Injuries Flashcards
fracture at the tarsometatarsal joint often associated with a dislocation of the joint
Most misdiagnosed injury
Lisfranc’s
X-Ray type that will show Lisfranc’s gap between 1st and 2nd metatarsal on the right side
Weight Bearing X-ray
Lisfranc’s MOI
sliding or falling on heel; severe ankle sprain
Lisfranc’s S/S
severe pain and swelling in the midfoot; pain with weight bearing
Lisfranc’s TX
splint; crutches; refer to MD; surgery
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
Tarsal Tunnel Floor (bones)
Talus
Calcaneus
Tibialis Posterior
Flexor Digitorum Longus
Flexor hallucis Longus
Tarsal Tunnel Roof (soft tissue)
Flexor retinaculum
Tarsal Tunnel Syndrome MOI
Most often seen with abnormal foot and ankle mechanics resulting in chronic eversion and excessive pronation; direct trauma; fractures; dislocation
pieces of tissue that hold tendons in place & form tunnels
Retinaculums
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
lateral ankle sprain
most common (accounting for 85%)
Inversion Ankle Sprain
Inversion Ankle Sprain MOI
Plantar Flexion ; inversion w rotational forces
Inversion Ankle Sprain TX
PRICEMM
Crutches
Bracing**/Taping
refer to MD
X-ray
appropriate rehab
Grade 1 Inversion Ankle Sprain
stretch of ATFL
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
Quicker weight bearing
the better
Bracing better than taping ?
yes
Tear of ATFL & stretch of CFL
Grade II ankle sprain
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)
Tear of ATFL & CFL
Grade III Inversion Ankle Sprain
Grade III Inversion Ankle Sprain S/S:
severe pain & point tenderness
marked swelling & ecchymosis
major loss of function
gross instability
Inversion Ankle Sprain DIAG
Anterior Drawer Test
Talar Tilt
Anterior Drawer Test Tests
to see if ATFL is still intact
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