4 Any bone Epiphyseal Fx Jones Fx Acute fx Stress fx Avulsion fx Fx to the growth plate (typically tib/fib)Plantarflexion and inversionSerious – potentially stunt growthJones FxAvulsion fx of the styloid process of the 5th MetatarsalForcefull muscle contraction w/ ankle inversionUnion vs non-union
7 Knock-off Fx Stress Fx Fx to lateral malleolus Forced dorsiflexion & inversionStress FxMost commonly tib/fib and MTReptative stress (usually from running)Pain becomes more intense at night and following activityUsually diagnosed with bone scan
10 Grading system Ligament: bone to bone Tendon: muscle to bone 1+/-: stretched, but no tearing/fraying of fibers2+/-: tearing, but incomplete3: complete tear
11 Cont’d Signs & Symptoms: Pain Swelling Decreased ROM Increased temp of skinBruisingNWB+ laxity test
12 Ligament/tendon injuires ATFL–Most commonly sprainedMOI – “rolling ankle”, stepping in holeAccounts for 85%Deltoid LigamentKeep ankle from evertion; stronger than ATFMOI – Stepping in holeHigh Ankle Sprain – Syndesmotic SprainMOI - Dorsiflexion and evertionAccounts for 15%Achilles Tendon Tendinitis/RuptureMore commonly torn with ageMOI – Forced Dorsiflexion with knee bent
13 Great-Toe Sprain Arch Sprain Plantar Faciitis Forced Flexion/Extension “Turf Toe”Arch SprainRepetative stress, running on hard surface, or improper footwearPain with running and swelling over affected archPlantar FaciitisInflammation of the thick connective tissue
16 “shin Splints” If left un-treated can cause: Caused by: Medial tibial stress syndrome (MTSS)Irritated and swollen muscles, often from overuse, ramping up workout intensity, changing the surface, improper/old footwearCaused by:Over-pronation or ''flat feet" -- when the impact of a step makes your foot's arch collapsesIf left un-treated can cause:Stress fractures, which are tiny breaks in the lower leg bones
17 Tx: Rest your body. It needs time to heal. Ice your shin to ease pain and swelling. Do it for 20’ every 3 to 4 hours for 2 to 3 days, or until the pain is gone.Anti-inflammatory painkillers. NSAIDsArch supports for your shoes. Orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet.Range-of-motion exercisesNeoprene sleeve for support.Physical therapy to strengthen the muscles in your shins.
18 You know it’s healed when.. Your injured leg is as flexible as your other leg.Your injured leg feels as strong as your other leg.Your can jog, sprint, and jump without pain.Your X-rays are normal or show healed stress fx.There's no way to say exactly when your shin splints will go away. It depends on what's causing them. People also heal at different rates; 3 to 6 months is not unusual.
19 Misc Injuries Ankle dislocation Contusion Toe Abnormalities HammertoeMiddle Phalanyx flexed while Distal and Proximal are hyperextendedIngrown ToenailNail grows into surrounding soft tissueoften result of poor trimmingMay need to be surgically excised
20 Diagnosis Process HOPS: History Observation Palpation – Provides a reference for the comparison of bilateral symmetry of bones, alignment, tissue temperature, or other deformity as well as the presence of increased tendernessJoint and Muscle Functional Assessment – impairment due to ROM, Strength, P with movementJoint Stability Tests – reference for laxity, gapping, hypo/hypermobility, end-feelSpecial Test
21 Manual Muscle TestingPatient position: Muscle tested must be against gravityExaminer position: stabilize proximal to the joint being tested and provide resistance to the distal joint“Break test”Positive test: weakness and/or pain compared contralateral
22 Grading 5/5 Normal: can resist max pressure with no pain 4/5 Good: can resist moderate pressure3/5 Fair: Can move body part against gravity thru full ROM2/5 poor: Can move body part in gravity-eliminated position thru full ROM1/5 Trace: cannot produce movement, but muscle contraction is palpable0/5 Zero: No contraction is felt
23 End-Feel (Normal) Soft: soft tissue approximation (ex: knee flexion) Firm: Muscular stretch/Capsular Stretch/Ligamentous Stretch (ex: MCP extension)Hard: bone to bone ex: Elbow ext
24 End-feel (pathological) Soft: occurs sooner or later in ROM than normal in a joint that normally has a firm or hard end-feel ex: edema/synovitisFirm: occurs sooner or later in ROM than normal in a joint that normally has soft or hard end-feel ex: Capsular/muscular/ligamentous shorteningHard: occurs sooner or later in ROM than normal in a joint that normally has soft or firm end-feel; feels like a bony block ex: Loose bodies in joint/myositis ossificans/fxSpasm: Joint motion is stopped involuntarily or voluntary muscle spasm ex: inflammation/strain/joint instabilityEmpty: no end-feel bc end of ROM is never reached; no resistance felt (except for patient’s protective muscle splinting or muscle spams called “muscle guarding”)