Brainscape's Knowledge GenomeTM

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


See full index

Sport Orthopaedic Biomechanics > Ankle Injury > Flashcards

Ankle Injury Flashcards

Lecture 3 of 5

You may prefer our related Brainscape-certified flashcards:
Sports Trivia flashcards
1
Q

How does the tibia and fibula connect to the foot?

A

They both articulate with the talus
The fibula articulates much lower

  • The tibia - talus joint is called the tibiotalar joint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the anatomy of the foot

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

What are the primary motions of the ankle?

A
  • Plantarflexion (ankle extension)
  • Dorsiflexion (Ankle flexion)
  • Eversion (abduction) (walking on the inside of your foot)
  • Inversion (Adduction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Explain supination and pronation

A

Supination = ankle inversion + plantarflexion

pronation = dorsiflexion + eversion

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

What muscles enable plantaflexion?

A

Gatrocnemius
Soleus
together called the Triceps Surae

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

Describe the gastrocnemius and soleus:

A

Both connect to the achilles tendon

Gastrocnemius: Largest and most superficial calf muscle, main propellant in walking

Soleus: Large muscle deeper than the Gastrocnemius, used in prolonged standing to maintain posture

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

What is the purpose of these muscles?

A

Tibialis Anterior:
- Dorsiflexion
- Inversion (turning the foot sole inwards)

Tibialis Posterior:
- Plantarflexion
- Inversion aswell
- Supporting the arch of the foot

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

What is the purpose the Peroneus Longus? and where does it connect?

A
  • Strongest ankle evertor muscle (sole of foot outside)
  • links into the medial cuneiform on the first metatarsal
  • links to the fibula head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the purpose of the Peroneus Brevis?

A
  • Secondary muscle assisting in ankle eversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 toe extensor muscles?

A

Extensor Hallucis Longus - Extends the hallux (big toe) pulling it back

Extensor Digitorum Longus - Extends the 4 toes back

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

What are the 2 toe flexor muscles? and their role?

A

Flexor Hallucis Longus - Flexes the hallux (big toe) pulling it down (Also supports the foot arch)

Flexor Digitorum Longus - Flexes the toes down (helps maintain balance)

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

which muscles are bigger out of the toe flexor and extensor muscles?

A

Extensor Digitorum Longus
Flexor Hallucis Longus

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

Name all the ankle ligaments linked to lateral ankle sprains

A
  • Anterior talofibular ligament (ATFL)
  • Posterior talofibular ligament (PTFL)
  • Calcaneofibular ligament (CFL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What percentage of people getting X-rays for lateral ankle sprains had actually broken a bone?

A

roughly 15%

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

What is a type 1 error result in ankle sprain x-rays?

A
  • False positive, so a case when an ankle sprain is identified but there is in fact not one
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a Type 2 error result in ankle sprain x-rays?

A
  • False negative, when no ankle sprain is detected but there is in fact one there
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is sensitivity and specificity?

A
  • Sensitivity is the proportion of correctly identified positive cases over the total number of positive cases (correctly identified and incorrectly)
  • Specificity is the true negative rate, the proportion of correctly identified negative results over the total of negative results
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

From this table Identify the Sensitivity and specificity equations

A

Sensitivity = a/(a+c)
Specificity = b/(b+d)

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

What are the mechanisms that cause:
1) Lateral ligamentous sprain
2) Medial ligamentous sprain

A

1) Lateral - Inversion / supination

2) Medial - Eversion / pronation

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

Name the ligaments commonly damaged in lateral and then medial ligamentous sprains

A

Lateral - ATFL (Anterior Talofibular lig), PTFL (Posterior Talofibular lig), CFL (Calcanofibular lig)

Medial - Deltoid ligament

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

What is the mechanism that can cause high ankle sprain/syndesmosis sprain? And what is damaged?

A

Mechanism: Inversion + Dorsiflexion
damaged: Syndesmotic ligament + interosseous membrane

22
Q

What can forceful plantarflexion sometimes result in?

A

Achilles tendon rupture

23
Q

What are the typical symptoms of lateral ligament sprain caused by inversion?

A
  • A ‘snap’ or ‘pop’ sound
  • Pain or swelling
  • Fibula extends to a lower position, creating a blocking to eversion
  • Exact diagnosis in first 5 days is hard due to swelling
24
Q

What anagrams are proposed for management of lateral ankle ligament sprains?

A

RICE
PRICE
POLICE
PEACE & LOVE

25
Q

What is RICE?

A
26
Q

How are Lateral ankle sprains graded in terms of severity

A

Anatomically graded:
Grade 1: ATFL rupture
Grade 2: PTFL + ATFL rupture
Grade 3: CFL + ATFL + PTFL rupture
Severity graded:
Grade 1: mild/stretched
Grade 2: Partial tear
Grade 3: Complete tear/rupture

27
Q

What is a method of physical examination to test for a torn ATFL?

A

Anterior Drawer test
- Hold the ankle in 10-20 degrees of plantarflexion
- Stabilise the tibia with 1 hand
- Pull the foot forward with the other hand
- Anterior translation indicates instability

28
Q

What is a method of physical examination to test for a torn CFL?

A

Talar tilt test
- Hold the foot and ankle in a neutral position. If the foot is plantaflexed then the ATFL is stressed so this test wont work.
- If the ATFL is okay, invert the heel
- Feel for separation between the tibia and the talus

29
Q

Explain a set of tests done for syndesmosis high ankle sprain
(3)

A

1) External rotation test: with the knee at 90 degrees externally rotate the foot
2) Squeeze test: Compress the tibia and fibula together at mid-calf
3) Crossed leg test: on a chain cross the affected leg over the opposite knee and apply downward pressure to the crossed knee

Pain indicates distal lower leg injury

30
Q

What is a typical route of action to manage a high ankle sprain? And why?

A
  • Walker boot with inflatable cushioning
  • Avoid weight bearing using crutches
    These measures avoid restretching of the syndesmotic ligament and interosseous membrane
31
Q

What is the typical route of action taken for a patient with a minor fracture in their ankle or lower limb?

A
  • Walker boot, walk with crutches and just avoid weight bearing
32
Q

What is the benefit of a walker boot?

A
  • It secures the joint in place avoiding any restretching and injury
  • It also allows for gradual weight bearing
  • Its a protective shell from any other damage
33
Q

After the acute (initial) phase of a sprain injury, what would be a longer term management solution?

A
  • Conservative functional exercises (wobble board and ankle disc) that aim to improve joint flexibility, strength, balance, proprioception, ROM and stability
  • Wear assistive prophylactic devices that provide mechanical support when returning to sport, such as a lace up ankle brace or taping
34
Q

What are the options to consider for a patient with a grade 3 tear? and the drawbacks of the options

A
  • a surgical approach or conservative treatment (exercises) approach
  • Operative is better for reducing pain on activity, however has risk of complications
  • Conservative has no complications and has no late symptoms from surgery
34
Q

Should a walker boot be used for ankle sprain injuries? and why

A
  • Never immobilise the joint
  • Even in severe ankle sprains, immobilisation can lead to joint stiffness, muscle atrophy and loss of proprioception
35
Q

What is the aim of surgical repair of the ligaments in an ankle sprain with ruptured ligaments?

A
  • To restore laxity to the joint by tightening up the loosened ligaments
36
Q

How can the Achilles tendon get ruptured?

A
  • Landing with a plantarflexed ankle
  • A contraction of the calf that is too forceful can rupture the tendon on takeoff
37
Q

What is the anatomy of the achilles? and its function

A

The Achilles connects the gastrocnemius and soleus muscles to the calcaneus
Function: To plantarflex the ankle joint

38
Q

What are the immediate signs of a ruptured achilles? (5)

A
  • Sudden pain
  • Hearing a ‘pop’
  • Heel swollen and bruised
  • Unable to walk properly
  • Palpable defect in the tendon (feel that it doesnt work)
  • Weak plantarflex
  • Unable to lift up toes
  • Dropped foot when walking
39
Q

Explain the physical examination for a ruptured Achilles tendon:

A

Thompson test
- Patient lies face down with feet extended over the edge of the bed
- Squeeze the patient calf muscle
- It should cause plantarflexion, if not you can actually feel for a ruptured Achilles tendon to be absolutely sure its ruptured

40
Q

What is the typical management plan for a ruptured Achilles?

A
  • Nearly always surgical repair is needed
41
Q

What are the 2 surgical options available for a ruptured Achilles?
1) If its ruptured in the middle
2) If it has detached from the calcaneus

A

1) Simply sew the 2 loose ends back together
2) Achilles reattachment surgery: Drill a tunnel into the calcaneus and anchor the tendon to this tunnel using suture anchors or bone screws

42
Q

Risk factors are defined as intrinsic or extrinsic, think of a few example risk factors for ankle sprains:

A

Intrinsic: Previous ankle sprain, overweight, inferior single leg balance
Extrinsic: Use of she with high heel or air cells, Not stretching before exercise, player positions in basketball

43
Q

Describe the aetiology of the injury for a lateral ankle sprain upon landing

A

1) Upon ground contact the foot is supinated
2) the Load does not pass through the join centre creating a twisting torque
3) this vigorous twisting torque causes a quick ankle inversion rupturing the lateral ligaments

44
Q

Explain how the delayed peroneal reaction is a factor in the lateral sprain mechanism

A
  • Ankle sprain injuries occur in 40ms, when ground contact forces peak
  • Peroneal muscles have a reaction time of 60ms
  • Peroneal muscles initiate ankle eversion, which opposes the sprain mechanism but this is too later
45
Q

In football there are 2 mechanisms that cause predominant cases of supination sprain, what are these?

A

1) Medial impact to an ankle just before landing, forcing a lateral inverted ankle
2) Forced plantar flexion when a player kicks another person already plantarflexed foot

46
Q

What does this experiment tell us?

A

It requires about 4.3Nm of rotational torque in an inverted direction to tear the ATFL ligament

47
Q

What are some consequences of repeated ankle sprain injuries?

A

1) Many patients suffer later symptoms such as tendinitis, ankle swelling, stiffness, pain weakness and giving out

48
Q

When is an ankle replacement surgery required?

A
  • When prolonged translational movement, poor laxity and stability has resulted in cartilage wearing and osteoarthritis
49
Q

What preventative measure are available to reduce risk of ankle sprain?

A
  • Ankle sprain prophylactic devices such as tape, foot brace and high top shoes
  • Technique training specific to landing
  • functional training such as resistance band strengthening, wobble board to improve proprioception and warming up
  • Change the rules of the game, eg no tackling from behind (red card offence)

Sport Orthopaedic Biomechanics (6 decks)

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