Lab Quiz 1 Flashcards
5 AT Competencies?
Prevention (Pre-exam, train/condition)
Assessment (HOPS, index of suspicion)
Intervention (on field, rehab programs, modalities)
Practice Management (record keep, eqp/ supplies, policies)
Professional Responsibilities (continuing education, research etc.)
Abbreviation for Assessment?
HOPS
History
Observation
Palpation
Special Tests
Assessment: History?
History of…
present injury
past med history
past treatment
social history
Pain (PQRST)
Gen Health
How to describe Pain (PQRST)?
PQRST
Provoked (by what)?
Quality?
Radiating?
Severity?
TIme? (AM vs PM)
Assessment: Observation?
Deformity
Limp
Facial Expression
Swelling
color
posture
atrophy
malalignment
Assessment: Palpation
Requires consent
Know and find bony and soft tissue landmarks
Systemic and w/ a purpose
Start distally, work towards injury
* Compare Both Sides
Looks for tenderness, warmth, msc guarding/ tone/ tension, swelling, deformity
Assessment: Special Tests
- ROM tests –> Active, passive, resisted
- Are different for each joint
- Functional Tests –> R2P or not, end -stage rehab –> sport specific
- Confirm or deny suspicions
- Know current stage of healing
Reasons for TAPING?
Injury Prevention
Acute injury management (support, stabilize, compress)
R2P -> during partial participation, decrease chance of re-injury
When not to Tape?
- If further assessment needed
- If functional disability present
- If swelling is present
- Right after cold is applied
- At night
Things to Consider Before Taping?
- Their condition
- Severity and Stage of Healing
- Phys requirements of Sport
- Is taping appropriate for the injury
- Know what structures/ what positions the structures need to be taped in
- Know appropriate taping technique
What joints respond best to taping?
Joints that rely on bony support/ stability ankle, wrist, thumb)
Taping Positioning?
Athlete –> structure being taped is supported and not under tension. In a closed pack position (at least for ankle)
Taper –> find adjustable table or table at a good height, avoid bending/ straining low back
Arguments against Taping?
Expensive, time consuming, decreased usefulness after short time.
Weakened structures, replaces rehab, false security, psychological crutch
Taping Mistakes?
Shadows –> overlap tape by half or else = weak points, irritations, tape cuts
Windows –> overlap by half or else = weak point, irritation, tape cuts
Wrinkles –> irritation, uncomfortable
Bones of the Ankle?
Tibia (medial malleolus - 90% WB), Fibula (lateral malleolus - 10% WB), Talus,
Cuboid,
Phalanges (1-5),
Calcaneus (most dense bone in body), Navicular (tubercle),
Cuneiforms (3 - med, intermediate, lateral),
Metatarsals (1-5),
Sesamoid Bones (2)
What are Sesamoid Bones and What are their Purpose?
- Floating Bones (like patella)
- Create space for a tunnel
- Decrease pressure in webbing of foot
- Increase mechanical advantage of big toe
2 Ankle Joints?
Talocrural Joint –> Talus/ Fib/ Tib.
- Dorsi and plantar flexion.
- Most stable in Dorsiflexion.
Subtalor Joint –> Talus and Calcaneus.
- Inversiona nd eversion
Lateral Ligaments (3)?
Anterior Talofibular Lig. (ATFL)
Posterior TAolofibular Lig. (ATFL)
Calcaneofibular Lig. (CFL)
A/PTFL are most commonly sprained Ligs.
Medial Ligs.?
Deltoid ligaments (4)
- 4 ligs. are combined = much stronger = decreased eversion
- Don’t need to know all 4 bands
Subtler Ligs. (5)
Connect subtalus to calcaneus
For Proprioception
Interosseous lig,
Cervical lig,
Medial Talocalcaneal lig,
Lateral talocalcaneal lig,
Posterior talocalcaneal lig
Meaning of Interosseous?
Situated between bones
Inferior Talofibular Ligs. (3)?
Involved in high ankle sprains
- Anterior inferior Tibfib lig.
- Posterior inferior TibFib lig.
- Interosseous lig. (higher than the other two and in/bw Tib and Fib
Muscle Compartments of Lower Leg? (4)
Anterior (4 msc, 1 a., 1n.)
Lateral (2 msc, 1 a., 1 n.)
Superficial Posterior (3 mscs.)
Deep Posterior (3 msc, 1 a., 1 n.)
Anterior Comp. of Lower Leg? - 4 msc, 1 a., 1 n.
Tib anterior (msc) = df & inversion - has a big tendon
Extensor hallucis longus (msc) = big toe extension
Extensor digitorum longus (msc) = extend toes 2-5
Peroneus Tertious (msc) = weak df and eversion
Deep peroneal n.
Anterior Tib artery
Lateral Comp. of Lower Leg?
2 msc, 1 n.
Peroneus Brevis (msc) - eversion
Peroneus Longus (msc) - eversion (head of fib to 1st MT)
Superficial Peroneal n.
Superficial Posterior Comp. of Lower Leg? 3 msc.
Gastrocnemius (msc) - pf
Soleus (msc) - pf (deep)
both of these combine into the achilles tendon
Plantaris (msc) - small/ weak assist for gastric. Long tendon but short msc
Deep Posterior Comp. of Lower Leg? 3 msc., 1 n., 1 a.
Mirror of Anterior Compartment
- Tib post (pf/ inversion)
- Flex hallucis Longus (big toe flex)
- Flexor Digitorum Longus (flex toes 2-5)
- Tib n.
- Post Tib a. (very protected)
What is Acute Compartment Syndrome?
Each lower leg compartment surrounded by Fascia –> doesn’t stretch
- Significant trauma = increased blood/ pressure in a compartment –> compresses artery and nerve supply to rest of leg.
- Requires Emergency Fasciotomy
Purpose of the EAP
- Take control and assess the situation
- Have a predetermined and rehearsed plan
- Have a set pattern of how to react
- Allows for action w/ out delay
Nerve Branching through lower leg?
Tib n. (DPC)
- Common Peroneal n. twists anteriorly and branches into the Superficial Peroneal n. (LC) and the Deep Peroneal n. (AC)
Tib n. continues down the posterior tibia towards ankle
Foot Arteries? (2)
Dorsalis Pedis a. –> branched from Ant Tib a. and runs down top of foot (feel around talocrural joint)
Posterior Tib a. –> Palpate behind medial maleolus of fibula
Ankle Mvms?
PF = 50-70°
DF = 10-20°
Inv. = 35°
Ev. = 15-20°
Positioning of Ankle?
Closed Pack Position = DF, Ev., Abbduction –> Most stable
Loose Pack Position = PF, Inv., Adduction –> Vulnerable
Most common Lig. sprains?
Anterior Talofibular Lig.
Calcaneofibular Lig.
Functional Tests for Ankle Sprain?
Walk
Toe walk
heel walk
full squat/ duck walks
Balance and proprioception
Hops and jumps
Change direction
Ankle ligs. Stress Tests?
- Anterior Drawer (ATFL)
- Inversion test (vary ankle position to test ATFL or CFL or PTFL
Injury Treatment Abbreviation?
POLICE
- Protect
- Optimal Load or REST
- Ice
- Compress
- Elevate
Types of fracture fixes abbreviations?
ORIF = opne reduction internal fixation (surgery w/ screws/ plates/ wires
CREF = Closed reduction external fixation (cast)
Treatment for Ankle Sprains (G1/2/3)
G1 = tape, R2P, 2-3 dyas, strengthen/ stretch, no pain ROM
G2 = open basket weave, 2-3 weeks, R2P w/ tape in 3-4 weeks, rehab
G3 = xray fro potential #, rehab w/ physio, 2-3 months, brace for rest of season
Arches of the foot? (4)
Anterior Metatarsal arch (non-WB)
Transverse Arch (WB and non-WB)
Lateral Longitudinal Arch (non-WB)
Medial Longitudinal Arch (WB)
What keeps arches up?
- Shape of interlocking bones
- Strength of plantar ligs. (spring lig, long/ short plantar ligs.)
- Plantar Fascia (60% WB when walking)
- Action of mscs through the bracing action of tendons
Purpose of Arches?
Support body weight
Absorb shock
Space for msc, n., a.
3 Main Ligs. of Bottom of Foot?
Long and Short plantar lig (calcareous to cuboid)
Spring lig. (plantar calcaneonavicular lig.)
5 mscs for arch support?
Tib anterior
Tib Posterior (tendonitis)
Peroneous Longus
Flexor Hallicus/ Digitorum Longus
4 msc layers of foot
Nerves of foot?
Common Peroneal branches into superficial and deep peroneal n. (top of foot)
Tib n. (posterior) branches into med and lat plantar n.
Function of Stance phase. (60%) of Gait?
Shock absorption
Mobile Adaptability allowed b/c pronation unlocks the mid tarsal joints to allow for shock absorption and adapt to uneven surfaces
Function of Swing Phase (40%)
RIGID lever
- Re-supination that occurs during terminal stance/ toe-off allows greater force to be exerted
Results of Excessive Pronation?
Due to msc structural deformity or msc imbalance
- Increases Internal Rotation up the chain (knee) = increased stress
- Joint hypermobility (1st ray)
- Lose mechanical advantage from peroneous longus tendon
5 Red flags of Pronation?
Foot Flair
IR of Knee
Bowed Achilles
Low medial Arches
Shoe wear pattern
Injuries from Excessive Pronation?
1) Stress # of the 2nd MT
2. Plantar fasciitis
3. Tibialis posterior tendonitis
4. Achilles tendonitis
5. Tibial stress syndrome
6. Medial knee pain
