Final Exam Study Guide Flashcards
Wells Clinical Prediction Rule for DVT
Active cancer (treatment within previous 6 months) (1)
Paralysis, paresis, or immobilization of LE (1)
Bedridden > 3 days b/c of surgery (within 4 weeks) (1)
Localized tenderness along distribution of deep veins (1)
Entire leg swollen (1)
Calf swelling > 3 cm (below tibial tuberosity) (1)
Unilateral pitting edema (1)
Collateral superficial veins (1)
Alternative Dx as likely as or more likely than DVT (-2)
Grade I ankle sprain
-Mild
-No instability
-No macroscopic tear of ligaments
-Minimal swelling
-Mild loss of function
Grade II ankle sprain
-Moderate
-Partial tear
-Moderate swelling
-Loss of function
Grade III ankle sprain
-Severe
-Complete tear
-Echymosis
-Severe loss of function
(Painful and restricted WB)
Instability
PRICEMEM
Protection, Rest, Ice, Compression, Elevation, Manual Therapy, Early Motion, Medications
Ankle sprain interventions
If acute, PRICEMEM, gentle open chain AROM in pain free ranges, consider boot.
A progression would be closed chain ROM, the goal is to have full closed chain DF. Proprioceptive and neuromuscular training and strengthening.
Mechanisms of ankle fractures
Sprain with fracture:
Fx generally occurs as an avulsion or compression
-Avulsion same side as ligament
-Compression opposite side as ligament
Direct trauma
-Talus fractures
Ankle fracture interventions
Immobilization (brace, boot, or cast)- 8 weeks
Surgical: ORIF
Post-immobilization manual therapy/exercise (mobilization, coordination/proprioception)
Insertional Achilles Tendinitis
Training error
-Overuse
-Change in habits (>10%/week)
-Hills, slopes
retrocalcaneal bursa, localized pain and x-ray may show calcification.
Insertional Achilles Tendinitis interventions
Ice, ionto
Rest
Stretching if needed
Training modification
Heel lift??
Non-Insertional Achilles Tendinitis
Inflammation of more superior fibers
Tendon may thicken and degenerate, potentially posing risking of rupture
Local tenderness, crepitus and decreased DF ROM
Achilles Rupture Surgery interventions 0-3 weeks
-Boot locked at 30 degrees PF
-NWB
-Pain and edema control (estim, ice)
Toe curls
Achilles Rupture Surgery interventions 3-8 weeks
TTWB – PWB. If successful, follow with FWB.
Boot locked at 10 degrees PF (usually adjust 5 degrees a week)
Isometrics of uninvolved ankle muscles- must not exceed DF allowed by boot
At 6 weeks- add stationary bike with heel push only
Achilles Rupture Surgery interventions 8-12 weeks
May wear shoe with heel at 8 weeks - cowboy boots or a ¼ inch heel lift
FWB
Manual full PROM into DF – Do NOT push
Progress cycling in shoe
Achilles Rupture Surgery interventions 3-6 mo
Wean off heel lifts
CKC exercises
Balance training
Cycling, stair climber
Achilles Rupture Surgery interventions 6 mo
Progress to jogging, running and eccentric loading
Stress Fractures
Female > Males
Common in the:
-2nd metatarsal shaft (march fx)
-Running and jumping
-5th metatarsal shaft
-Navicular
-Rhythmic overload
Risk factors
-Foot posture
-Inappropriate footwear
Stress fracture symptoms
Stiffness/soreness after activity
Mild soreness/pain during & after activity
Pain during activity that alters performance
Pain during and after, does not subside with complete rest
Stress fracture intervention
Immobilization (4-6 weeks)
Maintain CV fitness
Plantar Fasciitis
Medial Heel Pain
-Tenderness (medial, toward heel)
-AM pain
Plantar Fasciitis interventions
Calf stretches
Plantar fascia stretch
Orthotics
Night splints
Morton’s Neuroma
Mass about a nerve sheath
Common along digital nerves between toes
-Most commonly between 3rd and 4th met heads
Morton’s neuroma intervention
Footwear
Activity
Metatarsal bar
Teardrop pad
Compartment Syndromes symptoms
Symptoms (5 P’s):
-PAIN out of proportion to injury and unrelieved with medication
-Numbness or tingling
-Paralysis
-Loss of pulses
-Pallor
Do not use compression if vascular compromise is suspected
Compartment syndromes interventions
Release (fasciotomy)
Intervention
Functional and biomechanical factors
Maintain CV
Similar to stress fracture
