Injuries Flashcards by Arizay Juarez

fracture at the tarsometatarsal joint often associated with a dislocation of the joint

Most misdiagnosed injury

Lisfranc’s

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X-Ray type that will show Lisfranc’s gap between 1st and 2nd metatarsal on the right side

Weight Bearing X-ray

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Lisfranc’s MOI

sliding or falling on heel; severe ankle sprain

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Lisfranc’s S/S

severe pain and swelling in the midfoot; pain with weight bearing

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Lisfranc’s TX

splint; crutches; refer to MD; surgery

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compression of the tibial nerve in the tarsal tunnel
Floor:
talus, calcaneus, tibialis posterior, flexor digitorum longus, flexor hallucis longus
Roof: flexor retinaculum

Tarsal Tunnel Syndrome

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Tarsal Tunnel Floor (bones)

Talus
Calcaneus
Tibialis Posterior
Flexor Digitorum Longus
Flexor hallucis Longus

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Tarsal Tunnel Roof (soft tissue)

Flexor retinaculum

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Tarsal Tunnel Syndrome MOI

Most often seen with abnormal foot and ankle mechanics resulting in chronic eversion and excessive pronation; direct trauma; fractures; dislocation

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pieces of tissue that hold tendons in place & form tunnels

Retinaculums

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Tarsal Tunnel Syndrome (S/S)

pain and numbness in foot’s arch that radiates upward into the medial ankle region; running activities and dorsiflexion increase pain; pain may be worse at night; foot fatigue; numbness; burning

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lateral ankle sprain
most common (accounting for 85%)

Inversion Ankle Sprain

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Inversion Ankle Sprain MOI

Plantar Flexion ; inversion w rotational forces

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Inversion Ankle Sprain TX

PRICEMM
Crutches
Bracing**/Taping
refer to MD
X-ray
appropriate rehab

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Grade 1 Inversion Ankle Sprain

stretch of ATFL

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Grade 1 ankle sprain
S/S:

1 goal is to keep the ankle from swelling

Pain & Point tenderness
Mild & localized swelling over ATFL
minimum loss of function
no abnormal motions when tested

Probably not crutches unless absolutely necessary

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Quicker weight bearing

the better

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Bracing better than taping ?

yes

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Tear of ATFL & stretch of CFL

Grade II ankle sprain

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Grade II Ankle Sprain S/S:

increased pain & point tenderness
swelling & ecchymosis
moderate loss of function
slight to moderate instability

(everything in grade I has increased)

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Tear of ATFL & CFL

Grade III Inversion Ankle Sprain

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Grade III Inversion Ankle Sprain S/S:

severe pain & point tenderness
marked swelling & ecchymosis
major loss of function
gross instability

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Inversion Ankle Sprain DIAG

Anterior Drawer Test
Talar Tilt

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Anterior Drawer Test Tests

to see if ATFL is still intact

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Talar Tilt tests

CFL

Inversion Ankle Sprain Anterior Drawer Test is looking to prevent

anterior displacement

Inversion Ankle Sprain Talar Tilt is on

both sides

Medial ankle sprain resulting in stretching or tearing of deltoid ligament

Eversion Ankle Sprain

Eversion Ankle Sprain MOI

External Rotation with abduction & dorsiflexion 3rd is the high ankle sprain

3rd type of ankle sprain is the

high ankle sprain

2nd strongest ligament in the body

deltoid ligament

Eversion Ankle Sprain S/S:

pain point tenderness swelling ecchymosis instability

Eversion Ankle Sprain TX

PRICEMM crutches immobilizers refer to MD R/O syndesmosis x-ray

not as commmon as inversion ankle sprain due to length of lateral malleolus (distal end of fibula) & strength of deltoid ligament on medial side

Eversion Ankle Sprain

high ankle sprain resulting from a stretch or tear of the tibiofibular ligaments causing spreading of the distal tibiofibular joint

syndesmosis

more often than not happens on the same team ex. football

syndesmosis

Syndesmosis MOI

forced external rotation (lateral blow to the leg) w foot planted

Syndesmosis S/S:

Pain at the syndesmosis

Syndesmosis TX

PRICEMM Immobilize non-weight bearing 7-10 days surgery

Syndesmosis DIAG

Talar Tilt (eversion) Kleiger Test Squeeze Test

Not-so-good tests for Syndesmosis DIAG

Squeeze Test

Prevention of Ankle Injuries

Achilles Tendon Stretching (2 positions) Strength Training Proprioception Training Proper Footwear Preventative ankle bracing or taping

body's ability to tell where it is in space - vision is important

Proprioception

Sizes, fillings, metal soles

Proper footwear

dislocated ankles don't happen often but do happen

Ankle Dislocation

Inflammation of Achilles Tendon

Achilles Tendinitis

Achilles Tendinitis MOI

overuse an over stretching causing repeated microtrauma

Achilles Tendinitis S/S:

Pain Point tenderness swelling crepitus (squeaky noise sensation) decreased dorsiflexion

Achilles Tendinitis TX

PRICEMM NSAIDs Heel lift (bilateral) Stretching (2 positions)

stretch that hurts the most: knee bent

soleus stretch

straight stretch

gastroc stretch

Stretching or tearing of Achilles Tendon

Achilles Tendon Strain

Achilles Tendon Strain MOI

ankle sprain ; excessive dorsiflexion

Achilles Tendon Strain TX

Same as Achilles Tendinitis (pain / point tenderness / swelling)

Achilles Tendon Strain (TX)

Same as Achilles Tendinitis PRICEMM NSAIDs Bilateral heel lift stretching (2 positions)

Complete tear of achilles tendon

Achilles Tendon Rupture

Achilles Tendon Rupture MOI

Stop & go activity (push off) common in those over 30 - has changed = much younger population = 18 yr old

Achilles Tendon Rupture S/S:

Abrupt severe pain that subsides quickly - If you rupture something - you probably also ruptured the nerves = don't feel that much pain audible "pop" or "snap" palpable indentation Swelling ecchymosis loss of function

Achilles Tendon Rupture TX

PRICEMM refer to MD Surgery

Achilles Tendon Rupture DIAG

Thompson test

Easiest way to perform Thompson Test

lie on stomach w foot off the table & squeeze the calf If not intact = won't move

Rupture of plantaris muscle (fool's nerve injury)

Plantaris Rupture

Plantaris Rupture MOI

Excessive Contraction or stretch w running or jumping ; sudden change in direction

Plantaris Rupture S/S:

sudden pain behind the knee that disappears may report a pop

Plantaris Rupture TX

Treat symptomatically & rule out any other injuries happens in a muscle that isn't v developed

compression w/in the anterior compartment (maybe acute chronic or exercised induced)

compartment syndrome

Compartment Syndrome MOI

direct trauma (contusion) fractures Strains overuse

Most important compartment = medical emergency what happens in that compartment stays in that compartment

Anterior Compartment

Compartment Syndrome S/S

Pain Swelling Ecchymosis Firm & Tight over anterior shin weakness of foot dorsiflexion and/or extension of big toe (foot drop) parathesia of web between 1st & 2nd toe over the foot's entire dorsal region decreased dorsalis pedis pulse

Compartment Syndrome TX

medical emergency ice w/o compression no elevation may require surgical intervention

dragging toes on the group, can't lift foot

foot drop

nerves w/ parathesia of certain areas = pulse going away dorsalis pulse extremely difficult pulse to found in an healthy individual more difficult to find in the capillary refill on toe nail bed : white to red This part of the body is going to die

bld vessel effective

"tennis leg" strain to the gastrocnemius

Calf Strain

Calf strain MOI

quick starts & stops

Calf strain S/S

pain point tenderness ecchymosis swelling palpable defect depending on degree

Calf Strain TX

PRICEMM NSAIDs Heel lift stretching (2 positions)

Medial tibial stress syndrome lateral to the tibia could be medial could be all over the place

shin splints

Shin Splint MOI

overuse, faulty posture, footwear fallen arches, muscle fatigue, change in training regimen

Shin Splint S/S

pain point tenderness swelling disability

Shin Splints TX

PRICEMM NSAIDs Taping Gradual return

Shin Splint PREV

Check footwear adjust training be aware of surface - important

incomplete break in the bone (normally tibia)

Stress Fracture

Stress Fracture MOI

overuse repetitive overload stress to the bone

Stress Fracture S/S

pin-point pain over affected area point tenderness

Stress Fractures TX

PRICEMM NSAIDs refer to MD bone scan or x-ray gradual return to activity

Hit heel hard ; not a v accurate test

Percussion Test

broken leg to the tibia, fibula, or both

Fractures

Fracture MOI

direct force indirect force (torsion) ankle sprain

Fracture S/S

Pain; point tenderness; deformity; rapid swelling

Fracture TX

splint; assess distal pulse & capillary refill, check for possible S/S of shock refer to MD

Special Test: Foot & Lower Leg

Compression Test: fracture Tap (bump) Test: Fracture Percussion Test : fracture Lever Test: Fracture Distraction Test: integrity of MTP joint Distraction of longitudinal Arch: Arch Strain

Special Test: Ankle

Anterior Drawer Test: ATFL tear Talar Tilt Test: excessive movement of the talus in the talocrural joint (inversion tests CFL, Eversion tests deltoid) External Rotation Test: syndesmosis ankle sprain; deltoid Squeeze Test: Syndesmosis ankle sprain Thompson Test: Achilles tendon rupture