Card Set Information

2012-03-21 00:58:26
lower leg injuries

lower leg injuries exam 2 sses319
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  1. Anatomy of the Lower leg (Bones)
    • Tibia: Distal end is the lateral malleolus
    • Fibula: Distal end is the medial malleolus
    • Tibia and Fibula are held together by the interosseous membrane
  2. Muscles of the Lower Leg
    • Muscles are divided into four compartments
    • -Anterior
    • -Superficial posterior
    • -Deep posterior
    • -Lateral
  3. Muscles of the Lower Leg (Anterior compartment)
    • --These muscles work to dorsiflex the ankle
    • Extensor digitorum longus
    • Extensor Hallucis longus
    • Tibialis Anterior (primary dorsiflexor)
    • Superficial Posterior Compartment
    • --These muscles act to plantarflex the ankle
    • Soleus
    • Gastrocnemius
  4. Muscles of the Lower Leg (Deep Posterior Compartment)
    • --These muscles act to invert the ankle
    • Flexor Digitorum longus
    • Flexor Hallicus longus
    • Lateral Compartment
    • --These muslces work to evert the ankle
    • Peroneus longus
    • Peroneus Brevis
    • www.getbodysmart.com
  5. Prevention of Lower Leg Injuries
    • Stretching the achillies tendon
    • Strengthening the lower leg musculature
    • Improving neuromuscular control
    • Choosing appropriate footwear
    • When needed proper taping or bracing
  6. Assessing the Lower Leg
    • HOPS
    • -History
    • -Observation
    • -Palpation
    • -Special test
  7. History
    • How long has it been hurting
    • Where is the pain
    • Has the feeling changed
    • Is there any numbness or tingling
    • Is there a feeling of warmth
    • Does the leg feel weak
    • Is it difficult to walk or walking up and down stairs
    • How did the problem occur
    • Assessing the Lower Leg
  8. Observation
    • Are they any abnormalities in the leg
    • Are there any postural deviations, such as toeing in, genu valgum, genu varum, genu recurvatum, pronation or supination of the foot
    • Is there any swelling or redness or echymosis
    • Is there a normal gait
  9. Palpation
    • Tap tests
    • Is there any palpable mass or deformities in the leg
    • Is the leg warm or tender to the touch
  10. Tibial and Fibular Fx
    • Tibia is most commonly injured long bone in the body
    • Cause of Injury
    • -Direct blow to the lower leg
    • -Combination of rotary/compressive force
    • Signs of Injury
    • -Tibial Fx
    • -Immediate pain, swelling, and possible deformity. May be open or closed
    • -Fibular Fx
    • -Usually closed
    • -Presents with pain and point tenderness on palpation and with ambulation
    • -Almost always presents with a deformity
    • Care
    • -Immediate Immobilization with a splint
    • -Immediate medical referral
    • -Immobilization and restricted weight bearing usually for weeks and possibly months.
  11. Tibial and Fibular Stress Fx
    • Cause of Injury
    • Repetitive loading of the area during training and
    • conditioning
    • Typically occurs in athletes involved with jumping
    • -Gymnastics
    • -Triple jumpers/ long jumpers
    • -Volleyball
    • -Basketball
  12. Tibial and Fibular Stress Fx (Signs of Injury)
    • Pain with activity that may worsen after activity
    • Point tenderness
    • -Usually in the middle of the shaft for tibia and in the distal end of the fibula.
  13. Tibial and Fibular Stress Fx (Care)
    • Removed from offending activity
    • Refer to Dr. For X-ray and Bone Scan
    • Athlete can do weight bearing activities that do not cause pain
  14. Shin Splints
    • Garbage Dx
    • Also called Medial Tibial Stress Syndrome (MTSS)
    • MTSS is a strain of the posterior tibialis muscle and its fasial sheath at its attachment to the periosteum of the distal tibia
  15. MTSS (Causes)
    • Running
    • Faulty foot mechanics
    • Tightness of the heel cord
    • Muscle weakness
    • Improper footwear
    • Training errors
    • Changing surfaces or running on poor surfaces
  16. MTSS (Signs of Injury)
    • Increasing pain at the distal two-thirds of the posterior medial aspect of the tibia
    • Pain in usually diffuse
    • May only hurt after a workout but will gradually progress to pain with walking
    • Can progress to a stress fx if not treated properly
  17. MTSS (Care)
    • Activity modification
    • Correcting abnormal foot mechanics
    • Stretching program
    • Ice massage
    • Possibly taping the arch or shins for compression
  18. Shin Contusions
    • Cause of Injury
    • -Absence of muscular and adipose padding leave this area susceptible to contusions
    • -Direct blows or bumps
    • Signs of Injury
    • -Pain
    • -Swelling/ bulging hematoma
    • -Care
    • -Compression Wrap
    • -Ice
    • -Padding for return to play
  19. Compartment Syndromes
    Conditions where increased pressure in the lower leg causes pressure on the musculature and nerves in the lower leg.
  20. Three categories of compartment syndrome
    • -Acute compartment Syndrome
    • -Acute exertional compartment syndrome
    • -Chronic compartment syndrome
  21. Acute Compartment Syndromes
    • -Occurs after a direct trauma to the area
    • -This is an immediate emergency due to nerve compression
  22. Acute Exertional Compartment Syndrome
    -No trauma but evolves with minimal to moderate activity
  23. Chronic Compartment Syndromes
    • -Activity related and Symptoms occur at certain points in the activity.
    • -Usually occurs with running and jumping activities.
  24. Compartment Syndrome-Signs of Injury
    • -Deep aching pain
    • -Tightness and swelling of shin
    • -Pain with passive stretching
    • -Numbness/ tingling/ decreased sensation in foot
    • -Decreased circulation in foot
  25. Acute Compartment Syndrome-Care
    • -Ice
    • -Elevation
    • -Referral to ER
    • -Surgery = emergency fasciotomy
  26. Chronic Compartment syndrome-Care
    • -Removal from activity
    • -Ice massage
    • -Lower leg and heel cord stretching
    • -Refer to Dr. If Sy persist
  27. Achilles Tendonitis--Cause of Injury
    • -Inflammatory condition that occurs with repeated stress on the tendon or ankle
    • -Workouts are too intense too soon
    • -Hill running can aggravate this
    • -Chronic Tendonitis can lead to Full rupture
  28. Achilles Tendonitis--Signs of Injury
    • -Generalized pain and stiffness in the tendon
    • -Gradual onset over time
    • -Morning stiffness and discomfort
    • -Tendon may be warm and TTP
    • -Palpable crepitus
  29. Achilles Tendonitis--Care
    • -Limiting activity
    • -Aggressive stretching
    • -Heel lift
    • -Taping
    • -NSAIDs
  30. Achilles Tendon Rupture--Cause of Injury
    • -Can range from grade 1 to complete rupture
    • -Sudden forceful plantarflexion of the ankle
    • -Most common in athletes above 30
    • -Usually occurs in Basketball Gymnastics and Tennis?
  31. Achilles Tendon Rupture--Signs of Injury
    • -Athlete will hear or feel a pop
    • -Plantar flexion will be painful and limited
    • -A palpable defect will be noticed/ or bunching of the gastrocnemius muscle may occur
  32. Achilles Tendon Rupture--Care
    • -Ice
    • -Crutches
    • -Surgical repair vs. immobilization