FHE Quiz 4- hyperdorsiflexion

scenario

The major bony architecture in the ankle is the talus, located generally at the junction of the leg and the foot, the tibia, located superior to the talus, the fibula, located lateral to the talus, and the calcaneus which is located inferior to the talus The ankle is a very mobile joint and therefore has numerous movements associated with it, but since this injury results from hyperdorsiflexion, it seems prudent to focus on the two ankle movements related to hyperdorsiflexion: dorsiflexion and plantarflexion. Dorsiflexion refers to the motion in which the anterior angle between the foot and lower leg decreases, moving one's foot from a neutral position to lifting their toes upward. Plantarflexion, on the other hand, refers to the motion in which the anterior angle between the foot and lower leg increases, moving one's foot from a neutral position to pushing their toes downward range of motion test, one would notice that hyperflexion has occurred as the ankle is able to dorsiflex excessively compared to the healthy movements typical of the ankle. The end feel of the motion is extremely soft and mushy. likely notice that the individual's talus is posteriorly located. when the injury occurred, the ligamentous stabilizers that keep the ankle from hyperdorsiflexion were overcome by the force that caused the hyperdorsiflexion, likely injuring these ligaments. The injury to the ligaments meant that the talus bone within the ankle no longer had its typical support to keep it in place and consequently shifted posteriorly in response to the force of the hyperdorsiflexion, a movement referred to as a posterior translation of the talus relative to the lower leg. suggests that the ankle's static stabilizers responsible for preventing hyperdorsiflexion, the posterior talofibular ligament (lateral ligamentous static stabilizer) and the posterior tibiotalar ligament (medial ligamentous static stabilizer) have been disrupted. Since a disruption of these ligaments occurred, the ligaments likely entered the plastic region on the stress-strain curve, leading to a deformation of the ligament known as a sprain. Since it was a relatively severe hyperdorsiflexion, one might expect that the posterior talofibular ligament and the posterior tibiotalar ligament suffered from a grade 3 sprain leg cast and eventually a boot which will help immobilize the ligaments and take pressure off of them to promote their healing. eventually be able to stop using the boot and might spend some time with an ankle brace or transition directly to walking without any additional support the ligament will never return to its original strength To compensate for this weakened static stability and therefore weakened TAS, dynamic stabilizers can be trained through specific exercises

Overview

bony architecture of the articulation proper movement stability and mobility the components of articular stability- static and dynamic scenario/consequences

the components of articular stability- dynamic

dynamic stabilizers that can voluntarily change shape in response to forces and help prevent injury by augmenting and protecting the static stabilizers. Together, the strength of the static and dynamic stabilizers make up Total Articular Stability (TAS). This term refers to the combined strength of the stabilizers that work to protect articulations. In the dilemma addressed above, where the static stabilizer is now weakened and unable to ever go back to full strength, the TAS will decrease. However, dynamic stabilizers can be trained and built up to become stronger and compensate for the weakened static stabilizers. This increase in dynamic stability can overcome the decreased stability of the static stabilizers and return the TAS to a healthy, protective level. In addition, during this time, it is also beneficial to strengthen the muscles near the articulation to their typical strength to avoid injury since they were likely weakened by their lack of use during the stability period. However, this should be done cautiously, so as to not strengthen the provacators, or muscles that powered the movement of injury, as this could lead to re-injury.

bony architecture of the articulation

first thing a practitioner -determine and describe the bony architecture address and familiarize oneself with all of the bones near the point of injury. gather what the normative, healthy movements of the articulation of these bones would look like

the components of articular stability- static

Static stabilizers take shape in either bone, ligament, or cartilage. In this scenario, however, we will focus on ligamentous static stabilizers. These stabilizers prevent excessive movement above what is typical and healthy in articulations because they cannot voluntarily react to forces. When these static stabilizers are healthy and have not experienced disruption, they are able to prevent excessive movements very well and help stabilize articulations. In scenarios such as this, where an excessive movement causes injury, the forces that produce the injury have overcome the strength of the structures, including the static stabilizers, that were trying to prevent the excessive motion. This excessive movement often causes a disruption in the ligament as described in the previous paragraph. This means that ligaments as stabilizers work to prevent excessive movement and when excessive motion forces are too strong, the ligaments are often disrupted. Once a ligament is disrupted, it can only heal haphazardly, meaning even after a full recovery, the ligament will never return to its original strength.

stability and mobility

mobility and stability are indirectly related such that when an articulation is given high stability, it is given so much support that the articulation is immobilized, resulting in little to no mobility. Giving an articulation high mobility, however, does not provide the articulation much stability, allowing for more motion, but less support. When addressing injuries, one must assess the state of the injury and determine the appropriate level of mobility and stability such that the injured articulation receives enough support to avoid worsening or reinjuring the area, but avoid excessive stability to avoid unnecessary weakening of the surrounding structures

proper movement

resulting possible movements post-injury can be compared to understand how it differs from normative motion. inform how extensive the injury is and how the injury ought to be addressed. perform a range of motion test by using the proximal hand to stabilize the articulation and the distal hand to test the articulation's range of motion. The range of motion and end feel of the movement will allow the practitioner to understand the degree of damage that has occurred in the injury. If the end feel of the movement is leathery and the range of motion is normative, there is likely little damage to the injured area. if the end feel of the test is mushy and there is an excessive range of motion, there is likely more serious damage to the area. More serious damage implies a disruption in a ligament, injury has gone into the plastic region of the stress-strain curve, leading to a deformation of the ligament known as a sprain. Depending on the severity of the sprain, sprains can be divided into three different levels of severity: grade 1, grade 2, and grade 3. Grade 1 sprains are relatively minor injuries in which the majority of the ligament is in proper condition and a minimal portion is disrupted. Grade 2 sprains occur when a majority of the ligament is disrupted and only a minority is still intact. grade 3 sprain in which the ligament is fully disrupted and no longer intact.