Ankle-->hip Flashcards
inflammatory response 1 (macrotrauma)
acute-physical damage to capillary wall–>plasma + RBC’s + hemoglobin leak into interstitial space
-swelling and edema-blood migrates to skin and often causes ecchymosis
haemotoma
accumulation of necrotic debris at the site of injury
- removed by phagocytosis and proteolytic enzymes before healing can occur
- cells around it need nutrients and O2-cell death can cause Secondary Hypoxic Tissue Necrosis
- leads to swelling, pain, spasm, necrotic debris, and reduced joint motion due to pain
inflammatory response 2 (chronic microtrauma)
- capillary is dilated by chemical mediators (histamine, bradykinin) and space b/t cells allows some plasma proteins to leak out/fat molecules to leak in (Transudate=RBC free exudate, which doesn’t cause discoloration)
- osmotic gradient upset leads to greater net filtration and then swelling and edema
- eg achilles tendonopathy (chronic tendonitis) from wearing high heels (short) all day then running (trauma on tendon)
- leads to pain, swelling, spasm, necrotic debris, and reduced motion
effects of edema on ligaments
- disruption of a ligament inside a capsule causes swelling and pushes ligament ends away from each other
- can form block of scar tissue–>bones further apart and greater joint laxity
- importance of reducing edema ASAP and as much as possible-joint should be locked w/ligaments in shorter position (functional) can reduce laxity by causing some adhesions to form
treatment for most injuries
Rest
I: decrease pain, spasticity, and facilitate local blood flow to depth of about 5mm (ie, good for bony areas)
C: reduces edema (if the pressure is hard enough w/out occluding blood flow). Never wear at night b/c hyperemia happens
E: assist lymphatic drainage
when/where do you see the ecchymosis?
in subacute injuries (48-72hours after) and below the site of injury b/c of gravity
-ie a bang on the hip could possibly cause pain closer to the knee if ecchymosis goes that far
predisposition and causes of shock
illness, extreme fatigue, extreme dehydration, high anxiety
causes: extreme blood loss, pain, and/or psychological trauma
symptoms and treatment of shock
Sx: pallor of skin, clammy skin, weak rapid pulse and weak shallow breathing
Tx: 911, lay athlete flat, maintain body temp and monitor vitals, O2 if available, elevate legs slightly (controversial). also stop bleeding
secondary survey
HOPES- history, observation, palpatation, evaluation of function, selective tissue tensions
crural joint
-tibiofibular joint
-talofibular joint
-talotibial joint
does sagital plane movements of dorsiflexion and plantarflexion
subtalar joint
talus and calcaneas articulations
supination/pronation
midtarsal joints
b/t other tarsal bones
contribute to pronation/supination + some abduction/adduction
ankle bony stabablizers
-malleoli hold dome of talus
ankle static stabalizers (lateral)
bone: lat maleoulus
1. anterior tibiofibular ligament-holds them together
2. anterior talofibular-stops anterior motion of bones
3. calcaneal fibular-stops calcaneous from rotating down
4. lateral talocalcaneal
dynamic: peroneus brevis and logus (weak)
ankle static stabalizers (medial and anterior)
anterior
bone: wide margin of talus
static: joint capsule
1. anterior tibiofibular lig- syndesmosis joint (proximal and distal)
dynamic ant. compartment muscle and peroneus tertius
medial ankle stabalizers
bone: medial malleolus
1. deltoid ligament-stops pronation
2. spring ligament and short plantar ligament maintain longitudinal arch
dynamic: medial flexor group, tibialis anterior
cavus foot
high arch, permanent supination-good jumpers and leapers
- usually have clawed toes due to natural tension on flexor digitorum and flexor hallucis longus tendons
- rigid bone structure, doesn’t loosen to absorb the force
- common anterior compartment syndrome, stress fractures in tibia
planus foot (functional)
flat foot, excessive pronation
-can cause knee, hip, back problems
-sustentaculum tali roates down w/ the calcaneas (it’s usually stacked on top)
-the talus is no longer supported and subtalar valgus occurs
-can see a bend in the achilles b/c of extreme pronation
-disapate forces easily but inefficient toe off b/c can’t supinate to make rigid bone structure
+ internal torsion of femur
foot biomechanics: from heel plant to toe off
heel plant: subtalar joint and foot slightly supinated
-shock goes up calcaneas
midstance: joints unlock as foot pronates to absorb shock
toe off: supination and subtalar/midtarsal locking to provide rigid lever for propulsion
hyperdorsiflexion
talus wedges b/t bones and pushes malleolus away (if rotation happens)
hyperplantarflexion
can pull ant talofibular and and deltoid ligaments
-overstretches anterior capsule–>laxity in joint line
hallux valgus
mech: valgus displacement of 1st MTP joint
cause: genetic, mm imbalance, shoe fit
tx: taping, muscular control
- predisposition to bunions
morton’s neuroma
mechanism: enlargement from compression of interdigital nerve body
cause: shoe fit too narrow
tx: bare feet, wide forefoot shoes, surgery
- nerve thickens myelin sheath when compressed
morton toe
mx: elongated 2nd metatarsal, can cause sesamoiditis
cause: genetic
tx: nothing, proper fit shoes
- 2nd MT accepts too much ground reaction forces–>can stress fracture 2nd metatarsal
- PIP joint can buckle
claw toes
mech: contracture of DI
cause: cavus foot, short shoes
tx: stretching toes to dorsiflexion, correct shoe fit
tennis toe
mx: shear across unguum
cause: too short or long toenails
tx: shoe fit, hygiene
ingrown toenail
mx: lateral growth of nail
cause: poor hygiene (maybe narrow shoes also)
tx: v cut in nail
astro toe
mx: hyperextension of MTP joint, subperiosteal haematoma of sesamoid bone inside flexor hallucis brevis
cause: lack of forefoot cushion
tx: treatment for hyperextension, atro pads/more forefoot cushion
heel bruise
mx: subperiosteal haematoma
cause: contusion to calcaneal tuberosity
tx: taping and bilateral heel pads
runner’s bump
mx osteoblastic activity
cause pressure to posterior aspect of calcaneus from rigid heel counter in motion control shoes
tx felt donut
plantar faciitis
mx: excessive tension on plantar fascia
cause: excessive pronation-as arch drops foot lengthens and inflammation can happen
tx arch support and strengthening intrinsic mm
important to find specific cause of stretching (could be from pelvis)
achilles tendonitis
mx: traction forces on tendon
cause: excessive pronation, uphill running
- cavus foot b/c calcaneus is pulled down and achilles is lengthened on the bottom
- high heels
tx: bilateral heel lifts, rest, stretching and strengthening
achilles tendon rupture
mx eccentric contraction
cause landing from dismount or changing direction quickly
-chronic inflammation causes necrotic tissue and debris that makes the tendon weaker
tx surgery, complete repair can take 6mo
styloid avulsion
mx eccentric contraction of peroneals (brevis tendon)-b/c lig stronger than bone in pre pubitals
cause: planterflexion + inversion during contraction (jumping or landing)
tx surgery
metatarsal fracture
mx: axial load, transverse load
cause: kicking something (axial) or getting stepped on (transverse)
tx: soft-cast, surgery not typically needed unless bones are displaced
malleolar fracture
mx: avulsion (lig pulling), compression
cause: extreme eversion or extreme inversion
tx surgery
maisonneuve (fibular)
mx transverse compression of tibia (external rotation of a fibula)
cause: sliding tackle, kick, extreme inversion
tx surgery if displaced
-young ppl tend to fracture up higher, adults in middle
chronic compartment syndrome
mx: intrafacial swelling
cause: rapid hypertrophy-too little space for exercise hyperemia, inflammatory response
tx: rest, stretching, anti-inflammatory maybe
- cavus and planus foot more susceptible
acute compartment syndrome
mx: intrafacial swelling
cause: acute trauma over affected compartment (usually anterior)
sx: loss of motor function, pain (common for chronic and acute)
tx: if symptoms worsen when activity is stopped its a medical crisis-hemorrhaging
tibial stress syndrome
mx: stress fx to lower 1/3 of tibia, internal rotation of tibia
cause: pronation or cavus foot poor force distribution
sx pain over lover 1/3k bump @ fracture, made worse w/exercise
tx: rest until 10 days pain free`
generic shin splints
pain in lower 1/3
inflammation of interosseus membrane
tx: low dye tape job
knee stabalization
boney-none
static: cruciates, collaterals, and joint capsule
dynamic stabalizers
pes anserinus, gastrocnemius, extensors and flexors
ACL Rupture
from lateral femoral condyle
mx: anterior translation, excessive valgus stress, excessive internal or external (tears as wraps around condyle), tibial rotation, hyperextension w/internal rotation
- extrasynovial, so sometimes no swelling (rapid internal rotation w/no force)
dynamic stabalizers
pes anserinus, gastrocnemius, extensors and flexors
LCL
Mx excessive varus stress or internal tibial rotation
sx: +ve varus stress test or apley distraction, no end point
LCL
Mx excessive varus stress or internal tibial rotation
sx: +ve varus stress test or apley distraction, no end point
subpatellar pain syndrome
mx: lateral tracking of patella
-tightness of TFL pulls on IT band
cause: insufficient vastus medialis, problematic Q angle
Sx: subpatellar crepitus-can feel soft spot in cartilage (chondromalacia)
-stage 2, tissue dries up and starts to crack
-stage 3, crab meat stage
tx: strengthen vastus medialis and patellar stabalization
-braces, surgery
tibial tubercle traumatic apophysitis
mx distraction force on tibial tubercle from repetitive concentric or eccentric contraction
cause: jumping, skateboarding, dismounts
- traction forces pull growth plate away from bone-it eventually calcifies and becomes a bump (bigger on dominant leg)
sx: pain at tibial tubercle, worse w/exercise-pad in case they fall
tx: regulate exercise to tolerance levels and protect bump
tibial tubercle traumatic apophysitis
mx distraction force on tibial tubercle from repetitive concentric or eccentric contraction
cause: jumping, skateboarding, dismounts
- traction forces pull growth plate away from bone-it eventually calcifies and becomes a bump (bigger on dominant leg)
sx: pain at tibial tubercle, worse w/exercise-pad in case they fall
tx: regulate exercise to tolerance levels and protect bump
prepatellar bursitis
mx: repetitive microtrauma or single insult
cause: falling on hardwood, kick, kneeling for long periods, a rock
sx: golf-ball like swelling, usually little pain or dysfunction
tx: RICE, spontaneously resolves
dislocated patella
mx: patella alta and excess Q angle increase risk, extreme lateral excursion is mx
sx: deformity, pain 3+
tx 911
IT band friction syndrome
- genu varus
- tight IT rubs on lat epicondyle
- caused by tight TFL and IT band cont w/ retinaculum–can pull on this and move patella out of place
test: pressure on lat epicondyle while weight bearing at 30 deg flexion
IT band friction syndrome
- genu varus
- tight IT rubs on lat epicondyle
- caused by tight TFL and IT band cont w/ retinaculum–can pull on this and move patella out of place
test: pressure on lat epicondyle while weight bearing at 30 deg flexion
origin pull hamstring strain
same mxs
sx: pain w/deceleration, doesn’t hurt when accelerating, pain at ischial tuberosity, loss of function
tx: same +massage @ischial tuberosity
origin pull hamstring strain
same mxs
sx: pain w/deceleration, doesn’t hurt when accelerating, pain at ischial tuberosity, loss of function
tx: same +massage @ischial tuberosity
myositis ossificans
mx: ossification of CT (perimysium): ectopic bone formation
sx: reduce range of motion, X-Ray
- can’t be removed unless matured, can take a yr to recover from
myositis ossificans
mx: ossification of CT (perimysium): ectopic bone formation
sx: reduce range of motion, X-Ray
- can’t be removed unless matured, can take a yr to recover from
thigh contusion grades
I and II: ice in flexed position
grade III bed rest for 48 hours not flexed
stop activity imediately
femoral torsion
anteversion=pigeon toed
retroversion
why is abduction difficult?
greater trochanter compresses superior acetabular labrum
hip pointer
sx: exxhymosis, pain w/abdominal use
mx: subpeiostial haematoma from macroinsult to iliac crest
tx: RICE, can numb the area b/c another hit won’t likely do that much more damage
- as pain subsides athlete can walk/run faster and faster
hip pointer
sx: exxhymosis, pain w/abdominal use
mx: subpeiostial haematoma from macroinsult to iliac crest
osteitis pubis/pubic apophysitis
-stress fx at pubic tubercle in adults-feels like groin pull that doesn’t respond to treatment
-unknown mx-in runners, rugby, and soccer…
inflammation of growth plate in pre-pubitals
-no activity b/c pulls on pubic tubercles! long time to heal
