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PODMED3 > wk 10- leg and calf pain > Flashcards

wk 10- leg and calf pain Flashcards

1
Q

bone pathology of the leg

A

stress fracture (anterior tib or medial tib, fibula)

medial tibial stress syndrome

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2
Q

soft tissue pathology of leg

A

muscle strains (gastroc, soleus)

muscle contusions

DOMS

compartment syndrome

bakers cyst

pes anserine bursitis

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3
Q

joint pathology of leg

A

proximal tibiofibular sublax

OA/ inflammatory arthritis

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4
Q

neural pathology of leg

A

referred pain

nerve entrapment (tibial/sural)

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5
Q

vascular pathology of leg

A

vascular entrapment (popliteal)

DVT, thrombis, emoblism

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6
Q

leg pain can involve ?

A

one or more of five pathological processes often with multiple occuring at the same time

  1. bone stress
  2. vascular insufficiency
  3. inflammation
  4. nerve entrapments
    5.elevated intracompartmental pressures
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7
Q

pain absent at rest that presents with exertion

A

compartment syndrome

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8
Q

posterior pain absent at rest but presents on exertion

A

popliteal artery entrapement syndrome

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9
Q

improves with pre participation stretching

A

medial tibial stress syndrome and muscle strains

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10
Q

doest improve with pre participation stretching

A

stress fractures and compartment syndrome

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11
Q

pain when resistance to muscle tendon units including insertion/origin

A

MTSS
muscle strains
tendinopathy

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12
Q

focal pain over bone

A

stress fracture
muscle herniation

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13
Q

diffuse swelling in calf

A

DVT

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14
Q

palpable swelling on muscle insertion on medial border of tibia

A

MTSS

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15
Q

shooting pain, sensation loss, loss of motor power

A

nerve injury, entrapment or radiculopathy

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16
Q

improves with cold therapy and anti inflammatories

A

inflammation pathology
osteoid osteoma

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17
Q

night pain or wakes up a patient

A

tumour

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18
Q

difference between stress fracture and MTSS

A

pain:
SF: focal sharp tenderness
MTSS: diffuse on posteriormedial border of tibia

effect:
SF: constant or worse with impact
MTSS: decreases as warm up or stretches. worse in morning or after exercise

imaging:
SF: MRI
MTSS: MRI

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19
Q

what is MTSS

A

micro tears and inflammation of the periosteum

originally thought to be caused by post tib overuse therefore more common in pronated foot types

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20
Q

risk factors of MTSS

A

excessive pronation
training errors
footwear fatigue or improper footwear
surface
muscle dysfunction
decreased flexibility
female
high BMI

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21
Q

grading MTSS

A

frederickson classification system

grade 1: periosteal oedema
2/3- progressive marrow involvement
4- cortical stress fracture

22
Q

other DDx for MTSS

A

stress fracture
compartment sydrome
popliteal artery entrapment
muscle tear
nerve entrapment

23
Q

management for MTSS

A
  1. PEACE AND LOVE
  2. rest/deload
  3. shock abosorbing innersoles

if not getting better
1. immobilise/CAM walker, below knee
2. taping to control pronation
3. FW change
4. semi rigid orthotic
5. soft tissue therapy of tightness of focal thickening (friction massage)

24
Q

typically how long does it take to resolve MTSS

A

resolution in 1 month, 50% reduction in pain in 1 week

if untreated can develop to stress fracture

25
Q

return to impact activity dependent on grade of MTSS/SF

A

1- 2-3weeks (periosteal oedema)
2-4a: 6-7 weeks
4b: 9-10 weeks (cortical break)

26
Q

pathophysiology of bone stress injury

A

repetitive loading of bone causing microdamage without adequate bone remodelling through recovery

27
Q

clinical features of BSI

A

-increase in load
-focal pain around medial posterior tibia
-pain aggravated by activity
-may cause rest or night pain
-more common in rigid cavus foot types, pronated foot types, leg length differences
-eating disorder/BMD problems

28
Q

management of BSI

A
  1. immobilise (pneumatic CAM walker) 2 weeks, add another 2 weeks if pain present
  2. reintroduce load
  3. change surface, footwear, technique (shorter stride, slower speed, reduce distance)
  4. custom semi rigid orthotics
29
Q

anterior cortex stress fracture

A

prone to delayed union/ non union and complete fractures due to poor blood supply and under tension due to bowing of tibia

30
Q

management of anterior cortex stress fracture

A
  1. immobilise (penumatic brace)
  2. assess nutrition
  3. ultrasonic bone stimulation early on for healing
    if no progress after 4-6months
  4. intramedullary rodding
  5. bone grafting
  6. drilling

prognosis is 12 months return to sport using brace

31
Q

what is chronic exertional compartment syndrome

A

increased pressure within closed fibro osseous space due to thickened and non compliant fascia which doesnt allow the muscle to expand

this causes
1. reduced blood flow
2. reduced tissue perfusion

common in endurance athletes

32
Q

most common type of compartment syndrome

A

anterior

then
lateral
deep posterior

33
Q

clinical features of CECS

A

no pain at rest
ache, tightness building with exercise, usually around 10-15 mins in

decreases with rest

34
Q

how to test CECS

A

pressure testing, imaging is tyically negative because need to stimulate exercise

basal ICP of >10mmHg,
1 MINUTE post exertion >30mmHg
5 MIN POST >25mmHg

35
Q

muscles and nerve in anterior compartment

A

tib ant
ext dig longus
ext hallucis longus
peroneal tert

deep peroneal nerve

36
Q

muscles and nerve in lateral compartment

A

peroneus longus and brevis

superficial peroneal nerve

37
Q

lateral compartment syndrome can cause parathesis where

A

dorsum of foot

38
Q

management of CECS

A
  1. rest
  2. deep massage therapy
  3. soft tissue therapy (friction, needing, active release)
  4. running technique
    shorter stride
  5. botox injection to decrease pain
  6. surgery- fasiotomy (incision)/fasciectomy (removal of portion)
39
Q

muscles and nerve in posterior compartment of thigh

A

tib post
flexor hallucis longus
glexor digitorum longus

tibial nerve

40
Q

surgery outocmes of CECS

A

80-90% of patients satisfied
some had reccurance

which was most common with deep posterior compartment (52% satisfied with fasciotomy)

41
Q

gastroc/soleus muscle strain acute injury caused by

A

extending the knee with ankle dorsiflexion
lunge forward
sudden eccentric overstretch

most common on medial head as its longer

42
Q

grades for gastroc/soleus muscle strains

A

1- pain on SL calf raise or hop (10-12days)

2- pain and weakness with active plantarflexion, loss of dorsiflexion (16-21days return), mild to mod swelling/bruising

3- thomas test positive, cant contract calf (6months after surgery), presents with considerate swelling and bruising within hours

43
Q

management of muscle strain

A
  1. PEACE and LOVE
  2. heel raise in shoes to decrease stretch
  3. passive stretching and isometrics (resistance band)
  4. gradual loading of isotonics around 10 days when muscle as tensile strength (concentric calf raise, to then eccentric, bilateral to SL)
    5.soft tissue therapy
  5. agility/plyo/sport specific activity
44
Q

difference between PAES and CECS

A

PAES disappears immediately
CECS may take until the muscle cools down so longer

45
Q

PAES cause

A

anatomical variation of artery with medial gastroc attachment

causes a claudication type calf pain

46
Q

diagnosis of PEAS

A

doppler pulse during active plantarflexion or dorsflexion

post exercise pulse may be weak or absent

47
Q

what can PAES cause

A

enodthelial damage (atheroscleoris accelerating)

48
Q

management of PAES

A
  1. surgical correction of medial gastroc head insertion
  2. popliteal artery release
49
Q

disgnosis test of DVT

A

hollmans test

50
Q
A

PODMED3 (9 decks)

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