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Sports Injuries Lecture Week 8 - Lower Limb

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bethdrysdale94's version from 2017-01-18 23:51

Section

Question Answer
What body parts are tested in the beighton score?Spine/hips (touching floor with both palms), elbows, knees, thumbs and little fingers
When are Hamstring strains most common?During running or sprinting
What pysical examination tests are used in Hamstring strain diagnosis?Puranen-Orava and Bent knee stretch test
How do you perform Hamstring Strain tests?Puranen-Orava: patient stand, puts leg outstretched on high object eg examination bed (hip 90 degrees flexed, knee fully extended). Bent knee stretch test: patient lies in supine position, hip flexed and knee maximally flexed. examiner passively extends knee.
What would indicate a hamstring strain during the physical examination tests?Increasing posterior thigh pain during extension = hamstring strain or tendinopathy
What physical examination tests are performed to test for ACL injury?Lachman test, Anterior Draw and Pivot Shift
How do you perform ACL injury tests?Lachman: Patient supine. Examiner passively flexes knee to 30 degrees, applies anterior stress to the tibia. Anterior Draw: Patient lies supine, knee passively flexed to 90degrees, Examiner applies anterior stress to tibia. Pivot Shift: Patient lies supine, hip flexed to 30 degrees. examiner holds lower leg at 30 degree internal rotation. Applies valgus force and flexes the knee
What would indicate ACL injury (particularly complete tear or rupture) during ACL examination tests?Signs of anterior subluxation in all. in Pivot shift, reduction of subluxed tibia with flexion as iliotibial band goes from extensor to flexor.
What is different about a meniscus injury in comparison to an ACL injury?swells over a longer period of time (24 hours, less blood supply). Knee joint may lock due to torn meniscus blocking motion. If full extension is limited, surgery must be performed ASAP after swelling has diminished to prevent joint contracture.
What test can be done on physical examination for a meniscus injury?McMurray Test
How do you test for Meniscus injury during physical examination?Examine focal joint line tenderness. Observe reaction. Flex hip to just below 90 degrees, internally and externally rotate lower leg. Ask for tenderness and feel for any clicking in the joint.
Which lower leg injury accounts for 13-17% of all running related injuries?MTSS. Also common in Basketball and Tennis
What is believed to be the most probably cause of MTSS?Overpronation, fascial insertion of the medial soleus is put under stress as the soleus is the primary plantarflewor and inverter of the foot so undergoes eccentric contraction for overpronation.
What is the difference between pain from a stress fracture and pain from MTSS?Stress fracture = localised pain, MTSS = pain along lower 2/3s of the tibia.
When does MTSS most commonly occur?After an abrupt increase in intensity of training - hill training, increase in mileage, altered training surfaces or worn footwear
How do you examine a patient for MTSS?Palpate for pain, look for oedema and warmth along the posteromedial edge of the tibia. Perform PASSIVE dorsiflexion and ACTIVE plantarflexion against resistance, standing toe raises (two or one leg), standing jump or hop. Palpate for diffuse pain over lower 2/3s of tibia again.
What is imaging used for with MTSS?Discrimination from stress fracture. Imaging usually shows no signs with MTSS
What is the treatment for MTSS?Rest, reduce weight bearing with crutches if the pain is bad. To maintain fitness, non-weight bearing exercises eg swimming, cycling etc. Ice and NSAIDs can be used for pain management. Heel cord stretching targeting soleus. Orthotics to correct overpronation
What rehab exercises are recommended for MTSS?Pain free - 50% intensity and distance of previous training on soft surface. Warm up and cool down thoroughly. Increase if pain free by another 10% for 3-6weeks. Plyometric exercises also recommended.
What are the Ottawa ankle rules?XRAY required if: Bone tenderness at lateral malleolus, medial malleolus, base of fifth metatarsal, navicular, and inability to weightbear both immediately and in emergency department
What is the anatomical grading system for lateral ankle sprain?Grade 1: one ligament (usually ATFL), 2: two ligaments 3: three ligaments
What is the severity grading system for lateral ankle sprain?Grade 1: mild/stretched. 2: partial tear, 3: complete tear
How do you perform the anterior drawer test for ATFL injury?Hold ankle 10-20 degrees of plantarflexion, stabilise tibia, pull foot forward with other hand, anterior drawer translation indicates instability
How do you test for CFL injury?Talar tilt test: Hold foot and ankle neutral, invert hind foot, feel for separation of articular surfaces of tibia and talus
How do you test for syndemosis sprain?External rotation test; knee flexed 90 degrees, ankle neutral. rotate foot outward. Squeeze test: compress tibia and fibula together at mid calf. Crossed leg test: apply pressure to medial knee. - for all - pain in distal lower leg indicated injury
What is the Thompson test?Achilles rupture: patient lies face down, feet over edge of the bed, examiner squeezes calf muscle. normally foot will plantarflex. if not = achilles rupture. Palpate to feel achilles tendon
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