BIOMECHANICS Flashcards
(22 cards)
NOLDCAT
NATURE-what type of pain, shooting, sharp, burning
Onset-when does it hurt, triggers?
Location- where does it hurt?
Duration- how long has it been hurting for? when did you first notice?
Cause- acute event,. insidious
Aggravating/ alleviating: what makes it worse? what makes it better?
Treatment- have you seen/ had any other rx by health professionals
Metatarsal stress fracture
- Forefoot pain aggravated by WB activity/ sport
- Hx of inc training load
- Palpation- focal tenderness
- Radiology
Turf toe sprain 1st MTPJ joint sprain.
- Forced hyperextension injury (acute) o Axial load to a foot in fixed equinas o Drives hallux into hyperextension o Attenuating or disrupting plantar joint complex - Range in severity o sprain or tear of joint capsule o Dislocation - Hx related to footballers playing on hard surfaces in. cleats
Plantar plate injury
Plantar plate anatomy
- Fibrocartilaginous
- Trade off perfusion for strength
o Does not repair well if torn
Plantar plate serves to:
- Stabilise MTPJ and resist hyperextension
- Assist windlass mech through attachment to plantar fascia
- Absorb compressive loads
- Allows large forces to be transmitted through MTPJs during propulsion
plantar plate MOI
- Typically repetitive trauma/ overload o Abnormal loading patterns o Lesser MTPJ instability Plantar plate, synovitis, hammertoe or cross over def o Can be acute (traumatic) o 2nd most frequent - Clinically-palpation - V- sign o Med deviation of involved toe - Digit elevated (DF) o Floating toe - Radiolog: X-ray,US, MRI - Laxity> drawer test (Lachman test) o Prox phalanx dorsally translocated with met head stabilised
- Sesamoidopathy
- Acute injury (traumatic) > fracture o Hyperextenison or direct impact - Stress injury (overuse) > stress fracture o Runners with repetitive impact through forefoot - Medial sesamoid most frequent Clinical hx - MOI (repetitive stress or trauma?) - Careful palpation- compression - ROM - Radiology
- Morton’s neuroma
- Not a true neuroma
- Due to adaptive changes not tumor
- Non neo plastic- originates through adaptive changes
- Commonly in 3rd met spaces
- Middle aged womens
- Ache burning pain
- Tight compressed shoes
- Altered sensation- profound paraesthesia- sharp/ shooting
- Pain when walking
- Massage helps
Histopathology
Macrospoic- thickened - Not just cellular changes- vascular aswell
Mortons neuroma patho
- Chronic trauma theory- repetitive trauma from ambulation causes digit DF and flexor digitroum action,stretching the common
- Ischaemic theory: possible degermation of plantar digital arterial supply of hypertropgy of neural tissue
- Intermetarsal bursists-creates a compressive neuropathy fibrosis
- Entrapement theory- conintued irration- fibrosis, inc diameter or nerve,chronic compression
Mortons physical examination
- Transverse compression forefoot Squeeze test
- Direct compression b/w finger and thumb intermetasral 4/4
- Mulders click
population and investigation mortons neuroma
Common in - Sedentary women aged 50-70yrs o High heeled shoes o Overlaod of met heads - Athletics men aged 25-64 o Found to have long 2nd met o Repet activity
Investigation
- WB views: AP, MO and lateral
- Check for bone patho: #, arthritis, tumour
- Biomech features such as digital alignment +. Me length
AP view
- Transverse plane deformity
- Compare met lengths
Lateral view
- Rectus, contracted, subluxed or dislocated joint
- Assess: arthritis, long standing conditions demonstrate bony erosin of dosarl aspect of met head/ and or phalangeal base
- Provides baseline for future comparison of progression of deformity + assessing post op healing
- Lisfranc joint complex
MOI:
- Typically forced PF + ABD while the foot is in a fixed eqiunas position
- Range in severity
o Mild sprain> #/dislocation
lisfranc clinical ax
- Palpation and swelling o Tenderness to dorsal midfoot (TMTJ) region - Pain with stress testing o ‘Piano key’ testing - Stability? - WB (Ffoot loading) o Single limb heel raise o Propulsion in gait
lisfranc radiology
- X-ray (WB) o Widening (Diastasis) o Compare uninjured side- normal o ‘Fleck’ sign (avulsion) - MRI o Sensitivity
Achilles Tendinopathy
( implies inflammatory) - Tendinosis (im plies degenerative) - Rupture Stages: - Reactive - Tendon disrepair - Degenerative Insertional tendinopathy- Enthesis Non-interstional tendinopathy- mid- portion Clinical ax Hx - Load - AM stiffness and pain Palpation - Pain - Insertion v mid portion - Thickening - Swelling - Crepitus Passive range - PF (ddx posterior impingment) Thompson’s test (calf squeeze test) >rupture Function - Calf raise (double and single leg) - Hop - Hop forward - Eccentric drops - Lunge Imaging - X-ray MR - Pathology poorly correlated with pain and function - DDx or mis- diagnosis o PAI o Plantaris o Neural irritation - Systemic disease
ANKLE INJURY
- Articulation of the distal tibia and fibula with the trochlear surface of the talus
- Mainly SP- PF and DF
o Abd with DF& Add with PF - PF limited by ATFL& osseous block of the posterior talus on the tibia
- DF limited by trochlea shape of talus, triceps surae, posterior deltoid and PTFL
Ankle anatomy- ligamentous support
- Lateral ankle ligaments
a. Anterior talofibular ligaments (2 bands)
b. Calcaneofibular ligament
c. Posterior talofibular ligament - Medial (deltoid ligaments)
a. Insertions into talus, calcaneus and navicular
Superficial
- Tibiospring lig
- Tibionavicularlig
- Superior tibiotalar lig
- Tibiocalcaneal lig
Deep
- Deep posterior tibiotalar lig
- Anterior deep tibotalar lig - Syndesmosis
a. Anteriorinferior tibiofibular ligament (AITFL)
b. Posteriorinferior tibiofibular ligament (PITFL)
i. Superfical and deep components - Interosseous tibiofibular ligament
a. Continuation of interosseous membrane
Ankle sprain
- MOI
- Inversion> lateral lig damage
- Eversion> medial lig damage
- Compressive forces > consider osteochondral injury
- Df/ EXT rotation > syndesmosis
- Onset of pain
- Ability to WB
- Location and degree of pain and swelling
o Usually indicative of injury and severity - Initial management
- Previous hx
o Management/rehab
o Use of bracing or taping post injury
Observation - Swelling/ bruising
Palpation - Consider assoc injury
- Active movements (PF, DF, INV/ EV)
- Passive movements
- Resisted movements
- Functional movements (hop, lunge, SL balance)
Specifc tests- anterior draw test
Clinical examination Specific test: Syndesmosis - Squeeze test - Ext roation test - Crossed leg test
Syndesmosis injury (High ankle sprain)
- Df/ ext on a planted foot
- Range in severity
- Typically assoc with longer recovery/ healing
- Surgical consideration
Ankle sprain: Radiology
X-ray - Include base of 5th met (alvusion #)
- Ankle mortise or syndesmotic views if injury suspected
- Medial tibial stress syndrome (MTSS)
- Common in runners/ running based sports
Palpation - Diffuse pain along 1/3 posteromedial tibial border >5cm
Aetiology - Tibial bending
- Fascial tension
Running limb varus
- Medial tibial stress fracture
Palpation
- Localised pain (not diffuse)
- > intensity
- Chronic exertional compartment syndrome
- Inc in intracompartmental muscle pressure
o Tissue hypoxia and ischemia pain due to dec blood flow - Anterior compartment most common
- Symptoms ‘tightness’ or constricting’ pain, cramping, parathesia- relived on rest
- Acute compartment syndrome (surgical emergency)
- Biomechanical overload syndrome (BOS)
- Anterior tibial cortex stress fracture
Dread black line’
- Aiteology- tibial bending (SP)
- Signifcantly longer recovery
