Final Exam Study Guide

Question 1

Wells Clinical Prediction Rule for DVT

Answer 1

Active cancer (treatment within previous 6 months) (1)

Paralysis, paresis, or immobilization of LE (1)

Bedridden > 3 days b/c of surgery (within 4 weeks) (1)

Localized tenderness along distribution of deep veins (1)

Entire leg swollen (1)

Calf swelling > 3 cm (below tibial tuberosity) (1)

Unilateral pitting edema (1)

Collateral superficial veins (1)

Alternative Dx as likely as or more likely than DVT (-2)

Question 2

Grade I ankle sprain

Answer 2

-Mild
-No instability
-No macroscopic tear of ligaments
-Minimal swelling
-Mild loss of function

Question 3

Grade II ankle sprain

Answer 3

-Moderate
-Partial tear
-Moderate swelling
-Loss of function

Question 4

Grade III ankle sprain

Answer 4

-Severe
-Complete tear
-Echymosis
-Severe loss of function
(Painful and restricted WB)
Instability

Question 5

PRICEMEM

Answer 5

Protection, Rest, Ice, Compression, Elevation, Manual Therapy, Early Motion, Medications

Question 6

Ankle sprain interventions

Answer 6

If acute, PRICEMEM, gentle open chain AROM in pain free ranges, consider boot.

A progression would be closed chain ROM, the goal is to have full closed chain DF. Proprioceptive and neuromuscular training and strengthening.

Question 7

Mechanisms of ankle fractures

Answer 7

Sprain with fracture:
Fx generally occurs as an avulsion or compression
-Avulsion same side as ligament
-Compression opposite side as ligament

Direct trauma
-Talus fractures

Question 8

Ankle fracture interventions

Answer 8

Immobilization (brace, boot, or cast)- 8 weeks
Surgical: ORIF
Post-immobilization manual therapy/exercise (mobilization, coordination/proprioception)

Question 9

Insertional Achilles Tendinitis

Answer 9

Training error
-Overuse
-Change in habits (>10%/week)
-Hills, slopes

retrocalcaneal bursa, localized pain and x-ray may show calcification.

Question 10

Insertional Achilles Tendinitis interventions

Answer 10

Ice, ionto
Rest
Stretching if needed
Training modification
Heel lift??

Question 11

Non-Insertional Achilles Tendinitis

Answer 11

Inflammation of more superior fibers

Tendon may thicken and degenerate, potentially posing risking of rupture

Local tenderness, crepitus and decreased DF ROM

Question 12

Achilles Rupture Surgery interventions 0-3 weeks

Answer 12

-Boot locked at 30 degrees PF
-NWB
-Pain and edema control (estim, ice)
Toe curls

Question 13

Achilles Rupture Surgery interventions 3-8 weeks

Answer 13

TTWB – PWB. If successful, follow with FWB.

Boot locked at 10 degrees PF (usually adjust 5 degrees a week)

Isometrics of uninvolved ankle muscles- must not exceed DF allowed by boot

At 6 weeks- add stationary bike with heel push only

Question 14

Achilles Rupture Surgery interventions 8-12 weeks

Answer 14

May wear shoe with heel at 8 weeks - cowboy boots or a ¼ inch heel lift
FWB
Manual full PROM into DF – Do NOT push
Progress cycling in shoe

Question 15

Achilles Rupture Surgery interventions 3-6 mo

Answer 15

Wean off heel lifts
CKC exercises
Balance training
Cycling, stair climber

Question 16

Achilles Rupture Surgery interventions 6 mo

Answer 16

Progress to jogging, running and eccentric loading

Question 17

Stress Fractures

Answer 17

Female > Males
Common in the:
-2nd metatarsal shaft (march fx)
-Running and jumping
-5th metatarsal shaft
-Navicular
-Rhythmic overload

Risk factors
-Foot posture
-Inappropriate footwear

Question 18

Stress fracture symptoms

Answer 18

Stiffness/soreness after activity
Mild soreness/pain during & after activity
Pain during activity that alters performance
Pain during and after, does not subside with complete rest

Question 19

Stress fracture intervention

Answer 19

Immobilization (4-6 weeks)
Maintain CV fitness

Question 20

Plantar Fasciitis

Answer 20

Medial Heel Pain
-Tenderness (medial, toward heel)
-AM pain

Question 21

Plantar Fasciitis interventions

Answer 21

Calf stretches
Plantar fascia stretch
Orthotics
Night splints

Question 22

Morton’s Neuroma

Answer 22

Mass about a nerve sheath

Common along digital nerves between toes
-Most commonly between 3rd and 4th met heads

Question 23

Morton’s neuroma intervention

Answer 23

Footwear
Activity
Metatarsal bar
Teardrop pad

Question 24

Compartment Syndromes symptoms

Answer 24

Symptoms (5 P’s):
-PAIN out of proportion to injury and unrelieved with medication
-Numbness or tingling
-Paralysis
-Loss of pulses
-Pallor

Do not use compression if vascular compromise is suspected

Question 25

Compartment syndromes interventions

Answer 25

Release (fasciotomy)

Intervention
Functional and biomechanical factors
Maintain CV
Similar to stress fracture