ther-ex exam 3

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ther-ex exam 3
2015-03-31 18:20:18
hip pelvis knee ankle foot

ther-ex exam 3
Show Answers:

  1. what type of socket is the hip?
    ball and joint
  2. iliofemoral, pubofemoral, and ischiofemoral ligaments reinforce what joint?
  3. is the acetabulum convex or concave?
  4. is the femoral head convex of concave?
  5. which direction  does the femoral head slide in relation to physiologic movement of femur?
  6. which direction does the head of femur slide with hip flexion?
  7. which direction does the head of the femur slide with extension?
  8. in which direction would you decrease the lordosis during pelvic tilts?
  9. in which direction would you increase the lordosis in the lumbar spine during pelvic tilts?
  10. what is the normal range for angle of inclination?
    115-125 degrees
  11. which hip deformity results in a very inclined femur head?
    coxa valga
  12. which hip deformity results in a flat line femur head?
    coxa vara
  13. What do you call it when the femoral head sits more anteriorly?
  14. what do you call it when the femoral head sits more posteriorly?
  15. What is the normal angle of anteversion in adults?
    15; 35 is considered abnormal
  16. What does the Craigs test screen for?
  17. if the popliteal crease is level to the horizon where is the torsion?
  18. if the popliteal crease is angled where is the torsion?
    knee joint
  19. correction of movement dysfunctions and muscle imbalances. What type of Tx is this?
  20. protocols, target tissue, functional re-trng. and overall conditioning. This are all necessary in what type of Tx?
    surgical/post- surgical
  21. more than 70% of hip fx's happen in which population?
    >70yoa, women > men
  22. Mrs. Jones comes in with c/o pain in her groin, has pain mostly when she is using her leg is unable to bear weight or ambulate on her own. you also notice that her left leg looks a little bit shorter than her right. What would you immedietly suspect?
    hip fx
  23. location and severity
    extracapsular or trochanteric
    femoral neck or subcapital areas 
    proximal femoral shaft or subtrochanteric

    what do all of these have in common?
    they are how you classify hip fx's
  24. avascular necrosis
    delayed union

    what do all of these have in common?
    complications of hip fx's
  25. what is the procedure that secures fx fragments with rods, nails, pin, screws and/or plates?
  26. what do all hip fx's Tx depend mostly on?
    • age
    • status
    • type of fx
  27. How long can it take for DVT's to show after a surgical procedure?
    4-6 weeks
  28. What is the wells clinical prediction rules for?
    accesses risk for DVT or pulmonary embolism 
  29. what would there score be on the wells clinical for them to be at a high risk for DVT?
  30. what would there score be on the wells clinical for them to be a moderate risk? 
  31. what would there score be on the wells clinical or them to be a low risk?
  32. The post-op management for hip ORIF is dependent upon 4 things. What are they?
    • pt. status
    • location of fracture
    • method of fixation
    • MD protocols 
  33. age, bone quality, fx location and pattern, type of implant used for fixation and the degree of intraoperative stability achieved are everything you need to consider for ___________________ considerations 
    weight bearing 
  34. undisplaced, rigidly fixed, impacted femoral neck fx indicate that what is immediately permissible after hip ORIF surgery?
  35. what time frame is considered the maximum protection phase?
    day 1 to week 3
  36. what day do exercises begin after hip ORIF?
    day 1; performed within limits of pain
  37. how much active hip flexion do you need to reach by 2-4 weeks post-op for hip ORIF?
    80-90 degrees
  38. increase muscular strength, ROM of affected hip, and local muscle endurance
    improve overall conditioning
    enhance aerobic fitness
    reduce pain and swelling
    protect healing structures
    re-establish normalized gait mechanics

    these are the goals for what phase of hip ORIF?
    maximum protection 
  39. during the max protection phase of hip ORIF rehab what do you not want to do for the first 6-8 weeks?
    SLR and bridging 
  40. what are some of the exercises you would do during the max protection phase of hip ORIF rehab?
    • bilateral ankle pumps
    • isometric quad and glute sets
    • heel slides
    • hip abduction and adduction
    • supine medial and lateral rotation 
  41. after how many weeks has the soft tissue healed after a hip ORIF?
    6 weeks
  42. after how many weeks has some bone healing occurred after a hip ORIF?
    8-12 weeks
  43. what do you put the emphasis on during the mod-min protection phase after hip ORIF?
    increasing strength, function, flexibility, and muscular endurance 
  44. what time frame is considered the moderate protection phase of hip ORIF?
    3-6 weeks 
  45. during the moderate phase of hip ORIF you want more challenging exercises to?
    • regain hip and knee ROM
    • improve quad and ham strength
    • increase strength of hip extensors, abductors, and adductors 
  46. what time frame is considered the minimum protection phase of hip ORIF?
    6-8 weeks 
  47. the minimum protection phase of hip ORIF is characterized by?
    • normal gait mechanics
    • reduced use of assistive device 
  48. what are some closed kinetic chain exercises you would do during the moderate protection phase of hip ORIF to progress to FWB?
    • partial squats
    • step-up's 
    • bike or bike pedals (as allowed by hip restrictions) 
  49. What would you do during the minimum protection phase of hip ORIF for more advanced strengthening?
    • stair stepper
    • addition of SLR and bridging
  50. What are the 2 categories for pelvic and acetabular fractures?
    • stable
    • unstable
  51. what are the 2 classifications for pelvic and acetabular fractures?
    • simple
    • combined 
  52. How would you treat a stable pelvic/acetabular fracture?
    bed rest and protected WB 
  53. how would you treat an unstable pelvic/acetabular fracture?
    external fixator, ORIF, or bed rest 
  54. what is the rehab for pelvic fractures?
    • active bilateral UE ROM
    • LE's same as ORIF
    • protected WB for 8-10 weeks 
  55. the femoral component of a THA is typically made from _________________ and the acetabular component is made from ____________________.
    titanium; hi density polyethylene 
  56. beaded or meshlike surface of prosthesis allows bone growth to anchor in femur
  57. what type of THA fixation is most commonly used for pts with osteoporosis and poor bone stock and are over 60 yoa
  58. the purpose of a _____ is to correct intractable damage causing functional impairment due to ___________, _____________, _______________, _____________
    • THA;
    • OA
    • avascular necrosis
    • RA
    • fx 
  59. what are the three different types of surgical approaches for THA?
    • posterolateral
    • lateral
    • anterolateral 
  60. what is the most frequently used THA approach?
  61. what THA surgical approach is associated with the highest incidence of post operative joint instability and resulting in sbluxation or dislocation of the hip?
  62. which THA surgical approach requires release of up to 1/2 of proximal insertion or longtudinal splitting of the vastus lateralis that causes a disruption of the abductions which causes post op weakness and gait abnormalities
  63. which THA surgical approach is typically reserved for revisions or complex reconstructions for pts with muscle imbalances associated with CVA or CP and involves detachment of glute med, disturbance of glute min, TFL, iliopsoas, rectus femoris and vastus lateralis. 
  64. what are the precautions for a posterolateral THA approach?
    • no flexion >90 degrees 
    • No IR or AD-D
  65. How would you immobilize a pt. after a THA?
    • slight abduction
    • neutral rotation 
  66. The weight bearing status is determined by the ________________ and protocols based on if they are _________________ or ______________. 
    • type of prosthesis
    • uncemented
    • cemented 
  67. an uncemeneted THA would progress to FWB by week___?
  68. a cemented THA would progress to FWB by week ____?
  69. avoiding hip adduction, interal rotation, and flexion >90 degrees or a combo of any of the above what precautions for what type of THA surgical approach?
  70. for a THA pt. to avoid flexing >90 degrees, what type's of things would they want to avoid?
    • sitting in low chairs, toilets
    • bending forward at the hips
    • squats 
  71. What day do you begin exercise after a THA?
    day 1
  72. What exercises would you have the pt. doing for a THA while they are still in the hospital?
    • QS
    • glute sets
    • heel slides
    • isometric hip adduction but active hip abduction
    • ankle pumps
    • deep breathing
    • transfer trng. 
  73. what is the main risk you want to monitor for after a THA during the first 4-6 weeks?
  74. What are the 2 things you would notice that would make you suspect a hip dislocation?
    • shortening of one LE
    • inability to ambulate
  75. during the max protection phase for THA what type of exercises would you do or the affected LE?
    closed chain within WB restrictions
  76. during the max protection phase for THA what type of exercises would you do for the unaffected LE?
    • SLR's
    • QS, HS
    • AP's
    • full knee and hip mobility
  77. during the max protection phase for THA why don't you want to prop the leg up with pillows under the knee?
    to prevent flexion contracture
  78. What type of stretch would you use to prevent flexion contracture with a THA pt?
    supine to neutral stretch in thomas test position 
  79. during what phase of rehab for a THA pt. would you work on restoration of strength, muscular and cardiopulm endurance and ROM to functional levels 
  80. How long would you want to continue using the post-op precautions during ADL's for a THA pt.?
    12 weeks 
  81. using heavy exercise loads is not appropriate for pt.'s after THA and may contribute to what?
    prosthetic loosening 
  82. during what protection phase would you want to progress the pt. to a cane after progressing their WB status after a THA?
  83. what is a prosthetic replacement of the proximal femur?
    hemiarthoplasty of hip 
  84. abnormal abutment btw the acetabulum and femoral head causing progressive cartilage erosion
  85. There are two types of FAI's, what are they?
    • cam: femoral head
    • pincer: acetabular 
  86. Mrs. Jone's came in with c/o clicking and popping in her hip with pain that is intermittent with repeated hip flexion and IR. What would you suspect this is?
  87. FAI are a precurser for what?
    • labral tears
    • hip OA
  88. genetic morphological anatomy
    slipped femoral epiphysis
    hip dysplasias
    malunited fractures

    these are are predisposers for what?
  89. stability
    shock absorption
    pressure distribution

    these are the function of what structure of the hip?
  90. trauma
    capsular laxity/hypermobility

    these all have what in common?
    MOI for labral tears 
  91. your pt. c/o anterior hip/groin pain and says that her hip feels like it is "clicking, locking, and giving away" what might you suspect is wrong?
    labral tear 
  92. what is the gold standard for diagnosing labral tears?
  93. bursa becomes irritated and inflamed due to excessive compression and repeated friction as ITB snaps over bursa
    trochanteric bursitis 
  94. pain in groin or anterior thigh, maybe into patellar area and is aggravated with activites requiring exessive hip flexion
    psoas bursitis 
  95. tailors/weavers bottom; pain at ischial tuberosities especially when sitting
    ischiogluteal bursitis 
  96. Which are the most common muscles of the hip that are affected by tendonitis or muscle pull from overuse or trauma?
    iliopsoas, adductors, rectus femoris, hams
  97. Which is the most common bone to be affected by contusions in the hip?
    iliac crest due to direct contract from fall or external force 
  98. during the protection phase of soft tissue injury of the hip what do you want to do to control inflammation and promote healing?
    • cold or ice packs 20 min
    • compression
    • avoid pain causing motions
    • anti-inflammatories
  99. during the protection phase of soft tissue injuries of the hip you want to develop neuromuscular control for?
    alignment of the pelvis and hip 
  100. during the controlled motion phase of soft tissue injury for the hip what do you want to develop and improve?
    • develop: strong mobile scar and balance in length and strength of hip muscles
    • improve: flexibility, postural control and muscular control
  101. what tests the iliopsoas and rectus femoris tightness?
    thomas test
  102. what tests rectus tightness, can transition to femoral nerve assessment
    elys test 
  103. what tests for ITB tightness
    obers test 
  104. what tests either adverse neural of sciatic nerve, L-HNP, or hamstring tightness
  105. whats the sign for glute med weakness
  106. what tests for hip OA or impingement?
  107. what tests for excessive inversion in the hip?
  108. what are the mobilization techniques for the hip?
    • long axis distraction
    • lateral distraction 
    • anterior and posterior mobilization
    • inferior glide
  109. There are 3 joints of the knee. What are they?
    • tibiofemoral
    • patellofemoral 
    • proximal tib/fib
  110. which joint is biaxial, modified hinge joint, has 2 mensicii, is surrounded by muscles, and has the ACL, PCL, MCL, & LCL for stability. 
    tibiofemoral joint of the knee 
  111. which direction does the patella slide during knee flexion?
  112. which direction does the patella slide during knee extension?
  113. angle describes the lateral traking/bowstring effect quads and patellar tendon have on the patella. 
  114. the cruciates of the knee "______" upon each with IR of the tibia 
  115. which cruciate is taut in full extension?
  116. what percent of the load does the meniscii transmit across the joint?
  117. How much does the  mensical load increase to at 90 degrees knee flexion?
  118. How big of a role does the meniscii play in stability of the ACL intact knee?
    minimal to none 
  119. does the mensicii play a role in an ACL deficient knee?
    yes, HUGE!
  120. What is the shape of the MCL of the knee?
    broad, flat with superficial and deep fibers
  121. What does the MCL connect to?
    medial meniscus 
  122. with a MCL repair which portion has a tendency to heal tight?
    femoral and mid-substance 
  123. with a MCL repair which portion has a tendency to heal loose?
  124. with the knee, which is convex and which is concave?
    • convex: femoral condyles
    • concave: tibial plateua 
  125. where does rotation occur during the final degrees of extension; "screw home"
    btw femoral condyles and tibia 
  126. in open chain TKE how does the tibia rotate on the femur?
  127. in closed chain TKE how does the tibia rotate on the femur?
  128. which muscle "unlocks" the knee during __________.
    poplitius; internal rotation by initiation of knee flexion 
  129. what is the functional ROM of the knee needed for:
    stair climbing
    sitting down
    tying shoes 
    • walking: 67
    • stair climbing: 83
    • sitting down: 93
    • tying shoes: 106 
  130. systemic corticosteroid use, pre-existing arthritis, arthrocenesis, distant infection, and DM are predisposing factor what medical emergency?
    septic arthritis 
  131. What grade of ligament injury is accompanined by incomplete stretching of fibers, minimal pain and swelling, with no loss of function or sign of instability?
    grade 1/ 1st degree (mild) 
  132. what grade of ligament injury is accompanied by partial tear or complete tear of some fibers, moderate pain and swelling, with some loss of joint function, and some loss of joint stability
    grade 2/ 2nd degree (moderate) 
  133. what grade of ligament injuryis accompanied by complete tear of ligament, intense pain and severe swelling with loss of joint function and joint instability is present?
    grade 3/ 3rd degree (rupture) 
  134. ACL injuries usually involves combined forces of what?
    • valgus stress
    • internal tibial rotation
    • may be combined with knee hyperextension while foot planted 
  135. 75% of ACL injuries report the triad of what?
    • acute blow or twisting or cutting
    • immediate effusion of the knee
    • inability to continue play 
  136. What are the ACL stability test's?
    • lachmans 
    • anterior drawer test 
  137. What are the most commonly used tendons for the autograft reconstruction for ACL?
    • semi T
    • quadriceps 
    • gracilis 
    • TFL 
  138. when a tissue is taken from a cadaver, what type of reconstruction is that?
  139. when does avascular necrosis take place after an ACL autograft?
    6-8 weeks 
  140. when does the ACL autograft revascularize?
     12 weeks 
  141. what time frame is considered the maximum protection phase for ACL repair?
    day 1 - week 6
  142. what must do in order to prevent patellar contracture?
    • superior & inferior joint mobilizations
    • active quads 
  143. what is the wb status for the maximum protection phase for ACL repair?
    WBAT with axillary crutches 
  144. what should you not do under any circumstances during the maximum protection phase for ACL repair?
    • SAQ
    • LAQ
    • SLR with extensor lag 
  145. during the maximum protection phase after ACL repair what must the pt. do during ambulation?
    wear a brace locked in full extension 
  146. what are some exercises a pt. should be doing during the max protection phase after ACL repair?
    • ankle pumps
    • weighted knee extension
    • active & passive knee flexion
    • 3-way SLR
    • ham stretch and sets
    • mini squat, weight shifts 
    • RICE
  147. what is the minimum time frame a pt. must meet in order to progress to the moderate protection phase after ACL repair?
    6 weeks 
  148. what must the pt. demonstrate before progressing to the moderate protection phase after ACL repair?
    • ROM 0-120 degrees
    • FWB
    • quad and ham control
    • controlled pain and swelling 
  149. What would a exercise plan entail during the moderate protection phase after ACL repair?
    • proprioception
    • stationary bike
    • progressive ROM
    • biofeedback
    • initiate closed chain activities 
  150. Mrs. Jones has achieved: 
    full ROM and patellar mobililty 
    normalized FWB gait and removal of brace
    improved quad and ham strength
    continued control of pain and swelling
    and is 12 weeks post op

    what phase of protection is she ready to progress to?
    minimum protection phase 
  151. what are some progressive proprioceptive exercises you can do during the min protection phase after ACL repair?
    • balance board
    • mini tramp
    • standing TKE with tband
    • slide board
    • jogging 
  152. what are some progressive strenghtening exercises for the LE can you do for min protection phase after ACL repair?
    • leg presses
    • squats 
  153. posteriorly direted force on anterior flexed knee
    falling on flexed knee with tibial tuberosity point of contact
    hyperflexion of knee
    knee hyperextension with foot planted

    these are MOI's for what type of injury?
  154. How would you manage a grade 1 & 2 PCL injury?
  155. does the MCL have a tendency to heal over time?
  156. which is the most commonly injured ligament of the knee?
  157. how is the MCL most commonl injured?
    valgus force 
  158. what does the valgus stress test for ?
    MCL stability 
  159. What are the critical conditions for non-surgical rehab of MCL tears?
    • maintenance of torn fibers in close continiity 
    • intact and stable ACL and supporting ligament
    • immediate controlled motion
    • protection of MCL from valgus and lateral rotation 
  160. with a non-surgical rehab of MCL tear the may be immobilized in a range limiting brace that prevent the last _____________________.
    10 degrees of extension 
  161. what is WB status for a non-surgical rehab pt. for MCL tear?
    wbat with crutches 
  162. what is caused by femur medially rotating with foot fixed on the ground, squatting or trauma?
    medial meniscus tear 
  163. what does a medial meniscus tear cause?
    acute locking of the knee 
  164. when would a pt. have a surgical repair of a meniscus tear?
    if the tear occurs in vascular portion; outer 1/3 
  165. any tear of meniscus that is symptomatic and not considered repairable 
    tears/ruptures in inner 2/3 portion
    displacement of meniscus associated with locking

    these are indicators for what kind of repair for meniscal tears?
    partial meniscetomy 
  166. where is the highest prevelence of meniscal tears?
    football, soccer, basketball 
  167. How would a meniscal injury present?
    • joint line pain
    • true locking
    • pain with twisting and deep flexion 
  168. What are some of the special tests for meniscal injuries?
    • McMurray
    • Apley compression 
  169. what is meniscal healing influenced by?
    • blood supply 
    • pattern of tear; 
    •    longitudinal: heal better
    •    Radial: heal worse 
  170. What happens to the meniscus during immobilization?
    atrophy and decreased collagen content 
  171. is early ROM necessary to maintain the health of the menisci?
    for sure!! 
  172. What time frame is considered the max protection phase for meniscal tears?
    day 1 to 4-6 weeks 
  173. What do you want to limit knee flexion to during the max protection phase for meniscal tears?
    45-60 degrees 
  174. during the max protection phase for meniscal tears your emphisis should be on?
    • quad and ham control
    • SLR
    • hip strength
    • SAQ/LAQ
    • bicycling- 3 weeks post-op 
  175. during the moderate phase of protection for meniscal tears when would you start the functional closed chain activities?
    8 weeks 
  176. what are the functional closed chain activities would you do during the moderate protection phase for meniscal tears?
    • step up's
    • wall squats
    • leg presses
    • stair stepper 
  177. when should your pt. be FWB with a meniscal tear?
    6 weeks 
  178. what type of proprioceptive trng. would you do with a pt. in the moderate protection phase for meniscal tears?
    • SLS
    • balance board
    • mini tramp 
  179. When does the minimum protection phase for meniscal tears begin?
    9th week- 20th 
  180. What do you work on in the min protection phase for meniscal tears?
    • normalize gait
    • attain FROM
    • enhance functional activities 
  181. how long do you want to avoid full weighted squats after a meniscal tear?
    3-6 months 
  182. includes problems that cause increased functional Q-angle, tightness of lateral retinaculum, abnormal patellar tracking, weak glute med, excessive pronation, poor quad strength/recruitment, poor functional biomechanics 
    PFPS with malalignment or biomechanical dysfunction 
  183. patellofemoral instability includes ______________ or ________________ of single or recurrent episodes.
    • subluxation
    • dislocation 
  184. lateral retinacular release
    proximal/distal realignment of extensor mechanism

    these are all surgical repairs for what?
    patellofemoral and exensor mechanism
  185. what are the three ways in which you can fx the patella?
    • direct or indirect trauma
    • contact with hard surface
    • forceful contraction of the quads
    • AVN
  186. how would a non-displaced patella fracture be treated?
  187. how would a displaced patella fracture be treated?
    ORIF; tension band wire 
  188. extraarticular

    these are fx of what and how are they usually treated?
    supracondylar femur; ORIF 
  189. how is a displaced proximal tibia fx treated?
    ORIF and immobilization 
  190. severe jt. pain with WB or motion that compromises functional abilities
    extensive destruction of articular cartilage of the knee due to advanced arthritis
    gross instability or limitation of motion
    marked deformity of knee such a genu varum/valgum
    failure of non-op management or previous surgical procedure

    these are clinical indicators for what?
  191. what is the most common disability in the US, 33% of people age 63-94 are affected by?
    knee OA
  192. 80% of knee OA is located where?
    medial compartment 
  193. obesity
    OA at other sites
    previous knee injury/trauma/surgery
    being female
     established risk factors for knee OA
  194. physical activity
    estrogen deficiency
    controversial risk factors for knee OA?
  195. What are the ways to do a TKA?
    • unilateral compartment
    • two compartment 
    • three compartment if they resurface patella 
  196. what type of fixation method is used for TKA in pt.'s who are older and more sedentary and are WBAT the 1st day?
  197. which TKA fixation method theoretically should not deteriorate over time and is considered ideal for younger more active patients. it has a TTWB for first 6 weeks then progressed to WBAT after 6 weeks with crutches 
    porous ingrowth 
  198. non cemented femoral and patellar component with cemented tibial component?
    hybrid technique 
  199. what should a TKA pt. achieve before leaving the hospital?
    TKE and 90 degrees flexion 
  200. what is considered the motion phase for TKA rehab?
    2-6 weeks 
  201. what is the ROM goal for the motion phase of TKA rehab?
    0-110/115 degrees 
  202. what types of exercises would you do during the motion phase to TKA rehab?
    • partial squats
    • total gym
    • bike 
    • progressed hip exercises
    • progressed gait trng. and proprioceptive trng. with walker 
  203. How long can a TKA continue to swell?
    up to a year post-op
  204. During weeks 7-12 of TKA rehab what should you be working on?
    • progress ROM to >115 degrees 
    • cardio fitness
    • progress functional activities to lunges, squats, step-up's and full body movements for balance 
  205. reduction of pain
    correction of deformity or instability
    restoration of LE function

    these are goals for what?
    joint surgery 
  206. this type of joint surgery is used to redistribute WB forces btw tibia and femur
    osteotomy of proximal tibia 
  207. this type of joint surgery is used when erosion of articular surfaces becomes severe 
    total joint replacement arthorplasty 
  208. this type of joint surgery is only used in ery selective situations. 
    arthrodesis; fusion 
  209. What would be a postive for the lachmans?
    no endpoint, excessive anterior translation 
  210. how much translation is normal for the ACL?
  211. reduction or "jog" backwards of the tibia at 30-40 degrees knee flexion would be a positive for what special test? 
    ACL pivot shift 
  212. What are the two phases of the ACL pivot shift special test?
    • subluxation
    • reduction
  213. what is subluxation of the ACL?
    internal rotation of the tibia with knee extension 
  214. What is the reduction phase of the ACl pivot shift test?
    tibia clunks back into position; valgus force with knee flexion 
  215. What is the key of the ACL pivot shift test?
    ITB position change 
  216. What does the "dial test" access and how is it tested?
    posterolateral corner; knee's 30 degrees flexion and compare ER from side to side
  217. What are you looking at when doing the PCL posterior sag sign?
    positions of the tibial tuberosities 
  218. what does the varus stress test measure?
    LCL damage
  219. What does the clarkes test measure?
    retropatellar pain 
  220. What are the flexability tests for the knee?
    • SLR
    • thomas
    • ober's 
  221. what does the ober's test for?
    ITB tightness 
  222. what does the SLR test for?
    ham tightness or neural tension 
  223. what does the thomas test for?
    iliopsoas vs. rectus tightness
  224. what are the bony parts of the leg?
    • tibia
    • fibula
  225. what are the bony parts of the foot?
    • hindfoot: talus & calcaneous
    • midfoot: navicular, cuboid, 3 cuniforms
    • forefoot: 5 metatarsals & 14 phalanges
  226. What are the motions available at the foot and ankle?
    PF, DF, inversion, eversion, abduction, adduction, pronation, and  supination
  227. tibiofibular
    transverse tarsal

    what do all of these have in common?
    joints of the foot and ankle 
  228. which joint is considered the "ankle"
  229. what type of joint is the TC?
    synovial hinge
  230. What ligaments support the lateral side of the TC joint?
    • ant/post talofibular
    • calcaneofibular 
  231. what ligament support the medial side of the TC jt.?
    deltoid ligament 
  232. what type of joint is the subtalar joint?
  233. what joint is supported by the MCL/LCL of the ankle, talocalcaneal and the talocalcaneal interosseous membrane?
  234. what joint is supported by the deltoid, bifurcate and dorsal "   " ligaments?
  235. what joint is between the hind and midfoot?
    transverse tarsal 
  236. pes planus is also know as?
    flat foot/ overly pronated 
  237. pt.'s with pes cavus have what?
    high arched foot/ overly supinated 
  238. the gastroc and soleus are _________ muscles of _____________.
    • primary
    • plantarflexors 
  239. post tib, FHL, FDL, peroneus longus and brevis are ______________ muscles of ____________.
    • secondary
    • plantarflexors 
  240. ant tib, EHL, EDl, and foot intrinsics are muscles of?
  241. what type of ankle injury accounts for 85-95% of all ankle injuries?
  242. what is MOI for a LAS?
    pure inversion < inversion + plantarflexion 
  243. what might a pt. say they did to have caused their LAS?
    • stepped off a curb wrong
    • stepped into a small hole
  244. what is a 1st degree ligament rupture?
    only one ligament ruptured; most commonly the ATF
  245. what is a 2nd degree ligament rupture?
    2 ligaments are ruptured; ATF and fibulocalcaneal 
  246. what is a 3rd degree ligament rupture?
    all three lateral ligaments are completely torn; ATF, PTF, & fibulocalcaneal 
  247. which ligament prevents talus from migrating anteriorly and rotating internaly and is first to be injured with LAS?
  248. which ligament prevents exessive inversion opening btw both mortise and subtalar jts. and is the next to go after the ATF with LAS?
  249. which ligament checks subtalar joint separation during inversion and dorsiflexion?
    lateral talocalcaneal 
  250. what nerves are involved with the foot and ankle?
    • superficial peroneal/fibular
    • lateral sural cutaneous 
  251. which mechanical dysfunction is associated  with the talus being stuck anteriorly?
    DF; can't get it to glide posterior 
  252. which mechanical dysfunction is associated with the calcaneus being suck in inversion?
    lacks eversion 
  253. why do we emphasize ankle joint mobs?
    research proves that there is a significant increase in DF ROM, stride speed and length and it improved quicker 
  254. swelling and decreased DF may lead to what?
    • lack heel strike
    • bad balance
    • antalgic gait
    • circumduction 
  255. what would you expect to see with SLS after LAS?
    • trendelenberg
    • LOB w/in 30 seconds
    • hard knees 
  256. what does the anterior drawer test for with a LAS?
  257. what does the talar tilt special test measure?
    calcaneofibular rhythm 
  258. what does the figure 8 measure?
    ankle swelling 
  259. what does the SLS test with LAS?
    balance and proprioception 
  260. what part of the hand do you use and where is the placement of the hand when doing a dorsal glide of the talus?
    webspace; grasp forefoot with webspace over talus 
  261. what is the initial Tx for phase 1 of LAS?
    RICE 3-5X daily 
  262. what do you want to avoid during the max protection phase of LAS?
    PF and inversion 
  263. what kind of isometrics do you want to do during the max protection phase of LAS?
    DF and eversion 2-3 sets of 10 with 10 second hold each 
  264. how long is a grade 1 LAS in the subacute phase?
    2-4 days 
  265. how long is a grade 2 LAS in the subacute phase?
    3-5 days 
  266. how long is a grade 3 LAS in the subacute phase?
    4-8 days 
  267. what is phase 2 of LAS also known as?
    subacute phase 
  268. what are the goals for phase 2 of LAS?
    • decrease pain and swelling
    • increase painfree ROM
    • begin NWB proprioceptive trng.
    • begin strengthening and support as needed
  269. what type of ther-ex would you do during phase 2 of LAS?
    • active ROM (alphabets)
    • strengthening (open chain therband)
    • proprioceptive trng
    • stretching
    • unloaded gait 
  270. how long is a grade 1 LAS in phase 3 rehab?
    1 week 
  271. how long is a grade 2 LAS in phase 3 rehab?
    2 weeks 
  272. how long is a grade 3 LAS in phase 3 rehab?
    3 weeks 
  273. what are the goals for phase 3 rehab for LAS?
    • restore full pain free ROM
    • progress proprioceptive & strength trng
    • pain free FWB & gait without limp 
  274. what kind of balance and propriocptive training would you be doing in phase 3 LAS rehab?
    • SLS with or w/o ball toss
    • SLS 1/4 squats
    • standing baps
    • mini tramp 
  275. what kind of strengthening trng. would you be doing in phase 3 LAS rehab?
    • SL heel/toe raises
    • quarter squats
    • foot intrinsics 
    • FWB gait 
  276. What is phase 4 of LAS rehab also know as?
    return to sport phase 
  277. how long is a grade 1 in phase 4 with LAS?
    1-2 weeks 
  278. how long is a grade 2 in phase 4 with LAS?
    2-3 weeks 
  279. how long is a grade 3 in phase 4 with LAS?
    3-6 weeks 
  280. what are some of the things you worry about with LAS?
    • CAI
    • possible talar dome fx
    • development of anterior impingement 
    • development of ANTT 
  281. proprioceptive deficits, impaired neuromuscular control, strength deficits and impaired postural control all lead to what?
    functional ankle instability that leads to CAI 
  282. joint motion that exceeds normal physiological range can lead to what?
    mechanical ankle instability that leads to CAI 
  283. how do you get to CAI?
    • missed magnitude of injury
    • improper rehab
    • congenital hypermobility 
  284. peroneal weakness.tendonitis
    posterior tibial weakness.tendonitis
    talar dome articular cartilage lesions 

    these are all common impairments associated with what?
  285. according to brotzman, _____________, not __________ alone should e the primary criterion for ligament recontruction.
    • instability
    • pain 
  286. the diagnosis of CAI is bas upone Hx of multiple ________ ankle sprains with ___________________.
    • inversion
    • fairly minor provocation 
  287. what type of surgical option for the unstable ankle that requires direct surturing. It is the most common first attempts and is for pt.'s whose livelihood depends on FROM
  288. suturing of ATF with CFL and inferior ext retinaculum 
    modified brostrom 
  289. surgical option for unstable ankle that uses endogenous tendons or ligaments
  290. the goal for an unstable ankle is to restore stability while preserving normal ankle and ___________ motion.
  291. after surgical ankle stabilization how long are they NWB?
    2 weeks 
  292. what position is the foot in while in the walking boot after surgical ankle stabilization?
  293. after how many weeks after ankle stabilization surgery can you start mobs?
    4 weeks 
  294. when do you start ankle balance exercises after ankle stabilization surgery?
    6 weeks 
  295. when can you start sport specific trng. after ankle stabilization surgery?
    8 weeks 
  296. what must you achieve before you can progress to sport specific trng. after ankle stabilization surgery?
    full peroneal strength and multiple SL hops with NO s/s
  297. what is a syndesmotic ankle injury?
    high ankle sprain 
  298. eversion, ER with dorsiflexion; talus is pushed up into tib/fib joint resulting in injury to tib/fib ligament

    this the MOI for what type of ankle injury?
  299. what accounts for approx. 10% of all ankle sprains and common cause of chronic ankle pain?
  300. generally, what is the first ligament to go in a syndesmotic ankle sprain?
    anterior talofibular 
  301. generally, what is the second to go in a syndesmotic ankle sprain?
    interosseous membrane 
  302. rarely injured, but which ligament is last to go in a syndesmotic ankle sprain?
    posterior tibiofibular 
  303. what is considered the most accurate method of detection for syndesmotic injury?
    CT scan 
  304. what are the most common s/s with a high ankle sprain?
    • unable to bear weight
    • associated with fx
    • obvious increase in pain with dorsiflexion
  305. What does the squeeze test measure?
    high ankle sprain 
  306. What ligament is associated with eversion ankle sprains 
    • deltoid
    • spring 
  307. the keigler and peroneus subluxation special tests measure what?
    eversion ankle sprains 
  308. training errors; increase in training activity 
    resuming trng. after long period of inactivity
    running on uneven surfaces

    these are all contributors to what?
    achilles tendonitis 
  309. a positive painful arch is a sign for what?
    achilles tendinosis 
  310. achilles tendinosis is typically in the mature athlete and remains ___________ and ____________ until rupture 
    • asymptomatic
    • subclinical 
  311. what is very useful to discern btw paratenonitis and tendinosis?
  312. the MOI for ______________ is eccentric load with forcible ankle dorsiflexion
    acute achilles rupture 
  313. what is the thompson/calf squeeze test for?
    achilles rupture
  314. if the ankle fails to ___________ or only moves minimally this is considered a ___________ thompson test. 
    • plantarflex
    • positive 
  315. how long will a pt. be in a boot after achilles surgery and what position will the foot be in?
    • 4-8 weeks
    • plantarflexion 
  316. at how many weeks is the ankle slowly brought to neutral and weened from the boot?
    4 weeks 
  317. when can the pt. be FWB while in the boot and what position?
    6-12 weeks in neutral 
  318. fractures of the tibia
    crush injuries
    muscle rupture
    direct blow
    circumferntial burns

    these can all lead to what?
    acute compartment syndrome 
  319. with acute compartment syndrome if ischemia lasts ________ it will = irreversible damage; _________ will = usually no permanent damage
    • >12 hours
    • <4 hours
  320. what are the main s/s of compartment syndrome?
    • severe pain
    • shiny/tight skin
    • diminished pulse
    • swelling 
  321. distance runners are more at risk for what type of injury?
    posterior compartment syndrome 
  322. what is the conservative Tx for compartment syndrome?
    • rest
    • anti-inflammatory meds
    • ice
    • stretching
    • MFR 
  323. elevate for 24-48 hours
    WBAT for 7 days -> FWB
    gentle stretches initially and increase intensity of flexibility program 
    manage scar tissue

    this is rehab protocol for what type of surgery?
    fasciotomy for compartment syndrome 
  324. pain, parathesia, weakness that subside with gentle activity and then increases with excessive activity
    exertional compartment syndrome 
  325. numbness in webspace, trouble with dorsiflexion and deep ache is associated with exertional compartment syndrome in what area?
    anterior compartment 
  326. cramping sensation and buring is associated with exertinal compartment syndrome in what area?
    lateral compartment 
  327. this location of exertional compartment syndrome is diagnosed by pressure probe with activity by MD
    posterior compartment 
  328. what injects saline and measures back pressure?
    stryker pressure monitor 
  329. where is a pt. with plantar fascitis most tender?
    medial calcaneal tuberosity or along the medial arch 
  330. plantar fascitis is common in both what?
    supinators and pronators 
  331. Mrs. Jones came in with c/o stabbing pain w/ first step in the morning and with repeated heel raises or prolonged weight bearing. What would you suspect?
    plantar fascitis 
  332. You are watching a PT do an initial eval. He has his pt. standing on a stool with toe hanging off the edge. He stabilizes the ankle while the MTP is extended. He reproduced the pt.'s pain at the end of MTP extension. What special test did the PT just perform?
    positive windlass
  333. what are the main things you do with a pt. with plantar fascitis?
    • MFR; tennis ball, frozen coke bottle 
    • stretches
    • foot intrinsics
    • check out their shoes- motion control with structured heel box
  334. direction of force
    specific patterns of injury
    how many malleoli involved

    these are classifications for what?
    ankle fractures 
  335. what type of ankle fracture results from vertical or axial loads that "drive" or compress the tibial into the talus 
    distal tibia compression fracture 
  336. intraarticular depression caused by falls from a height that results in compression of calcaneus from talus
    calcaneal fracture 
  337. what type of fx is a concern after any traumatic inversion ankle injury?
    talar dome 
  338. dancers who weight bear chronically in a plantar flexed position are at a risk for what type of fracture?
    talar dome 
  339. s/s for talar dome fracture would include?
    • chronic pain
    • swelling
    • crepitis
    • very weight bearing sensitive 
  340. those who wear __________ are more at risk for mortons neuroma. 
    high heels 
  341. interdigital nerve entrapment btw transverse metatarsal ligament and metatarsal head or btw the metatarsal heads
    mortons neuroma
  342. where is a mortons neuroma most common?
    3rd and 4th metatarsals
  343. the mulders sign is a special test for what?
    mortons neuroma
  344. what are the 3 most common s/s reported pre-operative for mortons neuroma?
    • plantar pain increased by walking
    • relief of pain by resting
    • plantar pain 
  345. lateral or valgus deviation of great toe with soft tissue and bony deformity
    hallux valgus; bunion 
  346. how is hallux valgus made worse?
    narrow toe box; improperly fitting shoes 
  347. MTP neutral or extended
    PIP in flexion 
    DIP either flexed or extended 
    hammer toe 
  348. MTP neutral
    PIP neutral
    DIP neutral 
    mallet toe 
  349. MTP hyperextended
    PIP flexion
    DIP flexion
    claw toe