Lower leg and ankle MSK Flashcards
Anterior compartment of leg contains what
tib anterior (dorsi flex and inverter of foot) EHL EDL fibularis tertius anterior tibial artery (becomes DP) Deep fibular nerve
Lateral compartment of leg
Fibularis longus and brevis (plantar flex and everters), superficial fibular nerve
Superficial posterior compartment of leg
Gastroc, soleus, plantaris (plantar flexors)
If you want to test for an achilles tendon tear and you squeeze the calf it shouldnt plantar flex foot (thomson test), if the foot plantar flexes but there is a torn achilles then you are squeezing the
plantaris
Deep posterior compartment (tibial tunnel)
TP (inversion), FDL, FHL, Posterior tibial artery, tibial nerve
attachemnt of fib longus and brevis
base of 1st meta (long) base of 5th metatarsal (brevis)
MOA of ATFL injury
suddenly inverting foot, test with anterior drawer test
ankle doriflexors
TA, fibularis tertius, EHL and EDL
Ankle plantar flexors
Gastroc, soleus, plantaris, tib posterior, FHL and FDL, Fib longus and brevis
Ankle everters
fib longus, brevis (L5/s1 superficial fibular nerve) and fib tertius L5/s1 deep fib nerve
Pronation of foot
Eversion + DF + External rotation of tibia
Supination of foot
inversion, plantar flexion, internal rotation
Maisonneuve fx
complication of high ankle sprain, proximal fibular fx due to rupture of tibiofibular syndesmosis
Medial tibial stress syndrome diagnosis
squeeze medial and lateral sides of tibia tober (tibial squeeze) that reproduces pain along length of tibia
common risk factor is hyper pronation
Counsel your patient to return to running at about a 50% pre-injury level for intensity and distance to prevent recurrence of symptoms.
Untreated shin splints can lead to
tibial stress fracture, xray, MRI can show bone marrow edema, relative rest, if too much pain NWB and progressing to WB if there is pain with normal ambulation, tylenol, IC, PT, strengthing hip girdle and knee musculature, re-image before clearing for running again
Talus fx at risk for
AVN with talar dome fx, surgery/ortho referral, tx: NWB if nondisplaced fx and low risk for AVN otherwise ortho referral
talar dome
highest part of talus that articulates with tibia
Hawkin’s II and above talar neck fractures require an urgent surgical referral secondary to the increased risk of AVN. Hawkin’s I fractures require immediate closed reduction.
Calcaneal fx
cast and NWB if stress fx or small, otherwise ortho referral for ORIF
Sever’s disease
calcaneal apophysitis from achilles/gastroc pulling on calcaneus ; self limiting, calf stretches, RICE
Syndesmosis injury
talus pushes into fibula and fibula goes laterally tearing syndesmosis, AITFL and PTFL are torn as well, can cause maisonneuve fx (prox fibular fx), CAM boot for 3 weeks, if maisonneuve fx then ORIF
Lateral ankle sprain grading
Gr 1: partially torn ATFL, intact CFL
Gr 2: Fully torn ATFL, partially torn CFL
Gr 3: Fully torn ATFL and CFL (surgery vs rehab)
Talar tilt tests what
CFL
Anterior drawer test of ankle
more than 5 mm displacement, ATFL testing
A positive anterior drawer test performed with the ankle in plantarflexion is the best test of the answer choices listed to assess for an ATFL injury. A positive anterior drawer test in dorsiflexion best assesses the CFL.
Contents of tibial tunnel
Tibialis posterior, FDL, FHL, Tibial artery vein and nerve
Haglund’s deformity
bony enlargement on the back of the heel “pump bump!”, can irritate retrocalcaneal or retroachilles bursa
Acute Compartment syndrome of leg usually in what compartment
anterior compartment, pain out of proportion “pain, paresthesias, paralysis” 3 Ps; manometry and fasciotomy
Chronic exertional compartment syndrome
tight fascia that causes temporarily raised intra-compartmental pressure, pain, paresthesias, weakness, worse with exercise, resolved with rest ; diagnosis pre and post exercise manometry, tx fasciotomy , xray to r/o shin splints
Tib anterior tendon injury
tenosynovitis if overuse, rupture if eccentric overload , may be due to excessive pressure from EXTENSOR retinaculum
Tibialis posterior tendon injury
from excessive pronation or medial ankle sprains…medial retromalleolar pain and swelling worse with resisted inversion and plantar flexion “too many toes sign”
Too many toes sign
tib posterior injury
dancer’s tendonitis
FHL injury
Poorly vascularized area of achilles
distal 2-6 cm
Salter Harris type 1 fx
Transverse fx through hypertrophic zone of the physis, typically not visible on radiographs but there may be widening of growth plate
“S” straight across”
Salter Harris type 2 fx
Type II – A fracture through the growth plate and the metaphysis, sparing the epiphysis (most common)
“A” Above
Salter Harris type 3 fx
Type III – A fracture through growth plate and epiphysis, sparing the metaphysis
“L” lower, or below
Salter Harris type 4 fx
A fracture through all three elements of the bone, the growth plate, metaphysis, and epiphysis.
“T” two or through
Salter Harris type 5 fx
Type V – A compression fracture of the growth plate (resulting in a decrease in the perceived space between the epiphysis and metaphysis on x-ray)
“ER” erasure of growth plate
HOCM increases/decr with valsalva
increases
