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Musculoskeletal > Ankle Complex > Flashcards

Ankle Complex Flashcards

1
Q

What is the 2nd longest bone in the body?

A

Tibia

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2
Q

Where is the attachment site for muscles that provide stability to the talus in the talocrural joint?

A

fibula

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3
Q

What motions can occur at the distal tibiofibular joint?

A

slight ROT and elevation

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4
Q

What is the open packed position for the distal tibiofibular joint?

A

full PF

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5
Q

What is the closed pack position of the distal tibiofibular joint?

A

full DF

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6
Q

What is the capsular pattern of the distal tibiofibular joint?

A

There is no capsular pattern for this joint

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7
Q

Ligaments and the interosseous membrane of the distal tibiofibular joint are stressed with what motions?

A

combined DF and Eversion

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8
Q

What is the primary stabilizer at the distal tibiofibular joint?

A

interosseous membrane

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9
Q

The talus is wider (anteriorly/posteriorly)

A

anteriorly

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10
Q

What is the function of the talocrural joint?

A

distributes body weight posteriorly to the heel and anteriorly to the midfoot

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11
Q

What is the most stable position of the talocrural joint?

A

full DF

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12
Q

What motion occurs with ankle DF/PF at the talocrural joint? Why?

A

Conjunct ROT due to angulation of bony surfaces

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13
Q

Describe the arthrokinematics of the talocrural joint during DF.

A

Talus glides posteriorly and slightly everts

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14
Q

Describe the arthrokinematics of the talocrural joint during PF.

A

The talus glides anteriorly and slightly inverts

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15
Q

What is the OPP of the talocrural joint?

A

10 degrees of PF and midway between EV and INV

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16
Q

What is the CPP of the talocrural joint?

A

full DF

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17
Q

What is the capsular pattern of the talocrural joint?

A

PF = DF

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18
Q

What is the function of the ATFL?

A

Resists anterior displacement of the talus relative to the ankle mortise

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19
Q

What position is the ATFL stressed in?

A

combined PF and inversion

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20
Q

What is the most common lateral ligament to be strained in the ankle?

A

ATFL

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21
Q

What is the function of the calcaneofibular ligament (CFL)?

A

Resists excessive ankle inversion and calcaneal adduction through full ankle ROM.

Most effective at resisting these motions from neutral ankle through ankle DF

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22
Q

What is the strongest ligament of the lateral ankle?

A

PTFL

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23
Q

What is the function of the PTFL?

A

Resists excessive talar movements during extremes of combined ankle DF and eversion (High ankle sprain)

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24
Q

How are the deltoid ligaments damaged?

A

Damaged by hyper-eversion of calcaneus

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25
Describe the arthrokinematics of anterior subtalar joint calcaneal inversion.
calcaneus rolls AND glides medially on the facet of the talus
26
Describe the arthrokinematics of anterior subtalar joint calcaneal Eversion.
Calcaneus rolls AND glides laterally on the facet of the talus.
27
Describe the arthrokinematics of posterior subtalar joint calcaneal inversion.
Facet on the superior calcaneus rolls medially and glides laterally on the inferior aspect of the talus
28
Describe the arthrokinematics of posterior subtalar joint calcaneal eversion.
Facet of the superior calcaneus rolls laterally and glides medially on the inferior aspect of the talus.
29
What is the normal composite motion at the subtalar joint?
20 degrees of inversion, 10 degrees of eversion
30
What is the OPP of the subtalar joint?
midway between inversion and eversion
31
What is the CPP of the subtalar joint?
supination/calcaneal inversion
32
What is the capsular pattern of the subtalar joint?
limited calcaneal inversion/supination
33
What are the functions of the interosseous ligaments of the subtalar joint?
anterior band: holds the anterior joint surface together posterior band: holds the anterior and posterior joint surfaces together
34
What does the medial collateral ligament of the subtalar joint do?
Resists excessive valgus forces
35
What does the lateral collateral ligament of the subtalar joint do?
resists excessive varus forces
36
What happens with pronation of the ankle during WB?
- the medial longitudinal arch of the foor lowers - calcaneal eversion - talar ADD and PF - tibial IR
37
What happens with supination of the ankle during WB?
- medial longitudinal arch of the foot is elevated - calcaneal inversion - talar ABD and DF - tibial ER
38
What is the acute MOI leading to acute achilles tendonitis?
Sudden or extreme ankle DF. Rapid/forceful contraction of gastroc/soleus muscles in WB position
39
What is the common population that presents with acute achilles tendonitis?
males, 30-55 y/o
40
What is commonly seen with acute achilles tendonitis?
- abrupt onset of pain at insertion of achillies - swellling - aggs: stairs, wearing shoes that rub against achilles - pain at beginning of activity followed by decreased pain and then increased pain at the end of the activity - TTP over distal 1/3 of achilles tendon
41
What is the typical MOI of chronic achilles tendonitis?
repetitive microtrauma (often with running), hypovascularity in central portion of tendon, collagen degeneration (Chronic)
42
What is the most common population to present to the clinic with chronic achilles tendonitis?
males, > 35 y/o
43
What is commonly seen with chronic achilles tendonitis?
- gradual onset at the insertion of the achilles tendon - minimal to no swelling - aggs: stairs and shoes that rub against achilles - TTP over distal 1/3 of achilles tendon - painful ankle DF PROM - TTP over distal 1/3 achilles tendon
44
What are the MOIs for achilles rupture?
1. Pushing off with WB on forefoot with knee extended (running, sprinting, jumping) 2. Sudden DF with full WB which occurs with a slip, fall, sudden deceleration 3. Violent DF when jumping from a height and landing on a plantar-flexed foot
45
What population commonly presents with achilles rupture?
Males, 30-40 y/o
46
What is the typical PMH of achilles rupture?
- Report hearing a “pop” and describe the feeling as “being shot in the back of the ankle” - PMH of achilles tendinopathy or corticosteroid injections - fluoroquinolone antibiotic use
47
What is the typical clinical presentation of achilles rupture?
- limited ROM due to edema - weak/pain-free contractile testing for PF - unable to perform unilateral heel raises - swelling over the distal LE w/o ability to palpate tendon (+) thompson test
48
___% of PCPs miss the diagnosis of an achilles rupture
22%
49
What is the most frequent injury during physical activity?
lateral ankle sprains (70-80% of active individuals)
50
Almost ___% of ankle sprains involve the lateral ligaments
75%
51
What is the typical MOI of lateral ankle sprains?
Unanticipated ankle plantarflexion/inversion due to a miss-step (“rolling the ankle”)
52
What ligament is the most injured with lateral ankle sprains?
ATFL
53
What is the common presentation of lateral ankle sprains?
- Patients report “rolling their ankle” - Pain with walking, stairs, navigating uneven terrain - Sensation of instability - Swelling/bruising observed - Limited/painful ankle ROM-all directions - Contractile Findings: Painful/weak with ankle resistance testing - Impaired balance (especially SLS) (+) TTP over ATFL (most common) (+) Stress testing of lateral ligaments/Anterior Drawer Test
54
What is the population that is most likely to present with lateral ankle sprains?
females, 15-19 y/o
55
Patients with rearfoot (pronation/supination) are more at risk for ankle sprains.
supination
56
(true/false) HVLAT techniques have been shown to be extremely effective immediately following lateral ankle sprains
true
57
What is the CPR for Manual therapy and exercise after an Inversion Ankle sprain?
1. symptoms worse with standing 2. symptoms worse in the evening 3. navicular drop >5 mm 4. distal tibiofibular joint hypomobility
58
What is the typical MOI for high ankle sprains?
1. forceful ER 2. forceful EV of the talus 3. forceful DF
59
What is the common patient presentation for high ankle sprains?
- Pain/swelling reported over distal, anterior lower leg - Increased pain with ER of foot, WB, passive ankle DF/EV - Limited ankle ROM/strength - Sensation of instability & difficulty walking
60
What are risk factors for posterior tibialis tendinopathy?
- rearfoot PRON - HTN - DM type II - obesity - shortening of triceps surae
61
What is the presentation of posterior tibialis tendinopathy?
- posteromedial ankle pain and/or swelling - aggs: prolonged walking, stairs, running - pain with resisted ankle PF/INV (heel raise test) - TTP along PT tendon - collapse of medial longitudinal arch - limited subtalar mobility with INV
62
What are the s/s of medial tibial stress syndrome (Shin splints)?
- Vague, diffuse pain located in the middle, distal tibia which occurs with exertion - Patient reports pain is worse in the beginning of exercise and subsides after a few minutes of exercise. As the injury progresses, pain can occur at rest - TTP over anteromedial shin
63
definition: Swelling within the anterior compartment of the lower leg which can lead to compression of neurovascular structures
anterior compartment syndrome
64
What are the s/s of anterior compartment syndrome?
5 P's: - Pain - Pallor - Paresthesia - pulselessness - paralysis - bulbus calves
65
What is the gold standard for Dx compartment syndromes?
Compartment pressure measurement
66
What population most commonly presents with plantar fasciitis?
Females, 40-70 y/o
67
What are the s/s of plantar fasciitis?
- Report of medial, plantar heel pain - Pain with initial WB after prolonged inactivity (sleeping, sitting, driving, etc.) - Decreased pain with non-WB and as patient continues to walk - TTP - limited DF - intrinsic foot muscle weakness
68
Night splints to treat plantar fasciitis focus on maintaining ___.
DF
69
definition: Fracture that occurs 1.5 cm distal to the styloid of the fifth metatarsal.
jones fracture
70
What population commonly presents with a jones fracture?
Males = Females, Non-athletes over age 21
71
What is the s/s of a jones Fx?
Pain with running and WB
72
What is the treatment for a jones Fx?
3 months in a non-WB cast Surgical fixation
73
definition: Fracture of the medial cuneiform and/or bases of 2nd/3rd metatarsals and injury to ligamentous structures
lisfranc Fx
74
What is the MOI of a lisfranc Fx?
crush injury
75
What is the MOI of jones Fx?
repetitive WB and pivoting on the involved foot
76
What are the s/s of lisfranc Fx?
Inability to WB swelling over midfoot
77
What is the treatment for a lisfranc Fx?
non-WB cast for 6 weeks surgical fixation
78
When can an avulsion Fracture of 5th Metatarsal from Peroneus Brevis attachment occur?
With severe PF/INV ankle sprains
79
When can a bi-malleolar Fx occur?
with trauma involving sudden, forceful Eversion of foot
80
When can navicular Stress Fx occur?
Repetitive running in runners with excessive pronation and unsupportive footwear

Musculoskeletal (23 decks)

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