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Lowers > Lowers Exam #2 > Flashcards

Lowers Exam #2 Flashcards

1
Q

bones of the ankle

A

talus
tibia
fibula

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2
Q

articulations of the ankle

A

talocrural joint
subtalar joint
distal tibiofibular syndesmosis

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3
Q

talocrural

  • type of joint
  • ROM
  • support
  • -medial
  • -lateral
A 
type
-hinge or ginglymus
ROM
-dorsi: 0-20
-plantar: 0-50
medial support
-deltoid ligament
lateral
-ATFL
-CFL
-PTFL
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4
Q

deltoid ligaments

A

posterior tibiotalar
tibiocalcaneal
tibionavicular
anterior tibiotalar

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5
Q

talocrural

-closed-packed vs open-packed

A 
closed
-position where the joint is the most stable (most joint congruence - joint parts are touching each other
-dorsiflexed with slight eversion
open-packed
-joint is loosest and stretched
-plantarflexed with slight inversion
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6
Q 
subtalar
-type of joint
-which bones articulate there
-ROM
support
A 
type
-gliding (arthrodial)
bones
-talus
-calcaneus
ROM
-inversion: 0-30
-eversion: 5-10
support
-interosseous talocalcaneal ligament
-deltoid ligament
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7
Q

distal tibiofibular syndesmosis

  • response to walking
  • ROM
  • support
A 
response to walking
-stepping jams the talus between the tibia and fibula and stretches them apart
ROM
-none measurable
support
-interosseous membrane
-crural interosseous ligament
-ATFL
-PTFL
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8
Q

anterior compartment

  • muscles
  • vessels
  • nerves
A 
muscles
-TA
-EDL
-EHL
-peroneus tertius
vessels
-anterior tibial artery
-dorsalis pedis
--branch of anterior tibial artery
nerves
-deep peroneal nerve
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9
Q

lateral compartment

  • muscles
  • vessels
  • nerves
A 
muscles
-peroneus L + B
-superior and inferior peroneal retinaculum
vessels
-peroneal artery
-arises off of the posterior tibial artery
nerve
-superficial peroneal nerve
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10
Q

superficial posterior compartment

  • muscles
  • vessels
  • nerves
A 
muscles
-triceps surae
--gastrocnemius
-soleus
-plantaris
vessels
-posterior tibial artery
nerve
-tibial nerve
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11
Q

deep posterior compartment

  • muscles
  • vessels
  • nerves
A 
muscles
-TP (only muscle of deep post. that doesn't act on toes
-FDL
-FHL
vessels
-posterior tibial artery
nerve
-tibial nerve
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12
Q

TA

-OIA

A

O: anterior tibia and interosseous membrane
I: 1st metatarsal and medial cuneiform
A: ankle dorsiflexion, inversion

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13
Q

EDL

-OIA

A

O: anterior fibula and lateral tibial condyle
I: distal phalanges of 2nd through 5th toes
A: toe extension, eversion, dorsiflexion

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14
Q

EHL

-OIA

A

O: anterior fibula
I: base of distal phalanx of 1st toe
A: hallux extension, dorsiflexion, inversion

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15
Q

peroneus tertius

-OIA

A

O: distal, anterior fibula
I: dorsal surface of base of 5th metatarsal
A: eversion, dorsiflexion

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16
Q

pero L

-OIA

A

O: fibular head, lateral tibial condyle
I: 1st metatarsal, medial cuneiform
A: eversion, plantarflexion

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17
Q

pero B

-OIA

A

O: lateral fibula
I: styloid process at base of 5th metatarsal
A: eversion, plantarflexion

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18
Q

gastroc

-OIA

A

O: posterior surfaces of femoral condyles
I: calcaneus via Achilles tendon
A: plantarflexion, knee flexion

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19
Q

soleus

-OIA

A

O: posterior fibular head
I: calcaneus via Achilles tendon
A: plantarflexion

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20
Q

TP

-OIA

A

O: posterolateral tibia, medial fibula
I: navicular tuberosity, sustentaculum tali, cuneiforms, cuboid, bases of 2, 3, and 4 metatarsals
A: plantarflexion, inversion

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21
Q

FDL

-OIA

A

O: posteriomedial tibia
I: plantar surface of distal phalanges 2-5
A: toe flexion, plantarflexion, inversion

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22
Q

FHL

-OIA

A

O: posterior fibula
I: plantar surface of proximal phalanx of 1st toe
A: hallux flexion, inversion, plantarflexion

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23
Q

neural and vascular trees

A

powerpoint

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24
Q

bursae

A 
retrocalcaneal bursa
-between Achilles tendon and calcaneus
subcutaneous calcaneal bursa
-back side of calcaneus
-associated with retrocalcaneal bursitis
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25
Q

retinaculum

A 
extensor retinaculum (superior and inferior)
-at ankle joint
peroneal retinaculum (superior and inferior)
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26
Q

points of emphasis in the Hx of a lower leg/ankle injury

A

changes in activity/conditioning

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27
Q

chronic ankle instability and EBP

  • region specific questionnaires
  • generic questionnaires
A 
region
-Foot and Ankle Ablility Measure (FAAM) or Foot and Ankle Disability Index (FADI)
-CAIT
-Lower Extremity Functional Scale (LEFS)
generic
-SF-36 (gold standard
-Global Rating of function
-global rating of change
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28
Q

observation of ankle/lower leg

A 
visible abnormality
functional assessment (gait,etc.)
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29
Q

specific tests

A

joint and muscle function

  • ROM
  • MMT
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30
Q

joint stability and specific tests

A 
anterior drawer test
inversion talar tilt (inversion stress test)
eversion talar tilt
Kleiger's test
distal tibiofibular joint play
squeeze test
bump test
Thompson test
Homan's sign
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31
Q

anterior drawer test

  • position
  • action
  • +
  • implication
A

end of table with knee flexed
one hand anterior
other hand cups calcaneus while forearm supports foot in a position of slight plantarflexion
pull ankle forward
+: talus slides farther and other side, may be a “clunk”, patient may describe pain
implication
-sprain of ATFL

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32
Q

inversion (talar tilt) stress test

  • position
  • action
  • +
  • implication
A

patient supine or sitting with legs over end of table
one hand graps talus and calcaneus as a single unit and maintains foot and ankle in 10 dorsi to isolate the CFL
opposite hand stabilizes the leg
place thumb or forefinger over CFL to feel for any gapping
action
-roll calcaneus medially
+
-talus tilts or gaps excessively compared to uninjured side
implication
-CFL injury, possibly with ATFL or PTFL

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33
Q

eversion (talar tilt) stress test

A

opposite of inversion

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34
Q

Kleiger’s test

  • position
  • action
  • +
  • implications
A

position
-legs over edge of table
-one hand stabilizes leg but doesn’t compress distal tigiofibular syndesmosis
-other hand grasps medial aspect of the foot while supporting the ankle in a neutral position
action
-externally rotate foot and talus
-for syndesmosis stress, place the ankle in dorsiflexion
-for deltoid ligament stress, place ankle in neutral position or slightly plantarflexed
+
-deltoid: medial joint pain; may feel displacement of the talus away from the medial malleolus
-syndesmosis: pain described in the anterolateral ankle at the site of the distal tibiofibular syndesmosis
implications
-medial pain is indicative of trauma to the deltoid ligament
-pain anterior or posterior to tibiofibular ligament should be considered syndesmosis pathology unless otherwise determined
-fracture of the distal fibula

35
Q

distal tibiofibular joint play

  • position
  • action
  • +
  • implication
A

position
-supine w/ ankle relaxed into plantar flexion
-one hand stabilizes tibia
-the other grasps lateral malleolus
action
-apply an anterior and then posterior force to the lateral malleolus
+
-pain arising from the syndesmosis
-increased motion relative to the uninvolved side
implications
-sprain of the distal tibiofibular syndesmosis

36
Q

squeeze test

-position

A

position
-lying with the knee extended
squeeze lateral sides of leg away from the site of pain
begin inferior to fibular head
tests for ankle Fx (gross and stress) and positive interosseous problems
+
-point tenderness
-pain is described at the distal tibiofibular joint
-might alleviate pain w/ interosseous tear

37
Q

bump test

A

anchor proximal to injury
bump heel with base of hand
point tenderness away from bump

38
Q

thompson test

  • position
  • action
  • +
  • implications
A 
position
-prone with foot off edge of table
-one hand over muscle belly of calf
action
-squeeze calf
\+
-calf does not flex
implication
-achilles tendon rupture
39
Q

Homan’s sign

A

patient supine
place ankle into dorsiflexion and squeeze calf
tests for DVT
+
-pain increases in calf
typically use post-surgery to determine if blood is flowing

40
Q

lower quarter dermatomes

A

L5: superficial peroneal
S1: posterior femoral cutaneous
S2: posterior femoral cutaneous

41
Q

lower quarter myotomes

A 
L3: knee extension
L4: dorsiflexion
L5: toe extension
S1: foot eversion
S2: knee flexion
42
Q

peroneal neuropathy

A

outside of leg, little of lateral plantar surface, little of lateral dorsal surface

43
Q

anterior compartment syndrome

A

anterior tibial artery and deep peroneal nerve

over TA

44
Q

point of note about vascular

A

posterior tibial artery
-must be established after LE fracture or dislocation
dosalis pedis artery
-not detectable in all people

45
Q

specific components of RICE

A

compression
-horseshoe
crutches if they can’t walk without a limp

46
Q

inversion ankle sprain

  • anatomy
  • -static supporters
  • -dynamic supporter
  • etiology
A 
anatomy
-static supporters
--ATFL
--PTFL
--CFL
-dynamic
--peroneals keep it from inverting
etiology
-foot fixes
-inversion and plantarflexion
47
Q

inversion ankle sprain recognition for G1-3

  • pain
  • gait
  • laxity
  • swelling
  • discoloration
  • feel/hear
A 
pain
-G1: mild
-G2: moderate
-G3: severe
gait
-FWB
-PWB
-NWB
laxity
-G1: mild laxity, firm endpoint
-G2: moderate laxity, firm endpoint
-G3: gross laxity, no endpoint
swelling
-G1: minimal
-G2: moderate (orange)
-G3: severe (grapefruit)
discoloration
-G1: none
-G3: severe
feel/hear
-G1: nothing
-G2: pop/snap
-G3: pop/snap
48
Q

inversion ankle sprain management for G1-3

  • RICE
  • refer
  • NWB/immobilization
  • rehab
  • tape
  • RTP
A 
RICE
-G1: 1-2 days
-G2: 3 days
-G3: 3-7 days
Refer
-G1: no
-G2: r/o Fx?
-G3: r/o Fx?
NWB/immobilization
-G1: no
-G2: probably, 1 week immobilization
-G3: yes, >1 week immobilization
rehab
-G1: yes, minimal
-G2: yes, extensive
-G3: yes, extensive
tape
-yes for all
-RTP
-G1: 1 week
-G2: >1 week 1 month
49
Q

phase 1 of rehab

  • goals
  • exercises
A

phase 1

  • goal: decrease inflammation
  • exercises: gameready, ABCs, towel pulls
50
Q

phase 2 of rehab

  • goals
  • ROM exercises
  • NM control
  • strength
A 
goals
-repair
ROM
-ankle mobes
-wobble board
-prostretch
NM
-toe curls
-balance
strength
-ankle manuals w/ light resistance
-calf raises
-toe raises
51
Q

phase 3 or rehab

-strength exercises

A

strength

  • wobble board
  • aggressive step ups
  • ladders
52
Q

Ottawa Ankle Rules

A

used for determining need for radiograph & low costs
very sensitive
ankle X-ray
-pain over posterior edge of medial/lateral melleolus
foot X-ray
-pain over styloid process of 5th or navicular

53
Q

eversion ankle sprain

  • anatomy
  • etiology/MOI
  • recognition
  • -DDx
  • management
A 
anatomy
-deltoid ligament
-more ligaments and bony support - harder to sprain
etiology
-eversion and external rotation
recognition
-eversion talar tilt, Kleigers
-DDx - avulsion Fx
management
-opposite stirrups
-more heavy duty tape (moleskin)
-assume injury to spring ligament
54
Q

syndesmotic sprain

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-syndesmosis between tibia and fibula
etiology
-external rotation and dorsiflexion
recognition
-Kleiger's test
-location of pain
-weight bearing
management
-possible PWB
-similar to inversion/eversion
55
Q

ankle/leg fracture or dislocation

  • anatomy (types)
  • management
A 
anatomy
-Potts (bimalleolar, knock-off)
--compress one side and have an avulsion on lateral side
-avulsion
--bone chipped off by ligament
-complete tib-fib
--can be caused by stress fracture (predisposing fracture)
management
-immobilize
-check pulses
56
Q

osteochondritis dissecans

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-cartilage on top of talus
etiology
-fragments of articular cartilage that detach and move into joint space (joint mice)
recognition
-locking
-giving out/giving way
-pain, swelling
-RULE OUT other options
management
-refer for definitive Dx
-immobilize - NWB
57
Q

Os trigonum

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-back side of talus
-variation in whether it is fused and size
etiology
-plantarflexion
-dancer's injury - on point position
recognition
-tenderness
-point tender
-increase in Sx in plantarflexed position
58
Q

Achilles tendinosis

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-Achilles tendon
etiology
-degeneration of the tendon due to abnormal stress
recognition
-decreased strength
-decreased dorsiflexion ROM
-wilder tendon
-reddening of the cord
management
-solve root cause
--shoes, running surface
-heel lift
-orthotics (foot pronation/supination)
-stretch
-ice/ice massage
-cross-fiber friction massage
59
Q

achilles tendon rupture

  • etiology
  • S/S
  • management
A 
etiology
-explosive contraction of calf muscle
-common in weekend warriors
S/S
-sharp kick in calf
-unable to plantarflex (mostly, post tib may allow)
-Thompson Test
management
-RICE
-immobilize
-immediate referral
60
Q

tendinopathy of: peroneals, TA, TP

  • location
  • recognition
  • management
A

location
-peroneal: around lateral malleolus
-TA: front of ankle
-TP: medial malleolus
recognition
-decreased PROM in the stretched position
-decreased RROM in contracted position
-pain in activity, increasing with activity
-tight with rest
management
-rest
-fix root cause
-some of best results have been done with eccentric training
–decreases vascularization, which you are not supposed to have in blood vessels

61
Q

gastroc strain

  • etiology
  • recognition
  • management
A 
etiology
-overload muscle
-overstretch
recognition
-decreased strength
-decreased ROM in extended position
-localized tenderness
-feel deformity when bad
management
-achilles taping
-PRE: progressive resistance exercise
62
Q

peroneal tendon subluxation/dislocation

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-preoneus longus/brevis
-superior and inferior peroneal retinaculum
--superior is distal to lateral malleolus
--close to CFL
etiology
-severe inversion or really forceful contraction
-inversion injures ligaments as well
recognition
-see subluxation of peroneal tendon
--peroneus pops over lateral malleolus
-bruising
-swelling
management
-conservative
-horseshoe pad
-spling until acute Sx disappear
-4-6 weeks out until retinaculum disappears
63
Q

medial tibial stress syndrome (shin splints

  • garbage can term
  • recognition
  • management
A 
garbage can term
-stress fractures
-muscle strains or tendinitis (especially TA and TP)
-chronic anterior (exertional) compartment syndrome
-periostitis
--inflammation of the bone
--not a stress fracture yet
-interosseous membrane inflammation
recognition
-pain along tibia during palpation
-chronic onset
management
-treat root cause
--arches
--weak muscles (hip abductors)
--training patterns
--foot posture
--hip malalignment
64
Q

stress fracture of tibia or fibula

  • etiology
  • recognition
  • management
A 
etiology
-overuse
-more osteoclast activity than osteoblast activity
recognition
-bone scan: dark spots in middle bone
-takes 4-6 weeks to show up on x-ray/MRI/something
-pain w/ activity
-bump/percussion test
-point tenderness
management
-rest
65
Q

shin contusion

  • etiology
  • recognition
  • management
  • concern
A 
etiology
-blow to shin
--more specifically the periosteum (highly innervated)
--similar to having a bone bruise
recognition
-intense, fracture-like pain
-jelly-like hematoma (sometimes hard)
management
-RICE if no compartment syndrome
-RTP: if functional
--protect it
concern
-osteomyelitis
66
Q

compartment syndrome

  • anatomy
  • etiology
  • recognition
  • management
A 
anatomy
-anterior: TA, EDL, EHL, deep peroneal nerve, anterior tibial artery
etiology
-acute traumatic
--blow to leg
-acute exertional
--when exercising, body causes compartment syndrome
-chronic exertional
--over time pressure builds from exercise
recogniton
-deep pain
-tightness
-swelling
-neuro and vascular markers
-deep posterior
--weakness in plantar and inversion
--tingling in back of leg and plantar side of foot
-anterior
--drop foot (inability to maintain dorsiflexion
management
-acute traumatic
--emergency situation
--no compression
67
Q

leg cramps and spasms

  • anatomy
  • recognition
  • management
A 
anatomy
-tonic - rigid muscle contractions
-clonic - cramps and releases
recognition
-stretch
-pressure
-prevention
--electrolytes, hydration
management
-DDx - heat illness
68
Q

deep vein thrombosis

  • etiology
  • recognition
  • management
A 
etiology
-thrombosis: blood clot
--can be due to medication
--post-surgery - lack of movement
recognition
-swelling
-pain
-redness
management
-immobilize
-immediate referral - not emergency
69
Q

ankle and lower leg rehab/care

A 
joint mobilizations
flexibility
muscular strength
neuromuscular control
taping techniques/orthotics
70
Q

RTP criteria

-ideal

A 
low/no risk of harm
protect control/address modifiable risk factors
ideal
-pain free
-no swelling
-full ROM
-full strength (at least 90% compared bilaterally
-pass functional test
71
Q

on-field examination and management

A

p. 281-284
S: hear/feel anything, where does it hurt, can you move
O: bare the hurt

72
Q

ABC’S of radiography (X-rays)

A

alignment
bones
cartilage
soft tissue

73
Q

X-ray

  • risks/precautions
  • cost and variation
  • variations
A 
risks/precautions
-ionizing radiation
--can detach electrons from normal element/structure
--free electrons = problems
cost/availability
-lowest cost
-highest availability
variations
-contrast x-ray
-stress radiography
74
Q

contrast x-ray

A

BOOK

75
Q

stress radiography

A

BOOK

76
Q

computed tomography (CT)

  • capability, how it works, and normal use
  • risks/precautions
  • cost/availability
  • variations
  • patient education
A 
capability and how it works
-x-rays, spinning, creating slices
use
-generally for head and torso
risks/precautions
-same as radiography
-claustophobia
-implanted metal
cost/availability
-high cost
-mainly available at large medical centers
variations
-contrast dyes
patient education
-5-30 minutes laying still
77
Q

magnetic resonance imaging (MRI)

  • capability/how it works/normal cliical use
  • risks/precautions
  • cost/availability
  • variations
  • patient education
A 
how it works
-magnets, spinning, creating slices
use
-soft tissue
capability
-highest quality
risks/precautions
-no radiation
-claustrophobia
-patient size (24" hole)
-implanted metal or metal objects in the room can cause injury
cost and availability
-$2000ish
-fairly available - not as available as x-rays
variations
-lots
-fMRI (functional) - can detect metabolic changes in brain
patient education
-15-45 minutes
-noisy
-lay still
78
Q

bone scan

  • how it works
  • pathologies identified
  • risks/precautions
  • cost/availability
  • patient education
A 
how it works
-radionuclide Tc-99m: a tracer element
--non-harmful in small doses
-absorbed by remodeling bone "hotspot"
pathologies
-stress fractures
-bone tumors
-degenerative diseases (arthritis)
risks/precautions
-infection at injury site
-"is it safe"
cost/availability
-$600-700
-cheaper than MRI but more risks
-similar availability to MRI
patient education
-2-5 hours for tracer
-20-45 min scan
79
Q

bone scan vs. bone density scan (DEXA)

A

DEXA

  • gold standard for body fat %
  • also does bone density
80
Q

diagnostic ultrasound

  • capability
  • normal use
  • risks/precautions
  • cost and availability
  • variations
  • patient education
A 
capability/normal use
-sonogram
-superficial muscle/soft tissue
-think modalities
--frequency
--transducer sends, then listens
risks/precautions
-virtually none
cost/availability
-dopplar/color
patient education
-5-45 minutes
81
Q

nerve conduction study/electromyography

  • capablity
  • what does it measure
A 
capability
-detect pathology in nerves
--peripheral nerve entrapments
--nerve root injury
--muscle disease
how it works
-latency: time to fire a muscle after told to (75-200 ms)
-amplitude (how high or low they can go)
-normal firing and relaxation patterns
82
Q

nerve conduction study

A

time it takes for body to send signal through body (stimulate nerve and see how long it takes to contract certain muscle)

83
Q

nerve conduction study/electromyography

  • risks/precautions
  • cost/availability
  • patient education
A 
risks/precautions
-infection
cost/availability
-medium cost and availability
patient education
-small shock &/or needles
-0.5-2.0 hours

Lowers (7 decks)

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