Special Test Squeeze Test Dorsiflexion Test Kleigers Test Cross-leg Test Nussbaum et al. Imaging Techniques X-RAY
Radiographs AP, Lateral, Mortise Views AP View Fractures Tibiofibular clear space widening of 6 mm Tibiofibular overlap > 42% Fibula Width Medial clear space widening > 4mm Lateral View Non weight bearing ER Fractures
Imaging Techniques X-RAY Tibiofibula overlap Tibiofibula clearance space Medial clear space Imaging Techniques X-RAY Tibiofibula overlap Tibiofibula clearance
space Medial clear space Imaging Techniques X-RAY Lateral View Imaging Techniques X-RAY AP View Heterotopic Ossification
Imaging Techniques MRI & CT MRI (Magnetic Resonance Imaging) Frontal, Axial, Saggital Views High sensitivity and specificity More reliable detecting disruptions CT (Computed Tomography) More effective detecting minor disruptions Less Cost v.s. MRI
Imaging Techniques MRI Axial Views West Point Instability Scale Grade I Grade II Grade III
Edema & Ecchymosis Localized Mild Localized Moderate Diffuse Severe
Weight Bearing Ability Full or Partial Without Significant Pain Difficult Without Crutches Impossible Significant Pain
Ligament Stretch Partial Tear Complete Tear +AIFL +AIFL +IL Possible AD
+AIFL/PIFL +IL +AD Ligament Damage Ligament Involvement Treatment Criteria Based on Patients Goals Length of Symptoms
Severity of Injury Conservative Grade I Non-Fractures Stable Grade II Non Conservative Grade III Unstable Grade II Fractures Chronic Injury
Conservative Protocols Results vary patient to patient Grade I Injuries: 2-4 Weeks RTP Grade II Injuries: 6-8 Weeks RTP Without Instability or Fractures Conservative Protocols Phase I (0-5 Days) or (5-14Days) Immobilize Reduce Pain Reduce Inflammation
Cryotherapy E-Stim Increase ROM Manual 30* PF Stretch Ankle Pumps Toe Curls Towel Stretch Conservative Protocols Phase II (6-10 Days) or (2-4 weeks) Immobilize Grade II Reduce Pain
Reduce Inflammation Proprioception Increase Flexibility Increase ROM Increase Strength CV Endurance Conservative Protocols Phase III (18-25 Days) or (4-8 Weeks) Protect Injury Reduce Pain Increase Pain free Activity
Sports Specific Proprioception Increase Strength Increase Flexibility CV Endurance Conservative Protocols Phase III (18-25 Days) or (4-8 Weeks) Sports Specific Drill#1
Drill#2 Conservative Protocols Return To Play Criteria Full Strength Full ROM Functional Test Physician Clearance Protect Injury Operative Treatment Arthroscopy
Goal is to restore structures, and mobility Open Reduction & Internal Fixations Autographs Modified Brostrum Technique 4.5 mm Cortical Screws Complications Screw Breakage Screw Type Infection Calcification & Joint Stiffness
Operative Treatment Arthroscopy Before After Post-Operative Protocols Arthroscopy Results vary patient to patient Grade III Injuries: 4-8 Months RTP Non Weight Bearing 6-8 Weeks
Screw Removal @ 3 Months Follow-up Imaging every 2 weeks Post-Operative Protocols Phase I (1-3 Weeks) Phase I- Conservative Rehabilitation Immobilize & Non Weight Bearing Protect Wound Reduce Pain Reduce Inflammation Proprioception Increase ROM
Proprioception Increase Flexibility CV Endurance Post-Operative Protocols Phase III (8-12 Weeks) Phase II- Conservative Rehabilitation Full Weight Bearing & Cam-walker Remove Screws Reduce Pain Increase ROM Increase Strength
Proprioception Increase Flexibility Sports Specific CV Endurance Post-Operative Protocols Phase IV (4-8 Months) Phase III Conservative Rehabilitation Protect Injury Increase Pain Free Activity Increase ROM Increase Strength
Proprioception Increase Flexibility Sports Specific CV Endurance Post-Operative Protocols Return To Play Criteria Full Strength Full ROM Functional Test Physician Clearance Protect Injury
Conclusion Early Recognition Determine Extent of Injury Rule out Associated Injuries Conservative Treatment (2-8 Weeks)
Surgical Intervention (4-8 Months) Complications Questions References Eric Nussbaum, Timothy M. Hosea, Shawn Sieler, Brian Incremona, Donald Kessler. Prospective Evaluation of Syndesmotic Ankle Sprains Without Diastasis. American Journal of Sports Medicine. 2001; 29:31-35.
David A. Porter. Evaluation and Treatment of Ankle Syndesmosis Injuries. [Editorial]. 2009; 58:575-581. Cyrus M. Press, Asheesh Gupta, Mark R. Hutchinson Management of Ankle Syndesmosis Injuries in the Athlete. American Academy of Sports Medicine.2009; 8:228-233.
Marc L Wagener, Annechien Beumer, Bart A Swierstra. Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic Findings and Results of Anatomical Reconstruction. Bio Med Central Musculoskeletal disorders 2011; 12:1-7. Albert Alonso, Lynette Khoury, Roger Adams. Clinical Tests for Ankle Syndesmosis Injury: Journal of Sports and Physical Therapy. 1998; 27:276284.
Rubrics will be sent home and the IB grade will be posted on Gradespeed (Parent- Connect) SATTERWHITE. Late Work Policies . Work that is not completed by the start of class. Will be accepted for 5 calendar days after due...
Utility is responsible for design, construction, maintenance. INDOT will participate in costs if utility is reimbursable. INDOT Structures No attachment for facilities of: Hazardous, explosive, high voltage,high pressure, heated. Discourages attachment of all other types of facilities. Utility will request...
15-* Megacolon Hirschsprung disease—hereditary defect causing absence of enteric nervous system No innervation in sigmoid colon and rectum Constricts permanently and will not allow passage of feces Feces becomes impacted above constriction Megacolon: massive dilation of bowel accompanied by abdominal...
Mineralization of organic-P is an important source of plant available-P for several years as virgin soils are brought under cultivation. This release is more important for soils where the climax vegetation is similar to that of the cultivated crop (e.g.,...
Sugar. Source. Importance. Clinical. Significance. D-Glucose. Fruit juices. Hydrolysis of starch, cane sugar, maltose, and lactose. The sugar of the body. carried by blood the principal one used by the tissues
I use my web page to post useful links, copies of notes, worksheets, projects, and study guides. I may also use my homework page to highlight any announcements or special information. MDJH Webpage (from the MDJH webpage, click HOMEWORK.On the...
Ready to download the document? Go ahead and hit continue!