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37 Cards in this Set
- Front
- Back
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Sprain
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Ligamentous Injury
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Ankle Sprain
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sudden stress on one or more of supporting ligaments of the ankle : anterior talofibular or calcaneofibular
usually inversions, pain is acute, swelling occurs in first hour |
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Classifications of sprains
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First degree: minimal ligament tear and joint stability with minimal pain and swelling
Second degree: appreciable tear but stable joint, pain with bearing, with ecchymosis and swelling Third degree: complete ligamentous tear and joint instability and difficulty weight bearing |
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Severe ankle injuries
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1. Eversions
2. immediate diffuse swelling- may mean hemorrhage 3. inability to bear weight immediately 4. sensation of pop or snap or joint locking 5. positive drawer sign (anterior talofibular) or talar tilt test (calcaneofibular) or squeeze test (syndesmotic injury) |
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Squeeze test
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Place one hand on the patient's tibia and the other on his or her fibula. Make sure your hands are low enough on the leg to be close to the ankle.
-pain is positive |
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Talar tilt test
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To test the calcaneofibular ligament the examiner will adduct and invert the calcaneous into a varus position. The deltoid ligament is examined by abducting and everting the calcaneous into a valgus position. A positive test will result in laxity and/or pain.
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drawer sign
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pull ankle forward
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Ottawa Rules for Ankle Xray
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1. can't take more than four steps
2. malleolar pain 3. base of fifth metatarsal 4.bone tenderness/ pain in midfoot- navicular |
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Ankle treatment
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Refer all grade 3 and eversions to an orthopedist
RICE for the first 48 hrs hot and cold after the first 48 (4:1 min ratio), if the pain and swelling are resolving Initial exercises- writing alphabet with big toe NSAIDS 600-800mg q8h Tylenol for elderly and renal impaired Reassess 7 days post injury |
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Ankle fracture classification
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Weber
A: below the level of ankle joint B: at the level of ankle joint C: above the level of ankle joint |
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Knee injury
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Strains and sprains of the collateral and cruciate ligaments by force
-abduction, hyperextension or direct blow to knee |
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Strains
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stretching of muscles or tendons
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Grades of knee sprains
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1: involves stretching fibers without significant structural damage
2:involves partial disruption of fibers with increased laxity 3: involves complete tearing of ligamentous tissues |
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Clinical presentation of Knee Sprain
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pain, stiffness, tenderness, and swelling
typically involves tears of the medial and lateral meniscus |
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MCL
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most common knee sprain
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Predispostion of low back injurys
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occupational strain, obesity, exaggerated lumbar lordosis, abnormally forward tipped pelvis, weak paraspinal or adb muscles, leg length discrepancy
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ACL
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may have an audible pop with give away weakness and demonstrate positive lachman's test
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PCL
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positive drawer test
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Clinical presentation of meniscus injury
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medial more common than lateral
- recall twisting, flexion injury followed by pain, difficulty flexing knee and bearing weight -may involve clicking, locking, catching or give away -knee joint effusion and tenderness over joint line is common |
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Clinical presentation of patellar injury
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-subluxation or dislocation occurs more frequently in women and involves meidal tenderness and effusion
- dislocation reduces when leg is extended - extension and external rrotation/ direct blow to knee - palpate- pain at joint= mensicus, pain above or below= ligament |
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Knee Effusion
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- heat over joint
-can require artheoscentisis |
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Leg Fractures
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falls or accident
unable to lift thigh toes/ankle shoule be ok leg length decreased- femor or tibial crepitus |
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Assessment
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injury details, point of pain and most painful. previous injuries, swelling right after or over time, systemic- fever, chills, hobbies/occupation, self treatments, compare affected and non, gait and leg length, deformities and discolorations,
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Ottawa knee rules
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over 54 year old
isolated tenderness of patella only tenderness at the head of fibula inability to flex 90 degrees or bear weight and walk more than 4 steps |
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Knee Injury Treatment and Exercise
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RICE first 48, then hot/cold, NSAIDS PRN
Exercise: minor injuries- exercise after 1-2 days of rest extensive= isometric exercised for quadriceps and ROM after acute inflammation subsides |
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Knee injuries to refer
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Vascular compromised, tibia or femur dislocation, growth plate injuries, 2-3 grade sprain, knee that is locked, large mensicus tear, tumor suspected
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Low back Pain
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Lumbosacral strain
herinated invertebral disc spinal stenosis |
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lumbosacral strain
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unclear etiology, but usually results from stretching or tearing of muscles, tendons, ligaments or fascia of back secondary to trauma or chronic mechanical stress,
2nd to 4th decade of life, pain 12-36hrs after injury due to tissue swelling, pain in back, buttocks or legs |
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Herniated intervertbral disc
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occurs when tears in the annulus fibrosis which allows the nucleus pulposus to protude. When the nerve roots become compressed by this pathology, pain and other neurological signs and symptoms appear
- young and middle aged adults -characterized by radicular pain: sharp shooting, electric like pain, associated with foot or leg pain and worsened with valsalva maneuvers |
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spinal stenosis
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caused by soft tissue and bony encroachment of the spinal canal and nerve roots
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Cauda Equina
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compression of the lower portion of the nerve roots inferior to the spinal cord proper, may occur secondary to central disc herniation and presents as insidiously worsening rectal and/or perineal pain with decreased perineal sensation, loss of sphincter control and disturbances in bowel and bladder functions
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DX tests for back pain
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no tests if under 4 weeks and absence of signs and symptoms
if red flags: x-ray of the spine: a/p, flexion, extension CBC, ESR, UA, bone scan if CA suspect over 4 weeks: MRI or CT to r/o stenosis consult surgeon and add EMG to determine nerve root |
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pain management
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APAP/NSAIDS
short term opioids no bed rest minimize stress to back low stress aerobic |
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Indications for back Sx
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any pt with major or evolving neurologic deficits
abn bowel or bladder fxn disk disease sx when evidence of herination incapacitating nerve root pain despite tx for at least 4 weeks recurrent incapacitating pain despite conservative tx |
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Low back pain tx
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rest and back exercises ineffective for acute back pain
continue activities corticosteriod injectio yoga like exercises |
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Osteoarthritis
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degenerative joint disease with slow destruction of the articular cartilage
onset 53-64yo, more women, better in morning and worse as day goes worse with activity and relieved by rest dense smooth surfaced bone forms at the base of the cartilage lesion and marginal osteophytes develop synovial inflammation results estrogen excess is possible contributory factor genetic predisposition age, obesity, |
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OA clinical presentation
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angular deformities of affected joints, limited ROM, crepitus and occasional joint effusions,
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