Quiz 8 Flashcards by Sara Morris

What special test is used to implicate the deltoid ligament?

Valgus stress test or Kleigers

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Where should your thumb be placed for the anterior impingement test?

Sinus Tarsi

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What special test is used for a high ankle sprain?

External rotation test

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What is another special test that can be used for diastasis or syndesmos?

Compression/Distraction

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Name two special tests that can be used to assess for a stress fracture.

Calcaneal Tap

Compression/Distraction

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What is fractured in a Pott’s fracture?

Distal fibula

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What is fractured in a Maisonneuve fracture?

Proximal fibula

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What is fractured in a Jones’ fracture?

Styloid process of the 5th metatarsal

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What is the close packed position of the ankle?

Dorsiflexion

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What is the normal DF ROM?

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Plantar flexion?

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Inversion?

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Eversion?

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MTP Flexion

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MTP Extension?

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With the navicular drop test, what measurement is considered “normal”?

10 mm or less, otherwise pronator

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When using the longitudinal arch angle test, what goniometric measurement is considered to be normal?

130-150 deg

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What does the Helbing’s sign tell you?

Medial bowing of the achilles tendons = patient is a pronator

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What is the name for the neutral resting position of the foot

Bergman’s position

What is the position? (Bergman’s)

PF and Inversion

What are the three biomechanical components of pronation?

Calcaneal valgus
Midfoot eversion/collapse
Forefoot abduction (combined with varus and dorsiflexion)

What tests can you use to quantify the degree of pronation/supination that a patient has?

Feiss’ Line
Navicular Drop Test
Longitudinal Arch Angle

What is the term used for someone with a smaller/lower medial longitudinal arch?

Pes planus

What is the term used for someone with a higher/larger medial longitudinal arch?

Pes cavus

How many ankle sprains occur everyday?

25,000

What four areas should be palpated for tenderness when following the ottawa ankle rules?

Posterior lateral malleolus, posterior medial malleolus, navicular, and base of 5th metatarsal

When tenderness is absent, what is the next step in the ottawa ankle rules?

Have patient take 4 steps forward

Why do we use the ottawa ankle rules?

To see if they need a radiograph; reduce recommendations for radiograph

What are the grades and general tissues that are implicated for ankle sprains?

Grade 1-slight stretching and microscopic tearing of ligament fibers (interstitial damage) Grade 2- partial tear with ligamentous laxity Grade 3- Full rupture

Explain the importance of detecting a high ankle sprain.

It is a syndesmotic joint and tearing can create diastasis. | It can also lead to OA and instability.

What might you see in your observation that would lead you to believe that the patient had a high ankle sprain?

Ecchymosis that is more proximal than the malleoli

What are the arthrokinematics of the talocrural joint?

Convex on concave

What are three mobilizations you can do to improve DF?

Eversion at STJ (Valgus tilt) Posterior glide Anterior glide of fibula Mobilization with Movement (active DF with posterior glide)

What are three mobilizations you can do to improve PF?

Inversion at STJ (Varus tilt) Anterior glide Posterior glide of fibula Mobilization with Movement (active PF with anterior glide)

What is the capsular pattern of the talocrural joint?

PF > DF

What is a morton’s foot?

The 2nd ray is longer than the 1st ray (including not just the phalanges but also the metatarsal - the 2nd MTP will be passed the 1st MTP)

What is the clinical significance of this?

Alters the toe-off during gait - all the force will be going through the 2nd MTP joint instead of the 1st MTP joint that is designed for toe-off

What should be done for these patients?

Orthotic with a 1st ray extension

What percentage of the population has this?

22%

What are three aspects of the Well’s Criteria? (Keep in mind he may make us name 3 more…)

Paralysis, paresis or recent orthopedic casting of LE (1 pt) Recently bedridden (> 3 days) or major surgery within past 4 weeks (1 pt) Localized tenderness in deep vein system (1 pt) Swelling of entire leg (1 pt) Calf swelling 3 cm greater than other leg (measured 10 cm below tibial tuberosity (1 pt) Pitting edema greater in symptomatic leg (1 pt) Collateral non-varicose superficial veins (1 pt) Active cancer or cancer treated within 6 months (1 pt) Alternative diagnosis more likely than DVT (Baker’s cyst, cellulitis, external venous compression, etc.) (-2 pts)

What score do you have to get in order to have a high likelihood of DVT? (well's criteria)

> 3 points

What’s another quick test you can do to screen for DVT?

Homan’s test

In case he lets us choose another bonus...According to the Turner 2009 study, what is the strongest scapulothoracic muscle?

Upper trapezius

What is the weakest scapulothoracic muscle? If he makes us name them in order from strongest to weakest:

Lower trapezius upper trap, serratus anterior, middle trapezius, rhomboids, lower trapezius

Explain (he may make us draw it I think we had to last year) closed packed position

The talocrural joint resembles a mortise lock. The talus locks into the distal tibia and fibula when in dorsiflexion.

What is the loose packed position of the ankle and how does this affect the integrity of the supporting ligaments?

The talus is out of the “mortise” in plantarflexion therefore making the ligaments more susceptible to strain and injury due to increased stress and tension put on them.