ankle & foot sprains - final exam Flashcards
-What is one of the MOST frequent injuries in the sporting population?
–up to _____ of people unable to attend work for > 1wks.
Sprains
1/4
The risk of re-injury is common following a _____ sprain
inversion
General RF of ankle sprains: (4)
Previous ankle sprain(s)
Lack of external support
Lack of warm-up
Lack of coordination training
RF of ankle sprains: IMPAIRED DF possibly due to:
- Shortened Triceps Surae (Calf)
- Talar hypomobility
—decreased post. glide
—decreased ER - Fribrosed capsule
–universal hypo
–no distraction and limited glide in all directions
Limited DF may excessively load lateral foot because ___________jt. not reaching ______ and staying in a _______ longer before pronating.
talocrural; CPP; supination
Etiology of Lateral Ankle Sprains:
excessive PF and IV
Structures involved with Lateral Ankle Sprains:
Talocural Ligaments
—-ATF MOST COMMONLY
—CF
—PTF
The CF ligament is primarily torn with ______ ______
—will be on slack with ______
pure inversion
PF
The Talocalcaneal and ________ ligaments can also be involved with lateral ankle sprains.
—intraarticular -
—extraarticular -
subtalar
ant. interosseous
lateral attaches and runs parallel top CF lig so they will be damaged together
Lateral Sprains: BONE INVOLVEMENT
1. avulsion fx of lateral malleolus due to:
2. avulsion fx of 5th MT from:
3. medial malleolus fx form:
4. cuboid displacement due to:
5. fibula ant. subluxed on tibia by:
- ligamentous attachment
- excessive action of Peroneus Brevis
- excessive IV
- excessive action of pernoeus longus
- reversal of mm. action of peroneals
Symptoms of Lateral Sprains:
onset:
observation:
ROM:
sudden onset with trauma by “rolling ankle” and the foot turning inward
lat. ankle P!/swelling
limited and P!ful ROM, especially point foot (PF) and turning inward (IV)
difficult and P!ful WB
Signs: Lateral Sprains (cont. symptoms)
observation:
CDR to determine the need of:
Resisted/MMT:
swelling and possible ecchymosis
antalgic and asymmetrical gait
radiographs; determine ankle or foot
possible weak and P!ful EV
Signs of Lateral Sprains
Accessory motions findings: (2)
likely hypermobile ant, Talar glides due to ATF lig. laxity
possible hypomobile cuboid from subluxation
Lateral Lig. Special Tests:
What are these tests listed below: general or specific; talus or subtalar?
1. Stabilize leg, apply PA force to talus through calcaneus in 15º PF
2. In HL, with ankle in 15º PF apply AP force to leg
General; Talus
1. ant. drawer test
2. reverse ant. drawer (RADT)
Lateral Lig. Sprains: Special Tests
What are the specific test for ATF:
reverse antlat drawer (RALDR) -add ankle IR to RADT
antlat. talar palpation- palpate antlat talus with RALDT
Lateral Lig. Sprains: Special Tests
What is the specific test for CF:
What is the specific test for PTF:
medial talar tilt for CF - near 20º DF, IV and pull calcaneus obliquely to chest
-in neutral, twist calcaneus/talus in ER
Lateral Lig. Special Tests:
What is this test for below: general or specific; talus or subtalar?
1. pt. in side lying calcaneal medial glide stabilize talus in supine
general; subtalar
Specific Subtalar Lateral Lig. Special Tests: IV (2)
ant. interosseou hold IV then PF calcaneus: (-) no give
lateral- hold IV then DF calcaneus
Medial Sprains: Etiology
excessive EV
Structures involved w/ medial sprains
Deltoid Ligaments:
3 that connect Tibia w/talus. calcanues and navicular
reinforces medial arch
Structures involved w/ medial sprains: _______ or __________ lig.
intraarticular:
extraarticular:
subtalar; talocalcaneal
post. interosseous
medial
Medial Sprain: Bone Involvement
Bone- avulsion fx of
epiphyseal plate
muscle/tendons- possible __________strain and or subluxation if _________ torn
medial malleolus
medial malleolus
tibialis posterior; flexor retinaculum
Medial Sprain Symptoms:
Onset:
Observation:
ROM:
WB?
sudden onset w/trauma with ankle turning outward
medial ankle P!ful/swelling
limited and P!ful ROM, especially turning outward (EV)
difficult and P!ful weight bearing
Medial Sprain Symptoms: cont
Observation:
CDR to determine:
ROM:
Resisted/MMT:
swelling and possible ecchymosis & anatalgic and asymmetrical gait
If radiograph needed
limited and P!ful EV
possible weak and P!ful IV
Signs: Medial Sprains
–Accessory Motion Testing:
–Special Tests: ___________ & ____________ jt.
–_________ over-involved structures
potentially hypermobile calcaneal EV glides
talocrural & subtalar
TTP
What are Medial Sprain Special Tests:
–General Talar/Subtalar: (2)
–Delt. 3 fibers: (3)
Ant. and Reverse Ant. Drawer / medial calcaneal glide
–tibionavicular fibers
–tibiocalacaneal fibers
–tibiotalar fibers
Syndesmotic Sprains aka __________
high ankle sprain
Etiology of High Ankle Sprains:
primarily DF (talus wider anteriorly than posteriorly) so excessive Talar posterior glide with ER aka peeling mechanism, possibly EV
Structures involved with w/high ankle sprain:
—in order: 1st-4th
—bone:
- AITFL
- Interosseous membrane or syndesmosis
- PITFL
- Deltoid lig.
talar or distal tib/fib Fx
What are the symptoms of a high ankle sprain: (4)
onset?
location?
limited?
sudden onset w/trauma with ankle bent up
often anterior ankle P!/swelling
limited and P!ful ROM, especially bending ankle up
difficult and painful WB
High ankle sprain ROM: primarily limited and P!ful PF and possibly IV
-T or F?
False: DF and possibly EV
High Ankle Sprain: Signs
–AM
–Special Tests: likely (+) ligamentous test:
-gen/specific test?
likely hypermobile post-Talar glides
Inf. TibFib
–gen: reverse post. drawer
–specific: w/fibular ant/post-translation (possibly same as med. sprain)
High Ankle Sprain:
–__________test if able - inability is MOST sens syndesmotic test
–__________over-involved structures
single leg hop test
TTP
Chronic Ankle Instability aka CAI:
–presence of _________ or _________ instability
–RF (3)
functional and mechanical
increased Talar curvature
lack of external support
lack of coordination training following a prior sprain
Etiology: CAI
past severe and/or recent sprain(s)
80% reinjury rate following an IV sprain
——-*P! gone does not mean pt. functionally ready
S&S: CAI
——possible ________ S&S if aggravated otherwise may be asymptomatic
acute: **DO NOT fall for mm strain
CAI: S&S of hypermobility/instability plus:
decreased postural stability/proprioception and plantar sensation
altered mm. activation patterns
aberrant joint motion
the fibula is significantly more lateral from the tibia
All Sprains: PT Rx
______% successful
possibility brief period of ___________ and/or assistive device
____________ prn for protection/function
Modalities:
—best benefits
_____ should NOT be used w/acute sprains
90%
Immobilization
bracing/taping
cryotherapy
US
All Sprains: PT Rx
Taping standard - mechanical support significantly _________after 30 mins of exercise
Talar technique to limit __________glide
decreased
anterior
Distal TibFib Taping Technique:
Indication:
limits:
high ankle sprain
limits separation and anterior distal fibular glide
MT with MET
_______ including/for lymphatic drainage for swelling
STM
JM with MET: 4 goals
ROM, proprioception, tissue tolerances, and AP talar mobes
–sprains MET ultimate purpose?
–positional/directional biases?
tissue proliferation and stabilization
lateral (EV DF), medial (IV PF), high ankle sprain (PF)
Balance and Neuromuscular Training:
prevent ________
improved _________ and ___________ joint position sense and greater motor neuron excitability (reaction time)
reoccurrences
balance and inversion
What is the prognosis for return to activity following a sprain:
Grade I: 1-2 wks.
Grade II: 2-6 wks.
Grade: II >6 wks.
** track athletes shorter due to mostly in one plane
MD Rx - CAI Sx
Early functional rehabilitation appears ___________ to 6 weeks immobilization in restoring early function.
no procedure is better than another
superior
