Prevention and Care of Injury Exam #3

What is a Plica?

A fold of the fibrous membrane.

What are some common tendons around the knee where we see tendonopathies?

ACL, MCL, LCL, PCL.

What is the "unhappy" or "terrible" triad of knee injuries?

ACL, MCL, Medical Meniscus

What is the likely MOI for a tibial plateau fracture?

Acute - axial loading

Compare Acute Compartment Syndrome with Exertional Compartment Syndrome. How does the MOI differ? How does the immediate care differ? How do the signs and symptoms differ?

Acute Compartment Syndrome occur secondary to direct trauma. Exertional compartment syndrome occurs without precipitating trauma and can evolve with minimal to moderate activity.

What is the common MOI and Signs & Symptoms of a meniscus tear?

Acute Valgus force or external rotation. S&S: Medial knee pain, Joint effusion, Limited ROM

The foot contains a total of __ bones.

26

Type out the name of the four major ligaments of the knee: ACL, PCL, MCL, LCL.

Anterior Cruciate Ligament, Posterior Cruciate Ligament, Medial Collateral Ligament, Lateral Collateral Ligament.

Patellofemoral Stress Syndrome is a fancy name for _________________.

Anterior Knee Pain

What two compartments are most often affected by compartment syndrome?

Anterior is most common. Deep Posterior is second most.

The ACL resists __________ of the tibia.

Anterior translation, internal/rotation, and hyperextension of the tibia.

What is the name of the "new" knee ligament that is located near the LCL?

Anterolateral Ligament (ALL)

Muscles of the hamstring

Biceps Femoris, Semitendinosis, Semimembranosis.

Name the hamstring muscles from medial to lateral.

Biceps femoris, Semitendinosus, Semimembranosus

A hallux valgus deformity can lead to exostosis and a subsequent callus which is known as a ____. When the same process occurs at the MTP joint of the 5th, it is called a Bunionette.

Bunion, bunionette.

A hallux valgus deformity can lead to exostosis and a subsequent callus which is known as a ____. When the same process occurs at the MTP joint of the 5th, it is called a _____.

Bunion, bunionette.

How does the screw home mechanism vary if the individual is weight bearing (closed kinetic chain) versus non-weight bearing (open kinetic chain)?

CKC: femur will internally rotate to lock knee. OKC: Tibia will externally rotate to lock knee.

Define Osteochondritis Dissecans.

Chipping away of smooth surface of condyles of femur.

Contrast the three toe deformities we discussed in class: Claw toe, Hammer toe, and Mallet toe.

Claw toe: MTP & DIP hyperextension, PIP flexion. Hammer toe: MTP hyperextension, PIP & DIP flexion. Mallet toe: DIP flexion

What movements occur at the DIP and PIP joints? What movements occur at the MTP joints?

DIP & PIP: flexion and extension. MTP: flexion, extension, adduction, abduction.

Another name for a PCL injury is:

Dash board injury. Called this because it happens in car wrecks when the dashboard forces the tibia posteriorly tearing the PCL.

If the subtalar joint is pronated, the Chopart becomes _____, if the subtalar joint is supinated, the Chopart becomes _____.

Hypermobile; hypomobile

If you were a coach or teammate and you suspect an ACL sprain, how would you care for it?

Immobilize, crutches, refer

Name the subphases of walking beginning with the stance phase and ending with the swing face

Initial foot contact (heel strike), Loading, Midstance, Terminal strike, Toe off, initial swing, mid-swing, terminal swing.

What is a high ankle sprain?

Injury to distal tibiofibular syndesmosis

What is the most common type of ankle sprain? What ligaments are typically injured?

Inversion ankle sprain: Anterior talofibular ligament, Calcaneofibular ligament

Three types of fractures can occur to the base the fifth metatarsal. Contrast the location of the three.

Jones Fracture (medial), Avulsion (Base), Stress Fracture (Distal).

Compare and contrast Larsen-Johansson and Osgood-Schlatter diseases.

Larsen: Degeneration of attachment at south pole of patella. Osgood: Degeneration of attachment at Tibial tuberosity.

What structures stabilize the patella? Which are aligned vertically? Which are aligned horizontally? Which are aligned oblique?

Lateral and Medial Patellofemoral ligaments are aligned vertically. The Lateral and Medial Retinaculum are aligned oblique.

Patella dislocations and subluxations typically occur in what direction?

Laterally

How does the size and shape of the MCL and LCL differ?

MCL: two layers, thicker. LCL: smaller, cord-like structure.

When standing up on the toes what movement is occurring at the MTP joint? Subtalar joint? Talocrural joint?

MTP Joint- dorsiflexion. Subtalar-plantarflexion. Talocrural: extension

Shin splints simply refers to ____.

MTSS

Compare the size and shape of the medial meniscus to the lateral meniscus.

Medial Meniscus is larger, C-shaped, and thicker posteriorly. Lateral Meniscus is smaller, O-shaped, and equal thickness throughout.

What does MTSS stand for?

Medial Tibial Stress Syndrome

What are the roles/purpose of the menisci?

Provide stability, distribute force, maintain joint spacing, provide shock absorption.

Name the four quadriceps muscles. Which of the four is most medial?

Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedialis. Most Medial: Vastus Medialis

What muscles make up the pes anserine?

Sartorius, Gracilis, and Semitendinosis

What is the Q angle, and what are normal values for both men and women?

The relationship between the anterior superior iliac spine, midpoint of the patella, and tibial tuberosity. Men: 13 degrees Women: 18 degrees

Stress fractures in the lower leg most often affect what bone? Why?

Tibia since it is the weight bearer of the leg

Landing on a hard surface with a bent knee is the MOI for what two injuries we discussed?

Tibial Plateau fracture and Patella Fracture

Some possible causes of PFSS include:

Tightness of hamstring, tightness of lateral retinaculum, increased Q angle, Tightness of IT abdn, Pronation of the foot, patellar tendon length, weak hip adductors.

What is turf toe? What is reverse turf toe?

Turf toe: hyperextension of the great toe leads to sprain of the Metatarsophalangeal joint. Reverse Turf toe: sprain of dorsal ligament due to hyperflexion

Plantar fasciitis is characterized by what signs and symptoms?

pain in the anterior medial heel at the attachment of the plantar fascia to the calcaneus.

During walking, there are two primary phases, the ___ phase and the ____ phase.

stance and the swing phase

What is a DVT? Who is at risk? How can it be prevented?

Deep Vein Thrombosis, Older people, Different shoes, take pressure out of leg

What is Chondromalacia Patella including the signs and symptoms?

Degeneration/softening of cartilage. MOI: insidious. S&S: often asymptomatic. Deep & diffuse pain. More with knee extension or compression.

What are the signs and symptoms of an ACL sprain?

Diffuse pain throughout joint. No tenderness to palpation. Rapid effusion. Decreased ROM. Popping sensation. "gives out."

What is the single greatest concern if someone has a Jones Fracture?

Easily refractured.

A medial ankle sprain is caused by what MOI? What ligament complex is affected with this type of ankle sprain?

Eversion sprain, Deltoid ligament

When the quadriceps muscles shorten (concentrically), what movement occurs at the knee?

Extension

Where is the common peroneal nerve/fibular nerve located? Why is it vulnerable to injury?

Fibular head. It is superficial and lateral.

When the hamstring muscles shorten (concentrically), what movement occurs at the knee?

Flexion

The patella is the ____ bone in the body, and it is imbedded in the ____ tendon.

Floating; patellar

The IT Band inserts at ___________________ _________________ just below the knee.

Gerdy's Tubercle.

What test may be positive if someone has a ruptured PCL?

Have patient sit supine and observe Unilateral posterior displacement of tibia.

The infrapatellar fat pad is also known as _______ pad.

Hoffa's fat pad

Four arches of the foot

Metatarsal Arch, Transverse Arch, Medial Longitudinal Arch, Lateral Longitudinal Arch.

How are tears treated in the different vascularity zones of the menisci?

More vascular zones will likely be left to heal on their own. If suture is necessary it is very likely to be successful. Tears at the inner aspect are less likely to heal if sutured.

Compare non-contact ACL tears with contact ACL tears. How does the MOI differ?

Non-contact: Plant and twist causes Valgus force. Isolated ACL tear. Higher rate in females. Contact: Valgus force. Hyperextension. Other structures often involved. Higher rate in females.

List five appropriate care recommendations for someone experiencing the signs and symptoms of plantar fasciitis.

Orthotic Therapy, Extra deep heel cup, Taping, Night splint, Rolling foot over tennis ball

Zones of vascularity of the menisci.

Outer most parts of cartilage ring is most vascular (red-red-zone). The middle is somewhat vascular (red-white or pink zone). The inner most ring is not vascular (white-white zone).

Typically, how does the patellar tendon rupture? How should be care for it?

Overload of extensor mechanism. Care: Splint in extension and refer.

What is the best course of treatment for IT Band syndrome?

PRICE, NSAIDs, IT Band stretch. Foam roller.

If someone has Knee Plica syndrome, what is the course of care/management?

PRICE, NSAIDs, stretch. Occasional surgery.

The term ____ is used to refer to a foot with a high arch, and the term ____ is used to refer to a foot which appears flat.

Pes Cavus; Pes Planus

The PCL resists __________ of the tibia.

Posterior translation and external rotation of the tibia.

The bursa located directly superficial to the patella is called:

Pre-patellar Bursa

The three most common causes of "shin splints" are:

Stress fractures, Muscle strains, Chronic anterior compartment syndrome

Ankle Inversion and Eversion occur at the ___ joint; whereas, ankle Dorsiflexion and Plantar Flexion occur at the ____ joint.

Subtalar; ankle

What two bursae protect friction of the patellar tendon?

Suprapatellar Bursa and Deep Infrapatellar Burse

What ligaments along with the sendesmosis support the distal tibiofibular joint?

Syndesmotic ligaments

What ligaments support the talocrural and subtalar joints?

Talocrural: Calcaneofibular ligament, posterior talofibular ligament. Subtalar: Posterior tibiotalar ligament, tibiocalcaneal ligament

What should you do if you suspect a foot, ankle, or lower leg fracture?

Tell the person to stay off of the foot. Send them to get xrays.

What muscle is just proximal to the IT Band?

Tensor Fascia Latae

The knee's joint capsule includes which two joints, and is integrated with which ligament?

The knee's joint capsule includes the tibiofemoral joint and the patellofemoral joint. It is integrated with the MCL

What is it about the shape of the knee joint that creates the screw home mechanism?

The medial femoral condyle and medial tibial plateau are larger than their lateral counterparts.

The MCL protects against _______ force/stress; whereas, the LCL protects against ______ force/stress.

Valgus;Varus

Valgus vs. Varus

Varus stress/force occurs when the joint is moved laterally. Valgus stress/force occurs when the joint is moved medially.

What is the typical management/treatment for a fibularis longus avulsion fracture?

Walking boot, avoid pressure on it.