Common Injuries of the Leg

Question 1

Medial Tibial Stress Syndrome (MTSS or Shin Splints) - Characteristics and Risk Factors (9)

Answer 1

Exercise induced pain medial posterior tibial border.
Dysfunction of A and P tibialis.
Runners, dancers, female, military.
↑BMI, ↑ pronation, ↑ hip ER or IR, shoe design, training error.

Question 2

MTSS - Signs and Symptoms (4) (early/later stage)

Answer 2

Diffused pain on posteromedial border.
Tenderness on palpation for several days after activity.
Early: pain at beginning of exercise, decreases with warm-up.
Later: Can present during rest.

Question 3

MTSS - Assessment (4)

Answer 3

Alignment & gait biomechanics:
Muscle length, strength, endurance(calf).
Foot arch abnormalities.
Leg length discrepancies.

Question 4

Chronic Exertional Compartment Syndrome (CECS) - Characteristics

Answer 4

↑ pressure in muscle compartment (tight connective tissue).
↓ Blood flow, ↓ tissue perfusion.
Endurance athletes, bilateral.

Question 5

CECS - Symptoms (2)

Answer 5

No pain at rest.
Pain and tightness increases with exertion, resolves within minutes of stopping.

Question 6

CECS - Assessment (6)

Answer 6

No special tests.
Tense compartment on palpation.
Limb and foot alignment.
Training surface/shoe assessment.
Intracompartmental pressure measure.
Length of soleus and gastroc.
Pelvic/hip/knee control while running.

Question 7

Achilles Tendinopathy - Signs and Symptoms (6)

Answer 7

Gradual onset.
Morning stiffness/pain (ease w/movement).
Pain on tendon, mid portion.
Possible tendon thickening.
Pain with resisted PF and stretching.
Pain and stiffness following activity.

Question 8

Achilles Tendinopathy - Risk Factors (4)

Answer 8

↑ BMI
Diabetes mellitus, hypercholesterolemia, inflammatory arthritis.
Change in load, ↑ explosive movement (jumping).
Change in footwear or training surface.

Question 9

Achilles Tendinopathy - Objective Examination (5)

Answer 9

No special test.
Symmetry between muscle and tendon.
Tendon thickening/pain on palpation.
Calf raise/hopping: pain response.
Dorsi flexion range (WB lunge test).
VISA-A outcome measure.

Question 10

Achilles Tendon Rupture - Mechanism of Injury and Special Test

Answer 10

MOI: Full knee ext., strong PF contraction (pushing off ground).
Thomson squeeze test.

Question 11

Achilles Tendon Rupture - Signs and Symptoms (4)

Answer 11

Sudden loud snap.
Unable to continue activity.
Bruising and swelling.
May have weak PF.

Question 12

Gastroc Tear/strain - MOI and Characteristics (most common)

Answer 12

Medial head, middle age/older or young athlete playing tennis or other.
MOI: running, jumping. Eccentric DF with Knee extension, excessive stretch and forceful contraction.

Question 13

Gastroc Tear/Strain - Signs and Symptoms (4)

Answer 13

Immediate pain.
Swelling.
Might be unable to walk due to intense pain (depends on grade).
Tenderness on tear site.
Palpable defect (grade 3).

Question 14

Gastroc Tear/Strain - Objective Assessment (4)

Answer 14

Antalgic gait, bruising, swelling.
Palpable defect (grade 3).
Pain in active and passive DF.
Pain in resisted PF with knee ext.

Question 15

Grading of Muscle Tears - Grade 1

Answer 15

Mild. Able to continue activity.
Minimal loss of ROM and strength.
Minimal muscle fibers disrupted <10%.

Question 16

Grading of Muscle Tears - Grade 2

Answer 16

Moderate. Might be difficult to walk.
10-50% muscle fiber disruption.

Question 17

Grading of Muscle Tears - Grade 3

Answer 17

Severe. Palpable defect.
Complete disruption of muscle continuity (full thickness tear).
50-100% muscle fiber disruption.