shin splints - Fxs - final Flashcards by Demond Fleming

muscle involved with
- anterior shin splints:
- posterior shin splints:

anterior tibialis
posterior tibialis

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most common type of shin splints:

posterior (4-19% in athletes)

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risk factors of shin splints

females
high BMI
previous running injury
excessive pronation
- increased navicular drop
- eccentrically controlled by tib post
increased PF ROM (ankle instability)
greater hip ER

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does shin splints and shoe wear correlate?

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pathomechanics for post. shin splints

increased load on tib post. leading to tension on and inflammation of periosteal tissue

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symptoms of shin splints
- onset
- worsened with
- no ___
- co existing __

gradual onset of medial shin pain
worsened with exercise and NOT ADLs
no cramping, burning, tingling (these would mean compartment syndrome)
1/3 co existing leg injuries

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signs of shin splints
- observation

overstriding leading to greater heel strike
impaired LE control
- excessive pronation
- increased pelvic drop
- increased LE IR

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signs of shin splints:
- resisted

weak possibly painful PFs
limited hip ext/abd strength and endurance
weak and painful IV

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special test for shin splints:
- single leg hop on heel (+) =
- palpation

P! w < 10 reps - likely stress fx
** Due to PF of tib posst

TTP over postero-medial tibial border > 5 cm or 2 in in length

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what do you educate your patient on regarding movement pattern training with shin splints?

NOT changed by strengthening alone
reduce LE IR
decrease heel strike with cueing for shorter/faster steps

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what do you educate your patient on regarding shoe wear with shin splints?

light, supportive, cushioned
rotate shoes
change running shoes every 250-500 miles

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PT Rx taping/orthotics
- taping:
- orthotic for excessive pronation:
- orthotic for heavy heel striker:
- functional support that allows ankle motion
- severe cases:

assist tib post
prefabricated orthotic
cushioned inserts or gel heel cups
air cast
walking boot

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when do you use MT for shin splitns

any joint dysfunctions like limited DF

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MET primary focus for shin splints

unloading tibia and tib post

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PT Rx MET:
- improve hip _____
- improve:
- address

ext/er/abd strength
PF & IV strength (gastroc/soleus PF, tib post main invertor)
spinal stabilization as needed

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differential diagnoses of shin splints (3)

stress reaction
stress fx
compartment syndrome

who is more likely to get bone stress injuries?

athletes (correlated w overuse)
female
< 20
** tibia most common bone
runners

areas for bone stress injuries:
- tibia
- fibula
- metatarsals

runners
distal region more common
most common foot injury, most commonly base of 5th MT

what are the 3 zones of injury in metatarsals

zone 1: 90% of fx and mostly sprains
zone 2: most susceptible to AVN
zone 3: due to repetitive stress

risk factors of bone stress injuries

high forces
repetitive jumping/landing
lack of recovery from training
high training load
longer stride length –> greater heel strike

how does bone stress injuries happen

increasing load and frequency without recovery
osteoclastic activity exceeding osteoblastic activity

symptoms of bone stress injuries

worsening pain with ADLs and exercise, may become constant

test that can reproduce bone pain for tibial stress fx

hop test on heels within 10 reps

imaging for bone stress injuries
- radiograph
- MRI

fx may not appear for 2-6 weeks so not that useful
gold standard for earlier detection; not reflective of healing

what is the relation of BMD and growth spurts?

BMD decreases just before growth spurts and takes up to 4 years to increase afterwards

PT Rx for bone stress injuries

diet and hormonal limitations due to possible decreased bone mass density well managed sleep, stress, BMI (low is more concerning) medications (i.e. antacids)

why would it be common for a 12 year old female to have a bone stress injury?

period of skeletal weakness around or after growth spurt and are dealing with hormonal and skeletal changes which has greater affect on BMD and muscle strength

how do you treat a bone stress injury?

graded unloading to ambulate without pain --> essentially do whatever it takes to move without pain gradual and progressive return to activity while addressing risk factors and etiologies

prognosis for tibial stress fx - @ 3 months - @ 6 months

- BMD lowest at 3 months post fx in both legs --> reinjury to either LE more likely prior to 3 months - all were at baseline BMD by 6 months

pathogenesis of compartment syndrome

increased swelling with limited fascial extensibility, part. compressing neurovascular structures in the anterior leg compartment * pressure pushes outward but can't go anywhere so it comes back in and creates the compression on neurovascular structures

S&S of compartment syndrome - causes - primarily ___ - lengthening of ____ adds to _____

recent blunt trauma or over use to ant compartment primarily cramping, burning, tingling any lengthening or use of DFs adds to compression and P!

what are the 6 Ps (deciding factors) of compartment syndrome

pain - severe and persistent palpable tenderness pulselessness pallor paresthesias (deep peroneal n.) paralysis

what should happen if the 6 Ps of compartment syndrome are unrelenting?

medical emergency due to neurovascular compromise and need for surgical fasciotomy to prevent tissue death

what should happen if the 6 Ps of compartment syndrome are modifiable?

PT directed at source of inflammation and fascial extensibility (exercise, MT) surgery may be necessary

ankle fx aka Pott's - bi-malleolar: - tri-malleolar:

- distal tibia + distal fibula - tibia + fibula + post. tibial rim

what is the most common tarsal fx

calcaneus

true or false. midfoot fractures are common

false rare except navicular

what is the most common region of foot fx

forefoot