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Western University
Kinesiology 3336A/B
Dave Humphreys

Lab experience in athletic injuriesLECTURE 1 ANKLE INJURIESEpidemiology of ankle sprainso85 are lateral 10 syndesmosishigh 5medialStabilityoShape of bones capsule and ligaments strength of musclesdynamic stabillzersAnkle jointoLateral malleolus longer and more posterior than medialo Throchlear surface is wider anteriorly than posteriorly no muscle attachmentsoWith dosrsiflexion the wider portion lies between the malleolimore stableCapsuleLigamentsoThin and weak anteriorly and posteriorly to allow movementoStrengthened medially and laterally by ligamentsATFL capsular and strained with PFinversionCFtigtht in neutral dorsiflexionDeltoidlimits lateral tilt oToe region34 lengthDue to flattening of crimpStretch is reversibleoLinear regionpathological irresversible ligamnet elongationDisrupted until macroscopic failure is evidentEarly partmildgrade1 50Grade25080 fiber disruptionLOOKING FOR ENDPOINT PAIN AND LAXITY oRupture regionfailure point at 1020Complete rupture grade 3 less pain due to no tensionStrength of MusclesoEversion sprain damages invertors inversion sprain damges evertors in order to stabilize Injuries occur when loading and unloading least stable points of the joint Mechanisms of injury inversion and eversionoAPFATFL BNEUTRALCFL CDFAnterior drawer testonfield test test ATFLoLaxity of the ankle is maximal when nee is bent to 90 and ankle is PF to 10oTests at 30N of pull is more senstaive than 60NTalar tilt testat 90 degrees the calcaneus is inverted if calcaneus is evereted deltoid is tested EversionoMedial tendernessoPain and limitation on eversionoTalar tilts into eversion oLateral painfractureoStability if the medial ankle depends on deltoid ligament and lateral malleoulus oOttawa ankle rules100 sensitive for fracturesposterior press away from ligamenstRepetivie loading from running or poundingstress fractureMOIinversion and PF or contactjones fracture90 tennis avulsion fracture at tipavulsion fracture oSymptomsthTOP over 5 MTPain with weight bearingSweeling hard to walkoManagementImmobilizeIceSend for imagingCastingNon weight bearing progress as ableoREVIEW FIRST 11 PAGES LECTURE 2HEALINGLook for signsmarkers to find out what stage they are instInflammatory 1 23 days cellular injuryaltered metabolismrelease of chemical mediatorsproteinsoRedness swelling hot tenderness pain and loss of functionoPrimary damagetissue damage secondary damagewe can minimize Repair 72 hrs to 6 weeks inflammatory signs should be decreasing need to increase o2 and blood flow Initially very delicate scarRemodelling 6 weeks to years with increased stress and strain collagen changes and begins realignment Firm strong scar by end of 3 weeksoWe can push these people and can be sore during treatment but not afteroWatch out for pain and swelling after exercise Heat moist better for deep tissue dry better toleratedoIncrease blood flow until heat removedoWill peak after 5 minuetes and heat lost quickly after removaloIncrease increase increase increase decrease decrease depends on time of heat decreasePain casues spasm spasm casues ischemia ischemia casues painIce cold media
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