- If further assessment needed - If functional disability present - If swelling is present - Right after cold is applied - At night

Lab Quiz 1 Flashcards by Josiah Driedger

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.)

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Abbreviation for Assessment?

HOPS
History
Observation
Palpation
Special Tests

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Assessment: History?

History of…
present injury
past med history
past treatment
social history
Pain (PQRST)
Gen Health

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How to describe Pain (PQRST)?

PQRST
Provoked (by what)?
Quality?
Radiating?
Severity?
TIme? (AM vs PM)

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Assessment: Observation?

Deformity
Limp
Facial Expression
Swelling
color
posture
atrophy
malalignment

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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

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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

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Reasons for TAPING?

Injury Prevention

Acute injury management (support, stabilize, compress)

R2P -> during partial participation, decrease chance of re-injury

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When not to Tape?

If further assessment needed
If functional disability present
If swelling is present
Right after cold is applied
At night

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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

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What joints respond best to taping?

Joints that rely on bony support/ stability ankle, wrist, thumb)

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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

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Arguments against Taping?

Expensive, time consuming, decreased usefulness after short time.
Weakened structures, replaces rehab, false security, psychological crutch

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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

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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)

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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

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2 Ankle Joints?

Talocrural Joint –> Talus/ Fib/ Tib.
- Dorsi and plantar flexion.
- Most stable in Dorsiflexion.

Subtalor Joint –> Talus and Calcaneus.
- Inversiona nd eversion

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Lateral Ligaments (3)?

Anterior Talofibular Lig. (ATFL)
Posterior TAolofibular Lig. (ATFL)
Calcaneofibular Lig. (CFL)

A/PTFL are most commonly sprained Ligs.

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Medial Ligs.?

Deltoid ligaments (4)
- 4 ligs. are combined = much stronger = decreased eversion
- Don’t need to know all 4 bands

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Subtler Ligs. (5)

Connect subtalus to calcaneus
For Proprioception

Interosseous lig,
Cervical lig,
Medial Talocalcaneal lig,
Lateral talocalcaneal lig,
Posterior talocalcaneal lig

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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