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OMM Block 2 > CBL Sports Med > Flashcards

CBL Sports Med Flashcards

1
Q

Main ankle joints

A 
Tibiotalar joint (true ankle joint)
- responsible for plantar and dorsi flexion

Talocalcaneal or subtalar (false ankle joint)
- responsible for inversion and eversion as well as shock absorption

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2
Q

Too man toes sign

A

3+ toes can be seen when looking at a resting patient from the posterior

Often a result of pes planus

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3
Q

Most stable position of tibiotalar joint

A

Dorsiflexion
- superior dome of talus is wider anteriorly cause more contact with ankle mortise when rocking backward in dorsiflexion= better stability

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4
Q

Least stable position of tibiotalar joint

A

Plantar flexion
- superior dome of talus is more narrow posteriorly and makes less contact with the ankle Mortise when rocking forward and anteriorly during plantar flexion = less stable

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5
Q

Sprain vs strain

A

Sprain = abnormal stretch/tearing of a ligament

Strain = abnormal stretch/ tearing of a muscle or tendon

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6
Q

Why are inversion sprains more common than eversion?

A

Medial ligaments are stronger than lateral ligaments

In inversion, ankle is plantar flexed which is unstable

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7
Q

Grade 1 ankle sprain

A

Stretching or microscopic tearing of the anterior talofibular or calcaneofibular ligaments (usually)

Caused by forced inversion and plantar flexion

Clinical presentation:

  • mild tenderness and swelling
  • little or no function loss
  • minimal pain
  • no mechanical instability of ankle
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8
Q

Grade 2 ankle sprain

A

Partial or complete tear of the talofibular ligament and stretching of the calcaneofibular ligament

Clinical presentation:

  • moderate tenderness and swelling
  • moderate ecchymoses (brushing)
  • tenderness when palpating
  • some motion and function loss
  • pain when weight bearing
  • mild-moderate instability of ankle
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9
Q

Grade 3 ankle sprain

A

Complete Tears of both the anterior talofibular and calcaneofibular ligaments

Partial tears of the posterior talofibular ligament and tibiofibular ligament

Clinical presentation:

  • severe tenderness and swelling
  • severe ecchymoses (bruising)
  • strong tenderness when palpation of the ligaments and surrounding structures
  • loss of function and motion
  • serious mechanical instability of ankle
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10
Q

Anterior drawer and Tamar tilt tests

A

Anterior drawer test: slight plantar flexion of ankle with cephalad hand stabilizing distal lower leg
Caudad hand translates foot forward from calcaneus
(+) =. More than 5-8 mm compared to uninsured ankle

Talar tilt test; slight plantar flexion of ankle with one hand stabilizing the distal tibia just proximal to the medial malleolus. Other hand applies a slow inversion force with palpation at the lateral talus.
(+) = more more than 10 degrees compared to uninsured side

Grade 1 sprain: (-) on both
Grade 2 sprain: (+) on anterior drawer test, (+) or equal on talar tilt test
Grade 3 sprain: (+) on both

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11
Q

Treatment of ankle sprains

A
  • RICE and NSAIDs or acetaminophen when needed
  • OMT can be used as long as its indicated
  • PT should be started as soon as tolerated

Usually no surgery on lateral ankle sprains/strains however, can be done with medial ankle sprains/strains

Can use Velcro brace and/or walking boots when needed for support

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12
Q

High ankle sprains/syndesmoses injuries

A

Usually results from tearing the following

  • anterior inferior tibiofibular ligament
  • Posterior inferior tibiofibular ligament
  • interosseous membrane

Clinical presentation:

  • no fracture: pain with dorsiflexion
  • w/ fracture: cant put weight on it
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13
Q

3 phases of treatment in high ankle sprain conservative treatment

A
  • RICE and NSAID’s when needed in all phases*
    1st: non-weight bearing wearing a boot for 5-7 days and passive ROM exercise without booth 3 times a day
    2nd: wearing weight baring brace for as long as pain is present while hopping . Use gait and light proprioceptive exercises
    3rd: once no plain on foot and ankle with hopping. Protected full-weight baring (usually like a wrap) start resistive exercise and multi-axial ankle movements
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14
Q

Perineal muscle strains and factors that increase likelihood of occurring

A

Muscle strains in the lateral ankle via an eversion ankle sprain

Predisposed factors:

  • prior ankle injuries
  • respected inversion ankle injuries
  • pes planus
  • walking w/ excessive eversion for whatever reason
  • poor fitting athletic equipment

Clinical presentation:

  • pain and swelling along lateral ankle
  • feeling of weakness or instability
  • snapping sensation along lateral malleolus if retinaculum is torn
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15
Q

Muscle tendons in the medial ankle

A

Tibialis posterior tendon (Most common one injured during medial ankle sprain)

Flexor digitorum longus tendon

Flexor hallucis longus tendon

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16
Q

Factors that lead to tibialis posterior muscle strains

A

Over use

High impact sports

People older than 40 yrs

Obesity

Acute injury

Clinical presentation:

  • pain along medial foot and ankle (worsens w/ activity and standing for prolonged time)
  • swelling along medial foot
  • pes planus (sprains cause longitudinal arch to drop, leads to lateral foot pain)
17
Q

Testing for tibialis posterior muscle sprain and treatment

A

Stand on one leg and raise the heel of the stance leg.
(+) patient cant do this

  • overall limited flexibility especially dorsiflexion

Treatment =

  • RICE, acetaminophen and low impact exercises.
  • PT and arch support as well
18
Q

Medial ankle muscle tendons

A

Tibialis anterior tendon (most commonly injuried)

Extensor digitorum longus tendon

Extensor hallucis longus tendon

19
Q

Factors that lead to increase likelihood of tibialis anterior muscle strains

A

Overuse

High-impact sports

Running or jumping on hard surfaces repeatedly

Acute injury

Pes cavus

Clinical presentation:

  • pain along anterior-lateral tibia and dorsum of foot
  • swelling anterior-laterally
  • pain that worsens w/ activity and walking
  • dorsiflexion weakness
20
Q

Plantar fasciitis

A

Pain located at the anterior portion of the calcaneus in the plantar foot along the aponeruosis

Causes:

  • obesity
  • pregnancy
  • long distance runners w/ tight calf’s
  • prolonged time standing on feet
  • being bare foot a lot
  • more common in older than 40 and female
21
Q

Plantar fasciitis clinical presentation and treatment

A

Clinical presentation:

  • pain worse in morning or after prolonged inactivity. Pain will improve after walking
  • pain worsens when climbing stairs
  • flares with prolonged activity

Treatment:

  • RICE
  • stretching of gastrocnemius/ plantar fascia
  • orthotics
  • steroid injections
  • OMT or PT
22
Q

Achilles’ tendon rupture

A

Loud audible pop after experiencing Achilles tendonitis.

  • most often ruptures at the “watershed” area of the tendon (4-5 cm proximal to calcaneus)
23
Q

Ottawa ankle rules

A

Rules for getting an xray for the ankle

1) ankle pain in the malleolar zone compoundered with one of 2-4
2) bone tenderness along distal 6 cm of posterior fibular or the tip of the lateral malleolus
3) bone tenderness along the distal 6 cm of posterior tibia or the tip of the medial malleolus
4) inability to bear weight w/ 4 steps immediately after injury and at the office

24
Q

Ottawa foot rules

A

Rules for getting a foot x ray

1) foot pain in the mid-foot zone and one of 2-4
2) bone tenderness at the base of the 5th metatarsal
3) bone tenderness at the base of the navicular bone
4) inability to bear weight w/ 4 steps immediately after injury and in the office

25
Q

Three ankle X-ray views

A

AP: slight overlap of tibia and fibula

Lateral: fibula overlaps with posterior distal tibia

Mortise: 20 degrees of rotation of the foot (no overlap of tibia and fibula

26
Q

Maisonneuve fracture

A

Caused by forced external rotation of foot and ankle

Causes the following:

  • fracture of proximal tibia (usually spiral)
  • tear/disruption of the interosseous membrane and tibiofibular syndesmosis
  • malleolar fracture (usually medial)
  • rupture of the deep deltoid ligament

Mid calf squeeze test and forced external rotation will elicit high pain

27
Q

Types of 5th metatarsal fractures

A

Avulsion

Jones

Stress

28
Q

Avulsion fracture of the 5th metatarsal

A

Most common fracture of 5th metatarsal

Located at the styloid process of the 5th metatarsal

Causes:

  • pull from fibularis (peroneus) brevis
  • foot/ankle hyper-inversion

Treatment: short leg weight baring cast/hard sole cast shoe or surgery

29
Q

Jones fracture of the 5th metatarsal

A

Location: At the base of the 5th metatarsal at the metaphyseal-diaphyseal junction, proximal to the metatarsal cuboid junction

Causes: pull from Fibularis (peroneus) tertius

  • foot/ankle hyper-inversion
  • lateral motions of foot
  • dancing on toes
  • repetitive trauma

Treatment:
- non-weight baring cast for 6-8 weeks for minimally displaced. Otherwise surgery

30
Q

Stress fracture of the 5th metatarsal

A

Location: proximal portion of the diaphysis of the metatarsal

Causes:

  • sudden increase in physical activity
  • repetitive microtrauma
  • overuse

Treatment:

  • non-weight baring cast for 6-8 weeks
  • surgery for athletes
31
Q

Tarsal tunnel syndrome

A

Entrapment of the tibial nerve along the medial side of the ankle retinaculum

Causes:

  • pes planus
  • ankle swelling
  • diabetes
  • enlarged structures in feet

Clinical presentation:

  • numbness tingling from the medial ankle into the proximal plantar aspect of sole .
  • pain/ increased numbness when everting or dorsiflexion

Testing:
- tinel’s test over the tarsal tunnel and/or EMG

Treatment:
- Rest and NSAIDs, can use orthotics and splinting also. Surgery to cut retinaculum in extreme cases

32
Q

Morton neuroma

A

Chronic trauma/ stress leads to nerve irritation or entrapment of the interdigital nerve as it crosses under foot ligaments

  • most common between 3rd and 4th metatarsal, but can occur anywhere*

Causes:

  • chronic over pronation/ weaving tight shoes and heels
  • ballet dancing

Clinical presentation:

  • numbness, achy, burning sensations.
  • “Feeling like there is a stone in my shoe”

Testing: Morton’s squeeze

Treatment:
- wearing shoes with wider toe area, NSAIDs, orthotics. Surgery only when necessary

33
Q

Osteochondral defect

A

Focal area of damage that involves cartilage and underlying bone

  • typically occur during acute ankle sprains
  • caused by talus articulating with distal tibia during a sprain

Symptoms:

  • pain that does not improve with conservative treatments
  • “locking” sensation of the ankle
  • shows lucency on AP and mortise views near the tibiatalor joint

Treatment:

  • immobilization and RICE
  • surgery if lesions and bone fragments present
34
Q

Os Trigonum syndrome (ankle posterior impingement)

A

Bone at the posterior of the talus that is fractured or impinges nerves due to trauma or repetitive plantar flexion

Symptoms:

  • pain with activity
  • pain specifically behind ankle but in front of Achilles

Treatment:
- RICE, NSAIDs, immobilization. Surgery only if needed

35
Q

Lisfranc joint injury

A

Bones in the mid foot are broken or the ligaments that support the mid foot are torn

Causes:
- crush injuries or indirect rotational twisting on a plantar flexed foot

Symptoms:

  • painful swollen dorsum of foot
  • ecchymoses on the dorsum and or plantar aspect of foot
  • worsening pain w/ standing, walking or plantar flexing during gait

Treatment:
- if no fracture or complete ligament rupture = RICE, NSAIDs, immobilization , PT

  • if actual fracture or complete ligament rupture = surgery

OMM Block 2 (5 decks)

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