Week 2 (parts 1 and 2) Flashcards
what is are examples of arthrogenic structures
Joint, Bones, Ligaments
what are examples of a myogenic structure
Muscles + tendons
what are examples of a Neurogenic/ Neuropathic structure
Referred from Lumbar spine, Peripheral nerves, Morton’s neuroma
How many grades for ligament sprains are there
normal then 1-3
how many grades of muscle strains are there
normal then 1-3
what are red flags
Clinical features which help us IDENTIFY and REFER patients with concerning signs & symptoms that could relate to potentially serious or previously undiagnosed conditions
How many parts are there to an MSK objective Ax
9 - Preparation, Observation, Clearing Joints, AROM/PROM, palpation, Ottawa rules, Special tests, Muscle tests, Functional testing, Outcome measures
what should you observe during the observation phase of the objective Ax
Gait (while walking in/ more formal), Posture (whole body/ lower limb, foot posture), Functional (squat, lunge, SLS), Deformities (lumps/bumps, toe deformities), Skin (any wounds redness/ callus) swelling
what is clearing joints
Joints above or below, or with the potential to refer to the affected area should be ‘cleared’
* Full AROM in all directions (helps to rule out other joints, helps to identify deficits which may be contributing to the patients symptoms)
* If they have full pain free ROM the clinician can apply overpressure ( do not apply overpressure if AROM is restricted/ painful or condition is highly irritable
AROM/PROM for ankle joints
- Talocrural and Subtalar Joints (DF, PF, Inversion, Eversion)
- MTPJs and IPJs (Flexion, Extension)
- Weight Bearing lunge test
ankle palpation bony landmarks
- Anterior tibia, Anterior talo-crural joint, Medial and lateral malleoli, fibula, metatarsals including base of 5th metatarsal, Navicular, Cuboid
ankle palpation - muscles and soft tissues
ankle dorsiflexors (tib ant, ED, EDL), Peroneal tendons, Tibialis posterior, Gastrocnemius, Achilles tendon, Plantar Fascia
ankle palpation - Ligaments
lateral ligament complex (ATFL, CFL, PTFL), Deltoid ligament, Anterior inferior tibia-fibula ligament
what are the ottawa ankle rules
The Ottawa Ankle Rules are a set of clinical criteria used by healthcare professionals to determine the necessity of obtaining X-ray images in ankle injuries. They are designed to identify fractures accurately and avoid unnecessary imaging, reducing costs and radiation exposure
what is a special test
Specific tests specific to a certain joint which aid our clinical reasoning
special tests of the ankle
- Calf squeeze test / Thompson – Achilles rupture
- Anterior draw & Talar Tilt – lateral ligaments (ATFL/CFL)
- External rotation stress test & cotton test– High ankle sprain
what are the muscle tests you can use during a MSK objective Ax
Oxford Grading, Isometric muscle testing, Functional testing, Muscle Length Testing
what are the functional tests you can do on the ankle
- Balance tests (SLS, SLS eyes closed, balance error scoring system, star excursion test, Y balance test)
- Jump tests (Distance, Height)
- Hop tests (Single, triple hop test, crossover hop test)
- Other (Calf endurance test, Single leg squat, Lunges)
what is clinical reasoning
Subjective Ax + Objective Ax = Clinical Reasoning
what does clinical reasoning involve
- Hypothesis/DD
- Problem list
- Goals
- Treatment plan
- Rx/ Ongoing evaluation
WEEK 2 pt2
MSK Objective Ax
what are the three pain natures
Nociceptive, Neurogenic, Nociplastic
what is the order of an objective Ax
Observation, AROM, clearing joints, PROM, Muscle tests, palpation, special tests to area, Functional testing, neuro tests, outcome measures
how do you clear joints
Verbally check for other areas of pain (eg common referral areas) AROM and PROM with over pressure of joint above and below
what does SOAP stand for
Subjective - feedback from last session, treatment and exercises. Changes in symptoms, % improvement, subjective markers.
Objective – Repeated objective markers and measures. Planned tests from last session.
Treatment – what you did and the outcome of treatment.
Analysis – your ongoing thoughts, analysis on progress / changes in subjective and objective markers. Changes to diagnosis / hypothesis. Thought on main drive of the symptoms and where treatment focus needs to be – linked to subjective and objective findings.
Plan – Plan for next session or coming few sessions
what is the key mechanisms behind an ATFL tear
- Inversion mechanism of injury
- Most common ankle injury
- Graded 1-3
- Lateral ankle pain
- Associated swelling and bruising
- Can be associated with CFL and PTFL injuries.
what are the key mechanisms of an AITFL tear
- Corkscrew injury with dorsiflexion / eversion of the foot and knee adduction
- Higher force MOI eg landing from a jump
- Pain higher in ankle and anterior ankle
- Can be associated with other ligament injuries.
- More severe injuries often treated with a boot initially.
what are the Webber ankle fracture classification
- Webber A – fibula fracture below the level of the syndesmosis
- Webber B – fibula fracture at the level of the syndesmosis
- Webber C - fibula fracture above the level of the syndesmosis.
what is the Salter Harris classification
(1) S- separated growth plate
(2) A- above growth plate
(3) L- Below growth plate
(4) T- through growth plate
(5) ER- erasure of growth plate
