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DPT MSK Fall 22' - Spring 23' > shin splints - Fxs - final > Flashcards

shin splints - Fxs - final Flashcards

1
Q

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

A
  • anterior tibialis
  • posterior tibialis
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2
Q

most common type of shin splints:

A

posterior (4-19% in athletes)

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3
Q

risk factors of shin splints

A

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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4
Q

does shin splints and shoe wear correlate?

A

no

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5
Q

pathomechanics for post. shin splints

A

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

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6
Q

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

A

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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7
Q

signs of shin splints
- observation

A

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

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8
Q

signs of shin splints:
- resisted

A

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

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9
Q

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

A

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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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

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

A
  • assist tib post
  • prefabricated orthotic
  • cushioned inserts or gel heel cups
  • air cast
  • walking boot
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13
Q

when do you use MT for shin splitns

A

any joint dysfunctions like limited DF

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14
Q

MET primary focus for shin splints

A

unloading tibia and tib post

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15
Q

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

A
  • ext/er/abd strength
  • PF & IV strength (gastroc/soleus PF, tib post main invertor)
  • spinal stabilization as needed
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16
Q

differential diagnoses of shin splints (3)

A

stress reaction
stress fx
compartment syndrome

17
Q

who is more likely to get bone stress injuries?

A

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

18
Q

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

A
  • runners
  • distal region more common
  • most common foot injury, most commonly base of 5th MT
19
Q

what are the 3 zones of injury in metatarsals

A

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

20
Q

risk factors of bone stress injuries

A

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

21
Q

how does bone stress injuries happen

A

increasing load and frequency without recovery
osteoclastic activity exceeding osteoblastic activity

22
Q

symptoms of bone stress injuries

A

worsening pain with ADLs and exercise, may become constant

23
Q

test that can reproduce bone pain for tibial stress fx

A

hop test on heels within 10 reps

24
Q

imaging for bone stress injuries
- radiograph
- MRI

A
  • fx may not appear for 2-6 weeks so not that useful
  • gold standard for earlier detection; not reflective of healing
25
Q

what is the relation of BMD and growth spurts?

A

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

26
Q

PT Rx for bone stress injuries

A

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

27
Q

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

A

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

28
Q

how do you treat a bone stress injury?

A

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

29
Q

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

A
  • 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
30
Q

pathogenesis of compartment syndrome

A

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
31
Q

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

A

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

32
Q

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

A

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

33
Q

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

A

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

34
Q

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

A

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

35
Q

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

A
  • distal tibia + distal fibula
  • tibia + fibula + post. tibial rim
36
Q

what is the most common tarsal fx

A

calcaneus

37
Q

true or false. midfoot fractures are common

A

false
rare except navicular

38
Q

what is the most common region of foot fx

A

forefoot

DPT MSK Fall 22' - Spring 23' (29 decks)

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