Diagnosis and management of lower limb injuries

Question 1

Outline the Beighton score for hypermobility

Answer 1

standing bending forwards, can place 2 hands on the floor = 1 point

each elbow that can bend backwards = 1 point

each knee that bends backwards = 1 point

each thumb which can be bent back to touch the forearm = 1 point

each little finger that can be bent back past 90 = 1 point

score of 2 or more is predictive of hypermobility

Question 2

what common symptoms occur in patients with medial tibial stress syndrome

Answer 2

pain along the inner edge of the tibia lower 2/3rds

severe pain with training but subsides with rest

Question 3

what is the underlying cause of medial tibial stress syndrome

Answer 3

repeated trauma to the connective muscle tissue surrounding the tibia

Question 4

what factors can lead to the development of medial tibial stress syndrome

Answer 4

increase in mileage

change in running surface, mainly from flats to hills

change of running shoe

Question 5

how can the type of pain a person is feeling be an indicator of whether they have a tibial stress fracture or medial tibial stress syndrome

Answer 5

stress fracture gives a very localised pain

medial tibial stress syndrome gives pain along the lower 2/3rds of the tibia

Question 6

describe the process of a physical examination of a person with suspected shin splints

Answer 6

paplate for pain along the posteriomedial edge of the tibia

look for oedema or warmth

forced passive dorsiflextion
active plantarflexion against resitance

ask patient to do standing toe raises or standing jumps or hops

these tests should cause pain if they are suffering from medial tibial stress syndrome

Question 7

outline the treatment for medial tibial stress syndrome

Answer 7

rest, avoiding activity which causes pain

may need crutches if there is pain on walking or at rest

do non-weighbearing exercise e.g cycling or swimming to maintain fitness and strength

Ice and NSAIDS can be used for pain

heal cord stretching

wearing orthotics to prevent over-pronation

Question 8

explain some rehabilitation exercises which can be performed by patients suffering from medial tibial stress syndrome

Answer 8

run or walk at 50% previous intensity on a soft level surface when pain free

increase distance by around 10% each week as long as remianing pain free over 3-6 weeks

plyometic training e.g box jumos

Question 9

what methods can be tried to prevent medial tibial stress syndrome

Answer 9

wearing correct shoes with cushioning and arch support

use of orthotics to prevent over-pronation

avoiding training on hard suraces

gradual increases in activity

increase strength and flexibility

Question 10

what is the probable cause of pain in shin splints and what is the aetiology of the development of shin splints

Answer 10

fascial insertion of the medial soleus

foot lands in a slightly supinated position and then moves into a relatively more pronated position. it is believed that the soleus is contracting eccentrially to achieve this