04 Ankle 1 Flashcards Preview

7212 Pathophysiology > 04 Ankle 1 > Flashcards

Flashcards in 04 Ankle 1 Deck (59):
1

What are you looking for on an ankle radiograph?

diastasis of the ankle mortis

2

diastasis

separation

3

What is diastasis indicative of and why is it so important to not miss?

- indicative of syndesmotic injury
- typically goes on to DJD in the talus
- surgery would be done immediately

4

What is the radiograph view used for the ankle?

- talar tilt radiograph
- angle that's created with a stress radiograph

5

If the symptoms are on the physis, you can't see anything on the radiograph, but the patient is symptomatic, what would you think it is?

Salter-Harris type 1 fx

6

types of casts

- short leg cast
- leg cylinder cast
- long leg cast

7

rule of casting and bracing

always immobilize the joint above and below

8

Which cast is not used often and why?

- cylinder cast
- doesn't immobilize prox and dist joints

9

For surgeries on fractures, what dictates the type of surgery that's done?

fracture pattern dictates

10

What are the common causes for shin pain?

- anterior lateral shin splints
- posterior shin splints
- myositis
- tendonitis/osis
- periostitis
- medial tibial stress syndrome
- stress fx

11

anterior lateral shin splints

usually an overuse of extensor compartment

12

posterior shin splints

overuse of flexors (?)

13

What would lead you to think the shin pain was myositis?

- palpate
- if it's in the muscle, it's myositis

14

What would lead you to think the shin pain was tendonitis/osis?

more symptoms on the tendon area than the bone

15

periostitis

- propagation injury
- will progress to medial tibial stress syndrome

16

What is medial tibial stress syndrome a precursor to?

stress fx

17

medial tibial stress syndrome

- some microfractures of the tibia
- extremely painful

18

MTSS may involve one of these syndromes

- overuse syndrome
- can progress to irreversible, external compartment syndrome

19

How many grades of injury for MTSS?

4

20

Where can stress fractures occur?

anywhere in the lower extremity

21

Where are stress fx more commonly seen in the LE?

- 4th metatarsal
- then tibia
- then femoral neck

often seen in runners and military recruits

22

What is the most sensitive but not specific imaging technique to identify a stress fx?

- bone scan, not done as much now
- MR

23

tibial stress fx

- bigger deal than fibular because it bears 95% of the weight
- with a fx, it forms a callus

24

6 P's of acute compartment syndrome

- pain: out of proportion to clinical exam
- pressure
- pain: with passive stretch
- paralysis
- pulses
- paresthesia

25

6 P's of compartment syndrome: most significant early sign

pain out of proportion to clinical exam

26

6 P's of compartment syndrome: pressure

tense swelling
(early consistent finding)

27

6 P's of compartment syndrome: paralysis

muscle weakness

28

6 P's of compartment syndrome: pulses

present (pale toes)

29

6 P's of compartment syndrome: paresthesia

sensory deficit (usually late)

30

first steps in dx for acute compartment syndrome

1. OBTAIN URGENT SURGICAL CONSULT
2. maintain normal BP
3. remove anything that can impede circulation
4. maintain limb at heart level

31

surgery for acute compartment syndrome

open procedure, flayed open

32

What may happen if you miss acute compartment syndrome?

amputation

33

chronic compartment syndrome

- increased compartmental pressure
- 4 compartments of the lower leg, fascial tissue doesn't expand

34

What are the 4 compartments of the lower leg

- anterior
- deep posterior
- lateral
- superficial posterior

35

most to least common sites of chronic compartment syndrome

1. anterior
2. deep posterior
3. lateral
4. superficial posterior

36

Why might exercise exacerbate chronic compartment syndrome?

- causes perfusion of blood
- not much room for expansion

37

symptoms for chronic compartment syndrome

- leg is swollen, tight, pale, and shiny
- foot drop
- can't actively dorsiflex
- pain

38

What wil you feel with chronic compartment syndrome?

hard, "woody" feeling with no historesis response

39

What is happening in to the NV tissue in chronic compartment syndrome?

swollen muscle compresses the nerves and vessels in the leg

40

What is done to assess for chronic compartment syndrome?

put wick catheter into the area to gauge the pressure
- resting pressure
- exercise pressure
- recovery phase

41

chronic compartment syndrome: resting pressure

- each compartment has its own normative data
- will be elevated

42

chronic compartment syndrome: exercise pressure

- elevated and stays elevated for a prolonged period afterward
- much higher than normative data

43

chronic compartment syndrome: recovery phase

prolonged compared to normal individuals

44

procedure to fix chronic compartment syndrome

- fasciotomy is done to decompress
- done underneath the skin, so you can't really see it

45

Who typically gets chronic compartment syndrome and how does it manifest?

- runners
- c/o shin pain
- have been to several physicians with multiple dx and treatments
- can tell exactly when the pain starts (specific time or distance)

46

If a patient presents with chronic compartment syndrome, are they a PT patient?

NO NO NO

47

Why must you always palpate posteriorly for the Ottawa ankle rules?

85-90% of the time, the anterior talofibular ligament is involved in ankle sprains

48

What is pain over the distal tib-fib ligament indicative of?

syndesmosis injury

49

What is the most common type of sprain?

plantarflexion inversion sprain

50

What should you also consider with a plantarflexion inversion sprain?

also be concerned about a Pott's fx

51

What does an eversion sprain involve?

deltoid ligament

52

syndesmosis aka

high ankle sprain:
diastasis injury

53

What is happening with a diastasis injury?

- distal anterior tib/fib ligament is injured
- membrane between the tib/fib and distal part of interosseous injury

54

Why is a diastasis injury serious?

leads to:
- stability of the ankle
- subsequent OA changes

55

A high ankle sprain may also involve this type of force

ER

56

ER force in a high ankle sprain: what happens to the talus and fibula

talus forces the fibula out
- may get a Pott's fx
- tear the distal anterior tib/fib ligament

57

How can ecchymosis location tell you if it's a high ankle sprain?

- anterior lateral part of the ankle
- predictive of what kind of injury it is in the ankle

58

treatment for high ankle sprain

almost always ORIF

59

ORIF for high ankle sprain

- cancellous screw through fibula and into the tibia
- allows interosseous membrane to heal
- provides stability