Tissue Injury Final

Front 1

How do you classify foot type?

Back 1

Navicular tubercle position to the Feiss Line

Front 2

What is the feiss line?

Back 2

Line from the plantar surface of the head of the 1st MT to apex of medial malleolus

Front 3

When should foot type be measured?

Back 3

During weight bearing (Standing)

[Because arch changes when weight bearing]

Front 4

Where is the navicular tubercle during a pes planus foot?

Back 4

The navicular tubercle located below feiss line

Front 5

The pes planus foot is a _________ medial longitudinal arch, _______ forefoot and ______ rearfoot

Back 5

*Low or bulging

*Abducted

*Everted

Front 6

The pes planus foot is similar to pronation or supination?

Back 6

Pronation

Front 7

What does congenital pes planus foot mean?

Back 7

Hereditary

Front 8

What is acquired pes planus foot?

Back 8

Suffered an injury

Front 9

How does one have acquired pes planus foot?

Back 9

*Rupture or weakness of planatr fascia, plantar ligaments, spring ligaments, tibialis posterior or anterior

Fatigue or damage to static stabilizers of arch leads to PPF

Front 10

What is the too many toes sign?

Back 10

Since forefoot is abducted in the pes planus foot, so when stand behind someone who is not wearing shoes in their neutral stance you can see 3-5 toes because the forefoot is abducted

Front 11

What does an everted rearfoot look like?

Back 11

(See too much for the forefoot)

Front 12

For people with acquired pes planus they might need support and assistance with what?

Back 12

Straight leg heel raise

Front 13

What is an indicator of pronation?

Back 13

Navicular drop

Front 14

What is navicular drop

Back 14

The distance the navicular tuberosity moves in standing as the subtalar joint is allowed to move from its neutral to relaxed position

Get the person to stand. Then palpate the talus and adjust foot till feel equal medial and lateral heads and say that is the neutral position. Then have the subject relax and see if the foot collapses then meausre where the navicular was and see how much of a difference that drop was

Front 15

What does rigid pes planus foot mean?

Back 15

That the pes planus there for both weight bearing and non-weight bearing

Front 16

What does flexible pes planus mean?

Back 16

That pes planus only there during weight bearing

Front 17

Can you correct a rigid pes planus foot?

Back 17

No, but can cushion

Front 18

Do you have increased or decrease shock absorbing capacity with a rigid pes planus foot

Back 18

Decreased

(When we make contact with the ground we want to go from supination into pronation but if it is arleady in pes planus we don't have the ability to absorb forces through the pronation of gait so forces will be increased up the kinetic chain)

Front 19

How do you correct for flexible pes planus foot?

Back 19

Orthotics correction

Front 20

What are the possible assoications of pes planus foot?

Back 20

*MT Stress fracture

*Navicular stress fracture

*Knee pain

*Low back pain

*Plantar fasciitis

Front 21

How do you define PPF with an X-ray?

Back 21

Looking at calcaneal pitch

"Pitch" = inclination off the calcaneous

Front 22

Where is the navicular tuberosity located on a pes cavus foot?

Back 22

Navicular tuberosity is located above the Feiss Line

Front 23

Are there more or less people with pes cavus foot?

Back 23

Less

Front 24

Pes cavus foot has a _____ medial longitudinal arch, _____ forefoot and _____ rearfoot

Back 24

*High

*Adducted

*Inverted

Front 25

The pes cavus is more like pronation or supination

Back 25

Supination

Front 26

Since the pes cavus foot has a higher arch what does that do the stiffness of the foot?

Back 26

Stiff

Front 27

If there is a stiffer foot what does that do to the shock absorbing capacity?

Back 27

Decreased

Front 28

What are the possible association for the pes cavus foot?

Back 28

*Claw or hammer toe

*Metatarsalgia

*Plantar fasciitis

*Hypomobile first ray

*Stress fracture of the MTs, tibia and femur

Front 29

Why can pes cavus foot lead to plantar fasciitis

Back 29

The foot is rigid and so won't go through pronation as much, plantar fascia gets loaded a lot more

Front 30

Does the pes cavus foot have a higher or lower calcaneal pitch?

Back 30

Higher

Front 31

What does the wet foot test look like for the pes planus foot?

Back 31

Front 32

What does the wet foot test look like for a normal foot?

Back 32

Front 33

What does the wet foot test look like for the pes cavus foot?

Back 33

Front 34

What is hammer toe and claw toe

Back 34

Hammer toe is differnet than claw toe because the distal interphalangeal joint is extended as opposed to flexed

Front 35

What is the Morton's Foot (Mortion's Toe)?

Back 35

Shorted 1st MT so it looks like the 2nd toe is really short

Front 36

What is the consequence of Morton's Foot?

Back 36

Increased weight bearing through the 2nd toe and MT which is not designed to do that so it is more suseptible to stress fractures

Front 37

How much of the population has Morton's Foot/Toe?

Back 37

10%

Front 38

What does the plantar fascia do?

Back 38

Plantar fascia reinforces longitudinal arches of the foot

Front 39

what is the plantar fascia important for?

Back 39

Force absorption

Propulsion

Front 40

Aggravation of the PF can result in _______

Back 40

Irritatin and inflamation

Front 41

However many chronic cases of plantar fasciitis does not involve _____, but rather ______

Back 41

*Active inflammation

*Degeneration of the PF

Front 42

What is the mechanism of injury for plantar fasciitis?

Back 42

Repeat stress (overuse) or single traumatic episode

Front 43

What is baxter's nerve

Back 43

Possible entrapment of branch of lateral plantar nerve in the porta pedis

Front 44

How do you differnetiate between plantar fasciitis

Back 44

If load foot and don't do anything to the knee of hip and it is painful then it is probably plantar fascia

If load foot and nervous system by extending the knee and flexing the hip and feel pain then there is a nerve problem

Front 45

What is the signs and symptoms of plantar fasciitis?

Back 45

*Pain localaized at origin of PF (palpation on medial calcaneal tubercle is painful)

*Pain/stiffness upon waking in the morning (because when sleep in supine, feet is plantar flexion for around 8 hrs)

*Heel pain during/after activity

*pain with passive ankle doriflexion

*Pain in DF with passive toe extension (Windlass Effect)

Front 46

What is the prognosis for plantar fasciitis?

Back 46

*Conservative treatment is effective for 80% of cases but takes a long time to heal and sometimes greater than a year to feel satisfactory outcome

*Sgns and symptoms can persist for months to years

Front 47

Do bilateral or unilateral cases of plantar fasciitis respond less favorably

Back 47

Bilateral

Because probably has to do with the anatomy of the foot

Front 48

Does rupture (chronic plantar fasciitis) risk increase after corticiosteroid injection?

Back 48

es

Chronic plantar fasciitis doesn ot always result in rupture and there are people who can rupture the plantar fascia and never exterience ain beforehand

Front 49

Can plantar fascia rupture occure without prior history

Back 49

Yes

(For example males greater than 20-25 yrs old who pariticpate in running and jumping type sports)

Front 50

What are the early conservative treatments for people with plantar fasciitis?

Back 50

*Stretching of foot/gastroc-soleus complex

*Soft tissue release

*Longitudinal arch taping

*Ice cup massage with foot on stretch (post exercise)

Front 51

What is the prolonged conservative treatment of plantar fasciitis?

Back 51

*Prefabricated insoles, heel cups, orthotics (chornic cases)

*Night splint (Locked in 90 degres)

*Corticosteroid injection

Front 52

What is the agressive, chronic treatment for plantar fasciitis?

Back 52

*Electoporeal shockwave therapy (after 6 months of conservative treatment) [Powerful ultrasound, uncomfortable hammering on tissue)

*Surgical release (Come in and remve any scar tissue that is impinging on the nerve itself or creating extra pressure in the area)

Front 53

What is a heel spur?

Back 53

Exotosis, bony outgrowth of the medial calcaneal tubercle

Front 54

What is an exostosis

Back 54

Excessive bone growht that is typically seen on sites with insertion of structures at the origin of short toe flexor

Front 55

What shape is the heel spur?

Back 55

Hook shaped

Front 56

Can the heel spur occur simultaneously with plantar fasciitis?

Back 56

Yes, but not necessarily causal of each other

Sympotms are similar

Front 57

What is the signs and symptoms of heel spur?

Back 57

Gradual onset of symptoms

Pain during heel strike phase of gait

Front 58

What is the treatment of heel spur?

Back 58

*Still treat conservatively if at all possible

*Stretching

*Comfortable and supportive footwear

*Heel cups

*Surgery (spur removal or endoscopic plantar fasciotomy

Front 59

What is the mechanism of injury for the metatarsal fracture?

Back 59

Can occur with direct or overuse trama

Front 60

What are the types of fractures for the fifth metatarsal?

Back 60

*Jones Fracture (Base of the 5th MT)

*Stress Fracture (Distal to jones)

*Avulsion Fracture (Peroneal brevis avulses off styloid process)

Front 61

What is the metarsal fracture for the 2nd, 3rd or 4th MT?

Back 61

march fracture

Front 62

Is it rare to see a stress fracturei n the 1st MT? why

Back 62

Yes, because it is such a thick and strong bone

Front 63

What is the MT shaft fracture's mechanism of injury?

Back 63

Something dropped on the foot or the foot has twisting on it

Front 64

What is the 5th MT suseptible to fractures?

Back 64

Because the blood supply varies throughout the bone itself

When fractures are through the base of the 5th MT, the blood supply also affected so healing is much mroe complicated

Front 65

What is the signs and symptoms of MT stress fractures?

Back 65

Localized bone pain (dull pain that can be present at rest but increases with activity

Can progress to a gross fracture if not treated

Need to get patient to rest right away

Front 66

What is the signs and symptoms of acute MT fractures

Back 66

*Intense pain (may be unable to Weight bear)

*Crepitus (Assess for this during palpation --> Crunching sensation)

*Acute onset of swelling over fx site

Front 67

What is the treatment of avuslsion fractures

Back 67

Immobilization and non-weight bearing for four weeks

Front 68

What is the treatment for jones fracture?

Back 68

Immobilization and non weightbearing

Surgery (internal fixation with a screw)

Recovery for 8+ weeks

Front 69

What is the treatment of a stress fracture?

Back 69

*Rest

*PWB with fixed cam walker boot

*Bone growth stimulator

*Avoid aggressive return and resulting gross fracture

Front 70

Where is the lsfranc joint

Back 70

Tarso-metatarsal joint

Front 71

What are the type of injuries from a lisfranc injury?

Back 71

*Sprain

*Dislocation

*fracture-dislocation

Front 72

What is the MOI for a lisfranc injury>

Back 72

High energy axial loading of foot while distal segment is fixed and that causes a buckling of the join

(IE being stepped on back of the heel with ball of foot planted)

Front 73

Signs and symptoms for lisfranc injuries?

Back 73

*Range to from subtle to obvious (pain, swelling, deformity, ecchymosis on plantar surface) of midfoot

*Acute mid-foot injury with pain should have flip to r/o Lisfranc injury

-Lisfranc fracture: 2% of all fracture, but often misdiagnosed

Front 74

What is the conservative treatment of lisfranc injuries?

Back 74

Non-weight bearing

Front 75

What is the surgical treatment of lisfranc injuries?

Back 75

*Open reduction and internal fixation

*8 weeks NWB (cast/splint)

*Arthrodesis for ligamentous injury (surgical joint fusion) --> Worst case scenario

Front 76

What is an intermetatarsal neuroma?

Back 76

Enlargement of that erve

Front 77

What is morton's neuroma

Back 77

Typically entrapment of the 3rd common digital (plantar) nerve, located between 3rd and 4th MTs

Front 78

What is the MOI of Morton's Neuroma

Back 78

*Prolonged pressure of nerve resulting in formation of fibrotic nodules and edma around the nerve

Front 79

What the contributors to the prolonged pressure MOI for Morton's Neuroma?

Back 79

*Excessive pronation

*Improperly fitted shoes

Front 80

Are women or men more likely to get morton's neuroma?

Back 80

Women

Front 81

Is there a high re occurence rate of morton's neuroma?

Back 81

Yes

Front 82

What is the signs and symptoms of morton's neuroma?

Back 82

*Pain in transver (metatarsal) arch of foot, radiating to toes

*Numbeness/paresthesia into the toes

*Increased pain/numbness when pressure is increased in forefoot (standing on toes) or with tight shoes

*Positive: increase in symptoms with metatrsal compression (Squeezing foot)

Front 83

What positive test is for Morton's Neuroma

Back 83

Mulder sign

Front 84

What can you occassionally palpate on the plantar surface of the metatarsal arch for Morton's Neuroma

Back 84

Nodule

Front 85

What is the treatment for Morton's Neuroma

Back 85

*Metatarsal arch pad

*Low dye taping (Widens MT arch)

*Lidocaine/Corticosteroid injection

*footwear modification

*Surgical excision (remove scar tissue around nerve)

Front 86

What is hallux rigidus?

Back 86

Stiff great toe

Front 87

What does hallux rigidus involve

Back 87

Progressive degeneration of first MTP joint's articular surfaces

Front 88

Is hallux rigidus often a bilateral or unilateral ocndition?

Back 88

Bilateral, genetic disposition

Front 89

What may hallux rigidus progress to

Back 89

Ankylosed joint (Fused)

Front 90

What are the signs and symptoms of hallux rigidus

Back 90

*Stiff 1st ray

*Impacts toe off

*Pain and swelling after/during activity

*Exotosis devlopment possible on dorsal aspect of MTP joint

Front 91

What are the associations with hallux rigidus

Back 91

Morton's toe

(People with morton's toe are more suseptible to getting this condition)

Front 92

What is the treatment of hallux rigidus

Back 92

*Passive ROM and joint mobilization

*Orthodics to unload the first MTP joint (decrease hyperextension)

*Turf Toe taping (Limiting DF)

*Corticosteroid injection (Quiet down inflammation)

*Surgical intervention (Cheilectomy: Removal of distal portion of MT and exotosis)

Front 93

What is hallux valgus?

Back 93

Progressive degeneration and subluxation of the first MTP joint

charactized by the MTP because in over 20 degrees of abduction

"valgus deformity"

Associated with a bunion (exotosis) on medial aspect of the joint

Front 94

What is the treatment for the hallux valgus?

Back 94

Taping to increase adduction and limit abduction

Appropriate shoes

Pad between 1st, 2nd, 3rd phalanges

NSAIDS

Surgical intervention: Changing the shape of the foot (reshape of the 1st of MT)

Exosectomy (bunionectomy)

and

Osteotomy (chevron osteotomy at the distal end of MT)

Front 95

What is turf toe?

Back 95

Sprain at the 1st MTP joint

Front 96

what is the mechanism of injury for turf toe

Back 96

Foot planted, is made to go to dorsiflexion and first toe is hyperextended

Can also involved force walgus or varus of the 1st MTP joint

Front 97

What is the signs and symptoms of turf toe?

Back 97

*Pain with toe off during gait or quick stops

*Pain with palpation

*Limited ROM of MTP joint

Front 98

What is the treatment for Turf toe

Back 98

*Rest and NWB-PWB in acute stages (cam walker)

*RICE

*Turf toe tapingstrap (stabilize toe)

*Firm shoe inserts or fabricated orthoplast insertW

Front 99

What are the sesamoids?

Back 99

Two bones in the tendons of the flexor hallucis brevis tendons that act with the same mechanical advantage as the patellar tendon

They are less stable in the MT groove in extension therefore they have the most forces placed on them during extension

Front 100

What is the MOI for sesamoiditis?

Back 100

Overuse injury (in conjunction to poor shoe type) more stress during extension when it's not as stable in the MT groove

May result in stress fracture of seasmoids

Front 101

What is the signs and symptoms for sesamoidits?

Back 101

*Pain when "being on toes (IE toe off, high heeled shoes)

*Walk on outside of foot to avoid pressure

*TTP over ball of foot (Under 1st MT head)

*Painful passive extension ROM of 1st MTP joint

Front 102

What is the treatment of sesamoiditis?

Back 102

*Padding or orthotics designed to unload the ball of the foot and dissipate forces on sesamoid bone

*Corticosteroid injection

*Surgical excision of sesamoid bones (if chronic pain)

Front 103

What type of joint is the talocrural joint?

Back 103

Hinge joint

Front 104

What is the the angle joint movememnt of the talocrural joint?

Back 104

Dorsiflexion

Plantarflexion

Front 105

Is the talus dome wider anteriorly or posteriorly?

Back 105

Anteriorly

Front 106

Is the axis of rotation of the talocrural joint oblique or completely horizontal?

Back 106

Oblique (tilteD)

Front 107

What is the close packed position of the talocrural joint?

Back 107

Full dorsiflexion

Talus locked against the fibula and tibula

(Ie mid stance of gait and squatting)

Front 108

What is the subtalar joint?

Back 108

Talocalcaneal joint

Front 109

What movement does the talocalcaneal joint have?

Back 109

Inversion and eversion (1 degree of freedom)

Front 110

What are static stabilizers?

Back 110

Components of the lateral and medial ligment complexes of the talocrural joint

Front 111

Is inversion and eversion detrimental to the talocrural joint?

Back 111

Yes, because of its geometry

Front 112

Are the distal projections of the lateral and medial malleoli different?

Back 112

Yes

Front 113

Is inversion or eversion of the subtalar joint greater?

Back 113

Inversion

They increase potential stress on the talocrural joint static stabilizers

Front 114

Are lateral or medial ankle sprain more common?

Back 114

Lateral (80%)

Front 115

What are the MOIs for lateral ankle sprains?

Back 115

*Excessive supination (injure talocrural and subtalar joint)

*Pure inversion (Rolling over the lateral surface of the foot, stepping on an uneven surface (IE first base) with the ankle dorsiflexed)

*Contact with another player

Front 116

What are the three lateral ankle ligaments

Back 116

*Anterior talofibular ligament

*Calaneofibular ligament

*Posterior talofibular ligament

Front 117

Which is most often injured during the lateral ankle sprain?

Back 117

Anterior talofibular ligament

(Taut in supination)

Front 118

When is the clacaneofibular ligament injured during the lateral ankle sprain?

Back 118

Injured with more significant inversion

Front 119

Which is the most rarely injured ligament in lateral nakle sprains?

Back 119

Posterior talofibular ligament

Front 120

How do you injure the posterior talofibular ligament in a lateral ankle sprain?

Back 120

Inversion and dorsiflexed ankle

Front 121

What is the signs and symptoms of the lateral ankle sprain?

Back 121

*Popping

*TTP sinus tarsi and lateral ligament complex

*Diffuse ecchymosis and edmea/swelling (increases with the severity of injury)

*Pain or laxity with anterior drawer test or talar tilt test

Front 122

What do you have to rule out first for a lateral ankle sprian?

Back 122

Fracture (fibula, tibia, talus)

Avulsion fracture (styloid process of the 5th MT)

Front 123

What is the predispositon for the lateral ankle sprain?

Back 123

Previous history of ankle instability or sprain

Front 124

What are the two types of chronic ankle instability?

Back 124

Mechanical instability

Functional instability

Front 125

What is mechanical instability?

Back 125

Gross laxity of the talocrural or subtalar joints with clinical examination

Front 126

What is functional instability?

Back 126

History of repeated ankle sprains but normal findings during ligamentous stress tests

Reports instablity but none of that shown in tests, could be from neuromuscular control

Front 127

What are osteophytes?

Back 127

Bone spurs

Front 128

What are osteochondral defects?

Back 128

When ankle subluxes and goes back in, articular cartilage is damaged

Front 129

What is osteoarthritis?

Back 129

People who develop have an increased chance for a significant ankle trauma

Front 130

What are the secondary complications of ankle sprians?

Back 130

Osteophytes

Osteochondral defects

Osteoarthritis

Front 131

Baed on the ottawa ankle rules when do you get ankle films

Back 131

If there is malleolar pain and any of

1) Tender on posterior edge, tip or distal 6 cm of lateral or medial malleolus

2) Unable to complete 4 steps

Front 132

Based on the Ottawa Ankle Rules when do you get foot films

Back 132

Midfoot pain and any of:

1) Navicular tenderness (Navicular bone has poor outcome for healing so you don't want to miss it)

2) Base of 5th of MT tenderness

3) Cannot complete 4 steps

Front 133

What is a syndesmosis sprain?

Back 133

High ankle sprain

Front 134

What does the syndesmosis sprain come form

Back 134

Injury to the tibofibular syndesmosis (syndesmosis that is holding two bones together) and inferior anterior tibiofibular ligament

Front 135

What will syndesmosis sprain reuslt in?

Back 135

Lateral displaement of the distal fibula, shifting off the ankle

Front 136

Waht is the occurance rate of the syndesmosis sprain?

Back 136

10%

18% in NFL

Front 137

Is the prognosis for the syndesmosis sprain slower to return or quicker to return?

Back 137

Slower to return because it is the injury of a structure that holding two bones together that has been injured and when step down, thebones seperate and is very painful. Longer timing to heal mechanical outcome of injury is the problem

Front 138

What is the MOI of a syndesmosis sprain

Back 138

External rotation of talus when ankle is dorsflexed

Front 139

What is the signs and symptoms of the syndesmosis sprain?

Back 139

*Pain (TTP) localized anterior aspect of the ankle (inferior tibio fibular joint)

*Pain wiht ankle dorsiflexion

*Positive Keliger's test

*Pain with walking corresponds to painful location with palpation (morise widens during WB)

Front 140

Why do fewer medial ankle sprains occur/

Back 140

Configuration of static stabilizers and joint configuration which prevent excessive ankle eversion

Front 141

What ligament is often sprained in medial ankle sprain?

Back 141

Medial ankle sprain

Front 142

What can the medial ankle sprain also be associated with

Back 142

Syndesmosis injuries

Malleolar fractures

Front 143

What is the signs and symptoms of the medial ankle sprain?

Back 143

*TTP medial joint line

*Diffuse ecchymosis and edema/swelling on medial aspect of ankle

*Pain or laxity with the eversion talar tilt test

Front 144

What should you rule out for the medial ankle sprain

Back 144

*Medial malleolus fracture (knock off fracture)

Bimalleolar fracture (Pott's fracture)

Front 145

What is a knock off fracture

Back 145

If talus everts and rocks into the lateral malleolus can knock off the medial malleolulus

Front 146

What is a pott's fracture

Back 146

Bimalleolar fracture

If have knack off fracture through the medial malloelus and a fracture through the lateral malleolar

Front 147

What are complicated injuries of the ankle?

Back 147

Fracture and dislocation

Front 148

Will tibia shaft fracutres typically present with gross deformities?

Back 148

Yes

Front 149

Does a tibia shaft fracture equire signficant force?

Back 149

Yes

Front 150

Can peopel with tibia shaft fractures weight bear?

Back 150

No

Front 151

Is there is possiblity for radiating pain on the tibia shaft fractures?

Back 151

Yes

Front 152

What sort of leg fractures can rotational stresses cause?

Back 152

Fibula spiral fracture

Front 153

Can a person weight bear with a fibula spiral fracture?

Back 153

May be able to (limited)

Front 154

Is there swelling in a fibula sprial fracture?

Back 154

Yes, localized pain as well as swelling over location of fracture

Front 155

What should you rule out with ankle sprains?

Back 155

*Rule out fracture of superior portion of fibula with ankle sprains (Maisonneuve fracture)

Front 156

Does the achilles tendon have good or bad vasularity?

Back 156

Poor

Achilles tendon has a portion that is less vascularized than other (~2-6 cm above insertion on calcaneous)

Front 157

Where does the achilles tendon insert

Back 157

The tendon twists and inserts slightly medially on the axis of the subtalar joint on the calcaneous

Front 158

Where is the comon site of achilles pathology: tnedinosis or rupture

Back 158

Distal avascular zone

Front 159

What is a midsubstance achilles tendinopathy?

Back 159

*chronic tendinopathy of the achilles tendon so presents as thicker and can palpate and feel crepitis as person moves

It is acutely swollen around achilles so hard to see the contour of the achilles

Front 160

What is a pump bump

Back 160

Exotosis on the achilles tendon

Front 161

What is insertional tendinopathy

Back 161

Pain right wehre the achilles tendon inserts on the calcaenous

Front 162

Does a person with midsubstance or insertional achilles tendinopathy have a better prognosis

Back 162

Mid substance

Harder to heal insertional

Front 163

What is a partenon of the ahcilles tendon

Back 163

Highly vascularized layer surround the achilles tendon that is susceptible to inflammation and forms adhesions to underlying tendon

Front 164

What is the path of tendon rupture

Back 164

Paritenonitus

Tendinosis (often silent)

Tendon rupture

Front 165

What is achilles tendinosis

Back 165

Degeneration of tendon midsubstance

Leads to microscopic tears and necrotic areas

Front 166

Is achilles tendinosis often silent

Back 166

Yes

Front 167

Is achilles tendinosis visible with a disagnositic ultrasound or MRI?

Back 167

Yes

Front 168

What are the precipitating factors for achilles tendinopathy

Back 168

*Previou ankle sprain

*Hyperpronation (Continue to overload the achilels more because more tension on medial and achilles mainly work in sagittal plane)

*Tibial varum (Deliver more forces inot the achilles)

*Calcaneovalgus(Part of hyperpronation --> Calcaneous turned laterally)

*Achilles tightness

*Hamstring tightness

*Training errors

Front 169

What is the signs and symptoms of achilles tendinopathy?

Back 169

*Burning pain during activity

*TTP

*Palpable nodule

*Visible thickening (If chronic)

*Crepitis with active movement (Scarring between peritenon and achilles tendon)

Front 170

What is the treatment for achilles tendinopathy

Back 170

*Eccentric training

*Improve limited DF RoM through stretching and tissue and joint mobilizing

*Taping

*Surgery (Last course of action ot clean out debris)

Front 171

what may cause achilles rupture

Back 171

Achilles tendinosis or paratenonitis may lead to rupture but not necessary as precipitating factor

Front 172

Which is achilles rupture more common in?

Back 172

Males > 30 yrs old

Front 173

What is the MOI of Achilles rupture

Back 173

Forceful contraction (landing from jump, sudden changes in direction)

Front 174

What is the signs and symptoms of achilles rupture?

Back 174

*Loud pop (gunshot) at time of injury and person reports feeling that "was kicked in calf"

*Visible defect in tendon

*Absence of palpable in tact tendon

*Excessive edema/ecchymosis

*Positive thompson test

*Can actively plantar flex

*Can walk but can't do a single leg hell raise (can't get enough torque)

Front 175

How long does achilles rupture take to recover?

Back 175

7-9 months

Front 176

What is the conservative treatment of achilles rupture

Back 176

Immobilization (cast or night splint) 8 weeks

Front 177

Are outcomes better with surgery or conservative management for achilles rupture

Back 177

Surgery

*Lower instance of re rupture

*Faster return to pre-injury activity

Front 178

What are medial tibial stress syndromes also called?

Back 178

Shin splints

Front 179

What does medial tibial stress syndromes also involve

Back 179

Reaction of tissues along the medial border of the distal tibia (periostitis, posterior tibialis tendonopathy, tibial stress fracture)I

Front 180

ARe shin splints an overuse yes

Back 180

Yes

Or can be acute response to changes in surface, shoe type, volume of training

Front 181

Why can overpronation also contribute to medial tibial stress syndrome

Back 181

Because overloads the posterior tibialis makes change of tension and cause inflammation of the periosteum

Front 182

Do the medial tibial stress syndrome develop gradually?

Back 182

Typically

Front 183

Medial tibial stress syndromes have diffuse pain along where?

Back 183

Along posterio-medial tibial border during activity

Front 184

What is the treatment during medial tibial stress syndrome?

Back 184

Usually responds well to conservative treatement

*Ice

*Modified training

*Correcting alignement issues

*Improved shoe type

*Strenghtening of posterior tibialis

(Tape very tight because of gate theory --> But just masking problem)

Front 185

If the pain of a medial tibial stress syndrom goes from diffuse to focal what should be ruled out?

Back 185

Stress fracture of the tibia

Front 186

Where can stress fractures occur?

Back 186

Several locations:

Distal tibia

Midshaft of tibia

Distal fibula

Front 187

What kind of injury is a stress fracture

Back 187

Overuse injury

Front 188

How do you diagnosis a stress fracture

Back 188

X ray

Bone scan

Front 189

What is the signs and symptoms of a stress fracture

Back 189

*focal pain on bone

*Pan during activity and at rest

-"Night pain"

*Positive bump test or squeeze test (not always sensitive in early stages)

Front 190

What is the treatemnt for stress fractures

Back 190

*Rest

*Walking boot *PWB to NWB depending on severity)

*Modified conditioning to maintain fitness (Swim Ex)

*Bone stimulator *Pulse ultrasound

Front 191

What are the four compartments of the leg?

Back 191

*Superficial

*Postieror

*Deep posterior

*Anterior

Front 192

The four compartments of the leg are bordered by what

Back 192

Dense fascia and bone

Front 193

The dense fascia are poor elastic properties to accomodate expansion?

Back 193

Yes

Front 194

What happens to pressure in compartments as exercise

Back 194

Increases because more blood flow

Front 195

Abnormally high pressure in compartments has potential to do what?

Back 195

Damage nerves and vessels

Front 196

What happens when comparments have abnoramlly high pressure that exceeds capillary perfusion pressure (Pressure within capillaries that forces blood out to surrounding tissues)?

Back 196

Resultsi n ischemia and hypoxia, eventually leads to cell death because can't deliver oxygenated blood to the tissues that need it

Front 197

What are the two types of compartment syndromes?

Back 197

*External compartment syndrome (chronic vs acute onset)

*Traumatic compartment syndrome

Front 198

When do the signs and symptoms for the exertional compartment syndrome occur (chornic onset)

Back 198

During or after exercise)

Front 199

How long does it take to get to the chronic onset of the exertional compartment syndrome?

Back 199

Takes weeks or years

Front 200

What are the signs and symptoms of the exertional compartment sndrome

Back 200

Increased fascia thickness inibits venous outflow but not arterial inflow (can take blood into compartment but can't get out)

Front 201

What compartments are most susceptible for the exertional compartment syndrome?

Back 201

*Anterior

*Lateral

*Deep posterior

Front 202

What compartments don't have exertional compartment syndrome?

Back 202

*Superficial

*Posterior Wh

Front 203

What is different about the acute onset of exertional compartment syndrome?

Back 203

Same as s/s for chronic without the prior symptoms or history of tramatic injury

Front 204

What is the sign and symptoms of the exertional compartment syndrome?

Back 204

*Pain localized in compartment

*Possible numbness into the toes and / or dorsla and lateral aspect ofoot (anterior or lateral CS)

*Decreased strength of muscles associated iwth compartment

*Pain with passive ROM (stretching does not help)

*Possible visible swelling in compartment

*rEduced or absent pulse (dorsalis pedis) in advanced/extreme cases

Front 205

When is fasciotomy required?

Back 205

When the resting pressure is > 15 mmHg

>30 mmHg 1 min post ex

>20 mmHg 5 minutes post exercise

Front 206

Is traumatic compartment syndrome a medial emergency

Back 206

Yes could lead to significant muscular necrosis and lose muscle mass that doens't come back

Front 207

What is the MOI for traumatic compartment syndrome

Back 207

*Direct blow to the anterior or lateral compartment (most exposed)

*More common in the anterior compartment

*May also be present with tibia or fibula fracture

Front 208

What are the signs and symptoms of the traumatic compartment syndrome

Back 208

Related to the 5 P's

Pain

Pallor

Pulselessness

Paresthesia

Paralysis

Front 209

What are the signs and symptoms of a traumatic compartment syndrome

Back 209

Visibally swollen compartment

*Shiny skin (because stretch)

*Hard to touch compartment and TTP

*Inability to DF ankle or extend toe

*Pain with passive ankle ROM (stretch) --> Plantar flexion if anterior compartment

*Walking extreme pain

*Drop foot (if nerve peralis)

*Dorsalis pedis pulse integrity

Front 210

Do you apply compression wraps with traumatic compartment syndromes?

Back 210

No

Because will further resist ability of fluid to leave compartment

Front 211

What type of joint is the knee?

Back 211

Hinge

Front 212

Why do we need patella?

Back 212

Because increases the leverage of the quads and makes it more efficient

Front 213

Is the knee joint more or less stable than the ankle?

Back 213

More

Less likely to sprain the ankle because of the ligamentous support (cruciate and collateral ligament)

Front 214

What are the three articulations of the knee?

Back 214

Patellofemoral

Tibiofemoral

Fibulotibula

Front 215

What is the largest diarthrodial joint?

Back 215

Tibiofemoral joint

Front 216

How many degrees of freedom does the tibiofemoral joint have?

Back 216

3

Flexion/extension

Internal/external rotation

Abduction/adduction

Front 217

How many voluntary movements does the tibiofemoral joint have?

Back 217

2 DOF

Sagittal and transverse plane

Front 218

What is the ranking of ROM (osteokinematics)

Back 218

(Greatest to least)

Sagittal plane (140 degrees)

Transverse plane (IR 30 degrees, ER 45 degrees)

Frontal plane (Slight and passive)

Front 219

Will range of motion be greater or less wen measured dynamically during activity?

Back 219

Greater

Front 220

Is abduction valgus or varus?

Back 220

Valgus

Front 221

Is adduction valgus or varus?

Back 221

Varus

Front 222

During knee flexion the tibia _____ rotates on the femur

Back 222

Internally

Front 223

During knee extension, the tibia _____ rotates on the femur

Back 223

Externally

Front 224

What is the screw home mechanism?

Back 224

As the knee approaches terminal extension (last 20 degrees), tibia externally rotates

And when the knee flexes, the tibia internally rotates (important during the swing phase of the gait (unlock knee))

Front 225

Why does the screw home mechanism occur?

Back 225

Because of the femoral condyle curvature (allowing the tibia to glide and slide longer on the medial femoral articulating surface)

Increases the tibia stability on the femur (lockign the knee, tightening the cruciate ligaments)

Front 226

What is the knee flexing and the tibia interally rotating initiated by?

Back 226

Popliteus muscle

Front 227

Are medial and lateral femoral condyles convex or concave

Back 227

Convex

Front 228

Does the medial or the lateral condyle have a longer articulating surface

Back 228

Medial

Front 229

What is more prominent the lateral or medial condyle?

Back 229

Lateral

Front 230

Is the tibial plateaul concave or convex

Back 230

Concave

Front 231

What is the tibial plateau assisted by?

Back 231

Menisci

Front 232

Which tibial plateau is larger the medial or the lateral

Back 232

Medial

(The lateral TP is less concave than the medial TP)

Front 233

The convex and concave articulation translations (arthokinematics) provides an additional ___ DOF

Back 233

2

-Anterior-posterior

-Medial-lateral

-Superior-inferior (distraction/compression)

Front 234

When a concave surface moves on a convex surface the concave surface glides and slides in the ____ direction as the osteokinematic motion

Back 234

Same

Front 235

When the convex surfaces moves on a concave surface the convex surface glides and slides in the ____ direction as the osteokinematic motion

Back 235

Opposite

Front 236

If you flex the knee, the tibia rolls _____ and slides _____

Back 236

Back

In same direction

Front 237

In the ankle is the talus convex or concave

Back 237

Convex

Front 238

As the ankle goes into dorsiflexion, is the talus gliding posteriorly or anteriorly

Back 238

Posteriorly

Front 239

What is the glide of the tibia on the femur during knee flexion

Back 239

Glides posteriorly

Front 240

During squatting when the femur is moving the the tibia, what is the direction of the glide

Back 240

Femur gliding forward

Front 241

In an open kinetic chain when the talocrural joint is in dorsiflexion, the talus moving on the tibia/fibula is gliding in what direction

Back 241

Posteriorly

Front 242

When the talorcural joint goes into squatting and the tibia/fibula is moving on the talus what direction is the glide?

Back 242

Anterior

Front 243

What is the consequence of motion without gliding (translatory motion)

Back 243

During knee motion, menisci would more likely be pinched between the condyles and tibial plateau which leads to injury

Front 244

Patella displays ____ motion

Back 244

Translatory motion

Front 245

What is the patellofemoral arthrokinematic movements: when the knee flexes the patella glides _____

Back 245

Distally (inferiorly)

Front 246

When the knee extends the patella glides ____

Back 246

Posteriorly (superiorly)

Front 247

Is the knee more mobile in flexion or extension

Back 247

Patella is very mobile in extension when quads not working on it

Front 248

What is the mechanical advantage of the patella

Back 248

Moment arms for the quads is greater in presence of patella so less quad force required

Front 249

Does the patella offer less or more mechanical advantage when the knee is extended compared to when flexed

Back 249

Less

Front 250

What is the patellar tracking movement influenced by?

Back 250

Quad contraction and geometry of femoral condyles

Front 251

What is the medial and lateral shift of the patella

Back 251

C-curve pattern from the knee extension to flexion influencing medial and lateral tilt

Front 252

The patella tilts ____ from extension to flexion

Back 252

Laterally

Front 253

Does the contact area of the patella with the femur change as knee flexion changes

Back 253

es

Front 254

Why is the patella more mobile in extension

Back 254

Because in less contact with femur near extension

Front 255

Patellofemoral joint reaction forces ___ predictably in response to quad muscle force and ____ in knee flexion until about ___ degrees flexion

Back 255

*Increase

*Increase

*70

Front 256

Do you take the q angle standing or supine

Back 256

Standing

Front 257

Is the q angle larger in males and females why?

Back 257

Females

Pelvis width/femur length (Men have longer femurs)

Front 258

What lines create the q able

Back 258

1) Line from the tibial tuberosity and midpoint of patella

2) Line form midpoint of patella to ASIS W

Front 259

What sort of loading does the MCL resist?

Back 259

Valgus loading

Front 260

How many portions does the MCL have?

Back 260

2

(Superficial and deep)

Front 261

Where does the deep portion of the meidal collateral ligament go?

Back 261

Deep into the joint and inserts on the medial meniscus

Front 262

What kind of size doe sthe medial collateral ligament have

Back 262

Broad flat

Front 263

Is the MCL tigher or not when knee is extended

Back 263

Tighter

Front 264

What is the MOI for the MCL sprain

Back 264

Medially directed force on the lateral aspect of the knee resulting in valgus loading

Front 265

What are the signs and symptoms of the medial collateral ligament sprain

Back 265

TTP over the medial apsect of the knee (adductor tubercle to the tibial plateau or mid-substance of MCL)

*Positive valgus stress test (gapping medial joint line, pain)

*Decreased tolerance to AROM knee flexion/extension due to pain and/or swelling (Would especially not like it in extension because extension makes the medial collateral ligament more tense)

*Edema visible on medial aspect of knee (may take time to develop)

Front 266

How are most medial collateral ligaments treated, conservatively or surgically

Back 266

Conservatively

Front 267

What is treatment of medial collateral ligament sprains like?

Back 267

*Conservatively (Rest, ice, PWB-FWB, progressive rehabilitation)

*Imobilization brace for 2-3 degree injries

*3 degrees sprains can be surgically repaired when in conjunction with an ACL injury

Front 268

Adolescents displaying valgus laxity should be screed for waht

Back 268

Epiphyseal plate injuries

Front 269

What kind of shape does the lateral collateral igament have?

Back 269

Cord-like

Front 270

Does the lateral collateral ligament connect to the lateral malleolus

Back 270

No

Front 271

What kind of loading does the lateral collateral ligament resist

Back 271

Varus loading and deformity

Front 272

What is the signs and symptoms of the lateral collateral ligament sprain

Back 272

*TTP over lateral aspect of knee on lateral collateral ligament and joint line

*Localized swelling visible on lateral aspect of knee (LCL is extracapsular)

*Positive varus stress test (gapping lateral joint line, pain)

*Decreased tolerance to AROM knee flexion/extension due to pain and/or swelling

Front 273

What do you have to rule out with a lateral collateral ligament

Back 273

Fibular head fracture

Common peroneal nerve injury

Front 274

How are most 3rd degree LCL injureis treated

Back 274

Surgically (early repair: suture anchors on avulsed site or seqing ends together late reconstruction: Replacing LCL with tendon graft)

Front 275

What is the length of recovery for a mild-moderate lcl sprain

Back 275

4-6 wks W

Front 276

hat is the length of recovery for surgical managment of LCL sprain

Back 276

WB restriction up to 12 weeks then progress

Front 277

Adolescents displaying varus laxity should be screened for _______

Back 277

Epiphyseal plate injuries

Front 278

ACL is _____articular and ____synovial

Back 278

Intraarticular

Extrasynovial

Front 279

Will the synovial fluids benefit the anterior cruciate ligament at all?

Back 279

No, because it is outside of the synovial capsule

Front 280

What does the anteriro crucial ligament inhibit

Back 280

Anterior translation of tibia, intrarotation of tibia and restiricts valgus and varus of the knee

Front 281

What kind of bundle structure does the ACL have?

Back 281

Double bundle

Front 282

What are the two bundles of the ACL like in extension

Back 282

Parallel

Front 283

What are the two bundles of the acl like in 110 degrees of flexion

Back 283

Crossed

Front 284

What is the benefit of having a double bundle structure?

Back 284

"Regional Recruitment"

Allows knee to be afforded stability across a larger degree of motion

Because as go into flexion the AMB (anterior medial bundle) tightens while the PLB (Posterior lateral bundle tighens in extension)

Affords support thorugh the full range of knee motion

Front 285

What are the typical mechanism of injury for anterior cruciate ligament injuries?

Back 285

Non-contact

(Jump landing, rapid stopping, changes of direction)

Front 286

What is the difference between non contact, indirect and direct contact injuries?

Back 286

Non contact: No contact on the knee or from any opponent

Indirect: Actually cotact somewhere just not the knee

Direct: Contact the knee

Front 287

What is the mechanism of injury for the anterior cruciate ligament injuries

Back 287

*Valgus

*Rotatory loading (tibial rotation-can be both external and internal rotatio)

*Agressive quad force (Because will anteriorly translate tibia)

Front 288

In matched sports are females or males more likely to suffer ACL tears

Back 288

Femlaes

Front 289

Do males or females suffer more ACL injuries per year comapred to females? Why

Back 289

Males, just because there are more sports that males generally play

Front 290

What are the factors to consider when understanding injury risk?

Back 290

*Anatomical

*Hormonal

*Neuromechanical (Neuromuscular and biomechanical)

Neuromuscular = recuritment and activation of muscle and strength differences

Biomechanical = distribution of forces (kinetic and kinematics)

Front 291

What does the factors to consider for understanding injury risk help us determine?

Back 291

What do we know?

What we need to know?

How will we determine.measure what we need to know?

How we can intervene and prevent inuries

Front 292

What are the possible anatomical predisposing factors for anterior cruciate ligament injuries?

Back 292

*ACL size (Better ot have an increased corsssectional area, to increase strength and ultimate load to failure, females typically have a smaller ACL)

*Femoral intercondylar notch size (Only have so much space availabe because the ACL is nestled in the femoral intercondyler notch. If have smaller notch, tighter, more and less space for the ACL to move around the condyle)

*Pelvic tilt (How much the pelvis rotates back and forth)

*Pelvis width to femoral length ratio

*Joint laxity

*Q angle (line of force of quads)

*Tibial slope (If look at tibia from medial to lateral, tibia has line slope that is slightly posterior, people with an increased posterior slope more likely to tear their ACL)

Front 293

What are the hormonal predisposing factors of ACL injuries

Back 293

Menstruation: Estrogen and progesterone

Front 294

What are the neuromuscle predisposing factors for ACL injuries

Back 294

*Quad dominance (People who rupture ACL are typically quad dominatn)

*Poor ham strength

*Poor hip strenght (reduciton of femur adduction)

Front 295

What are the biomechanical predisposing factors for ACL injuries

Back 295

*Greater knee valgus during task

*Trunk position during task

*Over pronation (Tibial rotation affects the pronation of the foot)

Front 296

What is genu recuvatum?

Back 296

Hypermobility

Excessive laxity

Front 297

What is the unhappy tirad

Back 297

ACL rupture

MCL rupture

Medial meniscus tear

Front 298

What are the signs and symptoms of ACL injuries

Back 298

*Felt/heard a distinct pop at time of injury

*Felt like knee shift

*Effusion onset is rapid (hours)

*Palpation tenderness can be diffuse: Note pain on posterio-lateral corner of knee or lateral joint line due to concomitatnt bone bruise

*Can WB but prefers slight knee bend and shortened stance time

*Positive Lachman's and ADT

Front 299

Which is more sensitive the Lachman's Test or the Anterior Drawer Test

Back 299

Lachman'sW

Front 300

What does "sensitive" mean

Back 300

Less likely to have a false positive

Front 301

When is the anterior drawer test more likely to be useful and positive

Back 301

Post acute patient

Front 302

Both lacman's and anterior drawre test will be less likely to be positive after what?

Back 302

Several hours of injury due to muscle gaurding

Front 303

Is partial ACL tear (2nd degee) a misnomer?

Back 303

Yes, there is still a dysfunction in the ACL such that the knee stability is greatly affected. Surgery is not usually performaed in such a situation; however, it's usually inevitable the partial tear becomes a complete tear over time (return to activity)

Front 304

Is lack of clincial laxity a good predictor of functional ability and stability?

Back 304

No

(There are copers and non-copers, 10% are copers

Front 305

What is the early management of anterior cruciatel igament sprain?

Back 305

Knee mobilizer

PWB progressing ot FWB

Reduce swelling

Improve ROM and quad function

(Outcomes from the surgery are improved if full ROM and quad tone and function are improved prior to surgery)

Front 306

What is the surgical reconstruction of ACL sprain like?

Back 306

7-8 months recovery

*Patella bone-tendon-bone graft (autograft or allograft)

*Hamstring quadrupled bundle graft (autograft)

*Achilles tendon graft (allograft)

Front 307

What are the basic steps of the arthroscopic surgery of the knee for ACL reconstruction

Back 307

Tunnels drilled and then debris the knee and then have a little endobutton fixation and then screw fixation between the new and old bone (pulled graft through)

Front 308

Is the ACL surgery an open surgery?

Back 308

No