Ch 19- Specific Injuries

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Ch 19- Specific Injuries
2013-10-15 13:23:10

ch 19
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  1. 5-10% of ankle sprains

    · uncommon bc bony protection and ligament strength
    · Eversion force damages deltoid and possible fibula fx
    · Inversion can also hurt deltoid
    · More susceptible if promated, hypermobile, or depressed medial longitudinal arch

    Signs/ Symptoms
    · severe pain, inability to weight bear
    · pain with abduction and adduction

    · RICE, xray to rule out fx, posterior splint tape, NSAIDs
    · same treatment as inversion
    · Grade 2 or high cause more instability, and excessive pronation
    Eversion Ankle Sprain
  2. Etiology
    · injury to distal tibiofemoral joint  and ligaments (ant/pos tib fib ligament)
    · torn w/ external rotation or dorsiflexion

    · loss of function
    · pain w/ passive external rotation and dorsiflexion - usually anterolaterally

    · difficult to treat bc cant strengthen anything around it
    · same treatment as sprains but longer immobilization and rehab
    · surgery possible

    Syndesmotic Sprain
  3. Etiology
    · avulsion, bi-malleolar fx

    · Swelling, pain, extreme deformity

    · RICE
    · after swelling- walking cast/brace
    · immobilization 6-8 weeks
    Ankle Fracture/ Dislocation
  4. · develops after 1/3 of ankle sprains
    Mechanical- naturally loose

    Functional- person feels unstable bc of proprioception and/or neuromusclar deficits
    --- rehab works on this
    Chronic Ankle Instability
  5. Etiology
    · in superior medial articular surface of talar dome
    · fragment(s) of atricular caritlage w/ detachment of bone moving in joint space
    · from single or multiple traumas

    · pain and effusion w/ signs of atrophy
    · ***catching, locking, giving away

    · dx through xray
    · non displacement- immobilization and earl ROM
    · if displaced- surgery

    Osteochondritis Dissecans
  6. Etiology
    · Common
    · Often occurs w/ sprain or excessive dorsiflexion

    · mild- severe pain
    · most severe- partial avulsion of Achilles

    · Pressure and RICE
    · After hemorrhaging- apply elastic wrap
    · Conservative treatment bc usually problems usually chronic
    · Heel lift, stretching/ strengthening of Achilles

    Acute Achilles Strain
  7. · Inflammation of tendon, sheath  or paratenon
    · causes fibrosis and scaring that restricts tendon motion
    · can cause tendinosis
    Achilles Tendonitis
  8. Etiology
    · doesnt present w/ inflammation, abnormal apperanace w/ cell disorganization and scaring
    · Overloaded tendon bc of extensive stress
    · gradually gets worse
    · decreased flexibility worsens it

    Signs/ Symptoms
    · generalized pain/ stiffness, localized proximal to calaneal insertion
    · Warm, thick, painful
    · Morning stiffness
    · Crepitus w/ active plantar flexion and passive dorsiflexion

    · reduce stress on tendon and address structural problems
    · use anti-inflammatories
    · Cross friction massage break down scar tissue
    · Progressive strengthening so dont aggravate tendon
    Achilles Tendinosis
  9. Etiology
    · Sudden stop and go; forceful plantar flexion w/ knee in full extension
    · see in >30
    · history of chronic inflammation

    Signs/ Symptoms
    ·** sudden snap
    · pt tenderness, swelling, discoloration, indentation, decreased ROM
    · positive Thompson test
    · at calcaneal insertion

    · serious- surgery
    · RICE< NSAIDs, analgesics, non weight bearing cast 6 weeks, walking cast 2 weeks
    · Rehab 6 mo- ROM, PRE
    · heel lift

    Achilles Tendon Rupture
  10. Etiology
    · dynamic force to ankle
    · dramatic blow to posterior lateral malleolus
    · mod/severe inversion ankle sprain resulting in tearing fibularis retinaculum
    · tendon may rupture

    · snapping/ instability
    · eversion against manual resistance replicates subluxation
    · present w/ ecchymosis, edema, tenderness and crepitus over tendon

    · compression w/ felt horseshoe
    · reinforce compression w/ rigid plastic or plastic until signs subside
    · RICE, NSAIDs, analgesics
    · conservative treatment 5-6 weeks, then gradual rehab
    · surgery possible

    Fibularis Tendon Subluxation Dislocation