Penney 12-4-07 Em - Musculoskeletal

Front 1

Say the word "skeletal"

Back 1

wrong.

It's Skah-LEE-tul

Front 2

2 types of incomplete fractures

Back 2

Buckle (torus)
Greenstick

Front 3

Buckle (torus) fracture – buckling of one cortex due to excessive compressive forces applied to the bone, usually at the m_______

Back 3

metaphysis

Front 4

Greenstick fractures – angular force applied to the bone – fracture of one cortex with b________ of the opposite cortex

Back 4

bending

Front 5

In children, angulation of a long bone may cause the bone to break only on the _____ side.
a) concave
b) convex

Back 5

convex

Front 6

On the ____ side, the periosteum and cortex remain intact (similar to the bark on a young, flexible twig

a) concave
b) convex

Back 6

concave

Front 7

Incomplete fractures are seen in what people?

Back 7

children only

Front 8

type of fracture where Both cortices are disrupted

Back 8

Complete Fracture

Front 9

N______ fractures – limited contact with a solid object, soft tissue injury is minimal as multiple fragments are rare

Back 9

Nightstick

Front 10

____ velocity injuries – minimal soft tissue damage
Minimal bony fragmentation

Back 10

Low

Front 11

____ velocity injuries – significant bony fragmentation
Extensive soft tissue damage as fragments become secondarily penetrating objects

Back 11

High

Front 12

______ injury – results in multiple bony fragments with resultant significant soft tissue injury

Back 12

Crush

Front 13

Spiral Fracture
- R_______ forces applied to a bone
- Common in abuse situations

Back 13

Rotational

Front 14

Compression Fractures
- A______ loading
- Fracture pattern can vary based on additional rotational forces that may be concomitantly applied

Back 14

axial

Front 15

A_______ Fractures
- tendons/ligaments are maximally stretched, disrupting insertion sites

Back 15

Avulsion

Front 16

Spiral Fracture
Compression Fractures
Avulsion Fractures

are all types of ______ trauma

Back 16

Indirect Trauma

Front 17

type of spinal Fracture sustained by building jumpers and gymnastics

Back 17

compression

Front 18

No associated disruption of the overlying skin - a _______ fracture

Back 18

Closed Fractures

Front 19

OPEN FRACTURES:
- Variable soft tissue injury with disruption of the overlying skin
- warrant further management including:
- antibiotic coverage (what kind?)
- t_____ prophylaxis
- consider irrigation (usually managed in the operating room)

Back 19

(first generation cephalosporin +/- gentamycin)

tetanus

Front 20

___________tion – articular surface of a joint is completely disrupted

Back 20

Dislocation

Front 21

Subluxation – articular surface is ________ disrupted
- spontaneous relocation is relatively common

Back 21

partially

Front 22

Immediate Management of Fractures (Highlighted bullets)

C_________ Syndrome
Neurologic dysfunction
Vascular abnormalities
_____(color) extremities
_____(temp of) extremities

Back 22

Compartment Syndrome
Neurologic dysfunction
Vascular abnormalities
Pale extremities
Cold extremities

Front 23

If a fracture is causing neurovascular deficits, immediate __________ should be performed

Back 23

reduction and splinting

Front 24

Open fractures should be covered with ______

Back 24

gauze soaked with sterile saline

Front 25

Compartment Syndrome considered in the acute setting
Seen with ______ fractures

Back 25

closed

Front 26

Compartment Syndrome considered in the acute setting
Seen with closed fractures
__________ tissue overlying the fracture

Back 26

Tense soft

Front 27

Classical Findings of Compartment Syndrome
5 Ps

Back 27

Pallor
Pulselessness
Pain
Paresthesias
Pikilothermia

Front 28

Decreased or absent pulses are a late finding in compartment syndrome.
What if you find a pulse in the injured extremity?

Back 28

The presence of a pulse does not exclude compartment syndrome

Front 29

Due to alteration of normal mental status, delays in recognition of compartment syn are more likely to occur in what pts?

Back 29

sedated patients or those with head injuries

Front 30

Diagnosis of compart. syn. can be confirmed by measuring intra-compartmental pressures with a ______ needle or with a needle connected to an arterial line pressure monitor

Back 30

Stryker

Front 31

Stryker needle pressure Levels above 30 mm Hg are

a) normal
b) abnormal

Back 31

abnormal

think compartment syndrome

Front 32

Treatment Compartment Syndrome
Initially immobilization & elevation
cooling and removal of any constricting bandages or splints
Intra-compartmental pressures greater than 30mm Hg generally require immediate intervention with f___________
Procedure usually performed by surgeon if possible

Back 32

fasciotomy

Front 33

We should look up the Salter classifications

Back 33

system for classifying fractures, fracture-separations, and separations of the physis into five types.
Salter type I—a separation line through the epiphyseal plate only;
Salter type II—a partial separation of the epiphyseal plate and fracture into the metaphyseal bone;
Salter type III—a partial separation of the epiphyseal plate and a fracture through the epiphysis;
Salter type IV—a fracture through the metaphysis, across the epiphyseal plate and through the epiphysis;
Salter type V—a crushing or compression injury to the epiphyseal plate.

Front 34

_______ – cartilaginous end(s) of a bone

Back 34

Epiphysis

Front 35

_______ – cartilaginous zone between epiphysis & calcified cartilage(metaphysis)
(AKA epiphyseal plate or growth plate
After it closes – referred to as epiphyseal line)

Back 35

Physis

Front 36

_______ – ossified portion of an epiphysis

Back 36

Metaphysis

Front 37

_________ – shaft of a tubular bone

Back 37

Diaphysis

Front 38

Stage I, II, III, and IV of bone healing

Back 38

* 1. Reactive Phase
i. Fracture and inflammatory phase
ii. Granulation tissue formation
* 2. Reparative Phase
iii. Callus formation
iv. Lamellar bone deposition
* 3. Remodeling Phase
v. Remodeling to original bone contour

Front 39

Acromioclavicular Separations
Mechanism: ________

Back 39

fall to an outstretched or an adducted arm(FOOSH)

Front 40

Acromioclavicular Separations Presentation:

Back 40

pain over the AC joint
- more extensive injuries will have an obvious deformity over the AC joint

Front 41

Acromioclavicular Separations Diagnosis:

Back 41

X-rays should be taken of the shoulder and both clavicles
- stress views are no longer recommended

Severity – Types I-IV

Front 42

Type I AC Separation:
Partial tear of the acromioclavicular ligament (AC)
_________ ligament remains intact (CC)

Back 42

Coracoclavicular

Front 43

Type I AC Separation:

Partial tear of the AC joint
Coracoclavicular lig remains intact
AC joint itself maintains normal alignment
X-rays are _____
Treatment: is symptomatic
- analagesic and sling use as needed(prn)

Back 43

normal

Front 44

Type II AC Separation:
___ tear of the AC ligament
Intact CC ligament
Normal anatomic alignment of the AC joint is maintained
Slight displacement of the clavicle may be visualized on x-rays
Treatment is the same as for Type I

Back 44

Full

Front 45

Type III AC Separation:
Full tear of the AC ligament
Full tear of the CC ligament
An obvious deformity is present
The distal clavicle is displaced _______ both on physical examination and on X-ray
Treatment is controversial
- some cases managed operatively and some managed non-operatively

Back 45

superiorly

Front 46

Type IV-VI AC Separation:
Complete tear of the AC & CC ligaments
Clavicular displacement varying with the type of injury
All of these cases are managed _____

Back 46

operatively

Front 47

Sternoclavicular Dislocations
Mechanism: direct trauma to ___ joint
Falls to outstretched extremity

Back 47

SC

Front 48

Sternoclavicular Dislocations Presentation: pain over the joint
- pain with motion of the affected extremity
- high degree of suspicion must be maintained, as ___________ dislocations can be life threatening due to joint proximity to the mediastinum(& great vessels)

Back 48

posterior ********

Front 49

Sternoclavicular Dislocations Diagnosis: PE subtle deformity, pain at site, slight decreased ROM
X-ray: plain CXR (PA & lateral)
- Sternal views
- if X-rays negative – CT Scan
Treatment: _______ dislocations – surgical emergency proximity to great vessels
- Anterior Dislocations – analgesics & sling

Back 49

Posterior

Front 50

95% all shoulder dislocations:
a) anterior
b) posterior
c) inferior
d) superior

Back 50

Anterior Dislocation

Front 51

Anterior dislocation:
Affected extremity position – abducted & ____ rotated

Back 51

*********

externally

Front 52

Types of anterior dislocations

Back 52

: 1. Subcoracoid
2. Subglenoid
3. Intrathoracic
4. Subclavicular

Front 53

Light bulb sign = what dislocation?

Back 53

posterior

Front 54

Posterior dislocation:
Occur after s______ or lightening strikes, psychiatric

Back 54

seizures

Front 55

Posterior dislocation:
Affected extremity position – adducted, _______ rotated

Back 55

internally

Front 56

Name some nonsurgical treatments for should dislocation

Back 56

Traction – countertraction
Scapular manipulation
Stimson – prone,patients extremity dangling off stretcher

Front 57

Most common of the previous question

Back 57

Stimson

Front 58

When do you get a Orthopedic surgery consult with a dislocation?

Back 58

:
1. Any dislocation involving a fracture
2. A nerve injury
3. An inability to reduce the dislocation

Front 59

Complications of Dislocation/Reduction

Name some nerve problems****

Back 59

Axillary nerve damage(loss of sensation over deltoid)
Musculocutaneous Nerve injury (loss of sensation along dorsal forearm)

Front 60

Complication of dislocation reduction :
Bony injury – Hill Sachs Fracture – fracture of the posterior aspect of the humerus as it abuts the glenoid during the process of _________ dislocation

Back 60

anterior

****Board question

Front 61

Complication of reduction of dislocated shoulder:

Reverse Hill Sachs Fracture – fracture of the anterior aspect of the humeral head as it hits the glenoid during posterior dislocations is seen with ________ dislocations

Back 61

posterior

Front 62

Pts with cervical disc problem have high chance of what other MS problem?

Back 62

shoulder

Front 63

Rotator Cuff Injuries:
Seen after fall onto the shoulder, heavy lifting, after forceful _______ of the extremity
Presentation: weak ________, anterior shoulder pain

Back 63

abduction

Front 64

Rotator Cuff Injuries:
Chronic Tears: significantly more common, particularly after age 40, due to chronic impingement
Presentation: pain is more gradual in onset
- pain may be exacerbated by attempts at _________ and rotation of the shoulder

Back 64

abduction

Front 65

Rotator Cuff Injuries:
Diagnosis: PE – i_______ each the cuff muscles for strength testing
X-rays: are not necessary

Back 65

isolation

Front 66

Rotator Cuff Injuries:
Treatment: Analgesics, sling for comfort, attention to gentle ROM exercises prevent _________ capsulitis
- Chronic – periscapular strengthening/physical therapy
- possible surgical repair

Back 66

adhesive

Front 67

What are the SSIT muscles?

Back 67

Subscapularis
Supraspinatus
Infraspinatus
Teres minor

Front 68

Scapular Fractures:
Commonly associated with high velocity trauma(blunt trauma)
Injuries are often picked up during ATLS protocols
Subsequent __________ injury should be ruled out with imaging
Usually managed non-operatively with analgesics and sling

Back 68

lung and abdominal

Front 69

Proximal Humeral Fractures:
Commonly seen in the _______ who has tripped & fallen on FOOSH
Presentation: pain around shoulder, decreased ROM
Fracture is defined based on injury to following anatomic parts: - anatomic neck
- surgical neck
- greater tuberosity
- lesser tuberosity

Back 69

elderly

Front 70

Proximal Humeral Fractures:
Classification: one part fracture – one area affected & not displaced
Two part fractures –displacement of one fragment
Three part fractures – two displaced fragments
Four part fractures – _____ parts displaced

Back 70

three

Front 71

Proximal Humeral Fractures:
Treatment
Analgesics/sling
1,2,3 part fractures managed non operatively
4 part fracture – operative fixation(sometimes hemi-arthroplasty)
Rule out _______ n injury
Effect of gravity on slinged arm will reduce fracture

Back 71

axillary ********

Front 72

Humeral Shaft Fractures:
Occur with a FOOSH
May occur as pathologic fractures, particularly in ________ patients

Back 72

breast cancer

Front 73

Humeral Shaft Fractures:
If an associated _______ nerve injury (wrist drop) has been ruled out these patients can be placed in a coaptation sling & followed up with orthopedics
_______ nerve injury mandates ORIF

Back 73

radial

Front 74

Elbow Fractures(Proximal Ulna, Radial Head):
difficult to directly visualize on x-ray
Presence of a ________ fat pad sign on the lateral x-ray highly suspicious
Anterior fat pad sign may be seen on N x rays

Back 74

posterior

Front 75

Elbow Fractures(Proximal Ulna, Radial Head):
Anterior humeral line can be used to detect fractures (line drawn along the anterior border of the humerus on lateral x-ray, should transect the c________

Back 75

capitellum

Front 76

Elbow Fractures(Proximal Ulna, Radial Head):
Radial ______ fracture – should be suspected if the patient notes pain with pronation/supination
Assuming a N neurovascular exam, patients with occult fractures should be placed in a sling for comfort(non-displaced fractures) or a splint (displaced fractures) + ortho follow-up

Back 76

head

Front 77

Elbow Dislocations:
more common with anterior dislocations
- _________ nerves commonly injured
- any neuro deficit warrants immediate reduction
Once reduced patient should be splinted in flexion & ortho follow up

Back 77

ulnar & median

Front 78

Forearm Fractures:
M________ Fractures – fractures of mid-ulna with proximal radial dislocation
- radial nerve injury common
- necessitating ORIF

Back 78

Monteggia

Front 79

Forearm Fractures:
G______ Fractures – distal radial fractures with associated disruption of the distal radioulnar joint
- due to this joint instability ORIF required

Back 79

Galeazzi

Front 80

MUGER?

Back 80

?

Front 81

Hand & Wrist:
____ Fractures: most common carpal fracture
The MC mechanism –FOOSH

Back 81

Scaphoid

Front 82

Hand & Wrist:
X-ray – majority _____ (n or p?)
Management – neg x-rays & high clinical suspicion do not change management
Patients placed in a thumb-spica splint
Repeat x-rays in 10-14 days

Back 82

negative

Front 83

hand and Wrist:
Complications – prone to non-union & avascular necrosis due to tenuous blood supply
Most fractures thru the proximal aspect of scaphoid while the blood supply enters ________, thus making healing difficult

a) distally
b) proximally

Back 83

distally

Front 84

Smith vs. Colles Fractures:

Distal _____ fractures
Mechanism: FOOSH

Back 84

radius

Front 85

Smith vs. Colles Fractures:

Resultant dorsal angulation of the distal fragment – ______ fracture(displaced posteriorly)
_______ nerve injuries common associated with this fracture
Immediate attempts at closed reduction should be attempted once adequate x-rays & analgesia obtained

Back 85

Colles

Median

Front 86

Smith vs. Colles Fractures:

_______ fracture: FOOSH
Resultant volar angulation (displaced ________)
Median nerve injuries are not as common as with Colles
Immediate attempts at closed reduction after x-ray/analgesia
a) anteriorly
b) posteriorly

Back 86

Smith’s


anteriorly

Front 87

Injection Injuries to Hand:
True orthopedic emergency
Typically inflicted by _____ guns

Back 87

paint

Front 88

Injection Injuries to Hand:

Injury is far more extensive than surface lesions indicate
Fluid travels along the tendon s______
Nature of the substance injected must be considered
Toxic/necrotizing substances may cause further damage

Back 88

sheath

Front 89

Injection Injuries to Hand:

Management: affected body part splinted, transport to OR for definitive RX
Analgesics, broad spectrum antibiotics
T______

Back 89

Tetanus

Front 90

Extensor Tendon Injuries:
M_______ Finger: disruption of the extensor tendon from the DIP

Back 90

Mallet

Front 91

Extensor Tendon Injuries:
Affected joint should be splinted in extension for minimum __ weeks
Imperative not to remove splint for any reason

Back 91

6

Front 92

Extensor Tendon Injuries:
Failure to properly treat mallet finger may lead to __ deformity(persistent mallet finger with hyperextension of PIP)

Back 92

swan neck

Front 93

Boutonniere Deformity:
Opposite of the ______ finger

Back 93

mallet

Front 94

Boutonniere Deformity
Flexion of the PIP with hyperextension of the ____

Back 94

DIP

Front 95

Boutonniere Deformity:

This injury typically results from a ruptured central slip at the PIP
If this injury is found in ED the extremity should be splinted in extension X 6 weeks
Definitive operative repair is _______
a) optional
b) required
c) depends on details

Back 95

required

Front 96

DeQuervain’s Tenosynovitis:

An inflammation of the first _____ compartment of the hand

Back 96

dorsal

Front 97

DeQuervain’s Tenosynovitis:

Abductor pollicus _____ and extensor pollicus _____ are contained in this anatomic area

Back 97

longus

brevis

Front 98

DeQuervain’s Tenosynovitis:

Mechanism: injury frequently develops from _____ of the thumb/wrist

Back 98

overuse

Front 99

DeQuervain’s Tenosynovitis:

Diagnosis: F________ test – flexion of the thumb across the volar palm followed by ulnar deviation recreates symptomatology
Management:Thumb-Spica splint

Back 99

Finkelstein’

Front 100

Pelvic Fractures:
Mechanism/Classification: _______ trauma(MVA, pedestrian,crush, falls)

Back 100

high velocity

Front 101

Pelvic Fractures:
Classification – Kane modification system – based on the ______ of disruption to pelvic ring
Tile classification: based on the _______ of the applied force

Back 101

number

direction

Front 102

Pelvic Fractures:
Management: Standard ATLS protocols
Suspect pelvic fracture if blood is found at ________
_______ tenderness another clue
*******Potential for significant blood loss (up to 5L) – FAST US

Back 102

urethral meatus

Rectal

Front 103

Pelvic Fractures:

Attempts to stabilize pelvis – external binder, _______ tied around the pelvis –approximate SI joints
Operative fixation/embolization in angiography

Back 103

sheets

Front 104

If the pelvic ring is broken at its periphery or at one level, the fracture is _______

a) serious
b) stable

Back 104

stable

Front 105

If there is disruption at ___ levels, then there is potential for displacement and considered unstable

Back 105

two

Front 106

Hip Fractures:
Typical patient elderly individual tripped & fallen
Extremities held ______ & in ______ rotation typical for femoral neck fracture

Back 106

abducted

external

Front 107

Hip Fractures:
Patients may be ambulatory at time of presentation
Minimally displaced femoral _____ fractures occasionally treated with pinning, most require hemiarthroplasty

Back 107

neck

Front 108

Hip Fractures:
Extremities with marked _______ rotation more likely intertrochanteric fractures
Patient not able to ambulate
Treated with pinning and rarely hemiarthroplasty

Back 108

external

Front 109

Hip Dislocation:
Result of high velocity trauma
True ortho emergencies prolonged dislocations compromise vascular supply to femoral _____

Back 109

head

Front 110

Hip Dislocation:
Dislocations > 6 hours result in avascular ______ femoral head
Arthroplasty – hemiarthroplasty patients should be reduced ASAP to decrease muscle spasm

Back 110

necrosis

Front 111

Hip Dislocation:

No danger to vascular supply
________ Dislocation – more common than anterior 90:10

Back 111

Posterior

Front 112

Hip Dislocation:

Management: reduction technique begins with adequate conscious sedation
Affected limb is distracted _______ to disengage femoral head from the acetabulum
Once acetabulum is cleared femoral head is able to relocate into bony pelvis

Back 112

inferiorly

Front 113

Hip Dislocation:

Complications – ____ N injury

Back 113

sciatic

Front 114

Long-term, systemic (oral or intravenous) steroid use is associated with 35% of all cases of non-traumatic __________ necrosis

Back 114

avascular necrosis.

However, there is no known risk of AVN associated with the limited use of steroids.

Front 115

Why do steroids cause avascular necrosis?

Back 115

they may interfere with the body’s ability to break down fatty substances -->
build up and clog the blood vessels, causing them to narrow, ->
bone perfusion decreases

Front 116

Knee – ACL/PCL Injury

Posterior forces applied to extended knee can result in ___ disruption

Back 116

ACL

Front 117

Knee – ACL/PCL Injury:

Posterior forces applied to extended knee can result in ACL disruption
Significant posteriorly directed forces can result in ________ disruption as well

Back 117

posterior cruciate ligament (PCL)

Front 118

Knee – ACL/PCL Injury:

Posterior forces applied to a flexed knee (I.e..MVA) can result in isolated ____ injury

Back 118

PCL

Front 119

Knee – ACL/PCL Injury:

Addition of rotatory forces can result in collateral ligament A/O ____ injury

Back 119

meniscal

Front 120

Knee Examination:

Affected knee will likely have an e__________

Back 120

effusion(hemarthrosis)

Front 121

Knee Examination:

Tenderness along the bony insertions of the affected ligament
ACL stability should be assessed with the knee in 20 degrees of flexion(_______ Test)

Back 121

Lachman’s

Front 122

Knee Examination:

Anterior force applied to the tibia while stabilizing the femur
Laxity relative to the unaffected knee is indicative of ____ tear

Back 122

ACL

Front 123

Knee Examination:

ACL stability can also be assessed via the pivot ____ test – with the patient supine and hip flexed to 45 degrees, the extended knee is picked up by the examiner

Back 123

shift

Front 124

Knee Examination:

The knee is then flexed and fluidity of motion assessed(a click or catch during flexion indicates ____ tear)
RX: hinged knee brace

Back 124

ACL

Front 125

Meniscal Injury:

Function of menisci serve as shock absorber of knee
Mechanism – injured with twisting injury combined with ______ loading
Significant trauma not needed

Back 125

axial

Front 126

Meniscal Injury:

Presentation – significant pain along the joint line
Small effusion +/-
Patients may note a ______ sensation when walking as torn fragment is caught between tibia & femur

Back 126

clicking

Front 127

Meniscal Injury:
Larger tears may cause knee to ____

Back 127

lock

Front 128

Meniscal Injury:

Diagnosis: McMurray’s Test – patient supine, hip flexed to 90 D, knee extended while rotating tibia medially & laterally in attempt to catch the meniscal fragment between tibia & femur
A palpable ____ over the joint line is positive test

Back 128

clunk

Front 129

Muscles of the anterior lower leg compartment. name them (4)

Back 129

Tibialis anterior muscle
Extensor hallicus longus
Extensor digitorum longus
Peroneus tertius muscles

Front 130

Compartments Lower Leg:
Anterior Compartment:
These structures function to dorsiflex foot & extend toes
_______ nerve supplies theses muscles as does the ______ artery

Back 130

Deep peroneal

anterior tibial

Front 131

Lateral Compartment of lower leg

name muscles, nerve and function

Back 131

Peroneus longus muscle
Peroneus brevis muscle
Superficial peroneal nerve
Foot eversion

Front 132

Posterior Compartment of lower leg

name muscles

Back 132

Gastrocnemius
Soleus
Plantaris muscles
Primary plantar flexors of foot

Front 133

DEEP POSTERIOR COMPARTMENT of lower leg:

name muscles and function

Back 133

DEEP POSTERIOR COMPARTMENT
- Posterior Tibial muscle
- flexor hallicus longus
- flexor digitorum longus
- assist in plantar flexion of the foot

Front 134

Compartment Syndrome:
Can occur acutely in any of the compartments in the leg
Occurs with significant soft tissue injury / ______ fracture

Back 134

closed

Front 135

Compartment Syndrome:
Key Examination Findings:
- tense compartments
- pain out of proportion to exam
- loss of sensation
- pain with passive & active motion
- late findings include _______

Back 135

loss of pulses, loss of skin color

Front 136

Compartment Syndrome:

Treatment: immediate ____ release, formal measurement of compartment

Back 136

fascial

Front 137

Compartment Syndrome:

Chronic Compartment Syndrome – can occur with ________
- patients often asymptomatic between activities, develop symptoms within 5-10 minutes of activity

Back 137

regular exercise

Front 138

Ankle Injuries:

Lateral Ligaments:
list in order of injury frequency!
- commonly injured when a plantar flexed foot is inverted

Back 138

- anterior talofibular ligament(ATFL)
- calcaneofibular ligament
- posterior talofibular lig

Front 139

Ankle Ligaments – Deltoid Ligament

Medial ligamentous complex
Particularly strong
Isolated injuries are rare
________ of the foot will cause damage to this structure(pronation)

Back 139

Eversion

Front 140

Ankle Ligaments – Deltoid Ligament

Syndesmotic and or fibular injuries (M_______ fractures) commonly associated with deltoid lig injury as forces are transmitted across the syndesmois

Back 140

Maisonneuve

Front 141

Syndesmotic Ligaments

name them

Back 141

Anterior tibiofibular ligament
Posterior tibiofibular ligament
Transverse ligament
Interosseous membrane

Front 142

Syndesmotic Ligaments

Injuries are particularly _____ (stable/unstable?)
Require extended non-weight bearing status & physical therapy to return to previous levels of function

Back 142

unstable

Front 143

Syndesmotic Ligaments:

Diagnosis: palpate the joint line
- perform the ____ test
- squeeze the tibia & fibula together at the level of the distal gastocnemius belly
- this will send forces along the interosseous membrane – if the membrane is disrupted at the syndesmosis, the patient notes syndesmotic pain

Back 143

squeeze

Front 144

Syndesmotic Ligaments:

Ext.rotation test – patient sitting with knee flexed to 90D, externally rotate foot, pain at syndesmosis is indicative of ______ injury

Back 144

ligamentous

Front 145

General Diagnosis Ankle Injuries

History – What is position at time of injury?

Determine if previous injury

Back 145

patients often do not know position of foot/ankle at time injury

Front 146

General Diagnosis Ankle Injuries

Exam: all bony structures should be palpated
- both m______i
- syndesmosis
- proximal fibula
- base of the 5th metatarsal
- all bones of mid & forefoot

Back 146

malleoli

Front 147

General Diagnosis Ankle Injuries

Anterior Drawer Test- assesses ATFL stability
Patient sitting, knee flexed to 90D,ankle in neutral position
- one hand stabilizes distal tibia, while opposite hand is placed on c_______
- anterior force is applied to c_________, laxity compared to contralateral extremity

Back 147

calcaneus

Front 148

Ankle – Talar Tilt Test

Assess the ATFL & ______ ligaments

Back 148

calcaneofibular

Front 149

Ankle – Talar Tilt Test:

Extremity is placed in a similar fashion as the anterior drawer test
Instead of applying an anterior force the examiner ____ the foot
Again, laxity should be compared to the contralateral side

Back 149

inverts