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Kin191 A. Ch.5. Ankle. Lower Leg. Evaluation. Fall 2007
 

Kin191 A. Ch.5. Ankle. Lower Leg. Evaluation. Fall 2007

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    Kin191 A. Ch.5. Ankle. Lower Leg. Evaluation. Fall 2007 Kin191 A. Ch.5. Ankle. Lower Leg. Evaluation. Fall 2007 Presentation Transcript

    • KIN 191A Advanced Assessment of Lower Extremity Injuries ANKLE/LOWER LEG EVALUATION
    • INTRODUCTION
      • HISTORY
      • INSPECTION
      • PALPATION
      • ROM TESTING
      • LIGAMENTOUS STABILITY TESTING
      • NEUROLOGIC TESTING
      • VASCULAR TESTING
      • Location of pain
        • May be referred site for compartment syndrome, tarsal tunnel syndrome, peroneal/tibial nerve injury, sciatic nerve or lumbar nerve root impingement
      • Nature/type of pain
        • Aggravating/alleviating activities
        • Effect of pain on activities
      HISTORY
      • Onset of pain
        • Acute: trauma (sprain, strain, fracture, etc.)
        • Gradual/insidious - overuse syndromes
      • Mechanism of injury
        • Macrotrauma - typically easy to identify tissues involved
        • Microtrauma - typically involves more in depth questioning to arrive at cause of problem
      • Activity changes
        • Duration, frequency, intensity, surface, shoes, orthotics, etc.
      • Prior history
        • Those with prior history of ankle injury may present with increased laxity and/or decreased proprioception vs. normal
    • INSPECTION
      • General inspection
        • Weight bearing status
        • Gait pattern
        • Swelling
        • Obvious deformity
        • Discoloration
      • Inspection of the lateral structures
        • Peroneal muscle group
        • Distal one third of the fibula
        • Lateral malleolus
      • Inspection of the anterior structures
        • Appearance of the anterior lower leg
        • Contour of the malleoli
        • Talus
        • Sinus tarsi
          • Lateral aspect of the talus (anterior from the lateral malleolus)
      • Inspection of the medial structures
        • Medial malleolus
        • Medial longitudinal arch
      • Inspection of the posterior structures
        • Gastrocnemius-soleus complex
        • Achilles tendon
        • Bursae
          • Subtendinous (Retrocalcaneal) bursa
          • Subcutaneous calcaneal bursa
        • Calcaneus
    • PALPATION (fibular structure)
      • 1. Common peroneal nerve
      • 2. Peroneus longus and brevis
      • 3. Fibular shaft
      • 4. Anterior and posterior
      • tibiofibular ligaments
      • 5. Interosseous
      • membrane
      • 6. Superior peroneal
      • retinaculum
    • PALPATION (lateral ankle)
      • 1. Lateral malleolus
      • 2. Calcaneofibular ligament
      • 3. Anterior talofibular ligament
      • 4. Posterior talofibular ligament
      • 5. Peroneal retinaculum
      • 6. Peroneal tubercle
      • 7. Cuboid
      • 8. Base of the fifth metatarsal
      • 9. Peroneus tertius
    • PALPATION (anterior structures)
      • 1. Anterior tibial shaft
      • 2. Tibialis anterior
      • 3. Extensor hallucis longus
      • 4. Extensor digitorum longus
      • 5. Dome of the talus
      • 6. Extensor retinacula
      • 7. Sinus tarsi
    • PALPATION (medial structures)
      • 1. Medial malleolus
      • 2. Deltoid ligament
      • 3. Sustentaculum tali
      • 4. Spring ligament
      • 5. Navicular and
      • navicular tuberosity
      • 6. Tibialis posterior
      • 7 . Flexor digitorum longus
      • 8 . Flexor hallucis longus
    • PALPATION (posterior structures)
      • 1. Gastroncnemius-soleus complex
      • 2. Achilles tendon
      • 3. Subcutaneous calcanel bursa
      • 4. Calcaneus
      • 5. Subtendinous calcaneal bursa
    • Palpation of Pulses
      • Posterior tibial artery
        • Between the flexor digitorum longus and flexor hallucis longus tendons as they pass behind the medial malleolus
      • Dosalis pedis artery
        • Between the extensor digitorum longus and extensor hallucis longus tendons as they pass over the cuneiforms
    • RANGE OF MOTION TESTING
      • The ROM can be affected by
        • Muscular tightness
        • Bony abnormalities
        • Soft tissue constraints
      • Active ROM
      • Passive ROM
      • Resistive ROM
    • Active ROM
      • Plantar flexion/dorsiflexion at talocrural joint
      • Inversion/eversion at subtalar joint
      • PF – 50 degrees, DF – 15~20 degrees
        • Must have 10 degrees DF to walk with normal gait (15 degrees to run) – if absent, predisposes to biomechanical problems and overuse injuries
      • INV – 20 degrees, EV – 5~10 degrees
    •  
    • Passive ROM
      • Dorsiflexion
        • Measured with the knee extended to determine the overall influence of the triceps surae group
        • Measured with knee flexed to determine the influence of the soleus
        • Normal firm end-feel
      • Plantar flexion
        • Normal firm end-feel
        • Anterior joint capsule, deltoid ligament, and ATF ligament are stretched
      • Inversion
        • Should lie supine position
        • Normal firm end-feel (especially the CF ligament stretch) and peroneal muscles stretch
        • The tibia and fibular are stabilized to prevent hip or lower leg rotation
      • Eversion
        • A hard end-feel (because of the fibular’s striking the calcaneus)
    • Goniometry
      • Plantar flexion/Dorsiflexion
        • Sitting or lying with the knee flexed to at least 30 degrees
        • Fulcrum
          • Centered over the lateral malleolus
        • Stationary arm
          • Aligned with the long axis of the fibula
        • Movement arm
          • Parallel with the long axis of the 5 th metatarsal
    •  
    • Goniometry
      • Inversion/Eversion
        • Sitting or lying with the knee flexed to at least 30 degrees
        • Fulcrum
          • Over the talocrural joint line, centered between the malleoli
        • Stationary arm
          • Centered over the long axis of the tibia
        • Movement arm
          • Over the 2 nd metatarsal
    • Resistive ROM
      • Anterior talofibular ligament
        • Anterior drawer test
      • Calcaneofibular ligament
        • (Talar Tilt) Inversion stress test
      • Deltoid ligament
        • (Talar Tilt) Eversion stress test
        • Kleiger’s (External rotation) test
          • Place the ankle in neutral or slightly plantar flexed
      LIGAMENTOUS STABILITY TESTS
    • Anterior Drawer Test Talar Tilt Inversion Stress Test
      • Distal tibiofibular ligaments/syndesmosis
        • Kleiger’s (External rotation) test
          • Place the ankle in dorsiflexion
        • Squeeze (Compression) test
      • Stress fractures of lower leg: tibia, fibular, talus, and/or calcaneus
        • Bump (Percussion) test
    • Kleiger’s (External rotation) Test Squeeze (Compression) Test Bump (Percussion) Test
    • Homan’s Test Thompson Test
      • For Achilles tendon rupture
      • For Deep Vein Thrombosis
    • NEUROGIC TESTING
      • L4 – S2 dermatomes/myotomes/reflex
      • Tibial nerve
      • Deep peroneal nerve
      • Superficial peroneal nerve
    • VASCULAR TESTING
      • Anterior compartment
      • Lateral compartment
      • Deep posterior compartment
      • Superficial posterior compartment