Ankle, Sprains and Strains, Fracture Healing, PT Treatment

Question 1

Most commonly injured lateral ligaments with ankle sprains

Answer 1

Anterior Talofibular

Calcaneofibular

Posterior Talofibular Ligament - last to be injured if both others fail

Question 2

High ankle sprain injuries

Answer 2

Injury to anterior tibiofibular syndesmosis

Check for proximal fibula fracture

Can also injure posterior tibiofibular and interosseous ligaments with an inversion injury

Question 3

Ottawa Ankle Rules

Answer 3

Pain in the malleolar zone w/ palpation or inability to bear weight = get an ankle xray

Pain in midfoot zone and bone tenderness @ 5th metatarsal base or navicular bone or inability to bear weight = foot xray

Question 4

Sprain vs Strain

Answer 4

Sprain: stretch or tear of a ligament that was stretched too far from normal position by a sudden pull

Strain: Injury to a muscle or tendon

Question 5

Sprain Grading System

Answer 5

Grade 1: ligaments stretched or slightly torn w/ minimal functional loss and no instability

Grade 2: ligaments partially town w/ moderate functional loss and moderate instability

Grade 3: Ligaments completely torn with maximum functional loss and marked instability

Question 6

Key to fracture healing

Answer 6

Periosteum

Provides vascular supply

Bleeding triggers the healing process

Question 7

Reactive Phase

Reparative Phase

Remodeling Phase

Answer 7

Reactive Phase: fracture and inflammatory phase - granulation tissue and hematoma forms - fibroblasts take over

Reparative Phase: cartilage callus formation by chondroblasts, lamellar bone deposition, periosteal cells form fracture callus

Remodeling Phase: remodel to original contour where trabecular bone is replaced with compact bone

Question 8

Fractures to Refer

Answer 8

Any open injury

Any neurovascular compromise

High energy injuries

Excessive pain

Fracture with significant angulation or displaced or with known bad outcomes

Question 9

Mechanical Modalities

Answer 9

Evaluate joint, soft tissue, muscular, visceral, and neurovascular components

May limit motion or function

Question 10

Neuromuscular Modalities

Answer 10

Evaluate patients muscular ability to efficiently initiate and demonstrate proper strength and endurance for any given condition

Evaluate using automatic core engagement tests

Question 11

Motor Control Component Modalities

Answer 11

Individuals ability to utilize efficient mechanical and neuromuscular components to efficiently assume balanced posture during function activities

Question 12

Patellofemoral Pain Syndrome

Answer 12

Anterior knee pain

Ipsilateral hip abductor weakness and cartilaginous degeneration

Treatment: rest, hip strengthening, orthotics, NSAIDs, taping

Question 13

Trochanteric Bursitis

Answer 13

Inflammation of bursa between gluteus medius and minimus insertion

Localized pain and tenderness with walking and prolonged standing, hills/stairs, and lying on affected side

Treatment is activity modifications, heat, cortisone, stretching, strengthening