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MSK II - FOOT and ANKLE > Foot and Ankle- Other Sprains and CAI > Flashcards

Foot and Ankle- Other Sprains and CAI Flashcards

1
Q

What is the etiology of medial sprains?

A

excessive EV

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2
Q

What are the ligamentous structures involved with a medial ankle sprain?

A
  • deltoid
    > 3 that connect tibia with talus, calcaneus, and navicular
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3
Q

What do the deltoid ligaments do to the medial arch?

A

reinforces

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4
Q

What other ligaments can be involved with a medial ankle sprain?

A
  • subtalar or talocalcaneal ligaments
    > intraarticular: posterior interosseous
    > Extraarticular: medial talocalcaneal
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5
Q

What bony structures are involved with a medial sprain?

A
  • avulsion fx of medial malleolus
  • fx of lateral malleolus due to compression with excessive EV
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6
Q

What can happen with the epiphyseal plate with a medial sprain?

A
  • medial malleolus epiphyseal plate involved
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7
Q

What muscles and tendons can be involved with a medial sprain?

A
  • possible tibialis posterior strain and/or subluxation if flexor retinaculum torn
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8
Q

What are some symptoms of a medial sprain?

A
  • sudden onset with trauma with foot turning outward
  • medial ankle pain/swelling
  • limited and painful ROM, especially turning outward
  • difficult and painful weight-bearing
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9
Q

What are some signs with observation of a medial sprain?

A
  • swelling and possible ecchymosis
  • antalgic and asymmetrical gait
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10
Q

What CDR determines the need for radiographs for medial sprains?

A
  • Ottawa and Bernese Ankle CDR
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11
Q

What will we find in signs with ROM with medial sprains?

A
  • primary limited and painful EV
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12
Q

What will we find in signs for resisted/MMT for medial sprains?

A
  • possible weak and painful IV
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13
Q

What are some special tests for medial sprains?

A
  • medial ligamentous tests
    > talocrural
    > subtalar
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14
Q

What are the talocrural special tests?

A
  • generally, with anterior and reverse anterior drawer
  • specific medial ligament tests for deltoid ligaments
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15
Q

What glide is used for subtalar medial sprains and what ligaments is it stressing?

A
  • generally, with medial calcaneal glide
  • specific with posterior interosseous and medial lig tests
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16
Q

Where will we have TTP with medial ankle sprains?

A
  • TTP over involved structures
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17
Q

What is another term for syndesmotic sprains?

A

high ankle sprain

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18
Q

What is the etiology of a syndesmotic sprain?

A
  • primarily DF (talus wider anteriorly than posteriorly), so excessive talar posterior glide with ER aka peeling mechanism, possibly EV
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19
Q

What is the peeling mechanism?

A
  • the talus is shoved posteriorly and ER, which pushes the bones apart
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20
Q

What is the 1st ligament involved in syndesmotic sprains?

A
  • Anterior Inferior Tibiofibular Ligament (AITFL)
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21
Q

What is the 2nd ligament involved in a syndesmotic sprain?

A
  • Interosseous membrane or syndesmosis
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22
Q

What is the 3rd ligament involved in a syndesmotic sprain?

A
  • Posterior Inferior Tibiofibular Ligament (PITFL)
23
Q

What is the 4th ligament involved in a syndesmotic sprain?

A
  • Deltoid Lig
24
Q

What bones are a part of the syndesmotic sprains?

A
  • talar or distal tibia/fibular fx
25
Q

Is a syndesmotic sprain a sudden or gradual onset?

A

Sudden with trauma

26
Q

What are some symptoms of a syndesmotic sprain?

A
  • sudden onset with trauma, typically with ankle bent up
  • Often anterior ankle pain/swelling
  • Limited and painful ROM, especially bending ankle up
  • Difficult and painful WB
27
Q

What are some signs with observation of a syndesmotic sprain?

A
  • swelling and possible ecchymosis
  • Antalgic and asymmetrical gait
28
Q

What are some signs with ROM for a syndesmotic sprain?

A
  • primarily limited and painful DF and possibly EV
29
Q

What are some resisted/MMT signs with a syndesmotic sprain?

A
  • possibly weak and painful, no real specific direction
30
Q

What are some special tests for syndesmotic sprains?

A
  • ligamentous tests for inferior tibfib (reverse posterior drawer)
  • Possibly same as medial sprain
  • Single leg hop test if able
31
Q

What are the ligamentous tests for the inferior tibfib?

A
  • generally with reverse posterior drawer
  • specific with fibular ant/post translation
32
Q

Where will we have TTP with syndesmotic sprains?

A
  • over involved structures
33
Q

What is chronic ankle instability (CAI) defined as?

A
  • presence of functional or mechanical instability
34
Q

What are risk factors for CAI?

A
  • incresed talar curvature
  • lack of external support
  • lack of coordination training following a prior sprain
35
Q

What is the etiology of CAI?

A
  • past severe and/or recurrent sprains
36
Q

What is the re-injury rate following an InV sprain? (%)

A

80%!!!!

37
Q

What are S&S of CAI?

A
  • possible acute S&S if aggravated, otherwise may be asymptomatic
  • decrease postural stability/proprioception and plantar sensation
  • Altered muscle activation patters
  • Aberrant joint motion
  • Fibula is significantly more lateral from tibia, could use caliper to measure
38
Q

How successful is PT for CAI and sprains?

A

90% successful

39
Q

What can be useful for CAI as far as immobilization??

A
  • possibly brief period of immobilization and/or assistive device
40
Q

What modalities are useful for CAI and sprains?

A
  • cryotherapy benefits with pain, swelling, needing less meds, and gait
  • weak evidence for diathermy and LASER
  • conflicting evidence for electrotherapy
  • US should NOT be used for acute sprains
  • Acupuncture: conflicting evidence
41
Q

What can bracing do for sprains?

A

protect/help with function; reduce risk and frequency but NOT severity with basketball

42
Q

What can standard tape do for sprains?

A
  • mechanical support significantly decreased after 30 minutes of exercise
43
Q

What taping technique can limit the anterior glide with sprain?

A
  • talar technique
44
Q

What indicates the distal tib-fib taping technique for sprains?

A
  • indications: high ankle sprains
  • limits separation and anterior distal fibular glide
45
Q

What should we use STM for with sprains?

A

lymphatic draining for swelling

46
Q

What are JM with MET for sprains useful for?

A
  • ROM, proprioception and tissue tolerances
  • AP talar mobes
  • Hypo analgesic effect and subsequent increased ROM
47
Q

What is the ultimate purpose of MET for ankle sprains?

A
  • tissue proliferation (acute) and stabilization (acute and chronic)
48
Q

What other MET can we do for sprains?

A
  • balance and neuromuscular training
49
Q

What can balance training do for sprains?

A
  • prevents reoccurrences
  • improved balance and inversion joint position sense and greater motor neuron excitability (reaction time)
50
Q

What is the prognosis for return to activity for a GRADE I sprain?

A
  • 1-2 weeks
  • avg 7.2 days with track and field athletes
51
Q

What is the prognosis for return to activity for a GRADE II sprain?

A
  • 2-6 weeks
  • avg 15 days with track and field athletes
52
Q

What is the prognosis for return to activity for a GRADE III sprain?

A
  • > 6 weeks
  • avg 30-55 days with track and field atheletes
53
Q

What should we know about surgery for CAI?

A
  • NO procedure is better than another
  • Early functional rehab appears superior to 6 weeks immobilization in restoring early function

MSK II - FOOT and ANKLE (6 decks)

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