High Ankle Sprains: Diagnosis & Treatment
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Total HIP Replacement Exercise Program 1. Ankle Pumps 2. Quad
3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 5. Heel slides 1. Ankle Pumps Bend knee and pull heel toward buttocks. DO NOT GO Gently point toes up towards your nose and down PAST 90* HIP FLEXION towards the surface. Do both ankles at the same time or alternating feet. Perform slowly. 2. Quad Sets Slowly tighten thigh muscles of legs, pushing knees down into the surface. Hold for 10 count. 6. Short Arc Quads Place a large can or rolled towel (about 8”diameter) under the leg. Straighten knee and leg. Hold straight for 5 count. 3. Gluteal Sets Squeeze the buttocks together as tightly as possible. Hold for a 10 count. 7. Knee extension - Long Arc Quads Slowly straighten operated leg and try to hold it for 5 sec. Bend knee, taking foot under the chair. 4. Abduction and Adduction Slide leg out to the side. Keep kneecap pointing toward ceiling. Gently bring leg back to pillow. May do both legs at the same time. Copywriter VHI Corp 3 sets of 10 reps (30 ea) 2 times a day Total HIP Replacement Exercise Program 8. Standing Stair/Step Training: Heel/Toe Raises: 1. The “good” (non-operated) leg goes Holding on to an immovable surface. UP first. Rise up on toes slowly 2. The “bad” (operated) leg goes for a 5 count. Come back to foot flat and lift DOWN first. toes from floor. 3. The cane stays on the level of the operated leg. Resting positions: To Stretch your hip to neutral position: 1. -
Human Functional Anatomy 213 the Ankle and Foot In
2 HUMAN FUNCTIONAL ANATOMY 213 JOINTS OF THE FOOT THE ANKLE AND FOOT IN LOCOMOTION THE HINDFOOT -(JOINTS OF THE TALUS) THIS WEEKS LAB: Forearm and hand TROCHLEAR The ankle, and distal tibiofibular joints READINGS BODY The leg and sole of foot Subtalar joint (Posterior talocalcaneal) 1. Stern – Core concepts – sections 99, 100 and 101 (plus appendices) HEAD 2. Faiz and Moffat – Anatomy at a Glance – Sections 50 and 51 Talocalcaneonavicular 3. Grants Method:- The bones and sole of foot & Joints of the lower limb & Transverse tarsal joints or any other regional textbook - similar sections IN THIS LECTURE I WILL COVER: Joints related to the talus Ankle Subtalar Talocalcaneonavicular THE MID FOOT Transverse tarsal Other tarsal joints THE FOREFOOT Toe joints METATARSAL AND PHALANGEAL Ligaments of the foot JOINTS (same as in the hand) Arches of the foot Except 1st metatarsal and Hallux Movements of the foot & Compartments of the leg No saddle joint at base is 1st metatarsal The ankle in Locomotion Metatarsal head is bound by deep Ankle limps transverse metatarsal ligament 1. Flexor limp Toes are like fingers 2. Extensor limp Same joints, Lumbricals, Interossei, Extensor expansion Axis of foot (for abduction-adduction) is the 2nd toe. 3 4 JOINTS OF THE FOOT JOINTS OF THE FOOT (2 joints that allow inversion and eversion) DISTAL TIBIOFIBULAR SUBTALAR (Posterior talocalcaneal) JOINT Syndesmosis (fibrous joint like interosseous membrane) Two (or three) talocalcaneal joints Posterior is subtalar Fibres arranged to allow a little movement Anterior (and middle) is part of the talocalcaneonavicular. With a strong interosseus ligament running between them (tarsal sinus) THE TALOCALCANEONAVICULAR JOINT The head of the talus fits into a socket formed from the: The anterior talocalcaneal facets. -
Discussion Concerning Deltoid Ligament and Antero-Medial Capsule Repair in the Surgical Management of Supination External Rotati
ISSN: 2643-4016 Wei et al. Int Arch Orthop Surg 2017, 1:001 Volume 1 | Issue 1 Open Access International Archives of Orthopaedic Surgery ORIGINAL ARTICLE Discussion Concerning Deltoid Ligament and Antero-Medial Cap- sule Repair in the Surgical Management of Supination External Rotation Ankle Fractures Wei REN1,3, Masumi MARUO HOLLEDGE1, Yong Cheng HU2,3 and Jike LU1* 1Department of Orthopedic Surgery, United Family Hospital, Beijing, China Check for 2Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China updates 3Tianjin Medical University, Tianjin, China *Corresponding author: Jike LU, Department of Orthopedic Surgery, United Family Hospital, 2 Jiangtai Lu, Chaoyang District, Beijing, China, Tel: +4008-9191-91, E-mail: [email protected] the Lauge-Hansen classification is frequently utilized. Abstract In the classification, Supination-External Rotation (SER) Objective: To evaluate the importance of ankle deltoid liga- injuries are the most common occurrences. In a clinical ment and anteromedial capsule repair in Lauge-Hansen Su- pination-External Rotation Stage IV (SER IV) ankle fractures. setting, SER stage IV (SER IV) can be seen as a fracture of the lateral malleolus (Weber B fibular fractures) on Methods: A total of 15 patients with SER IV ankle fractures radiographs, when there is no medial malleolus frac- without medial malleolus fractures, were studied. All patients were treated with lateral malleolus Open Reduction Internal ture. However, the classification indicates that SER IV Fixation (ORIF) and transsydesmotic screws with the deltoid injuries include the syndesmotic ligament rupture and ligament, as well as anteromedial capsule repair. The Lower the deltoid ligament injuries (bimalleolar equivalent). Extremity Function Scale (LEFS), Foot and Ankle Disabili- Obviously, SER IV injuries are unstable ankle fractures. -
Medial Collateral Ligament (MCL) Sprain
INFORMATION FOR PATIENTS Medial collateral ligament (MCL) sprain This leaflet intends to educate you on Knee ligament sprains are graded in the immediate management of your severity from one to three: knee injury. It also contains exercises to prevent stiffening of your knee, Grade one: Mild sprain with ligaments whilst your ligament heals. stretched but not torn. Grade two: Moderate sprain with some What is an MCL injury? ligaments torn. Grade three: Severe sprain with There are two collateral ligaments, one complete tear of ligaments. either side of the knee, which act to stop side to side movement of the knee. The Symptoms you may experience medial collateral ligament (MCL) is most commonly injured. It lies on the inner side Pain in the knee, especially on the of your knee joint, connecting your thigh inside, particularly with twisting bone (femur) to your shin bone (tibia) and movements. provides stability to the knee. Tenderness along the ligament on the inside. Injuries to this ligament tend to occur Stiffness. when a person is bearing weight and the Swelling and some bruising. knee is forced inwards, such as slipping depending on the grade of the injury. on ice or playing sports, e.g. skiing, You may have the feeling the knee will football and rugby. In older people, this give way or some unstable feeling can be injured during a fall. An MCL injury can be a partial or complete tear, or overstretching of the ligament. Knee ligament injuries are also referred to as sprains. It’s common to injure one of your cruciate ligaments (the two ligaments that cross in the middle of your knee which help to stabilise), or your meniscus (cartilage discs that help provide a cushion between your thigh and shin bone), at the same time as your MCL. -
Ankle Ligament Injuries
ARTIGO DE REVISÃO Ankle ligament injuries Per A.F.H. Renström, M.D., Ph.D.1 and Scott A. Lynch, M.D.2 ABSTRACT ing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory Acute ankle ligament sprains are common injuries. The to bracing and external support, surgical treatment can be majority of these occur during athletic participation in the explored. If the chronic instability is associated with subta- 15 to 35 year age range. Despite the frequency of the injury, lar instability that is refractory to conservative measures and diagnostic and treatment protocols have varied greatly. bracing as outlined above, surgical treatment must address Lateral ligament complex injuries are by far the most com- the subtalar joint as well. mon of the ankle sprains. Lateral ligament injuries typically Subtalar ligament injury and instability are probably more occur during plantar flexion and inversion, which is the po- common than appreciated. Definition and diagnosis of this sition of maximum stress on the anterotalofibular liagment entity are difficult, however. Fortunately, it appears that in (ATFL). For this reason, the ATFL is the most commonly the majority of the acute injuries healing occurs with the torn ligament during an inversion injury. In more severe in- same functional rehabilitation program as that for lateral ankle version injuries the calcaneofibular (CFL), posterotalofibu- ligament sprains. lar (PTFL) and subtalar ligament can also be injured. For chronic subtalar instability an intial attempt at func- Most acute lateral ankle ligament injuries recover quickly tional rehabilitation with ankle proprioceptive training and with nonoperative management. -
Compression Garments for Leg Lymphoedema
Compression garments for leg lymphoedema You have been fitted with a compression garment to help reduce the lymphoedema in your leg. Compression stockings work by limiting the amount of fluid building up in your leg. They provide firm support, enabling the muscles to pump fluid away more effectively. They provide most pressure at the foot and less at the top of the leg so fluid is pushed out of the limb where it will drain away more easily. How do I wear it? • Wear your garment every day to control the swelling in your leg. • Put your garment on as soon as possible after getting up in the morning. This is because as soon as you stand up and start to move around extra fluid goes into your leg and it begins to swell. • Take the garment off before bedtime unless otherwise instructed by your therapist. We appreciate that in hot weather garments can be uncomfortable, but unfortunately this is when it is important to wear it as the heat can increase the swelling. If you would like to leave off your garment for a special occasion please ask the clinic for advice. What should I look out for? Your garment should feel firm but not uncomfortable: • If you notice the garment is rubbing or cutting in, adjust the garment or remove it and reapply it. • If your garment feels tight during the day, try and think about what may have caused this. If you have been busy, sit down and elevate your leg and rest for at least 30 minutes. -
About Your Knee
OrthoInfo Basics About Your Knee What are the parts of the knee? Your knee is Your knee is made up of four main things: bones, cartilage, ligaments, the largest joint and tendons. in your body Bones. Three bones meet to form your knee joint: your thighbone and one of the (femur), shinbone (tibia), and kneecap (patella). Your patella sits in most complex. front of the joint and provides some protection. It is also vital Articular cartilage. The ends of your thighbone and shinbone are covered with articular cartilage. This slippery substance to movement. helps your knee bones glide smoothly across each other as you bend or straighten your leg. Because you use it so Two wedge-shaped pieces of meniscal cartilage act as much, it is vulnerable to Meniscus. “shock absorbers” between your thighbone and shinbone. Different injury. Because it is made from articular cartilage, the meniscus is tough and rubbery to help up of so many parts, cushion and stabilize the joint. When people talk about torn cartilage many different things in the knee, they are usually referring to torn meniscus. can go wrong. Knee pain or injury Femur is one of the most (thighbone) common reasons people Patella (kneecap) see their doctors. Most knee problems can be prevented or treated with simple measures, such as exercise or Articular cartilage training programs. Other problems require surgery Meniscus to correct. Tibia (shinbone) 1 OrthoInfo Basics — About Your Knee What are ligaments and tendons? Ligaments and tendons connect your thighbone Collateral ligaments. These are found on to the bones in your lower leg. -
Anterior (Cranial) Cruciate Ligament Rupture
Cranial Cruciate Ligament Rupture in Dogs The cruciate ligaments are tough fibrous bands that connect the distal femur (thigh bone) to the proximal tibia (shin bone). Two cruciate ligaments, the cranial (anterior) and the posterior cruciate ligaments, are found in the knee joint of dogs and cats (and most other domestic animals). These ligaments work like a hinge joint in the knee and are responsible for providing anterior-posterior stability to the knee joint. Normal Knee Joint of a Dog Rupture of the cranial cruciate ligament is rare in cats. It occurs frequently in overweight, middle- and older-aged dogs. Certain dog breeds appear to be predisposed to cranial cruciate ligament rupture. Most commonly, the cocker spaniel and rottweiler are affected. The miniature and toy poodle, Lhasa apso, bichon frise, golden retriever, Labrador retriever, German shepherd and mastiff seem to be predisposed as well. The normal knee joint works as a hinge, keeping the knee stable as it bends. Tearing of the cranial cruciate ligament causes instability of the knee joint and it ceases to function properly. Most cranial cruciate ligament tears in dogs occur gradually, resulting in a low-level lameness that may or nay not improve over time. After the ligament tears, inflammation occurs within the joint. Continued use and weight bearing by the dog often causes the ligament to rupture completely. Dogs that rupture one cruciate ligament have about a fifty percent chance of rupturing the other. Normal Knee Joint of a Dog Rupture of the cranial cruciate ligament in dogs can also occur acutely. Similar to cranial cruciate ligament rupture in humans, resulting from athletic injuries to the knee, dogs can tear this ligament by jumping up to catch a ball or Frisbee or by jumping out of a truck or off a porch. -
Joints Classification of Joints
Joints Classification of Joints . Functional classification (Focuses on amount of movement) . Synarthroses (immovable joints) . Amphiarthroses (slightly movable joints) . Diarthroses (freely movable joints) . Structural classification (Based on the material binding them and presence or absence of a joint cavity) . Fibrous mostly synarthroses . Cartilagenous mostly amphiarthroses . Synovial diarthroses Table of Joint Types Functional across Synarthroses Amphiarthroses Diarthroses (immovable joints) (some movement) (freely movable) Structural down Bony Fusion Synostosis (frontal=metopic suture; epiphyseal lines) Fibrous Suture (skull only) Syndesmoses Syndesmoses -fibrous tissue is -ligaments only -ligament longer continuous with between bones; here, (example: radioulnar periosteum short so some but not interosseous a lot of movement membrane) (example: tib-fib Gomphoses (teeth) ligament) -ligament is periodontal ligament Cartilagenous Synchondroses Sympheses (bone united by -hyaline cartilage -fibrocartilage cartilage only) (examples: (examples: between manubrium-C1, discs, pubic epiphyseal plates) symphesis Synovial Are all diarthrotic Fibrous joints . Bones connected by fibrous tissue: dense regular connective tissue . No joint cavity . Slightly immovable or not at all . Types . Sutures . Syndesmoses . Gomphoses Sutures . Only between bones of skull . Fibrous tissue continuous with periosteum . Ossify and fuse in middle age: now technically called “synostoses”= bony junctions Syndesmoses . In Greek: “ligament” . Bones connected by ligaments only . Amount of movement depends on length of the fibers: longer than in sutures Gomphoses . Is a “peg-in-socket” . Only example is tooth with its socket . Ligament is a short periodontal ligament Cartilagenous joints . Articulating bones united by cartilage . Lack a joint cavity . Not highly movable . Two types . Synchondroses (singular: synchondrosis) . Sympheses (singular: symphesis) Synchondroses . Literally: “junction of cartilage” . Hyaline cartilage unites the bones . Immovable (synarthroses) . -
The Ligament Anatomy of the Deltoid Complex of the Ankle: a Qualitative and Quantitative Anatomical Study
e62(1) COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED The Ligament Anatomy of the Deltoid Complex of the Ankle: A Qualitative and Quantitative Anatomical Study Kevin J. Campbell, BS, Max P. Michalski, MSc, Katharine J. Wilson, MSc, Mary T. Goldsmith, MS, Coen A. Wijdicks, PhD, Robert F. LaPrade, PhD, MD, and Thomas O. Clanton, MD Investigation performed at the Department of Biomedical Engineering, Steadman Philippon Research Institute, and the Steadman Clinic, Vail, Colorado Background: The deltoid ligament has both superficial and deep layers and consists of up to six ligamentous bands. The prevalence of the individual bands is variable, and no consensus as to which bands are constant or variable exists. Although other studies have looked at the variance in the deltoid anatomy, none have quantified the distance to relevant osseous landmarks. Methods: The deltoid ligaments from fourteen non-paired, fresh-frozen cadaveric specimens were isolated and the ligamentous bands were identified. The lengths, footprint areas, orientations, and distances from relevant osseous landmarks were measured with a three-dimensional coordinate measurement device. Results: In all specimens, the tibionavicular, tibiospring, and deep posterior tibiotalar ligaments were identified. Three additional bands were variable in our specimen cohort: the tibiocalcaneal, superficial posterior tibiotalar, and deep anterior tibiotalar ligaments. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament. The origins from the distal center of the intercollicular groove were 16.1 mm (95% confidence interval, 14.7 to 17.5 mm) for the tibionavicular ligament, 13.1 mm (95% confidence interval, 11.1 to 15.1 mm) for the tibiospring ligament, and 7.6 mm (95% confidence interval, 6.7 to 8.5 mm) for the deep posterior tibiotalar ligament. -
Medial Ankle Instability Instabilidade Medial Do Tornozelo
AR T IGO ES P ECI A L Medial ankle instability Instabilidade medial do tornozelo Beat Hintermann1, Alexej Barg2, Markus Knupp3 Abstract While much is known about the anatomy and biomechanics of lateral ankle ligaments, the medial ankle ligaments are still poorly understood. Analogously, very little objective data is available regarding the clinical presentation of medial ankle instability. The focus of this article is to elucidate the anatomy and function of the medial ligaments, and to present our experience for diagnosis and treatment of incompetent deltoid ligament. Keywords: Ankle joint/physiology; Ankle joint/surgery; Arthroscopy; Collateral ligaments/ physiology; Collateral ligaments/surgery; Joint instability/etiology; Joint instability/ physioology; Joint instability/surgery; Ligaments, articular/anatomy & histology Resumo Até quanto é conhecida a anatomia e a biomecânica do complexo ligamentar lateral, o li- gamento medial continua mal compreendido. Analogamente, poucos relatos objetivos são direcionados ao quadro clínico da instabilidade medial. O objetivo deste artigo é elucidar a anatomia e a biomecânica do ligamento medial e mostrar a experiência no diagnóstico e na conduta da incompetência do ligamento deltóide. Descritores: Articulação do tornozelo/fisiologia; Articulação do tornozelo/cirurgia; Artroscopia; Ligamentos colaterias/fisiologia; Ligamentos colaterais/cirurgia; Instabilidade articular/etiologia; Instabilidade articular/fisiologia; Instabilidade articular/cirurgia; Ligamentos articulares/anatomia & histologia Correspondência -
Sports Ankle Injuries Assessment and Management
FOCUS Sports injuries Sports ankle injuries Drew Slimmon Peter Brukner Assessment and management Background Case study Lucia is a female, 16 years of age, who plays netball with the Sports ankle injuries present commonly in the general state under 17s netball team. She presents with an ankle injury practice setting. The majority of these injuries are inversion sustained at training the previous night. She is on crutches and plantar flexion injuries that result in damage to the and is nonweight bearing. Examination raises the possibility of lateral ligament complex. a fracture, but X-ray is negative. You diagnose a severe lateral Objective ligament sprain and manage Lucia with ice, a compression The aim of this article is to review the assessment and bandage and a backslab initially. She then progresses through management of sports ankle injuries in the general practice a 6 week rehabilitation program and you recommend she wear setting. an ankle brace for at least 6 months. Discussion Assessment of an ankle injury begins with a detailed history to determine the severity, mechanism and velocity of the injury, what happened immediately after and whether there is a past history of inadequately rehabilitated ankle injury. Examination involves assessment of weight bearing, inspection, palpation, movement, and application of special examination tests. Plain X-rays may be helpful to exclude a fracture. If the diagnosis is uncertain, consider second The majority of ankle injuries are inversion and plantar line investigations including bone scan, computerised flexion injuries that result in damage to the lateral tomography or magnetic resonance imaging, and referral to a ligament complex (Figure 1).