Phar 462 - Sports Injuries

Front 1

"Much of the sport and exercise medicine and the management of musculoskeletal injury has developed emotionally with little research evidence" True or False?

Back 1

TRUE

Front 2

When do you refer a sports injury to a physician?

Back 2

1) All traumatic joint injuries

2) Severe Pain

3) Pain in a joint/bone that lasts >2 weeks

4) Neck Injuries (Paralysis, Tingling, Numbness)

5) Any eye injury which results in blurred vision, loss of vision, mod-severe eye discomfort or pain

Front 3

What is the current controversy for Cryotherapy and RICE for sports injuries?

Back 3

It appears that both ICE and complete Rest may delay healing, instead of helping

Front 4

What is now recommended instead of RICE?

Back 4

Now we recommend MCE (Move Safely when you can, Compress, Elevate)

Front 5

What is the current evidence of efficacy for RICE for sports injuries?

Back 5

1 RCT shows evidence for cooling gel,

1 RCT showed NSS,

4 animal studies showed that modest cooling reduced OEDEMA but excessive or prolonged cooling is damaging,

Some evidence that it will inhibit function to athletes after applying ice

Front 6

What is the current recommendation in regards to RICE?

Back 6

Untill better evidence is available, practioners should use short cooling applications (<10mins) and/or undertake a progressive warm up prior to returning to play

Front 7

What is the evidence of NSAIDs for Inflammation associated with Sports Injuries?

Back 7

There is no evidence that NSAIDs will decrease inflammation

Front 8

What is the evidence of NSAIDs when compared to other analgesics for Sports Injuries??

Back 8

There is generally low/very quality but consistent evidence of no clinically important difference between NSAIDs and other analgesics for pain relief

Front 9

What is the evidence of NSAIDs when compared to other Opioids for Sports Injuries?

Back 9

Low evidence of better function and fewer ADRs with NSAIDs compared to Opioids

Front 10

What is the evidence comparing NSAIDs with Paracetamol for pain associated with Sports Injuries?

Back 10

Lack of clinical important differences between the two in pain at <24hrs, 1 day, 3 days and >7 days

Front 11

What is the evidence comparing NSAIDs with Paracetamol for Swelling associated with Sports Injuries?

Back 11

Lack of difference between the two groups for swelling at Days 3 and Day 7 and over

Front 12

What is the evidence comparing NSAIDs with Paracetamol for Return to functionality after a Sports Injuries?

Back 12

Little difference between the two groups in return to function at Days 7 or over

Front 13

What is the evidence comparing NSAIDs with Paracetamol for GI adverse events?

Back 13

Low evidence of a lower risk of GI adverse events in the paracetamol group

Front 14

What is the evidence comparing Topical NSAIDs and Oral NSAIDs for Sports Injuries?

Back 14

Topical NSAIDs provided good levels of pain relief in Sprains, Strains and Overuse injuries similar to that provided by Oral NSAIDs

Front 15

What is the evidence for Diclofenac/Ketoprofen gels for the treatment of Sports Injuries?

Back 15

7 or 8 people out of 10 with a painful strain, sprain or muscle pull had more reduced pain after seven days compared with only 2 or 3 out of 10 with placebo.

"1 in 20 in people had redness at the application site"

Front 16

What is the evidence for Salicylate containing Rubefacients for acute and chronic musculoskeletal pain in adults?

Back 16

Evidence does not support the use of topical rubefactants containing Salicylates for acute injuries or chronic condition

Front 17

What is the evidence for Sports Drinks and Water for enhancing performance?

Back 17

Lack of evidence to support the use for enhanced performance of recovery, including drinks, supplements and footwear.

A MA from cyclists concluded that relying on thirst to gauge the need for fluid replacement was the best strategy and there is NO evidence for pre-hydrating

Front 18

How can you determine if someone has a concussion?

Back 18

Ask the questions from the sideline concussion assessment;

i) At what venue are we today?

ii) Which half is it now?

iii) Who scored last this match?

iv) What did you play this weekend?

v) Did your team win the last game?

Front 19

How often do False negatives happen with Sideline concussion assessments?

Back 19

0-10%

Front 20

How often do False positives happen with Sideline concussion assessments?

Back 20

30-70%

Front 21

What are the Physical signs and symptoms of a Concussion?

Back 21

1) Headache 2) Nausea

3) Vomitting 4) Balance Problems

5) Dizziness 6) Visual Problems

7) Fatigue 8) Sensitivity to Light and Noise

9) Numbness/Tingling 10) Dazed 11) Stunned

Front 22

What are the Cognitive signs and symptoms of a Concussion?

Back 22

1) Feeling mentally "foggy"

2) Feeling slowed down

3) Difficulty concentrating

4) Difficulty remembering

5) Forgetful of recent informations and conversations

6) Confused about recent events

7) Answers questions slowly

8) Repeats questions slowly

Front 23

What are the Emotional signs and symptoms of a Concussion?

Back 23

1) Irritable

2) Sadness

3) More emotional

4) Nervousness

Front 24

What are the "Sleep" signs and symptoms of a Concussion?

Back 24

1) Drowsiness

2) Sleep more than usual

3) Sleep less than usual

4) Difficulty falling asleep

Front 25

When do Sore Muscles usually develop?

Back 25

Usually starts 8-24 hours after exercise, can develop even if in good shape

Front 26

What are the treatments available for Sore Muscles?

Back 26

No treatments are available for Sore muscles

Front 27

Does muscle stretching before exercise reduce muscle soreness?

Back 27

No

Front 28

What is a pulled muscle?

Back 28

An acute tear of the muscle fibers with sudden, localized and persistent pain

Front 29

What are the benefits of warming up before exercising?

Back 29

1) Prevents injuring in sports

2) Improves performances in experiences

Front 30

What is the benefit for stretching before exercising?

Back 30

1) Reduces the risk of experiencing bothersome soreness

Front 31

What is the NNT for Stretching?

Back 31

1 injury to muscle, ligament or tendon was prevented for every 20 people who stretch for 12 weeks (i.e. 3 months)

Front 32

What are the drawbacks of Static Stretching?

Back 32

Strength/Power/Explosive performance are ALL REDUCED by static stretching

Front 33

What is a Charley Horse?

Back 33

A muscle contusion where blood vessels are broken and the muscle is crushed

Front 34

What is the recommended treatment for a Charley Horse?

Back 34

MCE ± NSAIDs/Acetaminophen

(During MCE; muscles should be stretched and the knee should be flexed untill minimal discomfort)

Front 35

What is a Muscle Cramp?

Back 35

A painful sustained contraction of all fibers in a muscle

Front 36

What is the recommended prevention methods for Muscle Cramps?

Back 36

Increasing K+ intake via fruits & veggies might help

Front 37

What is the recommended treatment for Muscle Cramps?

Back 37

Stretch AND Squeeze the muscle

Front 38

"Salt Tablets are RECOMMENDED for the treatment of Muscle Cramps" True or False?

Back 38

FALSE

Front 39

What are "Stitches"?

Back 39

A muscle injury due to a cramp of the diaphragm which is caused by a decrease in blood supply to the muscle. It may also be caused by gas distending the colon

Front 40

What is the recommended prevention methods for Stitches?

Back 40

1) Don't eat for 3-5 hours before exercise

2) Strengthen diaphragm (sit up)

3) If gas is a problem increase bulk in diet

Front 41

What is the recommended treatment for Stitches?

Back 41

Slow down and push your fingers deep into the site of the pain

Front 42

What is Tendonitis?

Back 42

An inflammation(?) of the tendon -shoulder, elbow, knee and wrist usually caused by Tight muscles.

Front 43

What is wrong with using the term of Tendonitis?

Back 43

Inflammation is not necessarily always present and sometimes has a non-inflammatory pathology

Front 44

"There is insufficient evidence for the routine use of Injection therapy for Achilles tendinopathy" True or False?

Back 44

TRUE

Front 45

What are the types of Tennis elbow exercises?

Back 45

Medial: For forehand tennis elbow

Lateral: For backhand tennis elbow

Front 46

What is the evidence for the use of Steroid Injections for Tennis Elbow?

Back 46

Steroid injections are more effective than Physio in the short term (6 weeks) while it is much less effective in the long term (52 weeks)

Front 47

What is the evidence for the use of Nitrates for Tennis Elbow?

Back 47

Appears to provide benefit with about 20-30% more people reporting being asymptomatic at 3 weeks to 6months than those receiving placebo

Front 48

What is the evidence for the use of Tennis Elbow Orthotics?

Back 48

Multiple systematic reviews have been unable to provide conclusions about the benefits of orthoses for lateral epicondylitis

Front 49

What is the recommended treatment for Rotator Cuff Disease?

Back 49

Topical Glyceryl Trinitrate

Front 50

What is the evidence for the use of Topical Glyceryl Trinitrate for Rotator Cuff Disease?

Back 50

Some evidence (with high bias) that it is more effective than placebo among patients with acute symptoms (<7 days duration) , but no evidence for long term benefits

Front 51

What are the types of Ligament damage?

Back 51

Ankle, Knee, Shoulder

Front 52

What are the types of Ankle Sprains?

Back 52

1) Anterior talofibular ligament

2) Calcaneofibular ligament

3) Posterior talofibular ligament

4) Deltoid ligament

5) Syndesmotic Ligament Complex

Front 53

Which of the types of Ankle Sprains is most common?

Back 53

Anterior Talofibular Ligament Sprain

Front 54

What is the recommended treatment for ALL Sprains?

Back 54

MCE ± NSAIDs/Acetaminophen and Rehabilitation (stretching and exercising)

Front 55

What is the evidence for RICE in the treatment of Ankle Sprains?

Back 55

1) RICE is mostly based on anecdotal evidence

2) Controlled mobilisation and weight bearing challenges popular advice on protection and rest (exercise group increased ankle function and increased weight bearing)

Front 56

How does Functional treatments compare to Immobilization for the treatment of Ankle Sprains?

Back 56

Functional treatments appears to be the favourable strategy for treating acute ankle sprains when compared with immobilization (NSS after exclusion of low quality trials)

Front 57

Is their evidence for the use of Ultrasound in the treatment of Acute Ankle Sprains?

Back 57

Evidence does not support the use of ultrasound in the treatment of acute ankle sprains. The potential treatment effects of ultrasound appear to be generally small and limited clinical importance

Front 58

What is the evidence for the use of Semi-rigid orthoses/air-cast braces for reducing the risk of ankle ligament injuries?

Back 58

Good evidence for beneficial effect to prevent ankle sprains during high risk sporting activities (e.g. soccer, basketball)

Front 59

What is the evidence for the use of Elastic bandage for preventing acute lateral ankle ligaments injuries in adults?

Back 59

Has fewer complications than taping, but appears to be associated with a slower return to work and sport and more reported instability than a semi rigid ankle support

Front 60

What hampers definite conclusions on the use of physical protectors for reducing the risk of sports injuries?

Back 60

By the variety of treatments used and the inconsistency of reported follow up times

Front 61

What is the evidence for Prophylactic Ankle braces in reducing incidence of Acute ankle injuries?

Back 61

Two studies determined that ~29 football athletes and 15 basketball athletes need to be braced during an entire season to prevent 1 ankle injury.

BUT NO DIFFERENCE IN SEVERITY

Front 62

What is the evidence for Prophylactic Knee bracing in American Football?

Back 62

Has NOT consistently reduced MCL injuries. Therefore there is a lack of evidence to support routine use of knee braces

Front 63

"Bias and confounding variables limit the current evidence of Prophylactic Knee Bracing" True or False?

Back 63

TRUE

Front 64

What is the evidence for the use of Knee braces AFTER ACL reconstruction ?

Back 64

No evidence to support the routine use of functional or rehabilitative bracing in patients with a reconstructive ACL

[No clinical improvement in ROM, No decreasing PAIN, No improved Graft stability, No decreased complications]

Front 65

What is the evidence for the use of Steroid & Local anesthetic injections for Bursitis?

Back 65

Effective for Trochanteric Bursitis (mean improvement of 2.8 on a 10 point VAS)

Front 66

When does Ultrasound guided corticosteroid injections for Bursitis show benefit?

Back 66

Subaromial-subdeltoid bursa injections in adults with shoulder pain leads to statistically significant improvement better than placebo

Front 67

"There is benefit of Steroid injections for the treatment Olecranon Bursitis" True or False?

Back 67

False; there is NO benefit with Olecranon Bursitis (behind elbow)

Front 68

What is the evidence of using Patellofemoral braces for preventing Knee Pain?

Back 68

Appears to be effective for preventing Anterior knee pain

Front 69

What is the evidence for using Biomechanical insoles for reducing shin splits?

Back 69

Custom made biomechanical insoles may be more effective than no insoles for reducing shin splints IN MILITARY RECRUITS (NNT=5)

Front 70

What is Chondromalacia Patella/Patellofemoral Syndrome?

Back 70

Retropatellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint.

Anterior knee pain that typically occurs with activity and often worsens when they are descending steps or hills

Front 71

What is the evidence for using Knee braces/Sleeves/Straps for treating anterior knee pain?

Back 71

Lack of evidence to inform in the use of knee orthoses for treating PFPS. There is, however low quality evidence that using knee orthoses DID NOT reduce knee pain or improve knee function in the short term (<3 months) in adults who were also undergoing an exercise programme for treating PFPS.

Front 72

What is the evidence for the use of Foot Orthoses for Patellofemoral pain in adults?

Back 72

Available evidence does NOT reveal any clear advantages of foot orthoses over simple insoles or physiotherapy for Patellofemoral pain

Front 73

What is Iliotibal band syndrome?

Back 73

Inflammation of the illiotibial band, a thick band of fibrous tissue that runs down the outside of the leg

Front 74

What is the recommended treatment for Iliobital band syndrome?

Back 74

Rest and Stretching

Front 75

What is the cremaster muscle?

Back 75

A thin layer of skeletal muscle found in the inguinal canal and scrotum between the external and internal layers of spermatic fascia, surrounding the testis and spermatic cord

Front 76

What is a Blister?

Back 76

The result of persistent or repeated rubbing against the skin which causes a separation of skin layers and allows fluid to accumulate between the layers

Front 77

What are the causes of Blisters?

Back 77

Improperly fitting shoes and/or abnormal foot function

Front 78

What are the preventative measures for Blisters?

Back 78

1) Ensures shoe fits like a glove (thick socks just prevent a glove like fit, best to use two socks)

2) Rub Vaseline into shoe at sites where it rubs

3) Put adhesive tape or Spenco Second Skin over blister site

Front 79

What are the treatment options for Blisters?

Back 79

1) Clean blister site with alcohol

2) Sterilize a needle with a flame

3) Pierce the blister at its edge and drain the blister

4) Do not remove roof of blister

5) Apply plain adhesive tape over blister site and resume exercising

6) Some people put Vaseline or Spenco 2nd Skin on adhesive tape then cover with another layer of tape

Front 80

"Blisters definitely heal better when drained" True or False?

Back 80

FALSE

Front 81

What are the preventative measures for Skin Abrasions?

Back 81

Sliding Pads

Front 82

What are the treatment measures for Skin Abrasions?

Back 82

1) Clean with soap and water (or Hydrogen Peroxide)

2) Can use Tap water (NSS with Irrigation)

3) Can apply Spenco 2nd Skin (an occlusive hydrophilic dressing which provides an optimal healing environment)

4) No reason for Antibiotic Ointment?

Front 83

What is the evidence of efficacy for Kinesiology Tape?

Back 83

1) Limited potential to reduce pain in individuals with musculoskeletal injury (but potentially NSS)

2) Did NOT reduce specific pain measures related to musculoskeletal injury above and beyond other modalities compared in the context of included articles

3) The tape may be used in conjunction with or in place of more traditional therapies

Front 84

"Both Acetaminophen and NSAIDs (including) Topical are likely similar in their efficacy and toxicity for short term (1-3 days) use in acute sports injuries" True or False?

Back 84

TRUE

Front 85

"ALL prophylactic braces are of little value" True or False?

Back 85

False; Ankle prophylactic braces has potential benefit

Front 86

What Is the preferred treatment options for Skin Abrasions?

Back 86

Irrigation by tap water and soap. If further protection is required an occlusive hydrophilic dressing seems reasonable at least for comfort