Lecture 5

Question 1

Ant. compartment of lower leg

Answer 1

• Tibialis ant. (lat. condyle to base of 1st MT & med. cuneiform)
• Extensor hallucis longus (ant. fibula to distal phalanx of 1st toe)
• Extensor digitorum longus (lat. condyle to distal phalanx of toes 2-5)
• Fibularis (peroneal) tertius

Question 2

Superficial post. compartment

Answer 2

• Gastrocnemius (sup. med. and lat. condyles to achilles tendon)
• Soleus (soleal line of tib/head of fib. to achilles)
• Plantaris (lat. supracondyle femur to achilles)

Question 3

Tibia Fractures MOI

Answer 3

• rotation while weight bearing (spiral fracture)
• Boot top
• Direct blow
• Fatigue/stress

Question 4

Tibia fractures types

Answer 4

• Condylar (10-12 weeks)
• Shaft fracture (16+ weeks)
• avulsion of med malleolus (10-12 weeks, from deltoid lig)
• USUALLY OPEN!

Question 5

Tibia fracture S/S

Answer 5

-Gross instability/deformation
-Pain
-positive x-ray

Question 6

Tibia fracture treatment

Answer 6

-Stabilize!
-Activate EAP
-Treat for shock.

Question 7

Fibula Fracture MOI

Answer 7

• Rotation while weight bearing
• fatigue/stress
• sprain/avulsion (fibularis muscles)
• direct blow

Question 8

Fibula Fracture types

Answer 8

• Shaft fracture (4 weeks)
• Avulsion of lat malleolus (10-12 weeks)
• Spiral fracture
• OFTEN AFFECTED DURING TIB. FRACTURES

Question 9

Fibula Fracture S/S

Answer 9

-NWB or PWB
-Pain
-positive x-ray
-positive tuning fork test

Question 10

Fibula Fracture Treatment

Answer 10

-Stabilize!
-Refer for X-ray
-Crutches where applicable

Question 11

Stress Fracture MOI

Answer 11

-↑ in training, muscle fatigue/imbalance, slow bone remodeling.
-Training surfaces also play a role.
- TYPICALLY AFFECTS TIB.,FIB., BONES OF FEET

Question 12

Stress fracture S/S

Answer 12

-Initial X-ray may be Neg! (but if xrayed during prolif., there will be clear new white osteocytes)
-Pain w/ activity
-Mid season
-compartment syndrome
-Pain over medial crest

Question 13

Stress Fracture treatment

Answer 13

-Decrease activity level
-Address surrounding muscles
-Adjust training surface if possible
-May have to examine footwear.

Question 14

Stress Fracture Cycle

Answer 14

Fatigue > loss of shock absorption > inflamm./too much load > periostitis > Pain > self-limiting(compensation) > muscle atrophy > Fatigue

• solved by rest

Question 15

Gastrocnemius Strains causes

Answer 15

• Running uphill, cutting, planting, jumping (landing portion)
• poor warmup/footwear
• chronic strains can lead to rupture

Question 16

Tibialis ant. strains causes

Answer 16

-Down hill running,
-Poor arch support/footwear
-Compartment Syndrome
-Poor warm up

Question 17

Fibularis (peroneals) longus and brevis strains causes

Answer 17

-Secondary to inversion ankle sprain!!
-Cutting, planting.
-*needs to be strengthened in
rehab/prehab to avoid inversion
injuries.

Question 18

Triceps Surae rupture MOI

Answer 18

• Explosive plantar flexion (landing from jump)\
• Often occurs at MT junction
• AKA: Achilles snap

Question 19

Triceps Surae rupture S/S

Answer 19

-Pt. describes hear a pop
-Often a divot/deformity
-Must be seen quickly (swell)
-‘bunching of muscle belly’
-Pain w/ loss of function

Question 20

Triceps Surae rupture Treatment

Answer 20

-Surgical intervention
-Initial splinting post-op in plantar
flexion.
-Progressive rehab back to neutral
-Rehab is typically ~1year RTS

Question 21

What is the Thompson Test?

Answer 21

Clinician performs passive compression of the calf
muscles. This should produce slight plantar flexion at the ankle. If no plantar
flexion occurs, a possible rupture of the gastrocnemius–soleus complex or
the Achilles tendon should be suspected

Question 22

Compartment Syndrome MOI

Answer 22

-Tightness in compartment due to excess swelling, infection,
hypertrophy, or combination of.
- Affects the muscle’s arteries, veins, and nerves in the compartment

Question 23

Compartment syndrome S/S

Answer 23

Red, hot, shiny skin
THE 5 P’S OF COMPARTMENT SYNDOME
- Pain w/ passive stretch (most sensitive finding prior to onset of ischemia).
- Paresthesia/hypoesthesia (indicative of nerve ischemia in affected compartment).
- Paralysis (late finding full recovery is rare in this case).
- Palpable swelling (stretched skin).
- Peripheral pulses absent (late finding amputation usually inevitable in this case)

Question 24

Compartment syndrome Treatments

Answer 24

-Refer immediately
-E.I.R. (no Pressure!!)
-May need surgical release
(fasciotomy)
-Balance between stretching and
strengthening muscles during rehab.

Question 25

Shin Splints MOI

Answer 25

*AKA Tib. ant. or posterior tendinitis/tendonosis* -Running on hard surfaces - Too much activity, too soon - Poor arch support - muscle imbalance - Affects tib. ant and tib. post

Question 27

Shin splints S/S

Answer 27

3 stages of shin splints: i. pain w/ warmup ii. pain w/ activity iii. pain all the time Ant.: -Pain 6-10 inches above malleolus on lateral side -Pain with resisted Dorsi flexion post:- pain 1-6 inches above med. malleolus

Question 28

Shin Splint treatments

Answer 28

-Find cause, treat cause (footwear) -PEIR -Proper warm-up -Rest