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Ortho II > Ortho II: LLAF (Pathologies Part 1) > Flashcards

Ortho II: LLAF (Pathologies Part 1) Flashcards

1
Q

What type of ankle sprain accounts for 85% of ankle sprains?

A

Lateral Inversion Sprains

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2
Q

What do 34% of people with lateral inversion sprains suffer from?

A

Chronic Ankle Stability

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3
Q

In which order are the lateral ligaments stretched/torn from?

A

Anterior to Posterior

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4
Q

How should lateral ankle sprains be treated?

A

Conservatively

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5
Q

What should be done to treat ankle sprains conservatively?

A

PRICEMMM
Crutches until pain free WB
Taping/wrapping
Proprioception training
Orthotics
STM

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6
Q

What type of ankle sprains accounts for 10% of ankle sprains?

A

Medial Eversion Sprains

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7
Q

Where are 75% of ankle sprains located?

A

Medial side

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8
Q

Why are 75% of ankle sprains in the medial side of the ankle?

A
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9
Q

What classifies an ankle sprain as Grade I?

A

No loss of function
(-) Anterior drawer and talar tilt
Little or no ecchymosis
Point tenderness
Decreased ankle ROM < 5 degrees
Swelling < .5 cm

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10
Q

What classifies an ankle sprain as Grade II?

A

Some loss of function
(+) Anterior drawer
(-) Talar tilt
Ecchymosis present
Point tenderness
Decreased ankle ROM 5-10 degrees
Swelling 0.5-2.0 cm

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11
Q

What classifies an ankle sprain as Grade III?

A

Near total loss of function
(+) Anterior drawer and talar tilt
Ecchymosis present
Point tenderness
Decreased ankle ROM >10 degrees
Swelling > 2 cm

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12
Q

What 3 factors classify someone with chronic ankle instability?

A

At least one lateral ankle sprain
At least 2 giving way episodes in 6 months
Low self report function on current scales

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13
Q

What co-existing impairments contribute to persistent pain and swelling in people with Chronic Ankle Instability?

A

Decreased regional and global function
Increased fear of re-injury
Lower step count
Less moderate to vigorous activity

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14
Q

How common is it for people to seek treatment for Chronic Ankle Instability?

A

Many do not seek treatment

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15
Q

What are some differential diagnoses for Chronic Ankle Instability?

A

Fibularis tendon pathology
Accessory ossicles
Tarsal coalition
Sinus tarsi syndrome
Subtalar sprain
Spring ligament sprain
Ankle impingement

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16
Q

What should treatment for Chronic Ankle Instability be based off?

A

Exam findings

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17
Q

What are treatment options, based on exam findings, for Chronic Ankle Instability?

A

Manual therapy
Proprioception
Agility
Plyometric
Sport/occupation specific

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18
Q

What is the common name of a syndesmotic sprain?

A

High ankle sprain

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19
Q

What is the mechanism of injury in syndesmotic ankle sprains?

A

Unclear but generally excessive DF with ER of talus/foot

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20
Q

What type of ankle sprains make up 1%-11% of ankle sprains?

A

Syndesmotic ankle sprains

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21
Q

What increases the risk of high ankle sprains?

A

Contact sports

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22
Q

What common features of ankle sprains are not present in syndesmotic sprains?

A

Swelling
Recurrence

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23
Q

Where is tenderness typically located in syndesmotic ankle sprains?

A

Anterior inferior tibiofibular ligament
Along interosseous membrane

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24
Q

What are treatments for syndesmotic ankle sprains?

A

NWB with assistive device
Advance to walking boot

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25
What needs to be ruled out if a syndesmotic ankle sprain is suspected?
Ankle or proximal fibular fractures
26
What measurement on radiographic imaging has an 82% sensitivity and 75% specificity for syndesmotic injury?
Tibiofibular clear space > 5.3 mm
27
What measurements on radiographic imaging have a 36% sensitivity and a 87% specificity for syndesmotic injuries?
<10 mm in AP view and < 2.8 mm in mortise view of tibiofibular overlapping
28
What measurement on radiographic imaging is considered indicative of a deltoid ligament rupture and an indirect sign of a syndesmotic injury?
Medial clear space > 4.5 mm
29
What does the Ottawa Ankle Rules CPR determine?
The need for ankle or foot radiographs after an ankle injury
30
What factors determine if an ankle x-ray series is indicated?
Must have: -Pain on or superficial to the malleolar zone One of the two: -Bone tenderness from 0-6 cm up the posterior edge or on tip of either malleolus -Inability to bear weight both immediately and in the ER (Can't take 4 steps)
31
What factors determine if a foot ankle sprain is indicated?
Must Have: -Pain in midfoot zone One of the two: -Boe tenderness at navicular or base of 5th MT -Inability to bear weight immediately and in ER
32
What may be present that would prevent the Ottawa ankle rules CPR from being used?
Can't palpate bones due to excessive swelling
33
What is the diagnostic accuracy of the Ottawa Ankle Rules?
Sensitivity: .98 Specificity: .32 +LR: 1.4 -LR: .07
34
What are four conditions under the umbrella term of exercise related leg pain?
Medial Tibial Stress Syndrome (MTSS) Bone stress injury (BSI) Chronic Exertional Compartment Syndrome (CECS) Tendinopathy
35
What is the most common form of ERLP?
MTSS
36
Who is MTSS often seen in?
Long distance runners Military recruits Jumping athletes
37
What sex is MTSS most common in?
Females
38
How does pain present in individuals with MTSS?
Exercise induces pain along distal 2/3 of posteromedial border of the tibia
39
Is MTSS considered an overuse injury?
Yes
40
How does pain change over time with exercise?
Pain worse when first stating exercise Decreases over time while exercising Pain goes away completely when done exercising
41
How does palpation affect people with MTSS?
Pain with palpation at posteromedial tibia
42
Are there any neurological symptoms in MTSS?
No
43
Are there any findings on x-rays in MTSS?
No
44
How is pain described in MTSS?
Dull and achy pain that increases in intensity Continuous or intermittent Exacerbated by repetitive WB activities
45
What classifies MTSS as Type 1?
Inadequate bone strength leading to stress fracture, stress reaction, or stress microfractures
46
What classifies MTSS as Type 2?
Chronic periostalgia
47
What is chronic periostalgia?
Persistent pain at the junction of the periosteum and fascia
48
What classifies MTSS as Type 3?
Distal posterior chronic compartment ischemic syndrome
49
What are some risk factors to consider with MTSS?
Female Improper training techniques Level of competition Change in footwear Muscle imbalance or inflexibility Indirect links to lower limb overuse injuries Biomechanical abnormalities
50
What are some improper training techniques that increase the risk of MTSS?
Training on hard surfaces/uneven surfaces Increase training intensity too quickly
51
What are some indirect links to lower limb overuse injuries that increase the risk of MTSS?
High BMI Previous history of MTSS
52
What biomechanical abnormality can increase the risk of MTSS?
Excessive STJ pronation
53
How does excessive STJ pronation increase the risk of MTSS?
1. Longer eccentric firing of intrinsic and extrinsic muscles 2. Earlier fatigue 3. Increased force absorbed by tenoperiosteum and bone
54
How is MTSS treated in PT?
Relative rest Ankle strengthening Ankle stretching Cross training Modalities Foot orthotics Plyometrics
55
How should plyometrics be trained in MTSS?
Start in water, progress to land
56
What should be done to assess an individual's readiness for a plyometric program post MTSS?
Single hop test on soft surface
57
What is the conclusion of Thacker, 2002?
Shock absorbing orthoses may reduce occurrence of shin splints in young male athletes
58
What percent of cross country and distance runners have a history of bone stress injuries?
33-66%
59
What is the typical presentation of a Bone stress Injury?
Gradual onset of pain Focal pain Initially mild ache with exercise If untreated, pain persists after exercise
60
What is the most common site of a Bone stress injury?
medial tibia

Ortho II (7 decks)

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