased visionPainHyphemaDense subconjunctival hemorrhageDecreased eye movementBloody tearsManagement:Surgical repair, with intravenous and topical antibioticsDifferential Diagnosis:Hyphema Corneal abrasionReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 276. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 205. Print.Detached RetinaDefinition: one or more holes/tears in retinaEtiology/Mechanism: can be caused by illness, injury, or hereditary; holes/tears can be caused by shrinkage due to old age or sudden movement of vitreous humorSigns and Symptoms:Brief flashes of light (photopsia)“floaters”Curtain or shadow moving over field of visionManagement:Patch both eyesRefer to ophthalmologistRepair surgicallyDifferential Diagnosis:Posterior vitreous detachment (PVD)References: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 278-279. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 205. Print.HordeolumDefinition: infection of sebaceous gland of eyelash or eyelash follicle; also known as a “stye”Etiology/Mechanism: caused by a staphylococcal organism that has been spread by rubbing or by dust particlesSigns and Symptoms:Starts as erythema of eye and changes into pustule within a few daysRedness of eyePainManagement:Hot, moist compresses to eyeIf does not improve within 2 days, physician may need to prescribe topical ointmentDifferential Diagnosis:ConjunctivitisCorneal abrasionReferences:Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 204. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 838. Print.HyphemaDefinition: collection of blood in anterior chamber of eyeEtiology/Mechanism: blunt trauma to the eye; the blood comes from a damaged vessel in iris or ciliary bodySigns and Symptoms: PainBlurred visionManagement:Bed restWhen sleeping, head should be slightly elevatedTopical steroidsPupil-dilating drops (mydriatics)Eye pressure-lowering (if required)Differential Diagnosis:Ruptured globeCorneal abrasionDislocated lensTraumatic cataractBleeding in vitreous cavityIncreased intraocular pressureRetinal tear/detachmentReferences: Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. 71. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 273-274. Print.Orbital HematomaDefinition: varies from mild bruise to an extremely serious condition affecting vision to fracturing the orbital cavity; also known as “black eye”Etiology/Mechanism: eye may be bruised by direct contactSigns and Symptoms:Subconjunctival hemorrhageFaulty visionManagement:Cold application for 30 minutes24-hour rest period if patient has distorted visionNo blowing of noseDifferential Diagnosis:Skull fractureNasal fractureMandibular fractureOrbital blowout fractureReferences:Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 835. Print.Orbital Blowout FractureDefinition: the blunt trauma can cause a sudden increase in pressure in orbit of eye; this pressure can cause the orbital walls to breakEtiology/Mechanism: caused by blunt traumaSigns and Symptoms:Pain with eye movementDouble visionNumbnessRestricted eye movements in looking up or looking downDecreased sensation in cheek or upper lip on same side as injuryMisalignment of orbital rim when palpating“crunchy” sensation under skin of orbitManagement:Ice for 24-48 to reduce swellingCover eyeSurgical repair may be required if fracture is largeDifferential Diagnosis:Zygomatic fractureNeuropathy of ocular motor nervesReferences: Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. 592-595. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 277-278. Print.Section 6: MouthDental CariesDefinition: represent a multifaceted disease that includes interaction between teeth, microflora, saliva, and diet; “tooth decay”; can be classified as pit-and-fissure, smooth surface, cemental, and recurrentEtiology/Mechanism: occurs when bacteria accumulates on enamel surface of tooth forming plaque, which produces acids that cause tooth decaySigns and Symptoms:Initially will look white and chalky, will change to brown or blackRed, swollen gumsSensitivity to hot and coldRoughness of toothCavitiesManagement:Good dental hygieneProper nutritionReferred to dentist (annual visits)Can be repaired with fillings, or if more serious crowns are placedDifferential Diagnosis:GingivitisPeriodontitisFractured teethOral lesionsReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 311-312. Print.GingivitisDefinition: inflammatory condition of gums caused by bacteriaEtiology/Mechanism: food and not removed due to poor dental hygiene causes plaque depositsSigns and Symptoms:Red, swollen gumsBrushing causes pain and bleeding of gumsBad breathBad taste in mouthManagement:Aggressive oral hygiene program to stimulate gingivaeMore flossing, use of dental picks, and oral stimulatorsIf too advanced antibiotics, tooth scaling, and removal of plaque below gum line may be necessaryDifferential Diagnosis:Lacerations to gumsOral lesionsTooth decayReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 311. Print.PeriodontitisDefinition: receding gum line and loss of alveolar boneEtiology/Mechanism: may occur if gingivitis is left untreatedSigns and Symptoms: Tooth sensitivityRed, swollen gumsPain and bleeding with brushingPossible loosening of toothManagement:Good dental hygieneRegular dental visitsAntibioticsTooth scalingRemoval of plaque below gum lineDifferential Diagnosis:Lacerations to gumsOral lesionsTooth decayReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 311. Print.Tooth AbscessDefinition: infected tooth at root of gum and toothEtiology/Mechanism: decay into nerve of tooth; trauma; periodontal diseaseSigns and Symptoms:Severe painTooth hurts more when heat appliedFeels relief when cold appliedHurts to lie downSwelling of gum lineTooth may be looseManagement:Refer to dentistDifferential Diagnosis:GingivitisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 201. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 43. Print.Tooth FractureDefinition: visible fracture to enamel, dentin, pulp, and/or root of toothEtiology/Mechanism: trauma to toothSigns and Symptoms:Class 1 – sensitive from trauma; fracture in enamel onlyClass 2 – sensitive to elements; fracture into dentin, with no pulpal involvementClass 3 – pain and bleeding; fracture of crown with pulpal involvementClass 4 – severe pain and bleeding; fracture of rootManagement:Refer to dentistDifferential Diagnosis:Tooth avulsionReferences:Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 46. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 201. Print.Tooth ExtrusionDefinition: the tooth is partially withdrawn from bone and may be tilted anteriorly or posteriorly or may be twistedEtiology/Mechanism: trauma to mouthSigns and Symptoms:Soreness and possible bleeding from mouthLoose teethManagement:Refer to dentistDifferential Diagnosis:Tooth avulsionTooth intrusionTooth abscess References: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 839-840. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 49. Print.Tooth IntrusionDefinition: depression of tooth into alveolar process relative to contiguous teeth and to its match on opposite sideEtiology/Mechanism: trauma to toothSigns and Symptoms:TendernessBleedingTooth may be looseManagement:Refer to dentistDifferential Diagnosis:Tooth avulsionTooth extrusionReferences: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 839. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 48. Print.Tooth AvulsionDefinition: tooth being displaced from alveolar process completelyEtiology/Mechanism: direct traumaSigns and Symptoms:PainTooth out of socketBleedingPossible lacerated gumManagement:Refer to dentist with maxillofacial expertiseKeep tooth moistDifferential Diagnosis:Tooth intrusionTooth extrusionTooth fractureReferences: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 840. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 44. Print.Section 7: NoseDeviated SeptumDefinition: difference between spacing in nares and angulation of septumEtiology/Mechanism: blow to the side of the noseSigns and Symptoms:PainSwellingEpistaxis (bloody nose)Feeling of nasal obstructionAppears narrow on one sideManagement:Stop bleeding and reduce swellingCorrecting deviated septum with surgeryDifferential Diagnosis:Nasal fractureSeptal hematomaForeign bodyReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 305-306. Print.EpistaxisDefinition: blood coming from nose; can be anterior or posterior bleedsEtiology/Mechanism: erosion of mucosa that causes vessels to become exposed; can or cannot be trauma relatedSigns and Symptoms:BleedingComplaining of swallowing or spitting bloodLocal causesNose picking, excessive blowing, sneezing, rubbing of noseSystemic causesIntrinsic coagulopathies (hemophilia)Acquired coagulopathies (use of blood thinners or long-term aspirin use)Management:Direct pressure applied to noseHave patient sit with head elevatedPinching of nose should be done for 4-5 minutesCotton or gauze pad may be inserted to absorb bloodApply cold pack to noseRolled cotton gauze pad between anterior upper lip and gumDifferential Diagnosis:Deviated septumNasal fractureSeptal hematomaReferences: Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 306-307. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 846. Print.Nasal FractureDefinition: force to nose, resulting in fracture of nasal boneEtiology/Mechanism: direct blow to the noseSigns and Symptoms:Pain on and around noseBleedingDeformitySwelling in and around noseEcchymosis under inferior aspect of eyes (“raccoon eyes”)Crepitus and tenderness during palpationBreathing through nose may be obstructed Management:Physician referral Differential Diagnosis:Epistaxis resulting from URISinus conditionsNasal cartilage pathologySeptal hematomaReferences: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 835-836. Print.Section 8: Cervical SpineBrachial Plexus StretchDefinition: transient, unilateral neuropraxia due to traction of brachial plexus or compression of cervical nerve root; stinger or burnerEtiology/Mechanism: traction injury to shoulder or compression injury to neck; common in football and wrestling; most commonly involves C5-C6 nerve distributionSigns and Symptoms:Intense sharp, unilateral “burning” paresthesia or weakness in upper extremityManagement:Remove from activity until all symptoms are resolvedIf injury occurred from axial load injury or bilateral should warrant urgent evaluationRecurrent symptoms or symptoms lasting more than 24 hours should receive an MRI to rule out cervical spine stenosis and HNPStrengthening program from neckProtective neck collarNo back-pack wear, weight lifting, or any traction to affected armAvoid repetitive flexion-extension activitiesDifferential Diagnosis:Herniated discCervical stenosisReferences: Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones andBartlett Publishers, 2006.65. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010.138. Print.Cervical Vertebra Dislocation/SubluxationDefinition: joint dislocation within cervical vertebra; incomplete or partial dislocation of cervical vertebraeEtiology/Mechanism: most commonly resulting from hyperflexion or hyperextension and rotation of cervical spineSigns and Symptoms:Pain in cervical spineChest painNumbnessWeaknessParesthesia radiating in extremitiesCervical muscle spasmLoss of bladder or bowel controlTenderness, swelling, crepitus over cervical spineManagement:Maintain cervical spine stabilization, cervical collar applied, and spine boardedRefer to physicianSurgeryVertebral fusionCervical instabilityResidual neurological deficitSpinal stenosisPermanent malignantOnce cleared, demonstrate strength and ROMDifferential Diagnosis:Brachial plexus neuropathyIntervertebral disc injuryCervical vertebra sprainInjury of cervical musculatureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 879-880. Print.Cervical Vertebra FractureDefinition: break in a cervical vertebraEtiology/Mechanism: axial loading of cervical vertebra from force on top of head combined with flexion of neckSigns and Symptoms:Neck point tendernessRestricted movementCervical muscle spasmCervical painPain in extremities and chestNumbness in trunk and/or limbsWeakness or paralysis in trunk and/or trunkLoss of bladder and/or bowel controlManagement:Maintain cervical spine stabilization, cervical collar applied, and spine boardedDifferential Diagnosis:Brachial plexus neuropathyIntervertebral disc injuryCervical vertebra sprainInjury of cervical musculatureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A. Davis Company, 2015. 879-880. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 776-777. Print.Cervical Intervertebral Disc Rupture/HerniationDefinition: tear of intervertebral disc; varied levels of protrusion, extrusion, or sequestrationEtiology/Mechanism: develops from extruded posterolateral disk fragment or from degeneration of the discSigns and Symptoms:Neck painRestricted movementRadicular pain in upper extremityMotor weaknessSensory changesManagement:RestImmobilization of neck to decrease discomfortCervical tractionDifferential Diagnosis:Brachial plexus neuropathyIntervertebral disc injuryCervical vertebra sprainInjury of cervical musculatureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 784. Print.Cervical Nerve Root CompressionDefinition: contusion of nerves around cervical vertebraeEtiology/Mechanism: indirect trauma; lateral flexion of neckSigns and Symptoms:NumbnessParesthesiaHyperflexion or lateral flexion of neck on same side as symptoms may cause pain and/or numbnessTenderness over posterior aspect of neckDecreased sensation and reflexesMuscle weaknessPain on downward pressure of head with chin in supraclavicular fossa on same side as injuryManagement:Refer to neurologist or neurosurgeonDifferential Diagnosis:Spinal cord injuryCervical fractureCervical disc ruptureReferences: Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 89. Print.Spinal Cord InjuryDefinition: trauma to spinal cordEtiology/Mechanism: Axial loading to cervical spine with associated swellingIndirect trauma to skull or faceShockSigns and Symptoms:Immediate loss of neurologic function including motor weakness and loss of sensationBladder or bowel dysfunctionManagement:Call EMSMaintain cervical spine stabilizationMinimize additional trauma to spinal cordRefer to neurosurgeonDifferential Diagnosis:Laceration by bony fragmentsHemorrhageContusionCervical cord neuropraxiaReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 780-781.Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 90-91. Print.Intervertebral SprainDefinition: stretching or tearing of ligaments between cervical vertebraeEtiology/Mechanism: sudden snap of headSigns and Symptoms:Tenderness over transverse and spinous processesPain may be experienced the day after traumaPain stems from inflammation of injured tissue and a protective muscle spasm that restricts motionManagement:Refer to physicianSoft cervical collar to reduce muscle spasmRICE for 48-72 hoursCryotherapy or heat and massageDifferential Diagnosis:FractureDislocationDisc injuryReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 780. Print.Cervical Spine StrainDefinition: cervical muscle/tendon stretch or tearEtiology/Mechanism: excessive and rapid range of motion with muscles and ligaments of the neckSigns and Symptoms:Nonradicular neck and shoulder pain worsened by motion of neckDecreased cervical range of motionMusculature spasm in neckManagement:RestAnti-inflammatory medicationsIce massageConsider short-term rest neck in soft collarMuscle relaxantsRange of motion rehabilitationWork on postureDifferential Diagnosis:Cervical spondylosisCervical fractureCervical radiculopathyMeningitisMyofascial painReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 57. Print.Section 9: Lumboscaral SpineLumbar Vertebral Dislocation/SubluxationDefinition: bony fragments moving into spinal canal and damaging spinal cord and spinal nervesEtiology/Mechanism: only occur with associated fracture; due to orientation of facet joints in lumbar vertebraeSigns and Symptoms:Localized, palpable pain that may radiate down nerve root if bony fragments compress spinal nerveManagement:Maintain stabilization and spine boardX-raysBed restDifferential Diagnosis:Vertebral fractureDisc ruptureReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 785-786. Print.Anderson, M., Parr, G., Hall, S. Foundations of Athletic Training: Prevention, Assessment, and Management (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2009. 322. Print.Lumbar Vertebral FractureDefinition: direct blow to low back during contact sports (football, rugby, soccer, basketball, hockey, lacrosse)Etiology/Mechanism:Compression fracture Hyperflexion of trunk Falling from a height and landing on feet or buttocksUsually crushed anteriorly by traumatic force of body above injury siteFractures of transverse or spinous processesKicks or another direct impact to backSince surrounded by large muscles, may produce extensive soft-tissue injurySigns and Symptoms:Compression fractures are hard to find without an x-rayFractures of transverse or spinous processesPoint tendernessLocalized swellingMuscle guardingManagement:Maintain stabilization and spine boardX-raysDifferential Diagnosis:Intervertebral disc ruptureDislocation/subluxationNerve root compressionReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 785-786. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 231. Print.Lumbar Intervertebral Disc Rupture/HerniationDefinition: degeneration/tears/cracks in annulus fibrosus of lumbar discs in lumbar vertebrae; can be prolapsed, extruded, or sequestratedEtiology/Mechanism: forward bending and twisting that places abnormal strain on lumbar region; compressive loadingSigns and Symptoms:Sharp, centrally located pain that radiates unilaterally in dermatomal pattern to buttocks down back of leg, or pain spreads across backWeakness of lower limbPain is worse in the morning with axial loadingForward bending and sitting increase painTendernessManagement:Modalities to decrease pain (ice or electrical stimulation)Manual traction combined with passive backward bending or extensionReduce protrusion and restore normal posture (teach posture self-correction exercises)Back extensor and abdominal strengthening when pain and posture are normalRefer to neurosurgeonDifferential Diagnosis:Lumbar intervertebral fractureDislocation/subluxationNerve root compressionReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York, NY: McGraw-Hill Companies, Inc, 2014. 788-790. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 87. Print.Lumbar Nerve Root CompressionDefinition: contusion of nerves around lumbar vertebraeEtiology/Mechanism: indirect trauma; lateral flexion of neckSigns and Symptoms:NumbnessParesthesiaHyperflexion or lateral flexion of neck on same side as symptoms may cause pain and/or numbnessTenderness over posterior aspect of neckDecreased sensation and reflexesMuscle weaknessPain on downward pressure of head with chin in supraclavicular fossa on same side as injuryManagement:Refer to neurologist or neurosurgeonDifferential Diagnosis:Spinal cord injuryCervical fractureCervical disc ruptureReferences: Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 89. Print.SpondylitisDefinition: inflammation of vertebral synovial joints; “backache”Etiology/Mechanism: unknown causeSigns and Symptoms:Pain longer than 3 monthsStiffness affecting sacroiliac jointRadiating pain in one or both legsGradual limitations to ROMTenderness in sacroiliac jointManagement:X-raysRefer to orthopedic surgeonDifferential Diagnosis:SciaticaSpondylolysisSpondylolisthesisSpondylosisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 232. Print.SpondylosisDefinition: ankyloses of vertebraEtiology/Mechanism: repeated minor trauma; disk trauma due to incident; changes in lumbar vertebral body’s interspaces related to chronic discopathySigns and Symptoms:Increased back pain with activityPossible radiating painLoss of functionPain on hyperextensionPossible hypalgesiaManagement:X-rayMyelogramRefer to orthopedic surgeonDifferential Diagnosis:SciaticaSpondylolysisSpondylolisthesisSpondylitisDisc rupture/herniationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 235. Print.SpondylolysisDefinition: vertebral degeneration; pars interarticularis defectEtiology/Mechanism: movements that hyperextend spineSigns and Symptoms:Persistent mild to moderate back aching pain across low backStiffness in low backLow back area feels tired and fatigues easilyChanges positions quicklyFeels weak when straightening from forward bendingTenderness to localized segmentManagement:Bracing to reduce painBed rest 1-3 days to reduce painRehabilitation exercises to control or stabilize hypermobile segmentDynamic core stabilization exercisesDifferential Diagnosis:DiscitisSheuermann’sHNPSciaticaSpondylosisSpondylolisthesisSpondylitisDisc rupture/herniationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 790-791. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 283. Print.SpondylolisthesisDefinition: “step defect”; pars interarticularis defect with forward vertebral slippageEtiology/Mechanism: direct blow, sudden twist, or chronic low back painSigns and Symptoms:Persistent mild to moderate back aching pain across low backStiffness in low backLow back area feels tired and fatigues easilyChanges positions quicklyFeels weak when straightening from forward bendingTenderness to localized segmentManagement:Bracing to reduce painBed rest 1-3 days to reduce painRehabilitation exercises to control or stabilize hypermobile segmentDynamic core stabilization exercisesDifferential Diagnosis:DiscitisHNPCompression fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 790-791. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 286. Print.Intervertebral SprainDefinition: stretching or tearing of ligaments between vertebrae; most common is lumbar facet jointsEtiology/Mechanism: bending forward and twists while lifting or moving some objectSigns and Symptoms:Localized pain just lateral of spinous processPain becomes sharper with certain movementsLimited movement in painful rangesManagement:RICEJoint mobilizationsStrengthening exercises for abdominals and back extensorsTrunk stabilization exercisesBrace should be worn to limit movement during early return to activityDifferential Diagnosis:Lumbosacral sprainSpondylosisSpondylolisthesisSpondylitisSpondylolysisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 787. Print.Lumbar Spine StrainDefinition: stretching or tearing of ligaments in lumbar regionEtiology/Mechanism: forward bending and twisting that places abnormal strain on lumbar regionSigns and Symptoms:Pain will increase with passive flexion and active or resisted extensionDiscomfortManagement:Control pain and hemorrhageIcePassive stretching of low backCorset-type brace to compress areaRefer to physician in moderate to severe casesNSAIDs or muscle relaxantsDifferential Diagnosis:Sacroiliac sprainSciaticaIntervertebral sprainReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 786. Print.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 228. Print.Section 10: Thorax/Abdomen/Urogenital OrgansSudden Death SyndromeDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References: Celiac Plexus SyndromeDefinition: wind knocked outEtiology/Mechanism: direct trauma to celiac plexus by external object causing paralysis of diaphragm muscleSigns and Symptoms:PainTrouble breathing normallyAnoxiaHysteriaManagement:Differential Diagnosis:References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 199. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 215. Print.Rib ContusionDefinition: bruised ribEtiology/Mechanism: direct blow to rib cageSigns and Symptoms:Pain is sharp during breathingPoint tendernessPain is elicited when rib cage is compressedManagement:RICEAnti-inflammatory agentsRest and cessation to strenuous activitiesDifferential Diagnosis:Rib fractureSternal contusionCostochondral fracture/separationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 856. Print.Costochondral FractureDefinition: separation with fracture of cartilage between ribsEtiology/Mechanism: direct blow to anterolateral aspect of thorax or indirectly from sudden twist or fall on some object compressing rib cageSigns and Symptoms:Sharp pain during movement of trunkDifficulty breathing deeplyPoint tendernessSwellingRib deformityRib making crepitus noise when moving in and out of placeManagement:RestImmobilization by a rib braceDifferential Diagnosis:Rib contusionRib fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 199. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 857. Print.Chondrosternal SprainDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References: Costovertebral SprainDefinition: stretch of a ligament between ribs and vertebraeEtiology/Mechanism: trauma or overuse; stretching of costovertebral ligaments due to direct or indirect force applied to joint; compression of ribs; twisting of trunkSigns and Symptoms:Pain on active movement, passive stress, breathingLoss of function of thoracic movementRadiating pain on side of injuryPain in scapular areaPoint tenderness over ligamentSwellingHemorrhageInflammationPossible deformity with third-degree injuryManagement:X-rayRefer to orthopedistDifferential Diagnosis:Rib fractureCostochondral separationVertebral fracture References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 219. Print.Rib FractureDefinition: discontinuation of a rib boneEtiology/Mechanism: direct or indirect traumas and can be a result of muscular contractionsSigns and Symptoms:Severe, sharp pain during inhalation and expirationPoint tendernessCrepitus during palpationManagement:Refer to physician for x-raysSupport and restDifferential Diagnosis:Bruised ribCostovertebral joint sprainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 856-857. Print.HerniaDefinition: protrusion of internal tissues through abdominal/inguinal wallEtiology/Mechanism: Occur after birthAggravated by a direct blow, strain, abnormal intra-abdominal pressureCan be indirect, direct, and femoralSigns and Symptoms:Visible, tender swellingAching feeling in groin areaProtrusion increases with coughingFeeling of weakness and pulling sensation in groinManagement:Surgery Differential Diagnosis:Hip strain/sprainHydroceleVaricoceleReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 267. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 870-871. Print.HydroceleDefinition: fluid in tunica vaginalis of scrotum or along spermatic cordEtiology/Mechanism: Persistence of patent procesus vaginalisResult of an imbalance between scrotal fluid production and absorptionSigns and Symptoms:Usually asymptomaticIncreased fluid collection can cause scrotal achingManagement:Patients who are asymptomatic should be observed until they become symptomaticSurgerymay participation in athletics unless it becomes symptomatic or has been surgically repairedDifferential Diagnosis:inguinal herniavaricoceleReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 203-204. Print.VaricoceleDefinition: dilation of pampiniform venous plexus and internal spermatic veinEtiology/Mechanism: unclear etiology; occur in about 20% of adult male populationSigns and Symptoms:usually on left sidegenerally asymptomaticaching pain or heaviness in scrotumsoft thickening above testiclefeeling like a “bag of worms”Management:no medical treatment for patients who are asymptomaticsurgery involves ligation of involved veinscan return 2 to 6 weeksDifferential Diagnosis:hydroceleinguinal herniaReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 204. Print.Kidney Contusion/LacerationDefinition: bruise/tear of kidneyEtiology/Mechanism: direct contact or fallSigns and Symptoms:PainNauseaPossible shock, vomiting, hematuriaMuscle spasm in back musclesReferred pain in costovertebral area and lower abdominalManagement:Call EMSMaintain open airway and monitor breathingSupine with knees flexedTreat for shockMonitor vital signsTransport to hospitalDifferential Diagnosis:Costovertebral joint sprainRib fractureRib contusionCostochondral separationAbdominal muscle strainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200, 227. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 249. Print.Liver Contusion/LacerationDefinition: bruise/tear of liverEtiology/Mechanism: hard blow to right side of rib cage can tear/contuse liverSigns and Symptoms:HemorrhageShockReferred pain just below right scapula, right shoulder, substernal areaOccasional referred pain in anterior left side of chestManagement:Referral to physicianCall EMSMaintain open airway and monitor breathingSupine with knees flexedTreat for shockMonitor vital signsTransport to hospitalDifferential Diagnosis:HepatitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200, 227. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 865. Print.Spleen Contusion/LacerationDefinition: bruise/tear of spleenEtiology/Mechanism: fall or direct blow to left upper quadrant of abdomen when patient has existing medical condition that caused splenomegalySigns and Symptoms:History of severe blow to abdomenShockAbdominal rigidityNausea/vomitingReflex pain 30 minutes after injury (Kehr’s sign)Management:Call EMSMaintain open airway and monitor breathingSupine with knees flexedTreat for shockMonitor vital signsTransport to hospitalDifferential Diagnosis:MononucleosisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200, 227. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 869-870. Print.PeritonitisDefinition: inflammation of peritoneumEtiology/Mechanism: infection or trauma to peritoneum; involve stomach or appendixSigns and Symptoms:ChillsFever to 102 degrees FNausea/vomitingPainTenderness to abdomenPositive rebound testRapid breathing and pulseDiarrhea Management:Refer to general surgeonDifferential Diagnosis:AppendicitisLaceration to peritoneumReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 257. Print.Pneumothorax Definition: a collapsed lung, air is trapped inside pleural spaceEtiology/Mechanism: absence of traumatic injury to chest or lungsSigns and Symptoms:Pleuritic chest painShortness of breathTachypneicCough that exacerbates chest painMild respiratory distressLittle chest wall motion on affected sideShift of trachea away from affected sideDecreased or absent breath soundsManagement:Call EMSMaintain open airway and monitor breathingPosition seatedTreat for shockMonitor vital signsTransport via EMSDifferential Diagnosis:AsthmaTuberculosisPneumoniaCystic fibrosisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 200, 227. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. 142-143. Print.Section 11: ShoulderSternoclavicular Joint SprainDefinition: tearing or stretching capsule or ligaments of sternoclavicular jointEtiology/Mechanism: Indirect force applied to joint through clavicle (landing on outstretched arm)Anteriorly or posteriorly directed forces exerted on anterolateral or posterolateral shoulderSigns and Symptoms:Pain at SC joint areaPressure on neurovascular network can cause paresthesia in upper extremityPain increases with any shoulder motion at SC jointDeformity SwellingManagement:IceSling immobilizationROM for cervical spine and upper extremityWhen pain and swelling decrease, begin strengthening surrounding musclesDifferential Diagnosis:Proximal clavicle fractureSternal fractureFirst rib fractureMedial clavicle epiphyseal injuryPneumothorax References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 646-651. Print.Acromioclavicular JointDefinition: stretching or tearing of acromioclavicular and/or coracoclavicular ligamentEtiology/Mechanism:Repetitive stress or degeneration associated with agingFalling on AC joint areaForce applied longitudinally to clavicle (landing on outstretched arm)Signs and Symptoms:Deformity of clavicle (step deformity or piano key sign)Pain with overhead motionsManagement:Immobilization for pain controlWork on ROM and strengthening exercisesNSAIDsUltrasound-guided local corticosteroid injectionsDifferential Diagnosis:Distal clavicle fractureScapular fracture (coracoid)Rotator cuff pathologySLAP lesionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 653-656. Print.Glenohumeral Joint SprainDefinition: stretching or tearing of glenohumeral ligamentsEtiology/Mechanism: Arm forced into abductionArm forced into external rotationDirect blow shoulderSigns and Symptoms:Pain during arm movementDecreased range of motionPain during palpationManagement:Ice 24-48 hoursElastic or adhesive compressionRestImmobilization in slingCryotherapy or ultrasoundMild passive and active exerciseWhen patient regains for range of motion with no pain, begin resistance exercise programDifferential Diagnosis:Rotator cuff tendinitisSubacromial bursitisGlenoid labrum tearAcromioclavicular joint injuryReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 674-675. Print.Glenohumeral Dislocation/SubluxationDefinition: shoulder joint displacementEtiology/Mechanism:SubluxationExcessive translation of humeral head without complete separation of joint surfacesCan occur anteriorly, posteriorly, or inferiorlyDislocationDirect impact to posterior or posterolateral aspect of shoulderForced abduction, external rotation, and extension that forces humeral head out of glenoid cavitySigns and Symptoms:Flattened deltoid contourPatient carries arm in slight abduction and external rotationPainCannot touch opposite shoulder with affected armManagement:Immobilization in position of comfortImmediate reduction by physicianControl hemorrhage with cold packsProtective sling for 3 weeks after reduction has occurredDifferential Diagnosis:Acromioclavicular joint injuryClavicle fractureRotator cuff injuryReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 675-677. Print.Glenoid Labrum TearsDefinition: tearing of shoulder labrumEtiology/Mechanism: dislocation, fall, and weight lifting injurySigns and Symptoms:Pain click or pop in shoulderShoulder instabilityManagement:Rotator cuff rehab and observation with activity modificationReferral for chronic symptoms, chronic instability, SLAP lesions Differential Diagnosis:Loose bodyRotator cuff tendinopathyRotator cuff tearReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 92-95. Print.Shoulder Impingement SyndromeDefinition: involves mechanical compression of supraspinatus tendon, subacromial bursa, and long head of biceps tendon under coracoacromial arch.Etiology/Mechanism: repetitive compression that leads to irritation and inflammation; overhead activitiesSigns and Symptoms:Diffuse pain around acromionStiffness in armPain with palpation over subacromial spaceStagesStage 1Occurs in patients younger than 25 years oldInitial injury to supraspinatus or long head of biceps tendon produces aching after activityPoint tenderness over supraspinatus or biceps tendonPain during abduction, worse at 90 degreesPain during straight-arm full flexion or resist supination with external rotationNo palpable muscle defectInflammation with edemaThickening of rotator cuff muscles and subacromial bursaStage 2Permanent thickening and fibrosis of supraspinatus and biceps tendonaching during activity then becomes worse at nightsome restriction with arm movementno obvious muscle defectStage 3occurs between 25-40 years oldlong history of shoulder problemsshoulder pain during activity and increases at nighttendon defect less than 1 inchpossible muscle tearpermanent thickening of rotator cuff and acromial bursa with scar tissueStage 4Patients over 40 years oldObvious infraspinatus and supraspinatus wastingPain with 90 degrees of abductionTendon defect greater than 1 inch Limited active and full passive range of motionWeakness during external rotation and abductionPossible degeneration of clavicleManagement:Stage 1 and 2Restore normal biomechanics to shoulder joint to maintain space under coracoacromial arch during overhead activitiesRICEElectrical stimulationUltrasoundAnti-inflammatory medicationsActivity modificationStage 3 and 4ImmobilizationComplete restSurgical intervention if patient wants to continue activityDifferential Diagnosis:Rotator cuff injuryCervical radiculopathySuprascapular neuropathyBrachial plexus injuryReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 679-680. Print.Rotator Cuff TearDefinition: tearing of muscle or tendon within rotator cuff (subscapularis, supraspinatus, infraspinatus, teres minor)Etiology/Mechanism: fall onto shoulder or acute eccentric strain with liftSigns and Symptoms:Limited motion from weakness or painTenderness over anterior rotator cuff areaWeak supraspinatus and external rotatorsPositive impingement signsMay have positive drop arm testManagement:Rotator cuff rehab 1-4 monthsPain control medicationsModification in activityConsider subacromial injectionDifferential Diagnosis:Rotator cuff tendinopathyImpingement syndromeC5 or C6 neuropathy/radiculopathyBiceps tendinitis References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 74-79. Print.Rotator Cuff TendinitisDefinition: inflammation of rotator cuff tendonsEtiology/Mechanism: overuse, usually more common with overhead activitiesSigns and Symptoms:Limited motion from weakness or painTenderness over anterior rotator cuff areaWeak supraspinatus and external rotatorsPositive impingement signsManagement:Rotator cuff rehab 1-4 monthsPain control medicationsModification in activityConsider subacromial injectionDifferential Diagnosis:Rotator cuff tearAdhesive capsulitisImpingementReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 88-90. Print.Subacromial BursitisDefinition: inflammation of subacromial bursaEtiology/Mechanism: pinching of rotator cuff and subacromial bursa between acromion and greater tuberosity with abductionSigns and Symptoms:Motion may be limitedAC or subacromial crepitusPositive impingement signs and testManagement:Modification in activityNSAIDsRotator cuff rehab to focus on strengthening and stretching posterior capsuleTrial of subacromial steroid injectionsDifferential Diagnosis:Rotator cuff tearRotator cuff tendinopathyCalcific bursitisCervical radiculopathyBicep tendinitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 84-86. Print.Bicipital TendinitisDefinition: inflammation of biceps tendonEtiology/Mechanism: overuse of bicep or subluxation out of intertubercular grooveSigns and Symptoms:Anterior shoulder painTenderness over intertubercular grooveManagement:Rest from overhead and lifting activitiesModalities to decrease painConsider local corticosteroid injectionDifferential Diagnosis:Rotator cuff tearRotator cuff tendinopathyCalcific bursitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 90-92. Print.Bicipital TenosynovitisDefinition: inflammation of biceps tendon synovial sheathEtiology/Mechanism: overhead activities; repeated stretching of biceps that causes irritation of both tendon and synovial sheathSigns and Symptoms:Tenderness in anterior upper arm over bicipital grooveSwellingIncreased warmthCrepitusPain with overhead throwing-type activitiesManagement:Rest for several daysCryotherapy or ultrasound to reduce inflammationOnce inflammation reduced, begin strengthening and stretching program for bicepsDifferential Diagnosis:Rotator cuff tendinitisBicipital tendinitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 683. Print.Biceps Tendon RuptureDefinition: tearing of biceps tendonEtiology/Mechanism: commonly occurs at origin of muscle in bicipital groove; occurs in individual performing powerful concentric or eccentric contraction of muscleSigns and Symptoms:Hears resounding snapFeels sudden, intense pain at point of injuryWeakness when trying to flex elbowManagement:Immediate application of cold packControl hemorrhageImmobilize in slingRefer to physicianSurgery for repairDifferential Diagnosis:Biceps sprain/strainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 681-683. Print.Thoracic Outlet Compression SyndromeDefinition: compression of neurovascular bundle in neck and shoulderEtiology/Mechanism: compression between scalenes, between clavicle and ribs, and beneath pectoralis minor muscleSigns and Symptoms:VascularPain occurs distally (in hand)Pain in chest and throughout upper extremityNeurogenicAchy pain in lateral cervical spine, shoulder, axillary, periscapular region, and armIncreased pain at night or during the dayManagement:Surgical intervention occurs to decompress subclavian arteryReducing overhead movements and positionsFixing postureDifferential Diagnosis:Cervical disc herniationCarpal tunnel syndromeCubital tunnel syndromeVascular occlusive diseaseMalignant tumorsMultiple sclerosisFibromyalgiaRaynaud diseaseComplex regional pain syndromeAnginaReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 580-583. Print.Blocker’s ExostosisDefinition: bony outgrowth of humerusEtiology/Mechanism: repeated trauma to humerusSigns and Symptoms:PainPoint tendernessPossible paresthesiaPainful bony prominenceSwellingLoss of function of elbow flexion and extensionManagement:X-rayRefer to orthopedic surgeonDifferential Diagnosis:Humerus fractureContusion of bicepsReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 135. Print.Clavicle FractureDefinition: broken clavicle boneEtiology/Mechanism: direct blow to clavicle or fall onto shoulder with arm at side (adducted)Signs and Symptoms:Loss of motionDeformity of claviclePalpable crepitusManagement:Figure-of-eight brace for 4-6 weeksNSAIDsShoulder ROM as toleratedRehab as pain improvesFull activity 6 weeks (contact 8-12 weeks)Referral to orthopedics for proximal or distal third fracturesDifferential Diagnosis:Grade 3-6 AC sprain with significant clavicular displacementStinger/burnerCoracoid fractureAcromial fractureSternoclavicular joint subluxationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 199. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 71-72. Print.Scapular FractureDefinition: broken scapulaEtiology/Mechanism: result of direct impact or when force is transmitted through humerus to scapulaSigns and Symptoms:Pain during shoulder movementSwellingPoint tendernessManagement:Immobilize in sling for 3 weeksRefer to physician for x-raysBegin overhead strengthening exercises week 1Differential Diagnosis:Humerus fractureAcromioclavicular injuryReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 371. Print.Humeral FractureDefinition: broken upper armEtiology/Mechanism: result of high-impact forceSigns and Symptoms:Extreme painDysfunctionObvious deformityManagement:Splint humeral shaftReferral to physician immediatelyDifferential Diagnosis:Humeral epiphyseal plate fractureBlocker’s exostosisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 686. Print.Humeral Epiphyseal Plate FractureDefinition: fracture humerusEtiology/Mechanism: direct trauma; indirect trauma traveling along length of humerusSigns and Symptoms:Sudden painLoss of functionDirect or indirect tendernessPossible deformity, crepitus, false joint, bony deviationsRapid swellingDelayed ecchymosisManagement:X-rayRefer to orthopedic surgeonDifferential Diagnosis:Humerus fractureBlocker’s exostosisShoulder dislocation/seperationReferences: Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 134. Print.Axillary Nerve ContusionDefinition: axially nerve bruiseEtiology/Mechanism: direct trauma to lateral armSigns and Symptoms:Dermatome numbness in area of middle deltoidLoss of abduction of shoulderPoint tendernessLoss of function of deltoid and bicepsManagement:Refer to neurologistDifferential Diagnosis:Shoulder dislocationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 137. Print.Long Thoracic Nerve ContusionDefinition: bruising of long thoracic nerve; “winging scapula”Etiology/Mechanism: indirect trauma to shoulder or lateral thoracic wall; overuse of shoulder; prolonged tractionSigns and Symptoms:Dull ache around shoulder girdleDecrease active in shoulder motionProtruding scapula posteriorlyManagement:Refer to physicianElectromyography (EMG) studyDifferential Diagnosis:Scapular fractureDeltoid contusionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 107. Print.Section 12: ElbowOlecranon BursitisDefinition: inflammation of the olecranon bursa of the elbowEtiology/Mechanism: direct blow or prolonged pressure over olecranonSigns and Symptoms:Acute or chronic pain and swelling over olecranonTender to palpation over bursal sacWarmth and erythemaManagement:Compression and ice packs – 15-20 minutes for 2-5 daysNSAIDsElbow pads for protectionModalities – phonophoresis, electrical stimulationSteroid injections for chronic bursitisDifferential Diagnosis:Infection – S. aureus, β-hemolytic streptococciArthritis – manifestation of rheumatoid arthritis or crystalline arthropathyFractureCellulitisTendinitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 104-106. Print.Adhesive CapsulitisDefinition: inflammation of capsular lesions in elbow; “frozen shoulder”Etiology/Mechanism: injury, post-op, or idiopathicSigns and Symptoms:Painful loss of shoulder motionLimited motion with abduction and flexionManagement:Natural history of shoulder to improve over timeRotator cuff rehab and physical therapy to increase motionTrail of subacromial injectionsDifferential Diagnosis:Glenohumeral OARotator cuff tearRotator cuff tendinopathyUndiagnosed posterior dislocationProximal humeral fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 139. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 86. Print.Elbow Dislocation/SubluxationDefinition: elbow joint displacement; incomplete or partial dislocation of elbowEtiology/Mechanism: Fall on outstretched hand with elbow in hyperextensionSevere twist with elbow in flexionSigns and Symptoms:Involved rupturing and tearing of ligamentous tissueHemorrhageSwellingSevere pain and disabilityManagement:Apply cold pressureImmobilize by slingReferral to physician for reductionDifferential Diagnosis:Elbow fractureRupturing/tearing of elbow ligamentsReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 710-712. partment SyndromeDefinition: inflammation of forearm with increased neurovascular pressureEtiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Medial EpicondylitisDefinition: inflammation of medial epicondyle of elbow; “flexor tendinitis”Etiology/Mechanism: repetitive overuse injury of common flexor mechanism, effecting flexor carpi radialis, pronator teres, and flexor carpi ulnarisSigns and Symptoms:Medial elbow pain with activitiesSwelling and weakness of wrist flexors and pronator teresTenderness over medial epicondyleManagement:RICEMedicationsModalities for pain – ice, heat, ultrasound, high-voltage galvanic stimulationRehabilitation exercises Stretching wrist flexors and extensorsStrengthening wrist, elbow, and shoulder musclesCounter-force braceConsider steroid injectionsConsider surgery for failure of rehab for 6 months or moreDifferential Diagnosis:Ulnar collateral ligament (UCL) sprain or ruptureCervical radiculopathy at C5-C6Cubital tunnel syndromeTumor References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 100-102. Print.Lateral EpicondylitisDefinition: inflammation of lateral epicondyle of elbow; “extensor tendinitis” “tennis elbow”Etiology/Mechanism: repetitive or overuse injury of common extensor mechanism, effecting extensor carpi radialis brevis and sometimes extensor digitorum communisSigns and Symptoms:Lateral elbow pain with activitiesSwelling and weakness of wrist extensorsTender to palpation over lateral epicondyleManagement:RICEMedicationsModalities for pain – heat, ice, ultrasound, electrical stimulationRehabilitation exercisesRehabilitation exercises Stretching wrist flexors and extensorsStrengthening wrist, elbow, and shoulder musclesCounter-force braceConsider steroid injectionsConsider surgery for failure of rehab for 6 months or moreDifferential Diagnosis:Cervical radiculopathy C6-C7Posterior interosseous nerve (PIN) entrapmentRadial head fractureFibromyalgiaTumorReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 97-100. Print.Epiphyseal Plate FractureDefinition: injury to cartilaginous growth plate (Salter Harris injuries)Etiology/Mechanism: direct trauma or possible overuse injurySigns and Symptoms:Acute injury with painIsolated pain over epiphysisManagement:Immobilization – cast or braceOrthopedic referralDifferential Diagnosis:StrainSprainTumorReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 138. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 302-304. Print.Ulnar Nerve ContusionDefinition: bruise to ulnar nerveEtiology/Mechanism: deep penetration or succession of blows to sharp projections of elbowSigns and Symptoms:SwellingDiscolorationManagement:Ice and compression for 24 hoursDifferential Diagnosis:Elbow fracture References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 706. Print.Radial Nerve ContusionDefinition: bruise to radial nerveEtiology/Mechanism: deep penetration or succession of blows to sharp projections of elbowSigns and Symptoms:SwellingDiscolorationManagement:Ice and compression for 24 hoursDifferential Diagnosis:Elbow fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 706. Print.Osteochondritis DissecansDefinition: fragments of cartilage/bone in jointEtiology/Mechanism: repetitive trauma through throwing or repetitive axial loading in skeletally immature elbowSigns and Symptoms:Decrease in athletic performanceElbow pain with activitiesStiffness, inability to straighten elbow, “locking”Tender to palpation in readiocapitellar jointDecreased elbow ROMSwellingCrepitus Management:Rest and protection for nondisplaced lesionsLoose or partially detached lesions may be reattached by internal fixationDisplaced lesions should be removed surgicallyDifferential Diagnosis:Lateral epicondylitisBiceps tendinitisTumorInfectious or inflammatory arthritisRecent or remote radial head fracturePosterior interosseous nerve (PIN) entrapmentReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 291-293. Print.Cubital Tunnel SyndromeDefinition: ulnar nerve entrapment; an ulnar neuropathyEtiology/Mechanism: Traction injury from valgus forceIrregularities within tunnelSubluxation of ulnar nerve due to lax of ligamentProgressive compression of ligament on nerveSigns and Symptoms:Pain proximal or distal to medial aspect of elbowTender to palpation in cubital tunnelParesthesia reflected by burning and tingling in 4th and 5th fingersManagement:RestImmobilizationNSAIDsSplinting or surgical decompression or transportation may be neededAvoid hyperflexion and valgus stresses to elbowDifferential Diagnosis:Ulnar nerve contusionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 710. Print.Collateral Ligament SprainDefinition: stretching or tearing of ulnar collateral ligament in elbowEtiology/Mechanism: Valgus force from repetitive traumaStress of medial complexIndirect traumaOveruseSigns and Symptoms:Pain along medial aspect of elbowTenderness over medial collateral ligamentParesthesia Pain on active and resistive movementLoss of functionManagement:RestNSAIDsWhen asymptomaticEmphasis on strengtheningFix faulty mechanics If rest and rehab fail, refer to orthopedist Surgical intervention may be neededDifferential Diagnosis:Ulnar contusionOsteochondritis dissecansReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 707-708. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 161. Print.Section 13: Forearm, Wrist & HandFinger Dislocation/SubluxationDefinition: finger joint displacement at DIP, PIP, or MCP; incomplete or partial dislocation of fingerEtiology/Mechanism: hyperextension, varus or valgus forces, or torsional or shearing stresses during collision or contact sportsSigns and Symptoms:Pain and swelling at specific jointDorsal or lateral angulation of DIPDeformity and inability to moveTendernessPIP dorsally angulated 60-90 degressManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Reduction to jointSplinting after post-reductionBuddy tapingIrreducible dislocations – refer to orthopedicsDifferential Diagnosis:Ligament sprain at jointFracture at DIP, PIP, MCP jointReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 126-129. Print.Boutonniere DeformityDefinition: ruptured extensor tendon; also known as “central slip avulsion”Etiology/Mechanism: volar direct force on middle phalanx against semi-flexed finger attempting to extendSigns and Symptoms:Pain and swelling at PIP jointPIP in 15-30 degrees of flexionPoint tenderness over dorsal lip of middle phalanxInability to extend PIPManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Splinted 4-5 weeks in full extension, protected during sporting activity for additional 6-8 weeksDIP should be allowed to flexIf avulsion fracture is greater than 1/3 of joint, refer for possible ORIF (operative reduction and internal fixation)Differential Diagnosis:Collateral ligament injuryPIP dislocationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 116-117. Print.Lunate DislocationDefinition: lunate disassociates from carpal bonesEtiology/Mechanism: forced hyperextension of wrist and hand, resulting in displacement either dorsally or palmarlySigns and Symptoms:Pain along radial side of palmar or dorsal aspect of wristLimited ROM due to painBulge visible on palmar or dorsal aspect of hand proximal to third metacarpalSwellingPossible paresthesiaThird knuckle is level with other knucklesFracture of scaphoid bone should be suspectedManagement:If see early enough, closed reduction can be appliedImmobilization of wrist for 6-8 weeksIf reduction is not applicable, percutaneous pinning of lunate in reduced position or open reductionDifferential Diagnosis:Distal radioulnar joint subluxationTriangular fibrocartilage pathologyDistal radial fractureScaphoid fractureHamate fractureCarpal instabilityCarpal tunnel syndromeOther neuropathyReferences: Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 777-779. Print.Jersey FingerDefinition: avulsion flexor digitorum profundus tendon; also known as “football finger”Etiology/Mechanism: forced extension of distal phalanx while actively flexing DIPSigns and Symptoms:Pain and swelling at DIP jointUnable to flex isolated DIP with localized tenderness at level of retraction of avulsed segmentManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Refer for surgical repair within 3 w with retraction PIP, within 1 w if retracted to palmDifferential Diagnosis:Phalanx fractureMallet fingerReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 114-115. Print.Forearm SplintsDefinition: splints to forearm musclesEtiology/Mechanism: static constant contraction of forearm muscles; overuse; irritation of interosseous membrane and surrounding tissueSigns and Symptoms:Dull pain between extensor musclesPain on contraction Weakness of muscles against resistanceLoss of functionInflammation Management:X-rayRefer to orthopedistDifferential Diagnosis:Stress fractureChronic compartment syndromeMuscle strainReferences: Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 177. Print.Gamekeeper’s ThumbDefinition: sprain to UCL of thumb; also known as “skier’s thumb”Etiology/Mechanism: Hyperabduction of thumb MCP joint4 classes of UCL sprainType 1: avulsion fracture, non-displacedType 2: avulsion fracture, displacedType 3: torn ligament, stable in flexionType 4: torn ligament, unstable in flexionSigns and Symptoms:Pain over UCL areaWeak and painful pinchTenderness and swelling over ulnar aspect of thumb MCPManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Type 1: thumb spica cast with MCP in full extension for 4 weeksType 2: refer for ORIF (operative reduction and internal fixation)Type 3: thumb spica cast with IP free and MCP flexed 20 degrees for 3 weeksType 4: refer for ORIF (operative reduction and internal fixation)Differential Diagnosis:MCP joint dislocationPhalangeal fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 119-121. Print.De Quervain’s SyndromeDefinition: tenosynovitis of abductor pollicus longus and extensor pollicus brevis tendonsEtiology/Mechanism: repetitive wrist motion; most common in racquet and throwing sportsSigns and Symptoms:Pain and swelling along radial wristPain with gripping and rotational motionsTenderness along extensor thumb, radial wrist, and forearmPain with resisted thumb abduction and extensionManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Protective bracing with thumb spica splintPhysical therapy to address strength and flexibility issuesCorticosteroid injectionSurgical treatment involving synovectomy may be necessaryDifferential Diagnosis:Scaphoid fractureCarpal or capral-metacarpal DJDInstabilities References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 141-143. Print.Dupuytren’s ContractureDefinition: nodules in palmar aponeurosisEtiology/Mechanism: unknown cause; limits finger extension and cause flexion deformitySigns and Symptoms:Inability to extend finger from flexed position (ring or pinky finger)Management:Surgery to removed nodulesDifferential Diagnosis:Cyst References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 742. Print.Carpal Tunnel SyndromeDefinition: inflammation of flexor tendons results in swelling and increased pressure within closed space of carpal tunnelEtiology/Mechanism: compression of median nerve as it traverses carpal tunnel formed by volar surfaces of proximal carpal row, interosseous membrane, and median retinaculumSigns and Symptoms:Numbness involving mid and distal palmar hand, thumb and index, ring and radial half of ring fingerPain in wrist or handSymptoms may be worse at nightWeakness or clumsiness in affected handSensory changes in distribution of median nerveManagement:BracingOral anti-inflammatoriesActivity modificationCorticosteroid injectionSurgical release of flexor retinaculumDifferential Diagnosis:Thoracic outlet syndromeNerve root compressionProximal median nerve compressionsReferences: Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 276-278. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 784. Print.Swan Neck DeformityDefinition: MCP flexion, PIP extension, DIP flexionEtiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Scaphoid FractureDefinition: fracture to scaphoid carpal boneEtiology/Mechanism: falling on outstretched hand resulting in hyperextension of wrist; most common carpal fractureSigns and Symptoms:Pain in anatomic snuffboxPain with extension of wrist and firm gripSwelling and bruising Tender to palpation over anatomic snuffboxPain with extremes of flexion, extension, and ulnar deviationManagement:PRICEMMThumb spica cast for 6-12 weeks for non-displaced fractureDisplaced fractures, proximal fractures, and nonunions require surgical pinningDifferential Diagnosis:De Quervain’s tenosynovitisCarpal or carpal-metacarpal DJDInstabilities References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 135-136. Print.Hamate FractureDefinition: fracture of hamate carpal boneEtiology/Mechanism: direct blow or hyperthenar eminence fractures hookSigns and Symptoms:Pain, swelling and bruising at hyothenar eminenceNumbness over fifth digitTenderness at hamate/hookManagement:Hook fractures – surgical extraction of hookNon-displaced bodily fractures – short arm cast for 4-6 weeksDisplaced fractures – wire fixationDifferential Diagnosis:CMC sprainFracture of 4th or 5th MCIntercarpal sprainUlnar nerve palsyReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 136-137. Print.Triangular Fibrocartilage Complex Tear (TFCC)Definition: tear of wrist cartilage between ulna and fifth metacarpalEtiology/Mechanism: Fall on outstretched handHyperrotation of wrist or forearmSigns and Symptoms:Ulnar-sided pain following appropriate MOISwelling and bruisingPain with gripping or manipulationTenderness at carpi-unlar interspaceManagement:TFCC with DRUJ (distal radial ulnar joint) instability – surgeryTFCC without instability – cast or brace for immobilization in slight ulnar deviation/flexion for 4 weeks, followed by wrist ROM and strengthening and use of protective brace during activitiesChronic phase without previous diagnosis or treatment – immobilization for 2-4 weeks and possible corticosteroid injectionArthroscopic treatmentDifferential Diagnosis:Lunotriquetral instabilityExtensor/flexor tendinopathy or subluxationDegeneration of distal radioulnar jointWrist UCL sprainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 150-152. Print.Bennett’s FractureDefinition: avulsion fracture of first metacarpal; also known as “CMC fracture dislocation”Etiology/Mechanism: axial and abduction forces to thumb in collision or contact sportsSigns and Symptoms:Pain and swelling over base of thumb CMCVariable degree of deformity at thumb CMCManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Refer to orthopedicsDifferential Diagnosis:Gamekeeper’s thumbReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 125. Print.Wrist/Hand TenosynovitisDefinition: inflammation of extensor carpi radialis longus and brevis tendon sheathsEtiology/Mechanism: repetitive use and overuse of wrist tendons and sheathsSigns and Symptoms:Pain with usePain with passive stretchingTenderness and swelling over tendonManagement:Ice massage for 10 minutes four times a day for first 48-72 hoursNSAIDsRest When swelling subsides, begin range of motionUltrasound or phonophoresis used for anti-inflammatory effectsDifferential Diagnosis:FelonCarpal tunnel syndromeBursitisRheumatoid arthritisReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 735. Print.Colles’ FractureDefinition: fracture to distal radius with dorsal displacementEtiology/Mechanism: indirect or direct trauma to distal forearm by a fall on outstretched hand or hyperextended wristSigns and Symptoms:Sudden painLoss of functionDirect or indirect tendernessPossible deformity, bony deviation, crepitus, false joint motion, nerve damageRapid swellingManagement:X-rayRefer to orthopedistDifferential Diagnosis:Carpal tunnel syndromeEpiphyseal plate fractureDislocation Barton’s fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 170. Print.Wrist/Hand TendinitisDefinition: inflammation of flexor carpi radialis and flexor ulnaris tendonsEtiology/Mechanism: repetitive wrist flexion; activities that place pressure on palms; overuse of wristSigns and Symptoms:Pain with active or passive stretchingPain and/or weakness with isometric resistanceManagement:Ice massage for 10 minutes four times a day for first 48-72 hoursNSAIDsRest When swelling subsides, begin range of motionDifferential Diagnosis:FelonCarpal tunnel syndromeBursitisRheumatoid arthritisReferences: Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 735. Print.Barton’s FractureDefinition: fracture to distal radiusEtiology/Mechanism: indirect trauma; fall on outstretched handSigns and Symptoms:Sudden painLoss of functionDirect or indirect tendernessRapid swellingPossible deformity, crepitus, false motionDelayed ecchymosisManagement:X-rayRefer to orthopedistDifferential Diagnosis:Colle’s fractureEpiphyseal plate fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 193. Print.Ulnar Nerve PathologyDefinition: sensory changes along ulnar nerve distributionEtiology/Mechanism: compression or stretch of nerve at elbow or at handSigns and Symptoms:Entrapment at elbow – elbow pain radiating to wrist and 4th and 5th fingersParesthesias involve ulnar hand and 4th and 5th fingers; made worse with percussion in ulnar notch or maximal elbow flexionEntrapment at hand (Guyon’s canal) – distal paresthesias without motor weakness of flexorsManagement:Relative rest and anti-inflammatories for acute symptomsPadded palm gloves and alteration of wrist position with activitySurgical exploration if symptoms persistDifferential Diagnosis:Cervical radiculopathyLateral epicondylagiaCarpal tunnel syndromeComplex regional pain syndromeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 725. Print.Boxer’s FractureDefinition: fracture of fifth metacarpal; also known as “boxer’s knuckle”Etiology/Mechanism: direct blow to flexed MCP or by flexion and ulnar deviation force across MCP in collision or contact sportsSigns and Symptoms:Pain and swelling over dorsum of MCPMCP is tender dorsally with inability to actively extend joint from flexed positionAfter passive extension, patient is able to maintain extensionManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Splinting in full extension with PIP free for 4 weeksActive ROM exercises begin at 4 weeks with splint worn at all timesDifferential Diagnosis:Dislocation at MCP jointReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 115-116. Print.Radial Nerve PathologyDefinition: damage to radial nerve usually from midhumerus fracture; also called “wrist drop”Etiology/Mechanism: entrapment of posterior interosseous branch of radial nerve as it passes beneath fibrous arcade of supinatorSigns and Symptoms:Pain at lateral elbow and extends into extensor forearmTenderness at radial tunnelPain with resisted supination of wrist and extension of middle fingerManagement:Relative restWrist splintingAnti-inflammatory medicationsSurgical decompression considered with electromyogram confirmation and refractory symptomsDifferential Diagnosis:Lateral epicondylitis Cervical radiculopathyCarpel tunnel syndromeComplex regional pain syndromeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 725. Print.Smith’s FractureDefinition: fracture to distal radius with volar displacementEtiology/Mechanism: direct trauma from a fall on dorsum of handSigns and Symptoms:Sudden pain at distal end of radius and ulnaLoss of functionDirect or indirect tendernessRapid swellingHand is angled downDelayed ecchymosisPossible bony deviation, crepitus, false motionManagement:X-rayRefer to orthopedistDifferential Diagnosis:Colle’s fractureHand contusionFracture References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 199. Print.Median Nerve PathologyDefinition: damage to median nerve usually in carpel tunnelEtiology/Mechanism: direct trauma; repetition; compression from fracture or luxationSigns and Symptoms:Weakness in gripMuscle atrophy of thenar eminenceNumbnessSensory loss in nerve distributionLoss of functionManagement:Neurologist if s/s persistDifferential Diagnosis:Carpel tunnel syndromeContusionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 157. Print.Finger FractureDefinition: break to phalanxEtiology/Mechanism: direct trauma to finger during collision or contact sportsSigns and Symptoms:Pain and swellingTendernessVariable degrees of deformityVarying degrees of shortening, angulation, or rotationManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Stable, non-displaced, and non-angulated fractures – buddy tape and use thermoplastic splint for sport activityStable, minimal angulation fracturesMiddle phalangeal – immobilize MCP flexed at 70 degrees, PIP flexed at 45 degrees, and DIP free and buddy taping to control rotationProximal phalangeal – MCP flexed at 70 degrees, PIP and DIP free with buddy tapingUnstable fractures – refer to orthopedicsDifferential Diagnosis:Dislocation at DIP, PIP, MCP jointReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 121-123. Print.Wrist GanglionDefinition: synovial cyst on wristEtiology/Mechanism: frequently idiopathic, may arise after traumaSigns and Symptoms:Vague wrist painVisible, mobile mass that’s typically transilluminateTender to palpation on massManagement:Aspiration may be attemptedSurgical treatment for symptomatic ganglia, consmesis management or pain manangementDifferential Diagnosis:Wrist contusionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 153-154. Print.Epiphyseal Plate FractureDefinition: fracture to distal radius and ulnaEtiology/Mechanism: direct or indirect trauma from a fall on outstretched hand or hyperextended wristSigns and Symptoms:Sudden painLoss of functionIndirect or direct tendernessRapid swellingDelayed ecchymosisPossible deformity, crepitus, false motion, bony deviationManagement:X-rayRefer to orthopedistDifferential Diagnosis:Colle’s fractureLuxation of wristReferences: Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 176. Print.Bowler’s ThumbDefinition: ulnar nerve compressionEtiology/Mechanism: overuse of thumbSigns and Symptoms:NumbnessPainTinglingLoss of strengthLoss of sensation of thumbManagement:Refer to neurologist is s/s persistDifferential Diagnosis:Carpal tunnel syndromeContusionSprainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 189. Print.Volkmann’s Ischemic ContractureDefinition: ischemic necrosis of forearm musclesEtiology/Mechanism: supracondyle fracture of humrusSigns and Symptoms:Pain in forearmIncreases when fingers are passively extendedParalysisIschemia and neurologic changes (coldness, stiffness, or numbness of fingers)SwellingEcchymosisMuscle spasmPossible cessation of brachial and radial pulse, necrosis of musclesManagement:X-rayRefer to orthopedist and neurologistDifferential Diagnosis:Collateral ligaments sprainOsteochondritis dissecansReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 162. Print.Trigger FingerDefinition: tenosynovitis of flexor tendons, usually third and fourth digitsEtiology/Mechanism: nonspecific flexor tenosynovitis from overdemandSigns and Symptoms:Difficulty straightening involved finger, worse in morningVariable degree of painTenderness over flexor tendon sheath aggravated by active finger flexion or passive extensionPalpable nodule in sheathManagement:Splint finger at nightTriggering – injections toflexor tendon sheath, repeat in 6-8 weeks if symptoms persist, splint at nightDifferential Diagnosis:Dupuytren’s contractureCarpel tunnel syndromeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 117. Print.Subungual HematomaDefinition: blood under fingernail Etiology/Mechanism: direct traumaSigns and Symptoms:PainTendernessBlood under fingernail Nail may fall off at some point in futureManagement:if hemorrhage is acute and painful – can be relieved by drilling hole in nail, sterile dressing then appliedDifferential Diagnosis:contusion to fingerReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 250. Print.Mallet FingerDefinition: avulsion of extensor tendonEtiology/Mechanism: axial load against actively extending fingerSigns and Symptoms:Pain at dorsal distal interphalangeal jointInability to extend isolated DIPTenderness over dorsal proximal aspect of distal phalanxManagement:PRICEMM (protect, ice, compression, elevate, medications, modalities)No avulsion fracture – splint DIP fully extended for 6-8 weeks straight, additional 6-8 weeks if engaged in athletic activitiesDifferential Diagnosis:Jersey fingerReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 113-114. Print.FelonDefinition: cellulitis of fingerEtiology/Mechanism: infection of pulp of finger tip, often caused by puncture woundSigns and Symptoms:PainThrobbingSwellingRedness of tip of fingerInflammationManagement:Refer to physician if s/s persistDifferential Diagnosis:Subungal hematomaReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 192. Print.Section 14: Thigh, Hip, & PelvisSacroiliitisDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Hip SprainDefinition: stretching or tearing of hip ligamentEtiology/Mechanism: Any unusual movement exceeding normal ROM that may result in tearing of tissueViolent twist produced by impact force by another participantForceful contact with another participantFoot firmly planted and trunk forced in opposing directionSigns and Symptoms:Inability to circumduct thighPain in hip regionHip rotation increases painManagement:X-rays or MRI to rule out fractureRICENSAIDsAnalgesicsWeight-bearing should be restricted depending on grade of sprainCrutch walking used for grade 2 and 3 sprainsROM exercises and PRE delayed until asymptomatic Differential Diagnosis:Acetabular labral tearFemoral stress fractureAdductor/hip flexor strainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 638. Print.Osteitis PubisDefinition: inflamed pubic boneEtiology/Mechanism: repetitive overload to pelvis (running, jumping, etc.)Signs and Symptoms:Gradually worsening midline groin pain that worsens with activityTender at pubic symphysisPain in midline with single-leg stanceManagement:NSAIDsRelative rest until asymptomatic avoiding participation of ac tivitiesCorticosteroid injectionDifferential Diagnosis: Femoral stress fractureFemoral avascular necrosisAcetabular labral tearAdductor strain/tendinitisIliopectineal bursitisIliopsoas tendon strain References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 176-177. Print.Iliac Crest ContusionDefinition: bruise to iliac crest and attaching musculature; also known as “hip pointer”Etiology/Mechanism: contusion to ASIS due to direct blowSigns and Symptoms:Pain and bruising following mechanismTenderness at ASISPain with hip adduction or hip flexionManagement:Rest and protectionIce early, heat in subacute phaseDifferential Diagnosis:Trochanteric bursitisSnapping hip syndromeNeuropathies involving lumbar nerve roots (L2-L4)Neuropathies involving branches of iliohypogastric or subcostal nervesSclerotomal irritation of lumbar facet joints and paraspinal ligamentsFemoral head and neck pathology References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 181. Print.Femoral Stress FractureDefinition: incomplete break of femur, particularly neck of femurEtiology/Mechanism: changes in training volume or intensity in running sportsSigns and Symptoms:Vague, increasing groin or thig painPain worse with activityPain with hip flexion and at restTenderness at affected groinPain with single-leg stancePain with passive internal rotation of hipManagement:Femoral neck-distraction cortex – treat aggressively, refer early, often require surgeryFemoral neck-compression side – rest, radiographs to document healingCrutches with toe-to-floor weight bearing for 6-12 weeksPhysical therapy to improve flexibility and balanced muscle strengtheningRefer to orthopedic surgeon is symptoms persist, fracture is present on radiograph, or evidence of avascular necrosisFemoral shaft and pubis stress fracture – rest, activity substitutionDifferential Diagnosis:Femoral head avascular necrosisAcetabular labral tearAdductor strain/tendinitisIliopectineal bursitisIliopsoas tendon strainOsteitis pubisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 169. Print.Quadriceps ContusionDefinition: bruise of quadriceps musclesEtiology/Mechanism: direct blow to quadricepsSigns and Symptoms: Pain and bruising following mechanismPain with active contraction of quadricepsTendernessSwellingPain with passive stretching of quadricepsPalpable quadriceps muscle defect or bruiseManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Elastic wrap applied to leg and calf with knee flexed at 120 degrees to hold quadriceps in stretched position of 12-24 hoursLimits loss of flexibilityGentle stretching programDifferential Diagnosis:Myositis ossificans in quadriceps muscleReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 185-186. Print.Greater Trochanteric BursitisDefinition: inflamed bursa around greater trochanterEtiology/Mechanism: direct trauma or overuse in setting of sacroiliac dysfunction; common in runners, cross-country skiers and sedentary individualsSigns and Symptoms:Deep, aching, lateral hip painMay extend into buttocks or down into lateral kneePain aggravated by activity, local pressure or stretchingPain worse at nightManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Rehab exercises to improve flexibility of iliotibial band, sacroiliac function, and hip rotator strengthWeight loss, conditioning, proper lifting can aid preventing recurrent or chronic injuryCorticosteroid injectionDifferential Diagnosis:Trochanteric bursitisSnapping hip syndromeHip pointerNeuropathies involving lumbar nerve roots (L2-L4)Neuropathies involving branches of iliohypogastric or subcostal nervesSclerotomal irritation of lumbar facet joints and paraspinal ligamentsFemoral head and neck pathology References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 177-179. Print.Hamstring StrainDefinition: muscle or tendon stretching/tearing to biceps femoris, semimembranosus, and semitendinosusEtiology/Mechanism: single macrotraumatic injury or repetitive overuse of hamstringsSigns and Symptoms:Depend on mechanism of injuryAcute strains – severe pain following definable event (sprinting or jumping)Overuse injury – gradual onset pain, which prevents running or other activitiesManagement:NSAIDsIceUltrasoundElectrical stimulationRestAvoiding activities that make symptoms worseAggressive stretching programDifferential Diagnosis:Hamstring tendinitisAdductor strainSciaticaIschial bursitisLumbosacral referred painReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 184-185. Print.Piriformis SyndromeDefinition: inflammation of piriformis muscle with radiating painEtiology/Mechanism: muscle spasm, insertional inflammation, irritation of sciatic nerveSigns and Symptoms:Aching pain in buttocks associated with sciaticaPain is worse with prolonged sitting or ridingTenderness over gluteal prominencePain with resisted abduction and external rotation of hipPain with passive internal rotation of hipManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Deep tissue massagePhysical therapy to improve flexibility and correct SI dysfunctionChiropractic or osteopathic treatmentsCorticosteroid injectionDifferential Diagnosis:Ischial bursitisSciaticaLumbar disc diseaseSacroiliac dysfunctionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 181. Print.Quadriceps StrainDefinition: stretching or tearing to the muscle/tendon of quadriceps musclesEtiology/Mechanism: single macrotraumatic injury or repetitive overuse of hamstringsSigns and Symptoms:Depend on mechanism of injuryAcute strains – severe pain following definable event (sprinting or jumping)Overuse injury – gradual onset pain, which prevents running or other activitiesManagement:NSAIDsIceUltrasoundElectrical stimulationRestAvoiding activities that make symptoms worseAggressive stretching programDifferential Diagnosis:ContusionFemoral stress fractureJumper’s kneeReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 184-185. Print.Iliac ApophysitisDefinition: inflammation to pelvic apophysis/apophyses – ischial tuberosity, ASIS, and AIISEtiology/Mechanism: sudden acceleration or deceleration in activitySigns and Symptoms:Sudden, localized painLimited movementSwellingPoint tendernessMuscle testing increases painManagement:X-rayRICECrutches with toe-touch weight bearing for 1 to 2 monthsOnce pain and inflammation controlled – begin gradual stretch program80 degrees of ROM returned – begin PRE programDifferential Diagnosis:Avulsion fractureStress fractureReferences:Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 645. Print.Adductor StrainDefinition: muscle or tendon stretch/tear of adductor longus, brevis, mangus, gracilis, and pectineusEtiology/Mechanism: acute strain injury in collision or contact sportsSigns and Symptoms:Sharp pain in groin following injuryContinued pain with ambulation, kicking, jumpingTender in groinPain with passive abduction, active adduction, and resisted internal rotationManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Stretching and strengthening exerciseGradual return to full activities with augmented stretching programDifferential Diagnosis:Femoral stress fractureFemoral head avascular necrosisAcetabular labral tearIliopectineal bursitisIliopsoas tendon strainOsteitis pubisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 174. Print.Femoral Epiphyseal Plate InjuryDefinition: fracture to epiphyseal plate of proximal femurEtiology/Mechanism: direct trauma causing shearing force; occurs in 10-16 year oldsSigns and Symptoms:PainLoss of normal hip functionPain with weight bearingRapid swellingDirect/indirect tendernessDelayed ecchymosisPossible deformity, crepitus, bony deviation, false motionManagement:X-rayRefer to orthopedic surgeonDifferential Diagnosis:Slipped capital femoral fractureStress fractureAdductor strainReferences:Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 289. Print.Myositis OssificansDefinition: formation of bone in quadriceps muscleEtiology/Mechanism: follows a quadriceps contusion or sever hamstring injury with deep tissue bleedingSigns and Symptoms:History of substantial muscle injuryPainful, palpable mass in area of traumaGradual muscle contracture may limit ROM at adjacent jointsManagement:Prevention of repetitive injuryRestAggressive stretching and strengtheningSurgical release of mature ossificansDifferential Diagnosis:Quadriceps contusionFemoral fractureReferences: Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 186. Print.Slipped Capital Femoral EpiphysisDefinition: injured growth plate of proximal femur; femoral neck moved up and forwardEtiology/Mechanism: shearing failure of proximal femoral epiphysisSigns and Symptoms:Painful weight-bearingLimp with pain isolated to anterior groin, thigh, or kneeChronic cases – pain is dull, intermittent, and lasts for 3 or more weeksAcute cases – pain is sharp, persistent with more instabilityPainful ROM with limited internal rotationMay have shortening of affected limbPassive flexion of hip causes limb to abduct and externally rotate as thigh moves toward abdomen (positive Whitman’s sign)Management:Place in nonweight-bearing immediately when suspectedRefer to orthopedicsDifferential Diagnosis:Legg-Calvé-PerthesToxic synovitisTumor in femurAdductor strainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 299-300. Print.Iliotibial “Band” SyndromeDefinition: friction of IT band over lateral femoral epicondyleEtiology/Mechanism: IT band tightness leads to friction irritation at lateral femoral condyle, resulting in inflammation and painSigns and Symptoms:Lateral knee pain, “aching” painPain worse with activities like running, jumping, squattingTenderness and swelling at distal IT band as it crosses femoral condyleTightness of IT band when knee does not fall to table (positive Ober’s sign)Management:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Corticosteroid injectionPhysical therapy improving IT band flexibility through stretching exercise and hip abductor strengtheningShould address and foot biomechanical issues and underlying sacroiliac dysfunctionDifferential Diagnosis:Lateral meniscal tearLateral collateral ligament tearReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 213-214. Print.Femur FractureDefinition: broken femurEtiology/Mechanism: significant traumaSigns and Symptoms:PainCannot stand or walkMuscle guarding and resists any attempt to moveHip is externally rotated and slightly adductedShortening of limbManagement:Call EMSImmobilizedSurgery – open or closed reduction with pins or platesImmobilized in hinge brace after surgeryRehab program over 4-month periodDifferential Diagnosis:Femoral head avascular necrosisFemoral stress fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 626-627. Print.Quadriceps TendinitisDefinition: inflammation of tendon of quadriceps musclesEtiology/Mechanism: precipitated by excessive jumping or running; “jumper’s knee”Signs and Symptoms:Anterior knee pain at quadriceps tendonMild swelling, erythema, warmthStiffness after restMalalignment with increased Q-angle, lateral patellar tracking, weak ankle dorsiflexionTenderness and soft tissue swellingTightnessManagement:NSAIDsIce and elevationActivity modificationDefinitive therapy for correcting functional malalignment and tightness Continue alternative, non-painful activities during rehabDifferential Diagnosis:Retropatellar knee pain (Patellofemoral pain)Plica syndromeMeniscal tearBursitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 206. Print.Pelvic FractureDefinition: break among any of all bones of the pelvisEtiology/Mechanism: direct trauma; may be crushing-type forceSigns and Symptoms:Sudden painLoss of functionDirect and indirect tendernessRapid swellingDelayed ecchymosisPossible deformity, crepitus, false motionManagement:X-rayRefer to orthopedic surgeonDifferential Diagnosis:Hip dislocationReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 272. Print.Hip DislocationDefinition: femoral acetabular joint displacementEtiology/Mechanism: traumatic force directed along axis of femurSigns and Symptoms:Injury presents as flexed, adducted, and internally rotated thighHead of femur posterior to acetabulumTearing of capsular and ligamentous tissueDamage to sciatic nerveManagement:Call EMSImmobilization – 2 weeks of bed rest and crutches for a month or longerDifferential Diagnosis:Femoral fractureAcetabular labral tearAvascular necrosisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 140. Print.Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. 640. Print.Section 15: KneeBursitisDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Osgood-Schlatter’s DiseaseDefinition: tibial tubercle apophysitisEtiology/Mechanism: inflammation of apophysis of tibial tubercleSigns and Symptoms:Pain at tibial tuberosity with activityManagement:Relative rest from high-impact activity for short periodIce for pain controlResume activity as toleratedHamstring and quadriceps stretchingConsider patellar tendon counterforce brace for activityConsider immobilization or short use of crutches for severe episodes of painDifferential Diagnosis:Patella tendonitisTumor proximal tibiaOsteochondritis dissecans in kneeSinding-Larsen-JohanssonPatellofemoral pain syndromeSlipped capital femoral epiphysisLegg-Calve-PerthesReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 294-295. Print.Osteochondral FractureDefinition: fracture extending from cartilaginous surface into bony matrixEtiology/Mechanism: indirect compressive or shearing forces that are associated with knee torsionSigns and Symptoms:Sudden pain in knee jointLoss of normal knee movementLocking, snapping, buckling sensationPain on flexion and extensionPain on manual pressure against femoral condylesManagement:X-rayMRIRefer to orthopedic surgeonDifferential Diagnosis:Osteochondritis dissecansLigamentous damageReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 306. Print.Sinding-Larson-Johansson DiseaseDefinition: traction injury to inferior pole of patella at tendon originEtiology/Mechanism: apophysitis of inferior pole of patellaSigns and Symptoms:Activity related to anterior knee pain with high impact activities (running, jumping)PainSwellingTenderness at inferior pole of patellaPossible hamstring tightnessManagement:Activity modification when experiencing symptomsIce massage (15 minutes) or ice bag for post-activity painTherapy for hamstring and quadriceps flexibilityNSAIDsConsider patellar tendon counterforce brace or neoprene sleeveDifferential Diagnosis:Retropatellar knee painOsgood-SchlatterPatella stress fracturePatella tendonitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 295-296. Print.Chondromalacia patellaDefinition: softening of articular cartilage behind patellaEtiology/Mechanism: repeated trauma to patella; predisposing factorsSigns and Symptoms:Pain under patella with flexion and extensionTenderness along medial border and articular surface of patellaSlight stiffness of knee jointPain when walking up and down stairsInstabilitySwellingAtrophy of quadricepsManagement:X-rayMRIRefer to orthopedic surgeonDifferential Diagnosis:Sinding-Larsen-Johansson diseaseBursitisPatella dislocation/subluxationMeniscal tearPatella tendinitisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 307. Print.Patellar Tendon RuptureDefinition: tear of patella tendonEtiology/Mechanism: eccentric overload event with forceful quadriceps contraction in landing (deceleration), jumping (acceleration), or through direct blowSigns and Symptoms:Being able to describe appropriate mechanismSwelling on anterior aspect of kneeWeakness in standing or ambulationTenderness and intra-articular effusion presentUnable to maintain knee extension against gravity or actively extend from flexed positionManagement:Immobilization in full extensionSurgery within 24-28 hours of injuryDifferential Diagnosis:Patella dislocation/subluxationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 199-200. Print.Patella Dislocation/SubluxationDefinition: patellofemoral joint displacementEtiology/Mechanism:Twisting or valgus motion with forceful quadriceps contractionDirect blow to medial patellaSigns and Symptoms:Sensation of lateral patellar displacementIn subluxation, patella reduces as knee is extendedSubstantial pain, locking, and swellingLarge effusion following reduction of subluxationDislocation – patella easily palpated on lateral aspect of kneeManagement:Acute patellar dislocation – reduction, then immobilized for 6 weeks in full extension, physical therapy to regain full functionSubluxation without frank dislocation – immobilization for 2-4 weeks until pain subsides, physical therapy to focus on VMO strengthening and improving flexibilityPatella brace (open patella knee sleeve) and activity modificationSurgery for recurrent patellar dislocationDifferential Diagnosis:Patella fracturePatellar tendonitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 196-198. Print.Peroneal Nerve ContusionDefinition: bruise to peroneal nerve behind fibular headEtiology/Mechanism: direct trauma to proximal fibulaSigns and Symptoms: Immediate, severe local painElectric shock sensation radiating to anterior and lateral leg and dorsum of footNumbness and tinglingTenderness of underlying nerveEdemaPossible paresthesia with foot dropPossible paralysisManagement:Refer to neurologistEMG studiesDifferential Diagnosis:L5 neuropathySciaticaReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 317. Print.Tibiofemoral Dislocation/SubluxationDefinition: tibiofemoral joint disarticulation Etiology/Mechanism: knee hyperextension, rotation, posterior tibial shear force, posterior femoral shear force, valgus stress, varus forceSigns and Symptoms:Severe painMuscle spasmObvious deformity at jointUnreduced – deformity and possible shortening of involved limbSwelling and discolorationTenderness at joint line and surrounding structuresManagement:Call EMSSurgery – reduction and repair of ligamentous damageDifferential Diagnosis:Femoral fractureTibial fractureLigamentous injuryReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 366-371, 374. Print.Plica SyndromeDefinition: synovial fold inflammation of kneeEtiology/Mechanism: acute compression of patella or through repetitive extension/flexion activitiesSigns and Symptoms:Chronic anteromedial knee painPain worsens with running or jumping activitiesMild soft tissue swellingPalpable along medial patellofemoral joint, with knee in slight flexion and tibia internally rotatedManagement:Activity modificationPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Flexibility exercises for posterior chain and quadriceps groupSurgical treatmentAnti-inflammatory steroid injectionDifferential Diagnosis:Retropatellar knee painTendinitisMeniscal tearBursitisDJDReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 208-209. Print.Tibial Epiphyseal Plate InjuryDefinition: Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Popliteal CystDefinition: accumulation of fluid in popliteal spaceEtiology/Mechanism: posterior knee swelling related to intra-articular effusionSigns and Symptoms:Painful, local swellingPain worsens with walking, jumping, or squattingTender mass in popliteal fossaManagement:Treatment addressing underlying cause of joint effusionChildren – associated with intra-articular pathologyIntra-articular corticosteroid injectionDifferential Diagnosis:Hamstring or popliteal tendinitisMeniscal tearInternal derangementDVTReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 211-212. Print.Fat Pad ContusionDefinition: bruise of infrapatellar fat padEtiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Medial Collateral Ligament SprainDefinition: stretch or tear to MCLEtiology/Mechanism: valgus stress applied to lateral knee through direct blow or noncontact rotational stressSigns and Symptoms:Complaint of medial joint pain following appropriate mechanismPain extends to distal medial femoral condyle or proximal tibiaPain is worse with full extension and flexion beyond 90 degreesSwellingSymptoms of valgus instabilityMedial joint line tendernessModerate effusionPROM is painful at full extension and flexion beyond 90 degreesManagement:Low-grade injuries – crutches, rest, ice, NSAIDs, and functional bracing with full ROMRehab exercises should begin as symptoms resolveBegin cycling as alternative exercise activityRunning as symptoms allow – flat surfaces avoiding quick turns or cutting activitiesMCL bracing maintained throughout rehabilitative processSurgeryDifferential Diagnosis:Meniscal tearACL tearLCL tearReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 200-201. Print.Patella FractureDefinition: fracture of knee capEtiology/Mechanism: direct blow to patella or rapid hyperflexionSigns and Symptoms:Pain over patellaSwellingUnable to bear weight on involved sideMay be another deformityFalse joint may be notedManagement:Call EMSImmobilize affected knee in extensionDifferential Diagnosis:Patella tendon ruptureQuadriceps tendon rupturePatellar dislocationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 411-413, 416. Print.Lateral Collateral Ligament SprainDefinition: stretch or tear to LCLEtiology/Mechanism: varus strain, twisting, or hyperextension injurySigns and Symptoms:Complain of lateral joint pain with symptoms above or below joint lineComplain of instability with pivoting or twisting activitiesSwelling and bruisingTenderness at lateral joint lineIntra-articular effusionManagement:Low-grade injuries – crutches, rest, ice, NSAIDs, and functional bracing with full ROMStretching of quadriceps, IT band, and hamstrings; balanced quadriceps strengtheningOpen patella knee sleeve or various taping techniquesAlternative activities – cycling swimming, ski machineSurgery Differential Diagnosis:ACL tearPCL tearMeniscal tearReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 202-203. Print.Iliotibial Band Friction SyndromeDefinition: inflammatory condition affecting entire length of IT bandEtiology/Mechanism: tightness of IT band leads to friction irritation at lateral formal condyleSigns and Symptoms:Complain of lateral knee pain, “aching” painPain is worse with activities (running, jumping squatting)Tenderness and swelling along distal course of IT bandPositive Ober’s signManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Corticosteroid injectionPhysical therapy directed at improving IT band flexibility through stretching exercise and hip abductor strengtheningAddress any foot biomechanical issuesDifferential Diagnosis:Lateral meniscal tearLCL tearReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 213-214. Print.Anterior Cruciate Ligament SprainDefinition: stretching or tearing of ACLEtiology/Mechanism: direct blow to lateral, medial, or anterior aspects of knee causing valgus or varus strain, twisting, or hyperextensionSigns and Symptoms:Hearing or feeling a “pop”Massive joint effusionPain is diffuseInstability with quick turnsJoint line or posterior tendernessPositive Lachman and pivot shiftManagement:Knee immobilizer for 24-72 hours with crutchesPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Therapy early to limit strength loss and maintain ROMSubacute – proprioception training and training; functional brace for activitiesSurgery – when instability is persistentDifferential Diagnosis:Bone bruisingMeniscal injuryFracturePCL tearMCL tearLCL tearPatellar dislocationReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 189-192. Print.Meniscal TearDefinition: torn knee cartilageEtiology/Mechanism: twisting injury with foot planted, valgus or varus strain, hyperextension, or hyperflexionSigns and Symptoms:Appropriate mechanism describedMild to moderate swellingJoint line painPain with flexion or extensionSensation of locking or catching within knee jointEffusionJoint line tendernessPainful PROMPositive McMurray’s and Apley’s compressionManagement:PRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Activity modification with short-term crutch useFollowing initial rest period – exercise aimed at maintaining strength and flexibility while limiting pain (cycling, walking, swimming)As symptoms resolve – gradual running program with low intensityAvoid hills or turns and cutting and twisting activities for 8-10 weeksIf symptoms resolve in 6-12, refer for MRI or surgical evaluationIn mechanically locked knee – refer for urgent reduction or surgeryDifferential Diagnosis:FractureACL, MCL, LCL injuryDJDPatellar dysfunctionIT band friction syndromeBursitis References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 194-196. Print.Posterior Cruciate Ligament SprainDefinition: stretching or tearing of PCLEtiology/Mechanism: direct blow to anterior aspect of knee, extreme flexion or anterior directed stress with knee in full extensionSigns and Symptoms:AcutePain in posterior/lateral kneeSwellingOccasional instability with deceleration motionChronic instabilityPosterolateral tenderness and effusionPositive posterior drawer sign and sag signManagement:Knee immobilizer for 24-72 hours with crutchesPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Reconstruction is less commonDifferential Diagnosis:FractureACL, LCL, MCL injuryPatellar dislocationMeniscal tearReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 192-193. Print.Osteochondritis DissecansDefinition: fragments of cartilage/bone in knee jointEtiology/Mechanism: multifactorial (ischemia, genetic predisposition, abnormal ossification, trauma, cyclical strain)Signs and Symptoms:Knee pain (vague and diffuse)Intensity of pain related to activity level, often with swellingIf loose body present – may present with locking, catching, or giving wayManagement:Goal is to preserve articular cartilageRefer patients with loose bodiesStage 1 and 2 – activity modification, non-wt bearing and short-term immobilizationStage 3 and 4 – refer to orthopedics for arthroscopy Differential Diagnosis:FractureNeoplasmLigamentous injuryMeniscal injuryRetropatellar knee painReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 289-291. Print.Patella TendinitisDefinition: inflammation of patella tendon; also known as “jumper’s knee”Etiology/Mechanism: precipitated by excessive jumping or running; “jumper’s knee”Signs and Symptoms:Anterior knee pain at quadriceps tendonMild swelling, erythema, warmthStiffness after restMalalignment with increased Q-angle, lateral patellar tracking, weak ankle dorsiflexionTenderness and soft tissue swellingTightnessManagement:NSAIDsIce and elevationActivity modificationDefinitive therapy for correcting functional malalignment and tightness Continue alternative, non-painful activities during rehabDifferential Diagnosis:Retropatellar knee pain (Patellofemoral pain)Plica syndromeMeniscal tearBursitisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 206. Print.Tibial Plateau FractureDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Section 16: Ankle, Foot, & Lower LegAchilles Tendon RuptureDefinition: complete or incomplete tear of Achilles tendonEtiology/Mechanism: Occurs after sudden dorsiflexion of plantar flexed footEccentric load from a cutting motion or sudden change of directionSigns and Symptoms:Complain of sudden “pop in heelReports a feeling of being shot or kicked in heelDifficulty walkingPain with weight-bearingTender, palpable defect in tendonPositive Thompson testManagement:Initial managementPosterior, nonweight-bearing splint with 45 degrees plantar flexionCrutchesIce, pain medications, elevationRefer for operative repairIf nonoperative treatment decidedLong or short leg cast in gravity equinus positionNo weight-bearing on leg for 8 weeksCrutches for mobilityConsider recasting in reduced plantar flexion at 4 weeksAfter 8 weeks, cast removed and heel lift is worn for 4 weeksRehabilitation with passive, than active ROM and strengthening exercises including heel raisesDifferential Diagnosis:Gastrocnemius or soleus strainAchilles tendinopathyRetrocalcaneal bursitisAchilles bursitisCalcaneal avulsion fractureAnkle sprainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 239-241. Print.Great Toe SprainDefinition: stretching or tearing of extensor or flexor tendon of first toe; also known as “turf toe”Etiology/Mechanism: foot is planted and ankle is dorsiflexedSigns and Symptoms:Pain in joint during push-off phase of gaitPain during active joint motionPain during manual resistancePain when attempting quick stopsTender to palpationLimited ROMManagement:CrutchesFirm shoes insolePhysician may prescribe oral or injectable anti-inflammatory medicationsDifferential Diagnosis:Hallux rigidusSesamoditisMetatarsal fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 230. Print.Ankle Dislocation/SubluxationDefinition: displacement of one or more bones in ankleEtiology/Mechanism: fall from a heightSigns and Symptoms:Extreme painTotal loss of functionFoot may appear cold and paleSigns of shockManagement:Call EMSAssess neurovascular structureVacuum splint lower leg in position foundDifferential Diagnosis:Distal tib-fib fractureTalus fractureCalcaneal fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 241. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 505-506. Print.Hallux ValgusDefinition: lateral deviation of proximal phalanx on first MTP; medial aspect of head of first MTP enlarges and overlying bursa becomes inflamed and thickened (bunion)Etiology/Mechanism: previous injury; wearing shoes too short and too narrow for a long period of timeSigns and Symptoms:PainDeformity at first MTPTender to palpationManagement:Wear shoes with wide toe boxPadding around metatarsal prominenceOrthotics for overpronation or Morton’s toe if presentSurgery is pain becomes persistent despite conservative managementDifferential Diagnosis:Turf toeFirst MTP dislocationRupture of joint capsuleReferences: Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 250-251. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 399. Print.Syndesmosis SprainDefinition: stretching or tearing of anterior and/or posterior tibiofibular ligaments; “high ankle sprain”Etiology/Mechanism: ankle pronation with abduction or external or internal rotationSigns and Symptoms:Benign initiallyPain along interosseous membranePain proximal and anterior on ankleDiscomfort and swellingUnable to bear weightManagement:Ankle sprain without fracture or without radiographic evidencePhase 1 – immediate post injuryPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Crutches for ambulation – emphasize normal heel-to-toe gait with progression of weight-bearing over 1-5 daysROM exercise – write capital letters of ABC’s with big toe by moving at anklePhase 2 – begin when patient can tolerate without compensationStationary bikeROM exercise – DF, PF, eversion, inversionBalance and proprioception exercises – BAPS, foam roller balanceHeel raises and Achilles stretchingContrast bath for 20 minutesPhase 3 – when able to walk without limpStairmaster, slide board, squats, lungesBalance and proprioception exercises – mini trampoline/folded towel on floorIce ankle after exercise for 20 minutesPhase 4Gradual return to joggingJump ropeDot jumping, agility drills, balance and proprioception exercisesIce as neededConsider ankle brace for return to full activityRecovery time = 9+ weeksInjuries with radiographic evidence of syndesmotic injury, with or without fractureRefer to orthopedic surgeonDifferential Diagnosis:Ankle sprainOCD of talar domeLoose bodyInstabilityDistal tib-fib fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 229-231, 234. Print.Hallux RigidusDefinition: stiffness or fusion of first MTP jointEtiology/Mechanism: degenerative changes of first MTP jointSigns and Symptoms:Pain with walking or runningPain and swelling of first MTPRestricted extensionPain with forced extensionPalpable bony ridge along dorsal aspect of jointManagement:Shoes with wide toe box and rigid soleNSAIDsRocker bottom shoeSurgery Differential Diagnosis:Turf toeSemoiditis References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 252-253. Print.Anterior Talofibular SprainDefinition: stretch or tear of anterior talofibular ligamentEtiology/Mechanism: any combination of supination, plantar flexion, or talar rotationSigns and Symptoms:Pain at lateral aspect of ankleMay hear “pop” noiseSwelling around lateral joint capsuleEcchymosis Inability to balance on single leg of affected ankleManagement:Ankle sprain without fracture or without radiographic evidencePhase 1 – immediate post injuryPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Crutches for ambulation – emphasize normal heel-to-toe gait with progression of weight-bearing over 1-5 daysROM exercise – write capital letters of ABC’s with big toe by moving at anklePhase 2 – begin when patient can tolerate without compensationStationary bikeROM exercise – DF, PF, eversion, inversionBalance and proprioception exercises – BAPS, foam roller balanceHeel raises and Achilles stretchingContrast bath for 20 minutesPhase 3 – when able to walk without limpStairmaster, slide board, squats, lungesBalance and proprioception exercises – mini trampoline/folded towel on floorIce ankle after exercise for 20 minutesPhase 4Gradual return to joggingJump ropeDot jumping, agility drills, balance and proprioception exercisesIce as neededConsider ankle brace for return to full activityRecovery time = 9+ weeksDifferential Diagnosis:Syndesmotic ankle sprainSubluxating peroneal tendonTear of peroneus brevis tendon/muscleSubtalar joint sprainLateral malleolus fractureMedial malleolus fractureOsteochondral fracture of talusJones fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 270. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 229-231. Print.Hammer ToeDefinition: hyperflexion of PIP with hyperextension of DIPEtiology/Mechanism: wearing shoes too small over long period of time; intrinsic and extrinsic muscle contractureSigns and Symptoms:Pain from callus or corns formed on top of toe“Hump” or “head of hammer” appearance on toeFlexion of DIP jointManagement:Metatarsal pad my help control symptomsSurgery may be necessaryDifferential Diagnosis:Claw toeInterdigitial neuromaMallet toeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 498. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 400. Print.Calcaneofibular Ligament SprainDefinition: tearing or stretching of calcaneofibular ligament of ankleEtiology/Mechanism: any combination of supination, plantar flexion, or talar rotationSigns and Symptoms:Pain at lateral aspect of ankleMay hear “pop” noiseSwelling around lateral joint capsuleEcchymosis Inability to balance on single leg of affected ankleManagement:Ankle sprain without fracture or without radiographic evidencePhase 1 – immediate post injuryPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Crutches for ambulation – emphasize normal heel-to-toe gait with progression of weight-bearing over 1-5 daysROM exercise – write capital letters of ABC’s with big toe by moving at anklePhase 2 – begin when patient can tolerate without compensationStationary bikeROM exercise – DF, PF, eversion, inversionBalance and proprioception exercises – BAPS, foam roller balanceHeel raises and Achilles stretchingContrast bath for 20 minutesPhase 3 – when able to walk without limpStairmaster, slide board, squats, lungesBalance and proprioception exercises – mini trampoline/folded towel on floorIce ankle after exercise for 20 minutesPhase 4Gradual return to joggingJump ropeDot jumping, agility drills, balance and proprioception exercisesIce as neededConsider ankle brace for return to full activityRecovery time = 9+ weeksDifferential Diagnosis:Syndesmotic ankle sprainSubluxating peroneal tendonTear of peroneus brevis tendon/muscleSubtalar joint sprainLateral malleolus fractureMedial malleolus fractureOsteochondral fracture of talusJones fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 270. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 229-231. Print.Heel SpurDefinition: bony outgrowth on plantar surface of calcaneusEtiology/Mechanism: forced dorsiflexion of ankle combined with toe extensionSigns and Symptoms:Gradual onsetPain during heel-strike phase of gaitManagement:Changes in footwearRestoration of dorsiflexionDifferential Diagnosis:Calcaneal fracture/stress fractureFat pad syndromeTarsal tunnel syndromeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 216-217. Print.Deltoid Ligament SprainDefinition: tearing or stretching of deltoid ligament of ankleEtiology/Mechanism: eversion and/or rotationSigns and Symptoms:Pain on medial border of ankle and footSwelling around medial joint capsuleIncreased pain during midstance phase of gaitCrepitus may indicate avulsion fractureManagement:Ankle sprain without fracture or without radiographic evidencePhase 1 – immediate post injuryPRICEMM (protect, rest, ice, compression, elevate, medications, modalities)Crutches for ambulation – emphasize normal heel-to-toe gait with progression of weight-bearing over 1-5 daysROM exercise – write capital letters of ABC’s with big toe by moving at anklePhase 2 – begin when patient can tolerate without compensationStationary bikeROM exercise – DF, PF, eversion, inversionBalance and proprioception exercises – BAPS, foam roller balanceHeel raises and Achilles stretchingContrast bath for 20 minutesPhase 3 – when able to walk without limpStairmaster, slide board, squats, lungesBalance and proprioception exercises – mini trampoline/folded towel on floorIce ankle after exercise for 20 minutesPhase 4Gradual return to joggingJump ropeDot jumping, agility drills, balance and proprioception exercisesIce as neededConsider ankle brace for return to full activityRecovery time = 9+ weeksDifferential Diagnosis:Posterior tibialis tearFibular fractureDistal syndesmosis sprainMedial malleolus fracturePosterior tibial neuropathyReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. 277. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 229-231. Print.Ingrown ToenailDefinition: toenail edges embed in soft tissue; also known as “unguis incarnates”Etiology/Mechanism: improper footwear; improper cutting of nailSigns and Symptoms:PainPossible loss of activity in severe casesRednessSwellingInflammationImproperly cut or deformed toenailPossible infectionManagement:Refer to physicianDifferential Diagnosis:InfectionSubungal hematomaReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 416. Print.Bifurcate Ligament SprainDefinition: midtarsal joint stretch or tear of calcaneocuboid/calcaneonavicular ligamentEtiology/Mechanism: severe dorsiflexion, plantar flexion, or pronationSigns and Symptoms:PainSwellingUnable to bear weight due to painManagement:Adequate strappingArch supportsLimited weight-bearingRefer to physician if symptoms continueDifferential Diagnosis:Midfoot stress fractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 502. Print.Jones FractureDefinition: fracture of base of fifth metatarsalEtiology/Mechanism: direct trauma or inversion injurySigns and Symptoms:History of traumaPainTendernessSwellingEcchymosis Crepitus Management:Fracture of shaftShort leg walking cast or boot for 4-6 weeksDisplaced fracture should be referredAvulsion fractureStrapping and post-op shoeDifferential Diagnosis:Tendonitis SprainReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 258. Print.Distal Tibia-Fibula FractureDefinition: fracture at talar dome levelEtiology/Mechanism: torsional forceSigns and Symptoms:Extreme painGross deformityGross bone motion at fracture siteCrepitusSwelling Management:Call EMSImmobilize fractureDifferential Diagnosis:Fracture of talusReferences: Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. 516-517. Print.Pes CavusDefinition: high longitudinal arch; rigid foodEtiology/Mechanism: congenital, idiopathic, or due to neurologic disorder causing muscular imbalance contracture of soft tissue structuresSigns and Symptoms:General foot painPain at ball of footIncrease in overuse symptoms in ankle, knee, hip, or backClawed or hammer toesTight plantar fasciaShortening of Achilles Calluses on ball of foot or heelExcessive medial longitudinal archManagement:TapingOrthoticsChange in footwear Differential Diagnosis:Peroneal tendinitisPlantar faciitis Achilles tendinitisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 406. Print.Anterior Compartment SyndromeDefinition: increased pressure in lower leg compresses neurovascular vesselsEtiology/Mechanism: direct trauma to anterior compartment of lower legSigns and Symptoms:Possible loss of ankle dorsiflexion or great toe extensionPain during runningPain with active and resistive dorsiflexionPain on passive plantar flexionSwellingTendernessPossible dropped footInability to evert footManagement:Refer to orthopedic or general surgeonDifferential Diagnosis:Deep vein thrombosisReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 347. Print.Pes PlanusDefinition: flat longitudinal arch; pliable footEtiology/Mechanism: congenital; poorly fitted shoes; muscle atrophy and loss of support; obesity; excessive exercise; trauma to support structureSigns and Symptoms:Pain in medial longitudinal archLoss of spring in stepStiffnessTenderness at arch and heelSlight disabilityPossible low back painEverted position of calcaneusMedial bulging of navicular tuberosityManagement:TapingOrthoticsChange in footwearMedial longitudinal arch strain Differential Diagnosis:FractureReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 407. Print.Calcaneal ApophysitisDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Plantar FasciitisDefinition: inflammation of plantar fasciaEtiology/Mechanism: cavus foot, hyperpronation, excessive training, tight AchillesSigns and Symptoms:Onset heel pain“First step pain” or pain with first steps in morning or after long restPain after prolonged activityPoint tenderness at medial tubercle of calcaneus, may be tender along longitudinal archManagement:InitiallyNSAIDsAchilles stretchingCross friction massageIcePhysical therapy modalitiesArch supports/heel cups/arch tapingCounterforce bracingNo barefoot walkingLimit weight-bearing activitiesCross train in pool or on bikeIf symptoms persistNight splintsPossible cortisone injectionsShort leg walking castSurgery Differential Diagnosis:Calcaneal stress fractureNeuroma (lateral plantar nerve)Tarsal tunnel syndromeReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 261-262. Print.Medial Longitudinal Arch StrainDefinition:Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Plantar NeuromaDefinition: Morton neuroma; interdigital neuromaEtiology/Mechanism: thickening of plantar nerve where medial and lateral branches join and separate to pass adjacent sides of third and fourth toesSigns and Symptoms:Intermittent, sharp pain in lateral footSharp pain in third and fourth toesTemporary loss of functionTenderness between third and fourth metatarsal headsPalpation may reveal small tender mass in nerveManagement:Refer to orthopedic surgeonDifferential Diagnosis:Stress fractureTendon sheath ganglionNerve-sheath tumorStrain of plantar capsuleBursitis References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 409. Print.BunionDefinition: hallux valgus of first MTP joint causing bony outgrowthEtiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Achilles TendinitisDefinition: inflammation of Achilles tendonEtiology/Mechanism: overuse, increase in mileage, increase in hill running, poor calf/hamstring flexibilitySigns and Symptoms:Activity-related pain at tendonRecent change in shoes and/or trainingMorning stiffnessTenderness, swelling, and/or crepitus at tendonChronic tendinopathy is often thickened and nodularHamstring and gastroc-soleus inflexibilityManagement:InitialRelative restModification in activityOrthoticsHeavy eccentric exercisesSevere casesCasted in equinus position for 2-4 weeksRefer recalcitrant cases for surgical debridementDifferential Diagnosis:PeriotendonitisRetrocalcaneal bursitisReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 247-248. Print.BunionetteDefinition: angulation of fifth metatarsophalangeal joint; also known as “tailor’s bunion”Etiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Plantaris Muscle RuptureDefinition: complete or incomplete tear of plantaris tendon; also known as “tennis leg”Etiology/Mechanism: excessive contraction or stretch of musculotendinous unit; sudden change in directionSigns and Symptoms:Pain in lower leg with running or jumpingPossible pain around anklePossible loss of function in severe casesDescribes pain with “push-off”Tenderness below knee laterally or mediallyManagement:MRIRefer to orthopedic surgeonDifferential Diagnosis:Achilles tendon ruptureAchilles tendinitisGastrocnemious-soleus injuryReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 357. Print.Achilles BursitisDefinition: inflammation of Achilles bursaEtiology/Mechanism:Signs and Symptoms:Management:Differential Diagnosis:References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Medial Tibial Stress SyndromeDefinition: anterior shin pain; “shin splints”Etiology/Mechanism: overuse injury caused by running in deconditioned athlete, or sudden increase of intensity of trainingSigns and Symptoms:History of recent changes in pattern, frequency, or intensity of activityPoor fitting or worn shoesPain along posteromedial border of distal tibia, induced by exercise and relieved by restPain with resisted plantar flexion and inversionGradesGrade 1 – symptoms occur at start of activity, decrease during activity, or develop at end of activityGrade 2 – symptoms occur during activity with late onsetGrade 3 – symptoms during activity with early onset, persist throughout activityGrade 4 – symptoms limit quality or quantity of trainingGrade 5 – symptoms prevent trainingTenderness along posteromedial border of distal third of tibiaPain standing on toesPain with passive ankle dorsiflexion or active ankle plantar flexionManagement:Rest for 1 week with gradual return to full activityOrthotics for excessive pronatorsGastroc-soleus stretchingCross training to maintain fitness – swimming, water running, etc.Proprioceptive training once pain free considered after 1-2 weeks of restDifferential Diagnosis:Exertional compartment syndrome of deep posterior compartmentStress fractureTumorPeroneal nerve entrapmentDVTTennis legClaudicationPopliteal artery entrapmentReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 220-222. Print.Talus Chondral/Osteochondral FractureDefinition: articular cartilage fracture in ankle Etiology/Mechanism: traumatic or idiopathic etiologiesSigns and Symptoms:Describes vague pain “inside” anklePresents with prolonged pain or achingPersistent swelling, could be activity relatedPossible catching, locking, giving wayPain with weight-bearing activityBerndt and Hardy ClassificationsStage 1 – small area of compressionStage 2 – partially detached OCLStage 3 – completely detached, nondisplaced fragmentStage 4 – completely detached, displaced fragment, free body presentManagement:Refer for appropriate staging and managementCan range from nonweight-bearing cast to open reduction and internal fixationDifferential Diagnosis:OsteoarthritisAnterolateral soft tissue impingementInstabilityPoorly rehabilitated lateral ankle sprainCrystal-induced arthropathies References: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 237-239. Print.Tibial Stress FractureDefinition: overload-induced discontinuation of tibial boneEtiology/Mechanism: overuse; repeated loading of bone over long period of timeSigns and Symptoms:No history of impact or traumaIncreased pain upon activity that subsides with restPossible increase in training reportedTendernessLoss of functionSwellingInflammationPain with weight-bearingManagement:X-rayBone scanRefer to orthopedic surgeonDifferential Diagnosis:Medial tibial stress syndromeReferences:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 353. Print.CornDefinition:Hard – thickening of soft tissue on dorsum of toes; “callus durum”Soft – thickening of soft tissue between toes, usually fourth and fifth; “callus molle”Etiology/Mechanism:HardFriction; improperly fitting shoesSoftWearing narrow shoes that cause excessive pressure; excessive foot perspirationSigns and Symptoms:HardPainInability to function in activity due to location of cornTenderness over area of cornInflammationThickening of soft tissue on dorsum of toeRedness SoftPain between toes, usually fourth and fifthLoss of function in severe casesTendernessInflammationCircular area of thickened, white, macerated skinLoss of ability to run in severe casesManagement:Differential Diagnosis:References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 387-388. Print.Subungual HematomaDefinition: blood under toenail Etiology/Mechanism: direct traumaSigns and Symptoms:PainTendernessBlood under toenail Nail may fall off at some point in futureManagement:if hemorrhage is acute and painful – can be relieved by drilling hole in nail, sterile dressing then appliedDifferential Diagnosis:ContusionReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 250. Print.Peroneal Tendon Dislocation/SubluxationDefinition: displacement of peroneal tendon/partial displacement of peroneal tendon; usually longusEtiology/Mechanism: acute dorsiflexion and inversion stress to ankleSigns and Symptoms:Notes “pop” and/or snapping sensation posterior to lateral malleolusPain or swelling localizedManagement:Treatment is controversialConsider early referral to orthopedicsDifferential Diagnosis:More posterior peroneus longus tendon snapping over more anterior peroneus tendonAnkle sprainFibular fractureReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 233-234. Print.Talotibial ExostosisDefinition: bony outgrowth from surface or talus; can be anterior or posteriorEtiology/Mechanism: AnteriorRepetitive extreme dorsiflexion causing contact between talus and tibia, causing inflammation and irritation which leads to bone formationPosteriorRepetitive extreme plantar flexion that causes traction on attachment of joint capsule, resulting in microscopic bleeding and eventually spur formationSigns and Symptoms:AnteriorPain across ankle jointPain during “push-off”Pain with forceful manual dorsiflexionTenderness over dorsum of ankle at joint of talus and tibiaCannot run at full speedMild loss of function of ankle jointPosteriorPain in posterior aspect of anklePain on forced plantar flexionLoss of normal ankle functionTendernessCannot run at full speedManagement:X-rayRefer to orthopedic surgeon Differential Diagnosis:Ankle sprainAchilles tendinitisPlantaris fasciitis References:Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 360-361. Print.Tibia/Fibula Epiphyseal Plate InjuryDefinition: fracture to epiphyseal plate of tibiaEtiology/Mechanism: direct trauma to tibia; indirect trauma as in an excessive compression force or severe torsion Signs and Symptoms:Sudden painLoss of normal ankle functionDirect and indirect tendernessRapid swellingDelayed ecchymosisPossible deformity, crepitus, bony deviation, false joint motionManagement:X-rayRefer to orthopedic surgeonDifferential Diagnosis:Ankle fractureReferences:Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. 370. Print.Tarsal Tunnel SyndromeDefinition: entrapped posterior tibial nerve along medial malleolusEtiology/Mechanism: nerve compressionSigns and Symptoms:Medial posterior foot pain accompanied by burning and tinglingPain exacerbated by standing and activityMay complain of night painManagement:NSAIDsCorrection of biomechanical abnormalities (arch support, medial wedge)Cortisone injectionStretchingCast immobilizationSurgical decompression if symptoms persistDifferential Diagnosis:Calcaneal stress fractureRadiculopathyPosterior tibialis tendinopathyReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 142. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 264-265. Print.Metatarsal FractureDefinition: broken metatarsal boneEtiology/Mechanism: direct trauma or inversion/eversion of forefootSigns and Symptoms:History of traumaPainSwellingLocalized tendernessCrepitusEcchymosis Management:Comfort and protectionCast, post-op shoe, strappingMultiple fracturesShort leg walking castReferFirst metatarsal fracturesDisplaced fracturesFractures at base of metatarsalsDifferential Diagnosis:Lisfranc joint injuryTendonitisMidfoot OAReferences: Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. 141. Print.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. 265-267. Print.Works CitedAnderson, M., Parr, G., Hall, S. Foundations of Athletic Training: Prevention, Assessment, and Management (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins, 2009. Print.Anderson, M., Hall, S., Martin, M. Sports Injury Management (2nd ed.). Baltimore, MD: LippincottWilliams & Wilkins, 2000. Print."Arthritis." Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 30 Aug. 2015.Bernier J. Quick Reference Dictionary For Athletic Training. Thorofare, NJ: SLACK, 2005. Print.Cuppett, M. & Walsh, K. General Medical Conditions in the Athlete (2nd ed.) St. Louis, MI: Mosby, Inc, 2012. Print.Douglas May J. and Gallaspy J. Signs and Symptoms of Athletic Injuries. St. Louis, MI: Mosby-Year Book, 1996. Print.The Editors of Encyclopedia Britannica. “Neuritis (pathology).” Encyclopedia Britannica Online. Encyclopedia Britannica. Web. 13 Nov. 2015.. Enthesitis | Types, Pain, Symptoms and Treatments, 2015. Web. 5 Sept. 2015.Howard T. & Butcher B. The Little Black Book of Sports Medicine (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers, 2006. Print.Learn About Myositis - TMA - The Myositis Association. 1 March 2015. Web. 12 Sept. 2015.Long, B. & Hale IV, C. Athletic Training Exam Review. Baltimore, MD: Lippincott Williams & Wilkins, 2010. Print.“Lymphangitis: MedlinePlus Medical Encyclopedia.” U.S. National Library of Medicine. U.S. National Library of Medicine. Web. 13 Nov. 2015.O'Connor, Bob, Richard Budgett, Christine Wells, and Jerry Lewis. "Degenerative Diseases." SportsInjuries and Illnesses: Their Prevention and Treatment. Ramsbury, Marlborough, Wiltshire:Crowood, 1998. Print.“Osteomyelitis.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 6 Sept. 2015.“Post-concussion syndrome.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web.7 Sept. 2015. Prentice, William E. Principles of Athletic Training: A Competency-Based Approach (15th ed.). New York,NY: McGraw-Hill Companies, Inc, 2014. Print.“Radiculitis – Radiculitis Treatment – Bonati Spine Institute.” Bonati Spine Institute. Web. 13 Nov. 2015. Starkey C, Johnson G. Athletic Training And Sports Medicine. Sudbury, MA: Jones and Bartlett Publishers,2006. Print.Starkey, C. & Brown, S.D. Examination of Orthopedic and Athletic Injuries (4th ed.). Philadelphia, PA: F.A.Davis Company, 2015. Print.“Swollen lymph nodes.” Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 12Sept. 2015. ................
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