Strain in the Human Medial Collateral Ligament During Valgus Loading of the Knee

Total Page:16

File Type:pdf, Size:1020Kb

Strain in the Human Medial Collateral Ligament During Valgus Loading of the Knee CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Number 391, pp. 266–274 © 2001 Lippincott Williams & Wilkins, Inc. Strain in the Human Medial Collateral Ligament During Valgus Loading of the Knee John C. Gardiner, PhD*; Jeffrey A. Weiss, PhD*; and Thomas D. Rosenberg, MD*,** The medial collateral ligament is one of the most ligament and that this distribution of strain frequently injured ligaments in the knee. Al- changes with flexion angle and with the applica- though the medial collateral ligament is known tion of a valgus torque. Strain in the posterior to provide a primary restraint to valgus and ex- and central portions of the medial collateral lig- ternal rotations, details regarding its precise ament generally decreased with increasing flex- mechanical function are unknown. In this study, ion angle, whereas strain in the anterior fibers strain in the medial collateral ligament of eight remained relatively constant with changes in knees from male cadavers was measured during flexion angle. The highest strains in the medial valgus loading. A material testing machine was collateral ligament were found at full extension used to apply 10 cycles of varus and valgus ro- on the posterior side of the medial collateral lig- tation to limits of ؎10.0 N-m at flexion angles of ament near the femoral insertion. These data -0؇, 30؇, 60؇, and 90؇. A three-dimensional motion support clinical findings that suggest the femo analysis system measured local tissue strain on ral insertion is the most common location for the medial collateral ligament surface within 12 medial collateral ligament injuries. regions encompassing nearly the entire medial collateral ligament surface. Results indicated that strain is significantly different in different The medial collateral ligament is one of the regions over the surface of the medial collateral most frequently injured ligaments in the knee.12 Medial collateral ligament injuries of- ten occur during sports such as football or soc- From the *Department of Bioengineering, The Univer- cer from a direct blow to the lateral side of the sity of Utah; and **The Orthopedic Specialty Hospital, Salt Lake City, UT. knee or because of external rotation of the tibia Supported by Whitaker Foundation Biomedical Research during alpine skiing. Clinical reports suggest and Transition Grants and National Institutes of Health injuries to the medial collateral ligament most Grant Number AR47369. commonly are located near the femoral inser- Reprint requests to Jeffrey A. Weiss, PhD, The Univer- tion.10,11 After an isolated medial collateral sity of Utah, Department of Bioengineering, 50 South Central Campus Drive, Room 2480, Salt Lake City, UT ligament injury, adequate healing often occurs 84112. without surgical intervention. However, many Received: September 22, 2000. medial collateral ligament injuries are accom- Revised: December 8, 2000; February 12, 2001. panied by disruption of the anterior cruciate Accepted: March 13, 2001. ligament, resulting in a poor healing outcome 266 Number 391 October, 2001 Medial Collateral Ligament Strain 267 for the medial collateral ligament and the an- can be a difficult and time-consuming process. terior cruciate ligament, leading to chronic in- Accurate experimental input parameters such stability of the knee. A complete understand- as in situ strain are essential for creating sub- ing of the normal stress and strain state in the ject-specific models. The validation of com- medial collateral ligament can aid in the un- putational models also is dependent on exper- derstanding and prevention of ligament in- imental data to confirm that model-predicted juries and in the formulation of treatments. quantities such as local tissue strain or joint Previous studies of the mechanical function stiffness are accurate. Once validated, these of the medial collateral ligament can be cate- models can provide a valuable tool for under- gorized broadly as studies of ligament cutting standing the mechanical function of normal that measured changes in joint laxity after cut- and diseased joints and ligaments and for as- ting specific regions of the medial collateral sessing the effects of clinical interventions. ligament and other structures,5 or studies that Despite the importance of the medial col- measured overall load in the ligament14,15 or lateral ligament in maintaining joint stability, local tissue strain1,3,8 during external loading. many fundamental questions remain regard- Studies of ligament cutting and measurements ing its precise mechanical function. Measure- of tissue load have shown that the medial col- ments of medial collateral ligament strain re- lateral ligament provides a primary restraint to ported in previous studies have been limited to valgus rotation and a secondary restraint to ex- few locations within the tissue, despite indica- ternal rotation and anterior and posterior trans- tions that strain is highly inhomogeneous over lations. Measurements of local tissue strain the entire medial collateral ligament sur- provide detailed information regarding the rel- face.1,3,8 In particular, strain in the region of ative importance of different regions of the the medial collateral ligament often referred to medial collateral ligament during specific as the posterior oblique ligament has not been loading conditions. Measurements have indi- quantified previously, despite indications of cated that the strain distribution is inhomoge- its importance from ligament cutting studies.5 neous over the medial collateral ligament sur- In addition, strain measurements often have face and that this nonuniform distribution been made relative to a loaded reference changes with flexion angle and with the appli- state.1 This procedure may grossly underesti- cation of external loads. mate actual tissue strain levels by assuming a Computational modeling techniques such zero strain value exists in tissue that actually as the finite element method provide an addi- may be loaded at a level of 3% or more. Quan- tional means to assess medial collateral liga- tifying the initial tension in ligaments is an es- ment function and situations that may lead to sential step in the construction of accurate injury.2,4 Computational models of joints have computational models. The objective of the the potential to predict quantities such as tis- current study was to quantify the strain distri- sue stress and joint contact pressure that can be bution in the entire medial collateral ligament difficult or impossible to measure in experi- during passive flexion and valgus loading. It mental or clinical settings. Computational was hypothesized that the strain distribution in models also provide a repeatable tool for eval- the medial collateral ligament is nonuniform uating multiple clinical treatments, an ap- and that this distribution changes with flexion proach that can eliminate the large intersubject angle and with the application of a valgus variability that often limits the sensitivity of torque. It also was hypothesized that strain experimental and clinical investigations. Mus- would be highest near the femoral insertion in culoskeletal modeling methodologies and com- correspondence with clinically observed in- puting power have advanced significantly in jury patterns and that strain in the anterior por- recent years. Unfortunately, the effective con- tion of the medial collateral ligament would struction and validation of complex models decrease with increases in knee flexion angle. Clinical Orthopaedics 268 Gardiner et al and Related Research MATERIALS AND METHODS loading served to precondition the soft tissue struc- tures of the knee. The varus and valgus rotation was Sample Population and Preparation applied at 1.0Њ/second to torque limits of Ϯ 10.0 N- m. The rotation speed was chosen to provide qua- Eight knees from male cadavers (age, 50 Ϯ 7 years) sistatic loading, where tissue viscoelastic effects were used in the current study. The fresh-frozen and inertial effects of the kinematic fixtures could specimens were thawed at room temperature be minimized. The torque limit of 10 N-m is suffi- overnight before dissection and were inspected for ciently large to enter the terminal stiffness region of signs of previous injury or arthritis. All periarticu- the varus and valgus torque rotation curve but is lar soft tissue was removed until only the medial much smaller than the torque required to induce tis- collateral, lateral collateral, anterior cruciate, and sue damage, allowing multiple tests to be done with posterior cruciate ligaments and medial and lateral the same specimen. All data analysis was per- menisci remained intact (Fig 1). The femur, tibia, formed using the results obtained during the load- and fibula were potted in mounting tubes using a ing phase of the tenth valgus cycle. low-melt alloy. During all dissection and testing, the tissue was kept continuously moist with 0.9% Strain Measurement buffered saline. All testing was completed within 5 hours, during which time no noticeable changes in A noncontact three-dimensional motion analysis sys- the tissue were observed. tem (Peak Performance Technologies, Englewood, CO) was used for simultaneous measurement of Kinematic Testing strain at multiple locations on the medial collateral ligament surface. A custom calibration frame was The knees were mounted in custom fixtures on a bi- constructed, and 18 retroreflective fiducial markers axial material testing machine (MTS, Eden Prairie, were attached to the frame. The coordinates of the MN) that allowed application of varus and
Recommended publications
  • Physio Med Self Help for Achilles Tendinopathy
    Physio Med Self Help 0113 229 1300 for Achilles Tendinopathy Achilles tendon injuries are common, often evident in middle aged runners to non-sporting individuals. They are often characterised by pain in the tendon, usually at the beginning and end of exercise, pain and stiffness first thing in the morning or after sitting for long periods. There is much that can be done to both speed up the healing and prevent re-occurrence. Anatomy of the Area The muscles of your calf (the gastrocnemius and soleus) are the muscles which create the force needed to push your foot off the floor when walking, running and jumping, or stand up on your toes. The Achilles tendon is the fibrous band that connects these muscles to your heel. You may recognise the term ‘Achilles Tendonitis’ which was the previous name used for Achilles Tendinopathy. However the name has changed as it is no longer thought to be a totally inflammatory condition, but rather an overuse injury causing pain, some localised inflammation and degeneration of the thick Achilles tendon at the back of the ankle. Potential causes of Achilles Tendinopathy and advice on how to prevent it • Poor footwear or sudden change in training surface e.g. sand makes the calf work harder » Wear suitable shoes for the activity (type, fit and condition of footwear). » Take account of the surface you are exercising on and if soft and unstructured like sand or loose soil reduce the intensity / duration or take a short break or reduce any load you are carrying into smaller loads until you become conditioned to it.
    [Show full text]
  • An Evidence Based Medicine Understanding of Meniscus Injuries and How to Treat Them
    An Evidence Based Medicine Understanding of Meniscus Injuries and How to Treat Them Patrick S. Buckley, MD University Orthopaedic Associates June 1, 2019 Disclosures • None www.UOANJ.com Anatomy of the Meniscus • Act as functional extensions of the tibial plateaus to increase depth of tibial articular surface • The meniscotibial attachment contributes to knee stability • Triangular in cross-section Gross Anatomy of the Meniscus • Ultrastructural Anatomy – Primarily Type I collagen (90%) – 70% water – Fiber orientation is circumferential (hoop stressing) Meniscal Vascularity • Relatively avascular • Vascular penetration – 10 - 30% medial – 10 - 25% lateral • Non-vascularized portions gain nutrients from mechanical loading and joint motion Medial Meniscus • Semilunar shape • Thin anterior horn • Broader posterior horn • More stable & less motion than the lateral = tears more often Lateral Meniscus • Almost circular in shape • Intimately associated with the ACL tibial insertion • Posterior horn attachments – Ligament of Humphrey – Ligament of Wrisberg • Lateral meniscus is a more dynamic structure with more motion Main Importance of Menisci • Load transmission • Joint stability Load Bearing / Shock Absorption • MM 50% and 70% LM of load transmitted through mensicus in extension • 85 % at 90° of flexion • Meniscectomy – 50 % decrease in contact area – 20 % less shock absorption www.UOANJ.com Meniscal effect on joint stability • Secondary restraints to anterior tibial translation in normal knees • In an ACL-deficient knee: the posterior horn of the medial meniscus is more important than the lateral meniscus Interaction of ACL and PHMM • Lack of MM in ACLD knees significantly ↑ anterior tibial translation at all knee flexion angles • Think about with high grade pivot! (Levy, JBJS,1982) (Allen, JOR,2000) C9ristiani, AJSM, 2017) Meniscus Function -Now known to be important structure for load distribution and secondary stabilizer to the knee.
    [Show full text]
  • Ministry of Health of Ukraine Ukrainian Medical Dental Academy
    Ministry of Health of Ukraine Ukrainian Medical Dental Academy Methodical instructions for independent work for students during training to practical (seminar) classes and in class Academic discipline Surgical dentistry Module № 5 Lesson topic № 1 Anatomy of the temporomandibular joint (TMJ). Modern methods of diagnosing TMJ diseases. Arthroscopy, its possibilities in the diagnosis and treatment of TMJ diseases. Dislocations of the mandible: etiology, clinic, diagnosis, treatment. Curation of the patient in the clinic of maxillofacial surgery. Writing an academic medical history. Course V Faculty Stomatological Poltava 2020 1. Relevance of the topic. Knowledge of the anatomical structure of the temporomandibular joint (TMJ) and the characteristics of modern diagnostic methods for assessing their pathologies. The etiology, clinical diagnosis and treatment of mandibular dislocations allows you to choose a timely and effective way to treat this pathology, avoid mistakes and complications, allows the dentist to diagnose TMJ and prescribe optimal treatment. Academic history in which the student is able to use knowledge , obtained in the study of basic and applied sciences, obtained demonstrate practical skills. 2. Specific target: 2 .1.Analyze to know statistics, diseases TMJ.; 2.2. Explain the methods of diagnosing diseases TMJ; 2.3. To offer to examine patients with diseases of TMJ; 2.4. Classify diseases TMJ; 2.5. Interpret theoretical and clinical studies of diseases TMJ; 2.6. Draw diagrams, graphs 2.7. Analyze the treatment plan for patients with diseases TMJ; 2.8. Make a plan for the treatment of patients with diseases TMJ; 3. Basic knowledge, skills, abilities necessary for studying the topic (interdisciplinary integration). Names of previous Acquired skills disciplines Anatomy To study the anatomical and topographic structure of the temporomandibular joint.
    [Show full text]
  • ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – a Alt, W., Lohrer, H., & Gollhofer, A
    Vilas-Boas, Machado, Kim, Veloso (eds.) Portuguese Journal of Sport Sciences Biomechanics in Sports 29 11 (Suppl. 2), 2011 REFERENCES: ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – A Alt, W., Lohrer, H., & Gollhofer, A. (1999). FunctionalProperties of Adhesive Ankle Taping: COMPUTATIONAL BIOMECHANICS STUDY Neuromuscular and Mechanical Effects Before and After Exercise. Foot & Ankle International , 20(4), 238-45. Daniel Tik-Pui Fong1,2, Feng Wei3, Youlian Hong4,5, Tron Krosshaug6, Benesch, S., Putz, W., Rosenbaum, D., & Becker, H.-P. (2000). Reliability of Peroneal Reaction Time Roger C. Haut3 and Kai-Ming Chan1,2 Measurements. Clin Biomech , 15. Cordova, M. L., Bernard, L. W., Au, K. K., Demchak, T. J., Stone, M. B., & Sefton, J. M. (2010). Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion. J 1 Electromyogr Kinesiol , 20, 248-53. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Delahunt, E. (2007). Peroneal reflex contribution to the development of functional instability of the 2 ankle joint. Phys Ther Sport , 8, 98-104. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China 3 Docherty, C. L., & Arnold, B. L. (2008). Force sence deficits in functionally unstable ankles. J Orthop Orthopaedic Biomechanics Laboratories, Michigan State University, USA Res , 26(11), 1489-93. Department of Sports Science and Physical Education, Faculty of Education, 4 Eechaute, C., Vaes, P., Duquet, W., & Gheluwe, B. v. (2009). Reliability ans discriminative validity of The Chinese University of Hong Kong, Hong Kong, China sudden ankle inversion measurements in patients with chronic ankle instability.
    [Show full text]
  • Ankle Sprain Information
    DON’T STRAIN YOUR BRAIN WHEN CARING FOR AN ABOUT 28,000 ANKLE INJURIES occur in the United States each day. IT’S BELIEVED • Field hockey has the highest rate of • Ankle sprains are graded on severity ankle injuries and sprains, followed and range from grade 1 (mild; no by volleyball, football, basketball, signifcant structural injury) to grade 45% cheerleading, ice hockey, lacrosse, 3 (severe; complete rupture of the OF ALL ATHLETIC INJURIES soccer, rugby, track and feld, ligamentous structures). ARE ANKLE SPRAINS, making it the most common gymnastics and softball. • After an ankle is sprained, it has a sports injury. • An ankle sprain occurs when there is greater chance of becoming sprained a tear in the ligament, while an ankle again. Repeating ankle sprains strain occurs when there is a tear in put an individual at risk for ankle the muscle. osteoarthritis. KNOWING THE PHASES ACUTE PHASE: Usually the frst two weeks of injury. The ankle will have SUBACUTE PHASE: After the frst two weeks of injury. During this pain, heat, swelling, redness and/or bruising and loss of function. phase, the body begins to heal the damaged tissues of the ankle. By now, the ankle should have regained its range of motion, and should begin to improve in balance and strength. TREATMENT OPTIONS REST ICE COMPRESSION ELEVATION Not all ankle sprains are alike, so be sure to consult a health care provider, such as an athletic trainer or physician, for an individualized treatment plan. HOW TO PREVENT AN ANKLE SPRAIN Have a prevention program created by an athletic Tape or brace ankles during sport activities, such as trainer or qualifed medical provider that focuses games and practices.
    [Show full text]
  • Rotator Cuff Injuries
    Scott Gudeman, MD 1260 Innovation Pkwy., Suite 100 Greenwood, IN 46143 317.884.5161 OrthoIndy.com ScottGudemanMD.com Rotator Cuff Injuries Front View Muscles of the Rotator Cuff Shoulder Anatomy Subscapularis Back The tendons of four muscles in the upper arm form View Supraspinatus the rotator cuff, blending together to help stabilize the shoulder. Tendons attach muscles to bone and are the mechanisms that enable muscles to move bones. It is because of the rotator cuff tendons, which connect the long bone of the arm (the humerus) to the scapula (the shoulder blade) that we can raise and rotate our arms. The rotator cuff also keeps the humerus tightly in Infraspinatus the socket (glenoid) when the arm is raised. The tough Supraspinatus fibers of the rotator cuff bend as the shoulder changes Teres position. Minor What are Rotator Cuff Injuries? For normal shoulder function, each muscle must be healthy, securely attached, coordinated and condi- tioned. When there are full or partial tears to the rotator cuff tendons, movement of the arm up or away from the body is impaired, making it difficult or impossible to rotate the arm in its ball-and-socket joint. Causes of Rotator Cuff Injuries Injuries to the rotator cuff tendons of the shoulder can happen to anyone over time. Rotator cuff tendons can be injured or torn by excessive force, such as pitching, lifting a very heavy object with the arm extended or trying to catch a heavy object as it falls. Occasionally, these accidents happen to young people, but typically a rotator cuff tear occurs to a person who is middle-aged or older who has experienced problems with the shoulder for some time before the injuring event.
    [Show full text]
  • Common Elbow Injuries Symptoms
    During the summer months, many people stay active by playing golf or tennis. These sports, however, carry a risk of injury to the tendons – bands of tissue that connect muscles to bones – in the elbow. This month’s AT Corner will explain how these injuries happen, how to treat them if they occur and, most importantly, how to prevent them. Common Elbow Injuries Tendonitis: Inflammation, pain and difficulty using the joint caused by repetitive activities and/or sudden trauma. Tendonosis: A degeneration (breakdown) or tear of tendons which occurs as a result of aging. Symptoms of tendonosis usually last more than a few weeks. Note: Your risk of tendonitis and tendonosis increases with age. They also occur more frequently in those who routinely perform activities that require repetitive movement, as this places greater amounts of stress on the tendons. Tennis elbow: Also referred to as lateral epicondylitis, this condition occurs when there is an injury to the outer elbow tendon. Golfers’ elbow: Also referred to as medial epicondylitis, this condition occurs when there is an injury to the inner elbow tendon. Note: Injuries to these tendons can occur in other sports and activities that use the wrist and forearm muscles. Most times, the dominant arm is the one affected. Symptoms • Pain that spreads from the elbow into the upper arm or down the forearm • Forearm weakness • Pain that can begin suddenly or gradually worsen over time • Difficulty with activities that require arm strength Treatment Over-the-counter medications: NSAIDs, such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), or acetaminophen (Tylenol®) can provide pain relief.
    [Show full text]
  • I. BACKGROUND a Cervical Musculoligamentous Injury (Sprain/Strain)
    CERVICAL MUSCULOLIGAMENTOUS INJURY (Sprain/Strain) I. BACKGROUND A cervical musculoligamentous injury (sprain/strain) may cause neck pain due to a partial stretching or tearing of the soft tissues (muscles, fascia, ligaments, tendons etc.). Non-specific upper extremity complaints such as stiffness, muscle fatigue, and paresthesias may also be reported. Although injury to the neck can result in fracture or neurologic impairment, by definition, a diagnosis of cervical sprain or strain excludes a fracture. The recovery period following a cervical musculoligamentous injury is of variable duration, but symptoms generally resolve within 6 weeks. II. DIAGNOSTIC CRITERIA A. Pertinent Historical and Physical Findings The onset of neck pain and paraspinal muscle spasm may begin either immediately after the injury occurs or can develop gradually over the next 24-48 hours. This pain is usually aggravated with motion of the neck and/or shoulder and is frequently reduced with rest. The pain usually does not radiate below the shoulder. It can be accompanied by paresthesias or a sense of weakness in the upper extremities related to muscle spasm in the neck. Headaches arising from the cervical region or occiput may accompany neck pain. Physical findings include tenderness to palpation and/or spasm of the paraspinal, trapezius, or anterior cervical (e.g. sternocleidomastoid) muscles, and painful and/or decreased active cervical range of motion. With isolated cervical sprain/strain, the objective neurological examination should be normal. B. Appropriate Diagnostic Tests and Examinations Indications for radiographs of the cervical spine include high velocity trauma, neurologic injury on clinical examination, history of cancer or osteoporosis, age > 65 years, etc.
    [Show full text]
  • Mid-Back Strain
    Comp. by: Kkala Stage: Revises2 Chapter No.: 186 Title Name: Safran Page Number: 0 Date:16/6/11 Time:20:52:23 B978-1-4160-5650-8.00286-7, 00286 Mid-Back Strain DESCRIPTION Chronic inflammation, scarring, and partial muscle– tendon tears may occur. A mid-back strain is an injury to the muscles and tendons Healing or resolution of symptoms may be delayed, of the middle back that attach to the ribs and chest wall particularly if activity is resumed too soon. and to the spine. These muscles stabilize the spine and Prolonged disability may result. allow its motion. The mid back provides a large portion of the back’s overall motion, but it primarily allows for rotation of the back in a twisting motion. GENERAL TREATMENT CONSIDERATIONS COMMON SIGNS AND SYMPTOMS Injury to the back results in pain and inflammation. The Pain in the back that may affect only one side and is pain and inflammation result in muscle spasms in the worse with movement back, which in turn result in more pain. Thus the initial Muscle spasms and often swelling in the back treatment consists of rest, medications, and ice to relieve Loss of strength of the back muscles pain, inflammation, and muscle spasms. As pain and Crepitation (a crackling sound) when the muscles are spasms subside, exercises to improve strength and flexi- touched bility and education in the use of proper back mechanics and sports technique are started. Referral to a physical CAUSES therapist or athletic trainer may be recommended for these and possibly other treatments, such as transcutane- Prolonged overuse of the muscle–tendon units in the ous electronic nerve stimulation (TENS) and ultrasound.
    [Show full text]
  • ACHILLES TENDONITIS in GYMNASTICS by Holly Heitzman, MS, LAT, ATC, PTA
    ACHILLES TENDONITIS IN GYMNASTICS By Holly Heitzman, MS, LAT, ATC, PTA endonitis is common in Tendocalcaneal Bursitis- A bursa is a fluid-filled gymnastics with multiple sac designed to limit friction. When a bursa sac becomes irritated and inflamed, it is called bursitis. repetitions of floor routines, Tendocalcaneal bursa is located under the fibrous beam routines and sprinting Achilles tendon and behind the heel bone (calcaneus). toward the vault. The calf Achilles tendon rupture – In severe cases, a force Tmuscles and the Achilles tendons are may even rupture the tendon. The rupture may be constantly being worked and stressed. preceded by periods of chronic tendonitis. Multiple The Achilles tendon provides power episodes of tendonitis may weaken the tendon and its fiber structure. Many athletes report that a rupture when pushing off the foot. A strain can feels like someone kicked them in the leg. They no cause injury to the calf muscles or the longer have the ability to walk or push off. Surgery Achilles tendon. This can happen during is the common course of treatment for an Achilles rupture. a strong contraction of the muscle, as when sprinting toward the vault or when Sever’s disease – At the site at which the Achilles doing a tumbling pass, the foot may be tendon attaches to the heel, it becomes inflamed and the bone starts to deteriorate. Sever’s disease forced upward upon transition of landing may be associated with a growth spurt. As the bones to jumping. The strain may affect different get longer, the tendon becomes tighter; therefore, portions of the tendon.
    [Show full text]
  • Ankle Sprains & Strains and Fractures
    Sprains, strains and fractures pe o c S t Common causes of simple ankle injuries usually involve sports, biomechanical instability or trauma. Strains o A strain is usually attributable to overuse and repetitive damage to the muscle or tendon and are common in athletes and elderly patients — groups at high risk for wear and tear injuries. A patient suffering from a mild strain will complain of the ankle feeling sore and weak, and inflammation of the joint may be apparent. For a o severe strain, the patient will complain of significant pain and difficulty walking on the injured foot. This may indicate a full or partial tear of the muscle or tendon. Sprains F A sprain is a partial dislocation of the ankle joint with tearing of the ankle ligaments. Most sprains affect the ligaments on the lateral side of the ankle caused by sudden inversion of the ankle below the tibia, causing the lateral ligaments to stretch or tear. Sprains can occur in the opposite direction, with aversion injuries affecting the deltoid ligament, although this is less common and is usually minor. Severity of injury is graded based on the number of ligaments involved and the degree of damage. Grade 1 sprains: the patient will still be able to walk with minor discomfort and there will be no tearing of the ligaments. Grade 2 sprains: there will be partial tearing of the ligaments, the patient will find it painful to put weight on the affected foot, and the ankle will be inflamed with bruising. Grade 3 sprains: the patient may have heard an audible pop at the time of injury, indicating that ligaments will be completely torn.
    [Show full text]
  • Acute and Chronic Whiplash Disorders – a Review
    J Rehabil Med 2004; 36: 193–210 REVIEW ARTICLE ACUTE AND CHRONIC WHIPLASH DISORDERS – A REVIEW Ylva Sterner1 and Bjo¨rn Gerdle2,3 From the 1Department of Anaesthesia, Pain Clinic, Karolinska Institutet, Danderyd Hospital, 2Department of Rehabilitation Medicine, Faculty of Health Sciences, Linko¨ping and 3Pain and Rehabilitation Centre, University Hospital, Linko¨ping, Sweden Objective: This review examines acute and chronic whiplash- guidelines concerning WAD are sparse due to lack of random- associated disorders to facilitate assessment, treatment and ized, controlled and prospective studies. Assessment, investi- rehabilitation for further research and evidence-based gation and treatment strategies for WAD should be based on practises. science and experience-based practise, remembering that Design: A review of the literature. statistical results generally are on a group level and cannot be Results and conclusion: Whiplash-associated disorders correlated directly to individuals. account for a large proportion of the overall impairment During the First World War, it became clear that the violence and disability caused by traffic injuries. Rarely can a definite inflicted on the cervical spine of pilots during emergency ejec- injury be determined in the acute (or chronic) phase. Crash- tion was great enough to cause a blackout for several seconds related factors have been identified, and several trauma and accidents occurred that were due to a whiplash effect. This mechanisms possibly causing different injuries have been understanding resulted in the development of a headrest and a described. Most whiplash trauma will not cause injury, and shoulder harness to protect pilots. Although a great deal of the majority of patients (92–95%) will return to work.
    [Show full text]