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ATR 525: Advanced Injury Assessment of Lower Extremity > Chapter 9: Ankle and Leg Pathologies > Flashcards

Chapter 9: Ankle and Leg Pathologies Flashcards

1
Q

Which bone provides lateral stability to the ankle mortise?

A

Fibula

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2
Q

The Achilles tendon attaches on the _______ tubercle.

A

Calcaneal

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3
Q

What is the closed-packed position of the ankle mortise?

A

Dorsiflexion

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4
Q

The most stable position of a joint occurs in which position?

A

Closed-packed position

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5
Q

The ATFL is tight in which talocrural joint motion?

A

Plantarflexion

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6
Q

Which ligament limits anterior translation of the talus?

A

Anterior talofibular ligament

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7
Q

Which ligament limits posterior translation of the talus?

A

Posterior talofibular ligament

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8
Q

Which ligament is strongest of the lateral ankle ligaments?

A

Posterior talofibular ligament

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9
Q

What does the distal tibiofibular syndesmosis responsible for?

A

Allows for rotation and slight spreading of the ankle mortise.

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10
Q

What ligaments make up the deltoid ligament?

A

Anterior tibiotalar
Posterior tibiotalar
Tibiocalcaneal
Tibionavicular

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11
Q

What ligaments make up the distal tibiofibular syndesmosis?

A

Anterior tibiofibular
Posterior tibiofibular
Crural interosseous membrane

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12
Q

TRUE or FALSE

The fibula glides inferiorly during dorsiflexion.

A

FALSE

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13
Q

What nerve innervates the lateral compartment of the leg?

A

Superficial fibular

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14
Q

What nerve innervates the posterior compartment of the leg?

A

Tibial

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15
Q

What nerve innervates the deep posterior compartment of the leg?

A

Tibial

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16
Q

Which muscles act as dorsiflexors of talocrural joint?

A

Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
Peroneus tertius

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17
Q

Which muscle act as plantarflexors of talocrural joint?

A 
Gastrocnemius 
Soleus
Plantaris
Peroneus longus 
Peroneus brevis
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18
Q

List muscles of deep posterior compartment.

A

Flexor hallucis longus
Flexor digitorum longus
Popliteus
Posterior tibialis

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19
Q

Which two bursae are associated with the ankle and leg?

A

Subtendinous calcaneal bursae

Subcutaneus calcaneal bursae

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20
Q

Where is the subtendinous calcaneal bursae located?

A

Between the Achilles tendon and the posterior aspect of the calcaneus

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21
Q

Where is the subcutaneus calcaneal bursae located?

A

Between the posterior aspect of the Achilles and the skin

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22
Q

The deep fibular nerve and superficial fibular nerve arise from which nerve?

A

Common fibular nerve

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23
Q

What is the resting position of the talocrural joint?

A

Inversion

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24
Q

What is thrombophlebitis?

A

Inflammation of a vein and the subsequent formation of blood clots

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25
Q

Which ligament can be identified by locating sinus tarsi?

A

Anterior talofibular ligament

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26
Q

What does PQRST stand for?

A 
Provocation - what cause it to hurt?
Quality - how bad does it hurt?
Region - where does it hurt?
Severity - how bad does it hurt?
Timing - when does it hurt?
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27
Q

How many degrees of dorsflexion must be provided by the talocrural joint during walking?

A

10 degrees

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28
Q

How many degrees of dorsflexion must be provided by the talocrural joint during running?

A

15 degrees

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29
Q

AROM plantarflexion degrees from a neutral position

A

50 degrees

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30
Q

AROM dorsiflexion degrees from a neutral position

A

20 degrees

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31
Q

AROM inversion degrees from a neutral position

A

20 degrees

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32
Q

AROM eversion degrees from a neutral position

A

5 degrees

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33
Q

Inversion and eversion occur at the _______ joint.

A

Subtalar

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34
Q

What are the end-feels of the talocrural and subtalar capsular patterns?

A

Firm - soft tissue stretch

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35
Q

A hard end-feel of the talocrural or subtalar joint may be a result of damage to which structures?

A

Capsular or ligamentous structures

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36
Q

Which special test would you use to test the integrity of the anterior talofibular ligament?

A

Anterior Drawer Test

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37
Q

This test is used to determine if the calcanefoibular ligament has been injured?

A

Inversion Talar Tilt test

38
Q

Tests for deltoid ligament instability include…

A

Eversion Talar Tilt test

External Rotation Test

39
Q

If posterior talar glide is restricted then this talocrural joint motion will be limited.

A

Dorsiflexion

40
Q

If medial talar glide is restricted then this subtalar joint motion will be limited.

A

Eversion

41
Q

If lateral talar glide is restricted then this subtalar joint motion will be limited.

A

Inversion

42
Q

Special test used to evaluate lateral translation of the talus the

A

Cotton Test

43
Q

Special test used to evaluate distal tibiofibular syndesmosis instability.

A

Klieger’s External Rotation Test

44
Q

Why would overpressure at the end of dorsiflexion elicit pain?

A

If syndesmosis trauma is present forced dorsiflexion will wedge anterior border of talus between talocrural joint causing fibula to separate slightly from tibia thus causing pain

45
Q

Describe Lower Quarter Screen myotomes

A 
L2 - hip flexion
L3 - knee extension
L4 - dorsiflexion
L5 - toe extension
S1 - plantarflexion
46
Q

Describe Lower Quarter Screen dermatomes.

A 
L1 - Upper Anterior Thigh
L2 - Greater Trochanter of femur
L3 - Mid Anterior Thigh
L4 - Medial Malleolus
L5 - Dorsum 3rd MTP Joint
S1 - Lateral Malleolus
S2 - Popliteal Fossa
S3 - Ischial Tuberosity
S5 - Perianal Area
47
Q

What is the open packed position of the ankle?

A

Plantarflexion + inversion

48
Q

Pain and crepitus over the origin and insertion of the can indicate a possible…

A

Avulsion Fracture

49
Q

How much more likely is a basketball player who has suffered an ankle sprain than a player who has not?

A

5x

50
Q

This pulse must be established after any significant lower extremity bone fracture or joint dislocation.

A

Posterior Tibial artery

51
Q

What does the Cotton test assess?

A

The amount of lateral translation of the ankle mortise

52
Q

A positive Cotton test suggests a possible _______.

A

Tibiofibular syndesmosis sprain

53
Q

How does a tight triceps surae muscle group predispose an individual to lateral ankle sprain?

A

Tightness of the triceps surae muscle group place the ankle in a open-packed position (talocrural joint in a plantarflexed position and subtalar joint in an inverted position)

54
Q

Pain and crepitus over the origin and insertion of the involved ligament indicates a possible _______ .

A

Avulsion fracture

55
Q

This joint play test identifies the amount of anterior-posterior play in distal tibiofibular syndesmosis.

A

Distal tibiofibular joint play

56
Q

The presence of this pulse must be established after lower extremity fracture or dislocation and in those individuals suspected to have anterior compartment syndrome.

A

Dorsal pedis artery

57
Q

Describe the two theories of why individuals with a history of ankle sprains are more likely to suffer an ankle sprain by more than 70%.

A

(1) ankle sprains result in the loss of ligament ability to passively support the joint in conjunction with a reflex arc that is too slow to a evoke a contraction of the peroneal muscles
(2) decreased proprioceptive abilities of the capsule, ligament and peroneal muscles.

58
Q

Define osteochondral defect (OCD).

A

Injury to cartilage or bony defect

59
Q

Define osteochondritis dissecans.

A

Loose body of bone

60
Q

What are some common mechanisms for syndesmosis sprains?

A

Forced dorsiflexion

Excessive external rotation of talus

61
Q

Which other ligament will usually be affected by a syndesmotic sprain?

A

Deltoid ligament

62
Q

Diagnosis based on these observations:
(+) external rotation test (Klieger’s)
(+) squeeze test
Pain primarily on the anterior aspect of ankle and along interosseous membrane most prominent during forced dorsiflexion
TTP over anterior and posterior tibiofibular ligaments
Pain is reduced witch dorsiflexion compression test

A

Syndesmotic sprain

63
Q

Forces required to produce a syndesmotic sprain may lead to a spiral fracture to the distal 3rd of fibula called _______.

A

Maisonneuve fracture

64
Q

How does a “knock-off” fracture occur?

A

Commonly occurs with forced eversion, caused by the calcaneous colliding with the lateral malleolus.

65
Q

Describe an Os Trigonum injury.

A

The Stieda’s process seperates from the talus due to forced hyperplantarflexion or repetitive activity usually involving plantarflexion

66
Q

Os Trigonum injuries commonly occur in which population?

A

Dancers, gymnasts and swimmers

67
Q

Where is the Stieda’s process located?

A

Posterior aspect of talus

68
Q

Athlete is assuming a stiff-legged gait pattern characterized by external rotation of lower extremity. Reports landing with his right leg while ascending from a jump. Reports a sensation of being “kicked” followed with severe pain around posterior aspect ankle. What do you suspect based on this information?

A

Possible Achilles tendon rupture

69
Q

This test is used to confirm an Achilles tendon rupture.

A

Thompson Test

70
Q

Where is the Os Peroneum located?

A

On the lateral aspect of the calcaneocuboid joint.

71
Q

What are the “five P’s” used to describe the signs and symptoms of compartment syndrome?

A 
Pain
Pallor (redness)
Pulselessness
Paresthesia
Paralysis
72
Q

With a anterior compartment syndrome paresthesia may be present in the…

A

Web space between the 1st and 2nd rays and possibly on the dorsum of foot.

73
Q

List two contraindications for treatment of anterior compartment syndrome.

A

Compression wrap

Elevation

74
Q

Defien deep vein thrombosis (DVT).

A

Blood clot of a deep vein most commonly in leg

75
Q

Palpation reveals warmth, tightness of the calf musculature and pain. Posterior aspect of leg is red and patient has been experiencing leg fatigue. What could you suspect based on this information?

A

Possible DVT

76
Q

Lateral ankle sprains, fibularis brevis longus avulsion fracture, and medial malleolus fractures are associated with this mechanism.

A

Inversion ankle sprains

77
Q

Syndesmotic ankle sprains and fractures of the lateral malleolus and proximal fibula are associated with this mechanism.

A

Eversion ankle sprains

78
Q

Forced dorsiflexion can rupture (THIS TENDON) or cause sprain to this (THIS LIGAMENT).

A

Achilles tendon

Distal tibiofibular ligament

79
Q

A “snap or “pop” may be associated with a…

A

Ligament rupture or bony fracture.

80
Q

A description of being “kicked” in the calf may be associated with a…

A

Achilles tendon rupture

81
Q

Radiating pain or numbness in the anterior ankle and leg can indicate…

A

anterior compartment syndrome or trauma to the deep fibular nerve.

82
Q

Klieger’s Test assess injury to which ligament?

A

Deltoid ligament

83
Q

Whats the difference between the External Rotation Test and Klieger’s test?

A
  • External rotation test assesses tibiofibular ligament pathology
  • Klieger’s assesses deltoid ligament
84
Q

The External Rotation Test rotates the _______ into the _______ malleolus spreading the tibiofibular syndesmosis.

A

talus : lateral

85
Q

Cotton test glides the ______ bone against the ______ to open the distal tibiofibular syndesmosis.

A

Calcaneus

86
Q

What is possible pathology with this information.

Pain over distal syndesmosis is reduced with dorsiflexion compression test.
Localized pain with squeeze test

A

Distal syndesmosis sprain

87
Q

Explain x-ray referral with Ottawa Ankle Rule.

A
  • Pain with palpation over lateral borders of medial and lateral malleolus
  • Pain with palpation over navicular or base of 5th MT
88
Q

An ankle x-ray should be performed when pain is elicited over _______.

A

lateral and medial malleoli

89
Q

A foot x-ray should be performed when pain is elicited over _______.

A

navicular and base of 5th MT

90
Q

Define Homan’s Sign.

A
  • Passive dorsiflexion of foot with knee extended & the squeeze calf for 30-60 seconds
  • Pain in the calf; throbbing, Nx symptoms
91
Q

What can give you a false positive Homan’s Sign?

A

Gastroc or soleus strain may give false positive

ATR 525: Advanced Injury Assessment of Lower Extremity (4 decks)

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