Acute Injuries LL Flashcards by Rebecca Schedler

What are the 5 categories of acute injuries

Ligament
Acute fractures
Meniscal
Dislocations
Muscle injuries

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Common MOI questions of ligament injuries

Limb position
direction of movement
amount of pain/swelling
speed of swelling onset
immediate weight-bearing ability
progress since

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Ligament stress test - ATFL

Anterior drawer test

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Ligament stress test - CFL

Talar tilt inversion stress test

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Ligament stress test - Deltoid complex

Talar tilt eversion stress test

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Ligament stress test - bifurcate ligament

Supination stress test

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Ligament stress test - AITFL

Passive external rotation (syndesmosis)

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Ligament stress test - LCL

Varus stress test

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Ligament stress test - MCL

Valgus stress test

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Ligament stress test - PCL

Sag sign
Posterior drawer test

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Ligament stress test - ACL

Anterior drawer test
Lachman test

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Meniscal tests

Functional
Thessaly test
McMurrays test
Apley’s test

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Patellar instability or dislocation test

Patellar apprehension test

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Physical exam elements for ligament injuries

Observation
Assessment of articular effusion
Palpation
Ligament stress tests

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What are the grades of ligament injuries and their signs

Grade 1 - some fibres torn - no increase in laxity - firm end feel - pain felt

Grade 2 - most fibres torn - increased laxity - firm end feel - pain felt

Grade 3 - all fibres torn - increased laxity - no firm end feel - may or may not feel pain

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What are potential impairments associated with ligament injuries

function
ROM
muscle strength or endurance
muscle control (may have other structures involved)
balance/proprioception

What is chronic ankle instability and symptoms

repeated ankle sprains
giving way
instability
may have trouble with
balance
DF
joint glides
muscle strength

Difference in ‘copers’ and ‘non-copers’ with ACL injuries

Copers
- compensate for lack of ACL
- no giving way
- able to participate in activities

Non-copers
- knee instability
- unable to participate in activities
- same laxitiy as copers

What tests are used to determine functional stability in post-injury ACL patients

single hop for distance
triple hop for distance
crossover hop for distance

Elements of physical exam for fractures

observation
palpation
loading/wgt bearing
vibration
compression or bending

Pain in what areas suggest imaging for suspected ankle fractures

Ottawa Ankle Rule

Post edge of lat malleolus
Navicular
Base of 5th MT

What are associated impairments with fractures

Function
ROM
muscle strength/endurance
muscle control
balance/proprioception

Which meniscus is more commonly injured acutely

Medial

What are the types of meniscal tears (not grades)

longitudinal
degenerative
flap
radial
bucket handle
horizontal cleavage

Common MOI for meniscal

- wgt bearing + planted foot - twisting - no pain (small tear) to extreme (large tear) - swelling progresses slowly for small tears - may have locking or catching

Elements of physical examination for meniscal injuries

- AROM/PROM checking for locking or catching - articular effusion present? - joint line palpation - compression and rotation tests (non wgt bearing) - and wgt bearing

What arre typical signs of a small vs large meniscal tears

Small - slow onset swelling - wgt bearing - no locking - wgt bearing tests - pain Large - not able to wgt bear - clicking and locking - pain with ROM - non wgt bearing tests produce pain

Risk factors for patellar dislocation

- knee hyper E - genu valgum - patella alta - patellar tilt - hypermobility

Elements of physical exam for patella dislocations

- apprehension test - effusion - pain on palpation - pain on quad contraction (around patella)

Scale to assess hypermobility

Beighton scale

MOI for muscle injuries

- limb position - contraction or stretch - extrinsic force - amount of pain/swelling - speed of swelling - wgt bearing ability - progress since

Grades of muscle injury

0 - generalised muscle soreness 1 - small injury (tear) 2 - moderate injury (tear) 3 - extensive tear 4 - complete tear

Features of muscle grade injuries

0 - soreness after exercise, no reduced strength, increased tone on palpation 1- pain during/after activity, pain on contraction 2 - pain that stops exercise, limitation in ROM, pain on contraction, some strength deficit 3 - sudden onset pain, pain on walking, big decrease in ROM, big strength deficit 4 - onset of pain that stops activity, palpable gap

ABC grades of muscle injury (determined by injury)

A = myofascial location B = musculotendinous region C = intratendinous region

Important things to consider after muscle injury to determine re-injury or risk factors

- muscle strength (was their muscle weak) - agonist:antagonist strength ratio (quads stronger than hammies) - fascicle length