The Ankle Part 2: Exam 3 Flashcards
MOI lateral ankle sprain
Inversion and plantar flexion
Lateral ankle sprain ligaments
- ATFL
- CFL
How ATFL is injured
Plantar flexion and inversion
How CFL is injured
Inversion
Etiology of grade one ligament sprain
- inversion and plantar flexion
- causes stretching of ATFL
Symptoms of grade 1 ligament sprain
- mild pain and disability
- minimally impaired weight bearing
- point tenderness over ligament and no laxity
Management of grade 1 sprain
- RICE 1-2 days
- limited weight bearing initially and then agressive strengthening rehab
- tape can provide additional support
- return to activity in 7-10 days
Etiology of grade 2 sprain
-moderate inversion force causing great deal of disability with many days of lost time
Symptoms of grade 2 sprain
- feel/ hear a pop or snap
- moderate pain with difficulty bearing weight
- tenderness and edema
- special tests will be positive for laxity
Management of grade 2 sprain
- RICE for 72 hours
- x-ray to rule out fracture
- crutches for 5-10 days
- progress to weight bearing
Etiology of grade 3 sprain
- relativity uncommon but extremely disabling
- caused by significant force resulting in spontaneous subluxation and reduction
- damages the anterior/ posterior talofibular and calcaneofibular ligaments as well as the capsule
Symptoms of grade 3 sprain
- severe pain
- swelling
- hemarthosis
- discoloration
- unable to bear weight
- grossly positive instability test
Management of grade 3 sprain
- RICE
- x-ray
- possible dorsiflexion splint
- progressive weight bearing
- isometrics in cast
- ROM exercises and balance exercises one out of cast
- possibly surgery
Eversion ankle sprain etiology
-5-10%
What is injured with an eversion sprain?
-deltoid ligament and possible fib fracture
Who is more susceptible to eversion sprains?
-pronated and hypermobile
Symptoms of eversion sprain
- severe pain
- unable to bear weight
Management of eversion sprain
- RICE
- xray
- no weight bearing initially
- posterior splint
- NSAIDs
- same course of treatment of grade 2 sprain
What can happen with grade 2 or higher sprain?
Considerable instability and may cause weakness in medial longitudinal arch resulting in excessive pronation or fallen arch
Etiology of high ankle sprain
-external rotation and or forced dorsiflexion
What is injured in high ankle sprain
- anterior/posterior tibiofibular ligaments
- sydesmosis
Symptoms of high ankle sprain
- Pain anterolaterally
- loss of function
- pain
Management of high ankle sprain
- difficult and longer to treat
- modified weight bearing
Another name for high ankle sprain
Syndesmotic
Ankle fracture etiology
-blunt trauma and strong multidirectional forces
Symptoms of ankle fracture
- swelling
- pain
- crepitis
- deformity
Management of ankle fracture
- RICE
- walking cast or brace with immobilization lasting 6-8 weeks
Etiology of achilles tendon strain
Common and occurs with sprains or increased dorsiflexion
Symptoms of Achilles strain
- pain
- partial or complete rupture of achilles
Management of achilles strain
- RICE
- conservative treatment should be used to avoid chronic tendinitis
- elastic wrap
- heel lift
- stretching and strengthening
Achilles tendinitis etiology
- inflammatory condition
- overload due to extensive stress
Symptoms of tendinitis
- pain and stiffness
- warm/ pain to touch
- tendon thickening
Management of tendinitis
- RICE
- NSAIDs
- long term healing time
Achilles rupture etiology
- sudden stop and go
- more common in 30+ years
Symptoms of achilles rupture
- pain and rapidly subsides
- decreased range of motion
- swelling
- discoloration
- loss of function
- point tenderness
Management of achilles rupture
- RICE
- NSAID
- NWB
Peroneal tendon injuries
- dislocation and subluxation
- tendinitis
- similar symptoms
Peroneal tendon etiology
Direct blow to posterior lateral malleolus
Symptoms of peroneal tendon injuries
- pain
- snapping and instability
- discoloration
- swelling
- tenderness
- crepitus
Management of peroneal tendon injury
- RICE
- NSAID
- analgesic
- possible surgery
Tendinopathy/ tendinitis
Can occur in any of the tendons that cross the joint and is usually due to overuse and poor biomechanics
Muscle or shin contusions etiology
Direct blow
M/s contusion symptoms
- pain
- weakness
- swelling
- discoloration
- hard
- rigid
- inflexible
M/S contusion management
- RICE
- Modalities
- MAINTAIN ROM
- wrap or tape
Acute leg fractures etiology
- most common in fibula (mid third)
- tibial (lower third)
- direct blow or indirect trauma
Symptoms of acute leg fracture
- pain
- swelling
- leg hard and swollen due to increased pressure
Management of acute leg fractures
- splint
- xray
- reduction
- cast up to 6 weeks
Another name for shin splint
Medial tibial stress syndrome
Etiology of shin splint
- stress fracture
- repetitive micro-trauma
- 10-15% running
Four grades of shin splint pain
- pain after activity
- pain before and after activity
- pain before, during, after activity
- pain severe and cannot perform activity
Management of shin splints
- referral for xray and bone scan
- decreased activity
- biomechanics correction
- RICE
Stress fracture of tibia or fibula etiology
Overuse or unconditioned or non-experienced individuals
Symptoms of stress fx
- pain more intense after exercise
- point tenderness and percussion
- bone scan
Management of stress fx
- 2 weeks decreased activity
- NWB
- activity progression
Etiology of acute compartment syndrome
- traumatic and occurs after direct blow
- medical emergency due to risk of neurovascular compromise
Acute exertional compartment syndrome
Evolves with minimal to moderate activity and non traumatic
Chronic compartment syndrome
Symptoms arise during activity and in lower body sports
Symptoms of compartment syndrome
- deep aching pain and tightness due to pressure and swelling
- reduced circulation and sensation in foot
- intracompartamental pressure measures
Management of compartment syndrome
- conservative: RICE and NSAIDS
- acute and severe exertional: pressure monitored
- fasciotomy for chronic condition
- surgical release patient return to activity 2-4 months
Rehab for injuries
- weight bearing progression
- joint mobilizations
- flexibility (achilles)
- strengthening of surrounding muscles
- proprioception
- tape/brace
- functional progression
What decreases likely hood of eversion sprain?
-bony protection and ligament strength decrease likelihood of injury
Other than eversion sprains how can the deltoid ligament be injured?
-deltoid can also be impinged and contused with inversion sprains
