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DPT MSK Fall 22' - Spring 23' > ankle & foot sprains - final exam > Flashcards

ankle & foot sprains - final exam Flashcards

1
Q

-What is one of the MOST frequent injuries in the sporting population?
–up to _____ of people unable to attend work for > 1wks.

A

Sprains
1/4

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2
Q

The risk of re-injury is common following a _____ sprain

A

inversion

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3
Q

General RF of ankle sprains: (4)

A

Previous ankle sprain(s)
Lack of external support
Lack of warm-up
Lack of coordination training

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4
Q

RF of ankle sprains: IMPAIRED DF possibly due to:

A
  1. Shortened Triceps Surae (Calf)
  2. Talar hypomobility
    —decreased post. glide
    —decreased ER
  3. Fribrosed capsule
    –universal hypo
    –no distraction and limited glide in all directions
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5
Q

Limited DF may excessively load lateral foot because ___________jt. not reaching ______ and staying in a _______ longer before pronating.

A

talocrural; CPP; supination

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6
Q

Etiology of Lateral Ankle Sprains:

A

excessive PF and IV

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7
Q

Structures involved with Lateral Ankle Sprains:

A

Talocural Ligaments
—-ATF MOST COMMONLY
—CF
—PTF

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8
Q

The CF ligament is primarily torn with ______ ______
—will be on slack with ______

A

pure inversion
PF

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9
Q

The Talocalcaneal and ________ ligaments can also be involved with lateral ankle sprains.
—intraarticular -
—extraarticular -

A

subtalar
ant. interosseous
lateral attaches and runs parallel top CF lig so they will be damaged together

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10
Q

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:

A
  1. ligamentous attachment
  2. excessive action of Peroneus Brevis
  3. excessive IV
  4. excessive action of pernoeus longus
  5. reversal of mm. action of peroneals
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11
Q

Symptoms of Lateral Sprains:
onset:
observation:
ROM:

A

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

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12
Q

Signs: Lateral Sprains (cont. symptoms)
observation:

CDR to determine the need of:
Resisted/MMT:

A

swelling and possible ecchymosis
antalgic and asymmetrical gait

radiographs; determine ankle or foot
possible weak and P!ful EV

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13
Q

Signs of Lateral Sprains
Accessory motions findings: (2)

A

likely hypermobile ant, Talar glides due to ATF lig. laxity
possible hypomobile cuboid from subluxation

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14
Q

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

A

General; Talus
1. ant. drawer test
2. reverse ant. drawer (RADT)

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15
Q

Lateral Lig. Sprains: Special Tests
What are the specific test for ATF:

A

reverse antlat drawer (RALDR) -add ankle IR to RADT
antlat. talar palpation- palpate antlat talus with RALDT

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16
Q

Lateral Lig. Sprains: Special Tests
What is the specific test for CF:
What is the specific test for PTF:

A

medial talar tilt for CF - near 20º DF, IV and pull calcaneus obliquely to chest
-in neutral, twist calcaneus/talus in ER

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17
Q

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

A

general; subtalar

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18
Q

Specific Subtalar Lateral Lig. Special Tests: IV (2)

A

ant. interosseou hold IV then PF calcaneus: (-) no give
lateral- hold IV then DF calcaneus

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19
Q

Medial Sprains: Etiology

A

excessive EV

20
Q

Structures involved w/ medial sprains

A

Deltoid Ligaments:
3 that connect Tibia w/talus. calcanues and navicular
reinforces medial arch

21
Q

Structures involved w/ medial sprains: _______ or __________ lig.
intraarticular:
extraarticular:

A

subtalar; talocalcaneal
post. interosseous
medial

22
Q

Medial Sprain: Bone Involvement
Bone- avulsion fx of
epiphyseal plate
muscle/tendons- possible __________strain and or subluxation if _________ torn

A

medial malleolus
medial malleolus
tibialis posterior; flexor retinaculum

23
Q

Medial Sprain Symptoms:
Onset:
Observation:
ROM:
WB?

A

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

24
Q

Medial Sprain Symptoms: cont
Observation:
CDR to determine:
ROM:
Resisted/MMT:

A

swelling and possible ecchymosis & anatalgic and asymmetrical gait
If radiograph needed
limited and P!ful EV
possible weak and P!ful IV

25
Q

Signs: Medial Sprains
–Accessory Motion Testing:
–Special Tests: ___________ & ____________ jt.
–_________ over-involved structures

A

potentially hypermobile calcaneal EV glides
talocrural & subtalar
TTP

26
Q

What are Medial Sprain Special Tests:
–General Talar/Subtalar: (2)
–Delt. 3 fibers: (3)

A

Ant. and Reverse Ant. Drawer / medial calcaneal glide
–tibionavicular fibers
–tibiocalacaneal fibers
–tibiotalar fibers

27
Q

Syndesmotic Sprains aka __________

A

high ankle sprain

28
Q

Etiology of High Ankle Sprains:

A

primarily DF (talus wider anteriorly than posteriorly) so excessive Talar posterior glide with ER aka peeling mechanism, possibly EV

29
Q

Structures involved with w/high ankle sprain:
—in order: 1st-4th
—bone:

A
  1. AITFL
  2. Interosseous membrane or syndesmosis
  3. PITFL
  4. Deltoid lig.

talar or distal tib/fib Fx

30
Q

What are the symptoms of a high ankle sprain: (4)
onset?
location?
limited?

A

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

31
Q

High ankle sprain ROM: primarily limited and P!ful PF and possibly IV
-T or F?

A

False: DF and possibly EV

32
Q

High Ankle Sprain: Signs
–AM
–Special Tests: likely (+) ligamentous test:
-gen/specific test?

A

likely hypermobile post-Talar glides
Inf. TibFib
–gen: reverse post. drawer
–specific: w/fibular ant/post-translation (possibly same as med. sprain)

33
Q

High Ankle Sprain:
–__________test if able - inability is MOST sens syndesmotic test
–__________over-involved structures

A

single leg hop test
TTP

34
Q

Chronic Ankle Instability aka CAI:
–presence of _________ or _________ instability
–RF (3)

A

functional and mechanical

increased Talar curvature
lack of external support
lack of coordination training following a prior sprain

35
Q

Etiology: CAI

A

past severe and/or recent sprain(s)
80% reinjury rate following an IV sprain
——-*P! gone does not mean pt. functionally ready

36
Q

S&S: CAI
——possible ________ S&S if aggravated otherwise may be asymptomatic

A

acute: **DO NOT fall for mm strain

37
Q

CAI: S&S of hypermobility/instability plus:

A

decreased postural stability/proprioception and plantar sensation
altered mm. activation patterns
aberrant joint motion
the fibula is significantly more lateral from the tibia

38
Q

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

A

90%
Immobilization
bracing/taping

cryotherapy
US

39
Q

All Sprains: PT Rx
Taping standard - mechanical support significantly _________after 30 mins of exercise
Talar technique to limit __________glide

A

decreased
anterior

40
Q

Distal TibFib Taping Technique:
Indication:
limits:

A

high ankle sprain
limits separation and anterior distal fibular glide

41
Q

MT with MET
_______ including/for lymphatic drainage for swelling

A

STM

42
Q

JM with MET: 4 goals

A

ROM, proprioception, tissue tolerances, and AP talar mobes

43
Q

–sprains MET ultimate purpose?
–positional/directional biases?

A

tissue proliferation and stabilization
lateral (EV DF), medial (IV PF), high ankle sprain (PF)

44
Q

Balance and Neuromuscular Training:
prevent ________
improved _________ and ___________ joint position sense and greater motor neuron excitability (reaction time)

A

reoccurrences
balance and inversion

45
Q

What is the prognosis for return to activity following a sprain:

A

Grade I: 1-2 wks.
Grade II: 2-6 wks.
Grade: II >6 wks.
** track athletes shorter due to mostly in one plane

46
Q

MD Rx - CAI Sx
Early functional rehabilitation appears ___________ to 6 weeks immobilization in restoring early function.

A

no procedure is better than another
superior

DPT MSK Fall 22' - Spring 23' (29 decks)

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