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50 Cards in this Set
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- Back
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Unit 10
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see possible questions prior to this one
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What are the signs of ankle fracture or avulsion fracture?'
Avulsion: Small fracture caused by strong ligament that pulled off a small piece of the bone. TEST |
1) Heel percussion test +
2) Severe/broad swelling around the joint 3) Severe ankle tenderness, dysfunction of walking (sometimes hurts so bad they cannot lightly touch their foot on the ground) 4) Bony crepitus and abnormal appearance of affected joint 5) Radiology plain film diagnosis FRACTURE: Causes more swelling and swells the entire joint. If swelling on one side, it's typically just a sprain. NOTE: A fracture might also just look abnormal due to shift in the bone. |
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Which is more common avulsion on lateral or medial side?
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Medial, b/c the medial ligaments are stronger
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Which is more common side to sprain?
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Lateral, b/c the muscles, ligaments and bones are weaker on this side.
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What is the Tuina Tx Tech for ankle sprain?
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ACUTE (less than 2 days) Tech: GENTLE rubbing, kneading to affected area for acute case or AVOID. Or can use herbal paste, replaced daily (usu. moving blood, moving qi herbs, cooling blood).
CHRONIC Tech: Med pressure, KN, PL, RO, ThMed Can also set the affected joints with brace or cardboard brace (wrapped with bandage). |
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How do you create a brace?
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Cut cardboard into a kidney bean shape (according to the ankle area); or you can fold newspaper several times and then cut it. You put the KI bean divot so that it rests underneath the malleolus.
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What is the Tuina Tx protocol for ankle spains?
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1) Gentle or Medium massage
2) Stretches 2) Herbal paste 3) Brace 4) Wrap it NOTE: Can also ask the pt to do an herbal soaking |
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What is a simple formula for an herbal paste for an acute sprain?
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Da Huang, Huang Lian, Huang Bai, Zhi Zi, Huang Qin [ground into powder but you can make your own]
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What are the acupuncture points?
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SP5, KI6, ST41,
BL60, BL62, BL63 GB39 GB40 |
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Can you do bloodletting for an ankle sprain?
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yes, it's a quick way to remove the swelling and you can use cupping and herbal paste afterwards (but make sure the foot is cleaned well several times before bloodletting)
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Can you do moxa in the acute stage?
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No, better not but can use in the chronic stage.
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What are the precautions for an ankle sprain?
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1) Gentle technique if acute (less than 48 hours); med tech can be applied in recovery or chronic to relieve adhesion and stiffness
2) Fixation on the affected joint, avoid exertion of the affected foot in the acute stage 3) Start exercise slowly after acute stage such as ext and flex of toes and ankle joint 4) Avoid improper hand technique on ankle joint fracture. |
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What causes heel pain?
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Causative Factor: improper or violent exertion, obesity, over walking, improper shoes and heel degeneration.
NOTE: If overweight, try and encourage weight reduction. Support shoes. |
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What is the pathological process of heel pain?
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Acute or chronic strain, inflammation or congestion, swelling, adhesion, fibrosis or calcification [bone spur]
NOTE: It's common for the affected side to have puffy, tight heel (water retention, inflammation or the bursa and fat body). |
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How is heel pain treated?
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1) Relax muscle
2) Relieve tendon 3) Promote circulation 4) Relieve swelling |
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What is the order of the tuina for heel pain?
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1) calf [GR, KN, RO, PR]
2) sole, aponeurosis (heel pain is mostly caused by the plantar aponeurosis stress), [PR, PU deep, PL] 3) heel - Acute stage not too much stimulation on the local area...can also soak the feet - Chronic can use stronger techniques, PR and PL with knuckle joint |
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What is the acupuncture (points) remedy for heel pain?
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KI1, KI3-KI6, ashi
SP6 ST41 BL57, BL 60 GB40 |
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What is normal ROM for the knee joint?
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0 or 5-10 (over extension)
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What is normal ROM for knee flexion?
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120-150
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What is normal ROM for knee rotation (bilateral)?
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10
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What is the normal ROM for dorsal flexion?
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35
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What is the normal ROM for plantar flexion?
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45
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What is the normal ROM for ankle eversion?
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20
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What is the normal ROM for ankle inversion?
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45
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What are the manifestations for infra patella fat body strain?
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1) Soreness & weakness of knee joint (worse with exertion and knee joint over extension, released with rest),
2) tender points, 3) swelling of "knee eye", 4) myoatrophy |
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ROM for hip extension?
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10-30
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ROM for hip flexion?
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130-140
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ROM for ADduction?
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20-30
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ROM for ABduction?
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45-60
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ROM for internal rotation?
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30-45
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ROM for lateral rotation?
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40-50
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What are the Sx of M. Piriformis?
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1) Injury or wind, coldness & damp invasion Hx
2) SOreness in deep layer of the hip, radiate pain down to the back of the thigh, lateral of the leg or accompany with tingle numbness 3) Severe cases described as sharp, burning or throbbing in nature 4) Walk with a limp on the affected side 5) Muscle atrophy of the hip and lower limb of affected side in later stage |
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How to examine for Sx of M. Piriformis?
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1) Tender pts on hip
2) Lasgue sign is positive within 60 degress and negative beyond 60 degrees of hip flexion 3) + Test of Piriformis |
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What is the test of Piriformis?
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Pt lies supine with straight lower limbs and laterally rotates the affected lower limb. The examiner applies resistance on the same lower limb from the lateral sides against the lateral rotation. If the pt complaines pain on the buttock (posterior) it indicates Sx of Piriformis.
MOST PAINFUL POINT will be on the hip. Pain will radiate for M. Piriformis but not always with LIDP. Lasque's test will have more pain with more flexion if due to LIDP. Abdominal pressure doesn't affect M. Piriformis much. Both pt will limp but LIDP pt will prefer to stand. |
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Lists the tests for collateral ligament
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1) Bilateral stress test
2) Apley's ? |
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List the tests for meniscus injury
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1) McMurray
2) Apley 3) Bilateral stress test 4) Knee joint over extension |
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List the tests for patella chondrolitis
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1) Compressing and grinding test (two-handed grind)
2) Squat test 3) Clark's sign (pressure to superior patella with web btwn the thumb and index; ask pt to slowly contract quad 2-3 times) -> pain inferior to patella or not able to do it |
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How to diff btwn lateral meniscus injury aand medial collateral ligament injury?
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1) In the knee joint stress test a medial collateral ligament injury will manifest as pain on the medial side of the knee joint; while a lateral meniscus injury will manifest as pain on the lateral aspect of the knee joint
2) McMurrary's is a + sign for a lateral meniscus injury if there is a pop and pain on the lateral aspect of the knee 3) In Apley's it's a meniscus injury if pain is reported on the knee joint when the knee is twisted with pressure on the sole and is a collateral ligament injury if there is pain on either side of the knee joint when traction to the joint is applied |
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What is the drawer test for?
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Crucial ligament injury
it's anterior (ACL) if distal shift of the leg otherwise it indicates a posterior crucial ligament injury. |
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Which tests would you do to check for patella chondromalacia?
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1) Tender points around patella and knee joint
2) Half squat test is + 3) Clarke's test is + 4) Compression/griding test is + |
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What are the Sx of patella chondromalacia?
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1) Soreness or painful knee joint, morning stiffness, weakness and soreness (relieved with rest and worse with over exertion including too much walking, exercise or a weather change)
2) Difficulting walking, "soft knee" or "knee weakness" worse wigh going up or down the stairs; pt may even fall to the ground from pain or weakness |
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What's the Tx for patella chondromalacia?
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1) Middle of thigh down to the leg, RO, GR for 5-10 min (focus on quads and knee)
2) Around knee joint; KN, PL, GR on the 13-15 points around the knee joint 3) Apply "grinding" technique on the knee joint 4) sides of knee joint and xiyan; Scrubbing/Twisting 5) Knee joint, GR, gentle striking and apart pushing |
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What is acupuncture Tx for patella chondromalacia?
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ST34, ST35, ST36
SP10, SP9 Heding Xiyan GB34, GB33 Ashi points |
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What are some pt instructions for patella chondromalacia?
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1) Keep warm and proper rest of knee joint
2) Avoid extreme or intensive exertion, such as over flexion and extension, etc. 3) Light exercise and self-massage |
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What can manifest as pain around the medial malleolus?
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1) Injury of the medial collateral ligament
2) Fracture of medial mallelous 3) Arthritis of talus 4) tarsal tunnel Sx |
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What can manifest as pain posterior to the heel?
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1) Achilles tendon peritenoitis
2) Injury of heel tendon 3) Achilles bursitis 4) Epiphysitis of heel bone or periostitis |
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What can manifest as pain inferior to the heel?
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1) osteophyte of heel bone
2) infracalcaneal fat body inflammation 3) plantar aponeurositis |
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What can manifest as pain inferior to the lateral malleolus?
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1) lateral collateral ligament injury
2) fracture of the lateral malleolus |
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What are the 5 Dx test for foot?
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1) Ankle joint eversion and inversion stress test -> lateral or medial ligaments injury or malleolus fracture
2) Achilles tendon reflex -> CNS and/or PNS Ds 3) Ankle - clonus test (reflex test -> CNS damage of the pyramidal tract) 4) Babinski's sign (scratch test) 5) Resist plantar flexion of great toe (L5-S1) 6) Resisting dorsal flexion of great toe (L4-L5) |
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What are the signs of an achilles tendon rupture?
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1) Gastrox swell
2) Palpable absence on heel tendon, which is increased with dorsiflexion 3) Passive grasping of gastrox doesn't elicit foot plantar flexion |
