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Emergency Medicine > Ligament injuries > Flashcards

Ligament injuries Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are Ottawa rules for determining whether an ankle needs x-ray following suspected ligament injury?

A

Pain in the malleolar zone, plus:

  • Tenderness over posterior edge/tip of lateral malleolus
  • Tenderness over posterior edge/tip of medial malleolus
  • Inability to weight bear both immediately after injury and now
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2
Q

What are Ottawa rules for considering X-ray of foot for suspected ligament injury?

A

Pain in midfoot zone, plus:

  • Tenderness over navicular
  • Tenderness over base of 5th metatarsal
  • Inability to weight-bear both immediately adter and now
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3
Q

What other structures would you want to assess in an ankle ligament injury?

A

Palpate

  • Deltoid ligament
  • LAteral ligament complex
  • Fibula up to knee - head of fibula fracture
  • Squeeze test - syndesmosis
  • Weight bearing
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4
Q

How would you manage an ankle ligament injury?

A
  • Apply ice pack - 20 mins
  • Crutches
  • Analgesia
  • Advice
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5
Q

What advice would you give someone with an ankle ligament injury?

A
  • NSAIDs
  • RICE
  • Mobilise and weight bear as able
  • Fully weight bear for 2 mins twice per day for a month
  • Physio if not better after 1-2 weeks
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6
Q

How long does it take for a ligament stretch with microscopic tearing to heal?

A

2-4 weeks

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7
Q

What are clinical features of ankle ligament stretch with microscopic tearing?

A
  • Local tenderness
  • Minimal swelling
  • No joint instability
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8
Q

What are clinical features for ankle ligament stretch with partial tearing?

A
  • Local tenderness
  • Oedema
  • Ecchymosis
  • Partial loss of joint motion - definite end point
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9
Q

How long does it take to heal an ankle ligament stretch with partial tearing?

A

4-12 weeks

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10
Q

What specific management would you use for ankle ligament stretch with partial tearing?

A

Stirrup splint - 4 weeks

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11
Q

What are clinical features of complete rupture of ankle ligament?

A
  • Marked swelling
  • Severe pain
  • Gross ankle instability
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12
Q

How would you manage complete ligament rupture of the ankle?

A
  • Aircast boot - 6 weeks
  • Consider surgical management
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13
Q

How long would it take an ankle ligamnet rupture to heal?

A

3-6 months

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14
Q

What are the ottawa rules for knee ligament injuries which require X-ray?

A
  • Age > 55 years
  • Inability to weight bear both immediately after and now
  • Isolated patellar tenderness
  • Head of fibula tenderness
  • Inability to flex to 90o
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15
Q

Why might you need to ask someone to return in a week to have a suspected knee ligament injury examined?

A

May be difficult to determine extent as may be to painful to examine - allow a week then fully examine

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16
Q

How would you generally manage someone with suspected knee ligament injury?

A
  • Apply ice pack for 20 mins
  • Crutches
  • Analgesia
  • Advice
17
Q

What advice would you give someone with a knee ligament injury?

A
  • NSAIDs
  • RICE
  • Mobilise and weight bear as able
  • Try to fully weight ebar for 2 mins twice per day for a month
  • Physio if not better after 1-2 weeks
18
Q

What are the components of RICE?

A
  • Rest
  • Ice - 20 minutes 4 times per day
  • Compression - elasticated bandage
  • Elevation for 24 hours

Ibuprofen as well

19
Q

What are features of a knee ligament stretch with microscopic tearing?

A
  • Knee stable on clinical testing
  • Tenderness
20
Q

What specific management would you use for a knee ligament stretch with microscopic tearing?

A

Elastic or wool + crepe bandage for 2 weeks

21
Q

How long does it take for knee ligament stretch with microscopic tearing take to heal?

A

2-4 weeks

22
Q

What are clinical findings of knee ligament stretch with partial tearing?

A
  • Laxity but definite end point
  • Tenderness
23
Q

How would you manage a knee ligament stretch with partial tearing?

A

Knee brace - 4 weeks or until no laxity

24
Q

How long does it take for knee ligament stretching with partial tearing to heal?

A

4-12 weeks

25
Q

What are clinical features of complete knee ligament rupture?

A

Joint opens > 1cm

26
Q

How would you manage complete rupture of medial/collateral knee ligament?

A

Knee brace - 6-12 weeks or until no laxity

27
Q

How would you manage complete rupture of anterior/posterior cruciate knee ligament?

A

Cast and surgical reconstruction

28
Q

What are clinical features of damage to the menisci?

A
  • Knee gives way
  • Clicks or locks
29
Q

How would you manage a damaged meniscus?

A

Arthroscopic repair - if locked or no better after 2 weeks

Emergency Medicine (32 decks)

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