Preparticipation Physical Evaluation for Athletes
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Questions and Answers

What should be the focus of examination in identifying musculoskeletal issues?

  • Identifying psychological factors
  • Assessing cardiovascular health
  • Evaluating previous surgical interventions
  • Identifying risk factors like muscle weakness or overpronation (correct)

Which factor is NOT considered a modifiable risk factor for reinjury?

  • Inflexibility
  • Previous surgeries (correct)
  • Joint motion asymmetries
  • Muscle weakness

What is the primary goal of the musculoskeletal examination?

  • Conducting imaging studies
  • Focusing solely on age-related changes
  • Diagnosing infections
  • Evaluating for recovery from prior injuries and identifying asymmetries (correct)

When is an orthopaedic screening examination deemed sufficient?

<p>In asymptomatic athletes with no previous injuries (A)</p> Signup and view all the answers

What should be done if the comprehensive examination is beyond the examiner’s expertise?

<p>Refer to a sports medicine physician (A)</p> Signup and view all the answers

What is a strain primarily caused by?

<p>Sudden, forceful change in muscle length (B)</p> Signup and view all the answers

Which muscles are most commonly affected by strains?

<p>Muscles that cross two joints (C)</p> Signup and view all the answers

What is the initial treatment protocol for a muscle strain?

<p>Rest, ice, compression, and elevation (RICE) (A)</p> Signup and view all the answers

Which sign or symptom indicates a muscle strain?

<p>Muscle tenderness and weakness with contraction (B)</p> Signup and view all the answers

Which imaging modality is emerging for diagnosing muscle injuries?

<p>Ultrasonography (B)</p> Signup and view all the answers

Acute-onset muscle pain during activity is a common symptom of which condition?

<p>Muscle strains (C)</p> Signup and view all the answers

What is often mistaken for a muscle strain in skeletally immature athletes?

<p>Apophyseal avulsion fractures (C)</p> Signup and view all the answers

What type of contraction is most associated with causing muscle strains?

<p>Eccentric contraction (D)</p> Signup and view all the answers

What causes muscle contusions?

<p>Non-penetrating blows to the muscle belly (B)</p> Signup and view all the answers

Which area is most commonly affected by muscle contusions?

<p>Quadriceps (C)</p> Signup and view all the answers

What is a common cause of an adductor strain?

<p>Forceful hip extension and external rotation of the leg (C)</p> Signup and view all the answers

What symptom is commonly associated with an adductor strain?

<p>Sudden onset of pain in the inner thigh (A)</p> Signup and view all the answers

What is the primary method for diagnosing an adductor strain?

<p>History and physical examination (B)</p> Signup and view all the answers

Which of the following is NOT a factor that increases the risk of an adductor strain?

<p>High levels of balance training (B)</p> Signup and view all the answers

What are common treatment methods for muscle contusions?

<p>Rest, ice, compression, and elevation (RICE) (C)</p> Signup and view all the answers

What physical finding is commonly associated with an adductor strain diagnosis?

<p>Tenderness and bruising over the inner thigh (A)</p> Signup and view all the answers

What is the average time to return to sports after a Grade 2 lateral ankle sprain?

<p>15 days (B)</p> Signup and view all the answers

Which treatment is known to facilitate recovery during the first 7 to 10 days after an ankle injury?

<p>NSAIDs (B)</p> Signup and view all the answers

What is the common complication associated with syndesmosis sprains?

<p>Heterotopic ossification (C)</p> Signup and view all the answers

What rehabilitation strategy is shown to reduce the risk of recurrent ankle sprains?

<p>Proprioception training (B)</p> Signup and view all the answers

Which type of acromioclavicular joint injury involves both coracoclavicular ligaments?

<p>Type III (B)</p> Signup and view all the answers

After an initial sprain, what is the increased risk factor for reinjury?

<p>5 times higher (A)</p> Signup and view all the answers

Which factor is the most common cause of persistent pain after an ankle sprain?

<p>Inadequate rehabilitation (B)</p> Signup and view all the answers

What typically doubles the recovery time for medial ankle sprains compared to lateral sprains?

<p>Severity of the injury (D)</p> Signup and view all the answers

What is the recommended initial treatment for most adductor muscle strains?

<p>Activity modification and ice (A)</p> Signup and view all the answers

In which scenario are X-rays particularly recommended?

<p>In cases of tenderness at the site of bony insertion (D)</p> Signup and view all the answers

Who may require an MRI due to the nature of their injuries?

<p>Elite professional athletes (A)</p> Signup and view all the answers

What is a common cause of quadriceps contusion?

<p>Blunt contact of a knee to the thigh (C)</p> Signup and view all the answers

How long do most strains typically take to start improving?

<p>10-14 days (B)</p> Signup and view all the answers

What grading system for contusion severity is based on active knee flexion post-injury?

<p>Mild: active knee flexion greater than 90 degrees (B)</p> Signup and view all the answers

Which diagnostic imaging is especially helpful in identifying small hematomas deep within the muscle belly?

<p>Magnetic resonance imaging (MRI) (A)</p> Signup and view all the answers

What is essential for preventing most adductor muscle strains?

<p>Proper warm-up and stretching (B)</p> Signup and view all the answers

Which type of injury may require surgical reattachment?

<p>Avulsion injuries (D)</p> Signup and view all the answers

What is the primary benefit of immobilization of the knee in maximal tolerable flexion initially after diagnosis?

<p>It limits the size of hematoma formation. (D)</p> Signup and view all the answers

What symptom is associated with quadriceps contusion?

<p>Pain and swelling in the thigh (B)</p> Signup and view all the answers

What is a common physical examination finding in a patient with a muscle contusion?

<p>Weakness and pain with passive stretch (C)</p> Signup and view all the answers

What should be initiated after the first 24 to 48 hours of treatment for a quadriceps contusion?

<p>Active quadriceps stretching and isometric strengthening (C)</p> Signup and view all the answers

What is the expected prognosis for a patient if treatment is started promptly after injury?

<p>Excellent with normal return to function (A)</p> Signup and view all the answers

Crutches are recommended until the patient has achieved what knee flexion degree?

<p>At least 90 degrees (A)</p> Signup and view all the answers

Which of the following is NOT listed as a differential diagnosis for a quadriceps contusion?

<p>Biceps tendonitis (C)</p> Signup and view all the answers

Flashcards

Risk factors for reinjury

Musculoskeletal factors like muscle weakness or inflexibility that increase the chance of re-injury

Screening examination

Basic check-up for athletes without injury history. Sufficient for those.

Comprehensive examination

Thorough evaluation, used for athletes with prior injuries or symptoms like pain or limited movement

Referral for sports medicine physician

Needed when the examination expertise is beyond the current evaluator's skills.

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Musculoskeletal risk factors

Muscle weakness, pes cavus (high arch), or overpronation.

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Muscle Strain

A tear in some or all muscle fibers caused by a sudden forceful movement or repetitive overuse.

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Strain Etiology

Muscle strains commonly happen when muscles are stretched or contracted suddenly under a load.

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Strain Location

Strains are common in muscles of the lower leg that cross two joints, such as the hamstrings and rectus femoris.

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Strain Symptoms

Muscle strain symptoms include sudden pain, possibly a tearing sensation, pain with weight-bearing, muscle tenderness, swelling (edema), bruising (ecchymosis), pain with muscle contraction or stretching.

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Strain Differential Diagnosis

Diagnosis of a strain might involve ruling out other issues, such as an avulsion fracture (broken bone) in a young athlete or a stress fracture.

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Strain Grading

Muscle strains are categorized into different grades based on severity of injury.

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Strain Diagnosis

Clinically diagnosed or visualized with imaging to find location and severity.

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RICE Treatment

Rest, Ice, Compression, Elevation for initial strain treatment.

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Ankle Sprain Grades

Ankle sprains are classified into three grades based on the severity of ligament damage: Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe).

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Rehabilitation for Ankle Sprains

Rehabilitation after an ankle sprain aims to restore range of motion, flexibility, strength, and proprioception (awareness of body position) to the ankle.

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Time to Return to Sports (Ankle Sprains)

The time it takes to return to sports after an ankle sprain varies by the severity: Grade 1 (8 days), Grade 2 (15 days), Grade 3 (28 days).

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Risk of Reinjury (Ankle Sprain)

After an ankle sprain, the risk of reinjury increases significantly, up to 5 times greater than before the injury.

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Chronic Instability (Ankle Sprain)

A significant percentage of athletes (20-40%) experience ongoing ankle instability even after an initial sprain.

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Medial vs. Lateral Ankle Sprains

Medial ankle sprains (inside of ankle) take longer to recover than lateral ankle sprains (outside of ankle).

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Syndesmosis Sprains

Syndesmosis sprains involve the ligaments that connect the shinbone (tibia) and fibula, leading to instability in the lower leg.

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Acromioclavicular (AC) Joint Sprain

An AC joint sprain, also known as a shoulder separation, affects the joint between the collarbone (clavicle) and shoulder blade (scapula).

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Adductor Muscle Strain

A tear in one or more of the adductor muscles located in the inner thigh, responsible for bringing the legs together.

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Adductor Strain Causes

Often caused by sudden forceful movements, overuse, or imbalances in muscle strength.

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Adductor Strain Symptoms

Pain in the inner thigh, especially during activity, swelling, and difficulty moving the leg.

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Adductor Strain Diagnosis

Usually diagnosed based on physical exam, X-rays can be used to rule out other conditions.

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Adductor Strain Treatment

Most cases respond to conservative treatment, including rest, ice, anti-inflammatory medication, and physiotherapy.

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Adductor Strain Surgery

Surgery is rarely required, but may be necessary for severe tears or for avulsion injuries.

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Adductor Strain Prevention

Proper warm-up, stretching, and strengthening exercises can help prevent these injuries.

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Quadriceps Contusion

A bruise or injury to one or more of the quadriceps muscles located on the front of the thigh.

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Quadriceps Contusion Symptoms

The patient may experience knee stiffness, difficulty bearing weight, tenderness, swelling, bruising, weakness, and pain with stretching the quadriceps muscle.

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Quadriceps Contusion Examination

Exam findings may include a palpable mass, pain with active straight-leg raise, and limited knee flexion depending on severity.

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Quadriceps Contusion Severity

Contusion severity is graded based on knee flexion after injury: Mild (over 90 degrees), Moderate (45-90 degrees), Severe (under 45 degrees).

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Quadriceps Contusion Treatment

RICE (Rest, Ice, Compression, Elevation), knee immobilization for 24-48 hours, followed by gradual stretching and strengthening.

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Quadriceps Contusion Imaging

While X-rays may show normal findings, ultrasound or MRI can be used to evaluate the extent of the hematoma and guide treatment.

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Quadriceps Contusion Prognosis

Prognosis is usually excellent with prompt treatment.

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Quadriceps Contusion Return to Play

An athlete can return to play when full knee flexion and pain-free movement are achieved, and quadriceps strength is equal to the uninjured side.

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Contusion

A bruise to a muscle caused by a direct, non-penetrating blow. It involves bleeding and hematoma formation.

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Common Contusion Locations

The quadriceps (anterior or lateral thigh) and brachialis (upper arm) are the most frequently affected muscles by contusions.

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Adductor Strain

An injury to the adductor muscle group in the inner thigh, often caused by forceful hip extension & external rotation of an abducted leg.

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Causes of Adductor Strain

Adductor strains often occur during intense muscle contraction, like kicking, pivoting, or skating. Lack of warm-up, stretching, or overuse can also contribute.

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Adductor Strain Physical Exam

The doctor will check for tenderness when touching (palpation) the inner thigh, and may notice swelling and warmth over the injury. Range of motion is generally normal, but pain is triggered when contracting the muscles.

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When Are Special Tests Unnecessary?

Special tests are typically not needed for diagnosing an adductor muscle strain, as the history and physical examination are usually sufficient.

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Study Notes

Preparticipation Physical Evaluation (PPE)

  • PPE is a screening tool for athletes before training and competition.
  • Its purpose is to encourage safe participation, not exclusion.
  • Primary goals include assessing general physical and psychological health, identifying disabling or life-threatening conditions, evaluating conditions predisposing to injury or illness, facilitating discussions on health and lifestyle, and serving as an entry point for adolescents lacking a medical home into the healthcare system.

Timing

  • Ideally, PPE is integrated into an athlete's annual health supervision examination.
  • It can be incorporated into well-child care visits starting at 6 years of age.
  • PPE should be completed at least 6 weeks before the start of preseason practice.

Musculoskeletal History

  • Musculoskeletal history alone predicts 67%–92% of musculoskeletal problems in athletes.
  • Obtaining a complete, accurate history involves athlete and parent-completed questionnaires.
  • Identification of chronic conditions or incompletely rehabilitated injuries is a key goal.
  • Previous injuries or surgeries causing pain, instability, or limitations are examined.
  • Past disqualifications from competition necessitate deep re-evaluation.

Additional History

  • Previous surgery details (specific procedures) should be documented.
  • Information on activity restrictions, braces/supports, and postoperative rehabilitation following surgery is requested.
  • Use of support brace/device indicates potential unresolved or self-treated injury warranting further investigation.
  • Braces are assessed for proper fit and integrity pre-season.
  • Relevant questions regarding the bone and joint are asked and answered
  • Dietary and menstrual history (relative energy deficiency in sport) should be detailed for assessment.
  • Training errors and improper equipment (e.g., shoes) need to be addressed.
  • Examination focuses on potential risk factors (muscle weakness, pes cavus, overpronation) addressable through rehabilitation or support.
  • Goals of musculoskeletal examination include evaluating recovery from injuries, identifying modifying reinjury risks (muscle weakness, inflexibility), identifying musculoskeletal imbalances or asymmetries.
  • A thorough examination of affected areas is supplemented with a comprehensive evaluation for athletes with prior injuries.

Criteria for Clearance

  • Criteria for returning to play after a sprain, strain, dislocation, or overuse injury include full, pain-free range of motion, minimal to no swelling, near-normal muscle strength (at least 85–90% of opposite side), and absence of pain or instability with sports-specific activities.
  • Examination includes visual inspection of symmetry, range of motion, and strength in various body parts.

Clearance

  • For fractures, clearance is determined by the treating physician.
  • Return to play may occur in some cases using padding or splints depending on child comfort and risk.
  • Activity modifications might be needed for developmental issues or physical limitations.

Clearance Categories

  • Clearance is categorized based on factors including athlete risk for injury/illness and safety of other athletes, safe participation with treatment, and limited participation during treatment.

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Description

This quiz covers the essential aspects of Preparticipation Physical Evaluation (PPE) for athletes. Learn about the goals, timing, and significance of PPE in ensuring safe participation in sports. Test your understanding of musculoskeletal history and its importance in predicting athletic injuries.

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