级运动人体科学运动损伤与恢复专业方向研究生试卷新建由刀豆文库小编整理，希望给你工作、学习、生活带来方便，猜你可能喜欢“运动人体科学试卷”。
2010级运动人体科学运动损伤与恢复专业方向研究生试卷姓名
Anterior cruciate ligament(ACL)
Pathophysiology:
● The mechanism of ACL injury in the skeletally immature is the same as in adults, with most being noncontact.=。
● Females have a higher incidence of noncontact ACL injury than their male counterparts.● ACL injuries in this population may be tibial spine bony avulsions as well as ligament tears.● ACL injury has been reported in up to 65% of children with acute hemarthrosis.● The presence of open growth plates requires special attention in determining
treatment of ACL injuries.Evaluation:
● History
○ Establish the mechanism of injury.Claic presentation is sudden deceleration or twisting injury with a ‘‘pop,’’ immediate swelling, and inability to continue playing.● Physical examination
○ A positive Lachman test is sufficient to make the diagnosis.○ Evaluate for other aociated injuries, including ligamentous injury, patellofemoral instability, and meniscal injury.● Imaging
○ Standard four-view x-rays: weight-bearing AP and tunnel;lateral with knee in extension;axial patellar view at 30-or 45-of knee flexion(merchant,sunrise).○ MRI is helpful in determining the extent of the ligamentous injury as well as aociated injuries such as meniscal tears and chondral lesions.Treatment:
● Initial treatment involves ice, compreion and restoration of ROM, especially extension(not immobilization)and protected weight bearing.● Tibial spine ACL avulsions need urgent evaluation for surgery.● Concern exists regarding surgical management of intrasubstance ACL injuries in adolescents with open growth plates.● Nonoperative management has shown poor results as activity modification in adolescents is difficult and bracing provides little or no protection.● Postoperative rehabilitation and RTP criteria are the same as adults.Prevention: ● Implement a sport-specific conditioning program with periodization(3,4), including these elements that have been shown to have efficacy in specific populations:
○ Motor control(including core and lower extremity strength, balance, and
flexibility)
○ Technique training to include landing and sport-specific athletic skills programs ○ Risk awarene education
○ Proper care of playing surfaces and selection of shoe wear
● No prophylactic bracing has been shown to reduce ACL injury risk.It is eential that the team physician:
● Understand the claic history and mechanism of ACL injury.● Perform a Lachman test.● Understand the poor prognosis of the ACL deficient knee, especially in the adolescent.。
● Identify tibial spine ACL avulsions.It is desirable that the team physician:
● Recognize risk of noncontact ACL injury in adolescent female athletes and implement risk reduction strategies through the athletic care network.● Understand that current surgical procedures allow for reconstruction in the skeletally immature athlete.● Understand the aociated injuries that may accompany or result from ACL instability.The Adolescent Thrower’s Elbow
Pathophysiology:
● Valgus loads with rapid elbow extension produces:
○ Tensile stre along the medial compartment restraints
○ Shear stre in the posterior compartment
○ Compreion stre on lateral structures
● These loads can come from overuse, poor kinetic chain mechanics, weak shoulder or arm muscles, and a large number of pitches.Evaluation:
● History
○ Determine acute versus chronic injury, location of pain, mechanical symptoms, and decline in performance.○ Identify injuries in the kinetic chain.○ Measure exceive throwing by number of pitches per game or pitches per season.● Physical examination
○ Perform elbow examination to include areas of tenderne, ROM, valgus stre testing, manual muscle testing, and ulnar nerve testing.○ Evaluate kinetic chain to include core stability,scapular motion and position, and GIRD
● Imaging○ X-rays in two planes and consider comparison views with open growth plates.○ MRI with intra-articular contrast is useful to better define injury, including ligamentous and oeus injuries, and articular cartilage lesions.Treatment:
● Most injuries are the result of overuse and can be succefully treated with relative
rest, rehabilitation,and modification of throwing demands(4).● Medial epicondylar avulsions need urgent evaluation for surgery.● Elbow injuries that need evaluation for surgery may include ulnar collateral ligament injury unresponsive to conservative treatment or OCD lesions withmechanical symptoms.Prevention:
● Decreasing exposure to overuse and preservation of musculoskeletal and
biomechanical factors has been shown to be the best preventative program(9).● Enforcement of pitch counts per game and per season and limitation of specialty pitches in skeletally immature athletes(9).● Work with the athletic care network to educate athletes,parents, and coaches regarding overuse and overexposure.It is eential that the team physician:
● Conduct a history and physical examination.● Understand that the demands of throwing can contribute to injuries to the elbow and rest from pitching is a mainstay of treatment.。
● Identify medial epicondylar avulsions.It is desirable that the team physician:
● Understand pitch counts for individual age groups as a preventive measure and emphasize enforcement of pitch counts and limitations of specialty pitches(9).● Understand that multiple factors can create the injuries and musculoskeletal and biomechanical alterations that lead to elbow injury.● Understand rehabilitation and maintaining ROM, scapular control, and strength are also main treatment strategies.● Work with the athletic care network to educate athletes, parents, and coaches regarding overuse and overexposure.
