Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK > Ankle conditions > Flashcards

Ankle conditions Flashcards

1
Q

What is the epidemiology of lateral ligament sprain

A

5000 injuries in the UK daily
Suffered by over 50% of the population
25% greater risk of grade 1 sprain in female athletes than male
One of the most common mSK injuries
11% of any injury are ankle sprains
Most common sports injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the aetiology of lateral ankle sprain

A

forced plantar flexion with inversion
Jumping / landing
Uneven surfaces when walking or running
foot to foot contact
greater risk if have postural sway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the commonly injured structures
in lateral ankle sprain

A

lateral ligament complex
ATFL is damaged in 65% of inversion sprains
Combined injury of ATDL and CFL in 20% of injuries
PTFL very rarely injured as very strong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology of lateral ligament injury

A

Bleeding and inflammation occurs
Proliferation occurs
ie growth of new capillaries and proliferation of fibroblasts producing collagen
remodelling phase begins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diagnosis of Anterior tibiofemoral ligament

A

Active ROM, anterior draw test, palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnosis of calcaneofibular ligament

A

medial talar tilt, palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

diagnosis of posterior talofibular ligament

A

palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are possible parts conditions for differential diagnosis with lateral sprain

A

Syndysmosis injury (squeeze test, external rotation test, shuck test)
Fracture (malleolar, base of 5th metatarsal, navicular)
Tendons (peroneal tendon leads to dislocation)
Osteochondral lesion of talar dome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should tests occur for lateral ankle sprain?

A

Manual tests best 4-7 days after pain and spasm reduced
Should be kept simple initially
Area of maximal swelling and tenderness usually indicates injured structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what kind of imaging should be done for lateral ankle sprain

A

X-ray to rule out fracture
MRI of talar dome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the aims at the acute stage for lateral ankle sprain

A

Reduce pain, reduce swelling, prevent further tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What treatment should be used in early stages of a lateral ankle sprain

A

PRICE (protection, rest, ice, compression, elevation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the benefits of ice

A
  • ↓Pain via ↓nerve conduction velocity.
    – ↓Tissue metabolism.
    – ↓Rate secondary cell destruction.
    – ↓ oedema formation
    – Vasoconstriction → ↓ oedema formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what should be used during compression in lateral ankle sprain and why?

A

Compression pad and elastic bandage
Elastic bandages help to stop compartment syndrome
Felt pad is around ankle and helps to ensure swelling doesn’t remain around ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What kinds of medical management in initial stage are there for lateral ankle sprains and what are the benefits

A

NSAIDS (less pain, return to training faster, increase exs endurance on return to training)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the treatment and aims of intermediate stage of a lateral ankle sprain

A

Continue to decrease pain, swelling and risk of damage
Promote:
Healing and tensile strength + mobility of tissue
Restore normal ROM, flexibility, muscle strength and neuromuscular function to include balance and gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are possible exercises and focusses in the last stages of a lateral ankle sprain

A

jogging
agility drills
sprints
directional-change
plyometrics
Functional / sports-specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what can reduce the incidence of sprains in sport in general

A

Taping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a osteochondral lesion of talar dome?

A

shallow, wafer-shaped lesion of articular cartilage and subchondral bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the symptoms of osteochondral lesion of talar dome

A

Excessively severe or prolonged joint pain
Tenderness on anterior joint line palapation
May not appear on initial x-rays and MRI should be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the epidemiology of lateral ankle sprain

A

Common in athletes such as american footballers and downhill skiers
account for 1-11% of all injuries
Incidence of 29% in american footballers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the aetiology of syndesmosis injuries

A

Most commonly caused by extreme external rotation or dorsiflexion of the talus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the key anatomy involved in a syndesmosis injury

A

ligaments that bind distal tibia and fibula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what other injuries often occur with syndesmosis injuries?

A

Fractures of the malleolus or proximal fibular spiral fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are key clinical features of syndesmosis injuries

A

Less swelling than lateral ankle sprains
loss of full flexion and inability to weight bear
Ecchymosis may appear several days post-injury due to injury to the interosseous membrane
Difficulty walking

26
Q

what are possible differential diagnosis components for syndesmosis injuries

A

Tibia, fibula and talus fractures should be ruled out
Lat ankle sprain
medial ankle sprain
compartment syndrome
severe joint laxity
severe contusion
dystrophic calcification
infection
tumour

27
Q

What are the key components of examination for syndesmosis injuries

A

Observation
Palpation
(key areas are proximal to anterior tibiofibular ligament and proximal interosseus membrane, medial and lateral malleoli, fibula from distal to proximal tibiofibular joint to rule out maissoneuves #)
Distal pulses
Girth measurements

28
Q

What special tests may be used for syndesmosis injury?

A

Kleigers tests
Squeeze test
Cotton test / shuck test
Fibular translation test

29
Q

How is the external rotation stress test (or kleigers test) carried out and what does it test?

A

it determines if theres damage to the deltoid / medial collaterol ligament or tibiofibular syndesmosis

Knee is in 90 degree flexion and ankle is in neutral
with hand underneath bring foot into maximal dorsiflexion and then into external rotational force is applied to foot and ankle
+ if patients anterolateral pain is reproduced

30
Q

what does the squeeze test show and how is it conducted

A

allows separation of tibia and fibula, also indentifies fibular fracture or syndesmosis sprain

pt in supine, squeeze proximal tib and fib together, then continue distally to malleoli

+ if pain reproduced along fibular sharft if fibular #, along distal tibiofibular joint = syndesmosis sprain, injury more severe if pain more proximal

31
Q

How would the shuck / cotton test be carried out and what does it assess?

A

Assesses syndesmosis instability with diastasis

Supine, slight knee flexion and ankle over plinth, stabilise distal tibia and fibula one hand, lateral translation force to foot with other hand

positive test is demonstrated when there is lateral translation indication syndesmotic instability, clunk heard or translation greater than 3-5 mm

32
Q

What are the goals for syndesmosis treatment in 1st 2 weeks

A

Increase ROM, decrease pain and swelling, protect ligaments

33
Q

What are the goals for treatment in 3 weeks onwards for syndesmosis injuries

A

Restore normal ROM
Strengthen ligaments and supporting muscles
Training to improve endurance and balance

34
Q

What is the long term goal for syndesmosis injuries

A

Prevention of reinjury

35
Q

what are the components for education with syndesmosis injuries

A

WB protocol
Advice against vigorous physical activity until FWB and dynamic balance is normal
gair training for crutch use or boot /brace use
falls risk

RICE
NSAIDS in short term (pain management)

36
Q

What are likely exercises for syndesmosis injuries

A

first 2 weeks:
AROM flexion, alphabet, DF/ PF etc

week 3-4:
Standing stretch, seated DF stretch with theraband, double heel calf raise to single heel calf raise

Progressive weight bearing progressing to treadmill use

Progress to jogging, cycling, agility, jumping and sport-specific drills

37
Q

What manual treatments may be wanted for syndesmosis injury?

A

PA movements of talocrural joint and subtalar joints with passive stretching to help stiffness

38
Q

What is the epidemiology of achilles tendinopathy

A

52% of runners experience in lifetime
risk factors as women, black individuals, higher BMI, middle aged middle-distance/long-distance runners
9% in dancers, 5% in gymnasts

39
Q

what is the aetiology for achilles tendinopathy

A

prior tendinopathy or fracture
Higher BMI
greater running
stiff achilles tendon increases risk
precise cause unknown
High BP
Family history
inappropriate footwear (elderly)
Type II diabetes

40
Q

What is the key anatomy affecting achilles tendinopathy

A

2 types, insertional = between tendon and bone, midportion is >2 cm from insertion

Achilles tendon stems from gastroc and soleus at bottoms of calcaneus

Achilles tendon is surrounded by paratenon that is an elastic sleeve to allow free movement
blood supply to tendon poor, but supplied through paratenon, leads to slow healing rate post trauma

41
Q

What is the suggested cause for achilles tendinopathy

A

Excessive overburdening on the tendon

42
Q

What are the symptoms of achilles tendinopathy

A

Pain appearing when overburdened
localized to tendon
swelling and pain not as common
tendon can appear to change in outline
tendon will have a sensitive zone, situation dependent

43
Q

What is the tendon continuum

A

Reactive tendinopathy, tendon disrepair, degenerative tendinopathy
cycle back and forth

44
Q

what are possible conditions for differential diagnosis with achilles tendinopathy

A
  • Plantar fasciitis
    • Calcaneal fracture stress
    • Heel pad syndrome
    • Haglund deformity
    • Sever’s disease
    • Posterior ankle impingement
    • Medial tendinopathy
    • Retrocalcaneal bursitis
    • Sural nerve
    • Lumbar radiculopathy
    • Ankle OA
    • Deep vein thrombosis
    • Partial Achilles tendon rupture
45
Q

What would be conducted in an objective ax for achilles tendinopathy

A

Observation
□ Atrophy is an important clue to the duration of the tendinopathy and present with chronic conditions
□ Swelling, asymmetry and erythema in pathologic tendons are often observed in examination
ROM, strength and flexibility testing
Palpation = localized tenderness

46
Q

Special tests for achilles tendinopathy?

A

royal london hospital test

47
Q

How would the royal london hospital test be conducted?

A

Find maximally tender portion of tendon
DF actively, palpate same region
+ test if less tender in dorsiflexion

48
Q

What education may an achilles tendinopathy patient need

A

Should not completely rest
Continue recreational activity within pain tolerance
counsel on theories of mechanical loading, modifiable risk factors e.g. BMI and shoe wear, typical time course for recovery from symptoms
controlled tendon loading

49
Q

what observations should be made in an ankle assessment

A

static postures
dynamic postures
specific areas of interest
swelling, muscle form and deformity at joint

50
Q

what is the ideal posture in lateral, anterior and posterior views

A

Does line of gravity run through greater troch, posterior to patella, anterior to lateral (lat view)

Pelvis level, femurs straight, patellaw level and straight, knees straight, ankle malleoli level, foot arches present and equal, feet rotated laterally (ant view)

level gluteal folds, level popliteal folds, achilles tendons vertical, calcanei vertical

51
Q

what do pes planus and pes cavus mean

A

flat feet, excessive arched feet

52
Q

what muscle tests should be done on ankles

A

isometric:
dorsiflexors
plantarflexors
invertors
evertors

53
Q

what are the ligament tests for the ankle

A

anterior drawer test
medial talar tilt
lateral talar tilt

54
Q

how is the anterior drawer test carried out

A

tests laxity in anterior talofibial ligament

prone position, leg bent up, stabilise distal tib fib and move anteriorly

or sitting edge of plinth, create 10-15 degree plantar flexion and stabilise tib-fib, pull anteriorly

postitive increased anterior translation, and dimple may appear

55
Q

How would a medial talar and lateral talar tilt be conducted

A

tests deltoid complex on ligaments on the medial side and calcaneofibular ligaments on lateral side

EIther in prone with knee flexed 90 degree or SOEOB, originally in slight plantar flexion, if in prone can use both hands to hold foot in varying degrees of flexion

the test is positive if there is pain or theres excessive gapping

56
Q

What are the possible injuries to the peroneum

A

Peroneal retinaculum or peroneal tear

57
Q

What is a peroneal retinaculum tear

A

peroneal tendons are secured by superior and inferior peroneal retinaculum, ankle sprain can tear the superior retinaculum

58
Q

What occurs in a peroneal dislocation

A

Peroneus longus is dislocated, producing instability

59
Q

how is the peroneal longus dislocation test carried out?

A

Pt in prone with knee flexed to 90, pt asked to actively PF and evert against resistance, palpate the tendon whilst carrying out, tendon will sublux round malleolus

60
Q

How are calf muscles measured in length?

A

Knee to wall test
Pt with foot on floor, lunges forward to bring knee to the wall, can move foot back to require pt to maximally DF, max distance is recorded, and carried out on other leg

Muscle length testing can also be carried out using a goniometer, with 10 degree DF normal for gastroc and 20 degrees normal for soleus

MSK (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions