injury scenario Flashcards
valgus
decreased lateral joint angle (knock-kneed)
varus
increased lateral joint angle (bow-legged)
strain
stretching or tearing of a tendon or muscle
acute 1st degree treatment
POLICE
2-3 days decreased activity
sprain
stretching or tearing of a ligament
acute 2nd degree treatment
POLICE
2-3 weeks decreased activity
3rd degree
POLICE
2-3 months decreased activity
surgery often required
Ankle- observation
swelling
position of ankle
ankle fracture test- fibular fractures
squeeze test
tap test
ankle ligament stress tests
-anterior posterior drawer test
-posterior drawer test
-anterior talofibular ligament (ATFL) slight plantar flexion
-calncaneofubular ligament (CFL) neutral
- deltoid ligament (anterior fibres slight PF and Ev. Middle fibres neutral and Ev.)
-AITFL: WB dorsiflexion
ext rot test
squeeze test
Ankle palpation
-ATFL
-CFL
-PTFL
-deltoid ligament
-anterior inferior tibiofibular ligament
What are the 2 possible ankle injuries?
inversion sprain
eversion sprain
Ankle inversion sprain
Hx, Ax, Tx
Hx: roll ankle plantar surface of foot facing medial, ankle in PF position, more common than eversion
Ax: pain and laxity w ATFL, CFL, PTFL, anterior drawer pos, posterior drawer pos, restricted ROM (esp PF and INV), weak restricted eversion
Tx: Deal w suspected fracture first, POLICE, ligament frictions, ROM, strengthening, balance/proprioception, running progression, sports specific exercise, gradual RTP
Eversion sprain
Hx, Ax, Tx
HX: Roll ankle, plantar surface of foot facing lateral, usually with ankle in neutral
position
AX: Pain and laxity with one or both Deltoid ligament tests, positive Anterior drawer test, restricted ROM especially into EV., weak resisted INV.
TX: Deal with suspected fracture first, POLICE, ligament frictions, ROM, strengthening, balance/proprioception, running progression, sport specific exercise, gradual RTP
Ankle tape jobs
ankle inversion sprain
ankle eversion sprain
Foot observations (4)
-foot posture
(pes cavus vs. pes planus)
-footwear
-1/3 squat test (arch suppport)
-twist test (arch support)
Foot AROM/PROM (6)
PF
DF
INV
EVER
Toe flexion
Toe extension
Foot length testing
gastocnemius
soleus
flexor hallucis longus
Foot palpation
medial calcaneal tubercle
general calcaneus
plantar fascia
dorsal pedal pulse
What are the 2 possible foot injuries?
plantar fasciitis (chronic grad onset)
fat pad syndrome (chronic grad onset)
Plantar fasciitis
Hx, Ax, Tx
Hx: gradual onset, progressive heel pain, nontraumatic, unilateral, pain worse in morning
Ax: Either pes cavus or planus, loss of control of arch through arch support testing on injured side, possible tightness in Gastroc, Soleus and FHL, pain over Medial Calcaneal Tubercle, occasionally pain into entire plantar fascia
Tx: POLICE, correct biomechanics, foot strengthening, night splint, tape jobs
Fat pad syndrome
Hx, Ax, Tx
Hx: gradual onset
Ax: pain in general calcaneus, often more pain w weight-bearing DF
Tx: rest, heel cup, supportive footwear, fat pad tape job, address biomechanics
2 ankle tape jobs
Low dye arch
Fat pad
Posterior lower leg assessment
gait pattern
foot biomechanics
Posterior lower leg
AROM/PROM
plantar flexion
dorsiflexion
inversion
eversion
Posterior lower leg: strength testing
plantar flexion
- gastrocs
- soleus
dorsiflexion
inversion
eversion
posterior lower leg: 1 special test
thompson’s test
posterior lower leg palpation
- achilles tendon
- muscle belly
- gastrocs
-soleus
What are the 3 possible posterior lower leg injuries?
achilles tendon rupture (acute)
achilles tendinopathy (chronics)
calf strain (acute)
achilles tendon rupture
Hx, Ax, Tx
Hx: push off acute injury with feeling of being kicked in the heel or hit in the calf
Ax: NO active PF, NO movement w thompson’s test, excessive DF, can’t do single leg PF, swelling/bruising
Tx: POLICE, hospital, surgial/non-surgical repair
Achilles tendinopathy
Hx: chronic gradual onset, over training, biomechanical issues, achilles pain worse in morning
Ax: Pain w active PF, no weakness, mild pain w passive DF, tenderness on palpation 2-6cm above calcaneous
Tx: biomechanical correction of feet, assess footwear, eccentric loading program!!!!!, tape
Calf strain
Hx, Ax, Tx
Hx: acute injury, can occur either in gastroc or soleus musculotendinous junction, mid belly or high on medial/lateral heads of gastroc, result of forceful push, feels like being hit in the calf
Ax: TOP over injury site, pain and weakness w active PF, possible pain w passive DF, possible swelling
Tx: POLICE, heel lifts to unload calf, NO stretching for first 1-2 weeks depending on severity
isometric –> concentric –> eccentric exercise,
taping
Anterior lower leg observation
gait
lower extremity biomech: tibial torsion
Anterior lower leg AROM/PROM, strength testing
PF/DF
INV/EVER
Toe flex/Ext
Anterior lower leg special tests (2)
- gastroc soleus length test
- tuning fork
Anterior lower leg palpation (3)
- dorsal pedal pulse
- anterior compartment
- tibia
What are the 3 possible anterior lower leg injuries?
acute anterior compartment syndrome (acute)
chronic anterior compartment syndrome (chronic)
medial tibial stress syndrome (chronic)
Acute anterior compartment syndrome
Hx, Ax, Tx
Hx: impact from external force, object or other player, numbness in foot, pain and
tightness in front of leg, loss of sensation 1st inter-webbed space, progressively
worsening symptoms, not relieved with rest
AX: decreased dorsal pedal pulse, TOP and tightness with palpation anterior
compartment, weakness DF, no improvement in symptoms with rest
TX: Medical EMERGENCY, send to ER