Athletic Training Final

Two sesamoid bones in the foot

-located at the 1st metatarsophalangeal joint

*found in the flexor hallucis brevis tendon

-assist in reducing pressure in weight bearing

Inner Longitudinal Arch (movement)

-composed of calcaneus, talus, navicular, 1st cuneiform, and 1st metatarsal

-main supporting ligament is the plantar calcaneonavicular ligament (returns arch to normal after stretch)

Outer Longitudinal Arch (support)

-comprised of calcaneus, cuboid, 5th metatarsal

Anterior Talofibular Ligament

most frequently injured

Anterior Compartment

-Tibialis Anterior

-Extensor Hallucis Longus

-Extensor Digitorum Longus

Deep Posterior or Medial Compartment

-Tibialis Posterior (main support of inner longitudinal arch)

-Flexor Hallucis Longus

-Flexor Digitorum Longus (flexor retinaculum holds tendons behind medial malleolus)

Plantar Fascia

-white band of tissue running from the calcaneus to the heads of the metatarsals

-support plantar surface of the foot (longitudinal arch)

Contusion to leg can cause

Compartment Syndrome (anterior) - increased pressure and compromised blood flow

Complete Tear/Rupture of Achilles Tendon

-most commonly done by 30-50 year olds

-Thompson test=lay down, foot off table, squeeze calf and foot should plantar flex

Morton’s Toe

short great toe

Sesamoiditus

-inflammation at the tissue surrounding the sesamoid bones

-there are 2 in the foot at the head of 1st metatarsal in the flexor hallucis brevis tendon

March Fracture of the foot

-stress fx of 2nd, 3rd, and 4th metatarsals

Plantar Fascitis

-inflammation to the band of tissue supporting Medial Longitudinal Arch, can lead to heel spurs

Fallen Anterior Metatarsal Arch

-supporting ligaments and muscles can’t retain the arch, results in added stress to metatarsals

-may result in callus under 2nd-4th Metartarsal heads and stress (March) fx’s of 2-4 MT

Fallen Inner Longitudinal Arch

-medial tibial stress syndrome (cause from excessive pronation)

-distal 1/3 medial tibia

-Plantar calcaneonavicular ligament is main supporting ligament

Rupture of Tibial Posterior will cause hyper-pronation

Inversion Ankle Sprain

-80-85% of all ankle sprains are inversion

-1st ligament=Anterior Talofibular which limits anterior translation of talus on tibia

Anterior Drawer Test

-ankle in slight plantar flexion (isolates ant talofib lig)

-one hand stabilizes lower tibia, other holds posterior calcaneus and exerts anterior force

-excessive forward movement indicates ATF damage

Talar Tilt/Inversion Stress Test

-attempt to tilt talus into inversion

-plantar flex and invert (ATF)- testing for laxity and pain

Semitendinosus (medial)

Hamstring muscle that inserts as Pes Anserine

Pes Anserine Muscle Group (flex knee)

-Sartorius

-Gracilis

-Semitendinosus

Knee Ligament Stress/Stability Tests

-Valgus test= MCL and tibial collateral

-Varus test= LCL and fibular collateral

-test @ 0 degrees (ACL/PCL/MCL/LCL) and 20-30 degrees flexion (MCL/LCL)

Knee Anterior Drawer Test (90 degrees flexion, ACL)

-neutral foot, ACL only

-external rotation, ACL and MCL, Medial capsule

-internal rotation, ACL and LCL, Lateral capsule

Injury to MCL

-caused by valgus force, usually foot planted and hit from outside

-O’Donaghue’s Triad (medial collateral, anterior cruciate, medial meniscus)

Injury to LCL

-caused by varus stress (less common)

-possible bicep femoris and IT band damage

Knee Strain

-usually in belly of muscle, could be at myotendinous junction or at origin/insertion

-from explosive force (contraction/shortening)

-from tension/stretching (lengthening)

Knee Contusion

-can cause Myositis Ossificans

-treat as contusion first using ice, cryotherapy, thermatherapy, and padding

Patella Femoral Pain Syndrome (PFPS)

-patella doesn’t stay in groove between the femoral condyles, it tends to ride over the lateral condyle of the femur

-due to tight lateral retinaculum or weak vastus medialis

Patella Femoral Grind Test

-apply pressure to patella while quads flex and look for pain
-A large Q angle= increased Patella femoral pain syndrome (ASIS then center patella to tibia tubercle)

-vastus medialis is the 1st to atrophy

Iliotibial Band Impingement/ Friction Syndrome (ITBIS/ ITBFS)

-during flexion and extension the IT band may irritate a highly vascularized fat pad, location is 2-3cm above lateral joint line

Ober’s Test

-examiner lifts top leg and then allows it to lower, if it doesn’t then there is tightness

-checks for Hip/ IT band tightness (length)

Osgood Schlatter’s Disease

-traction injury of the growing tibial tuberosity (patella tendon insertion)

-pain, swelling and point tenderness to tibial tuberosity

Larsen Johansson Syndrome

-overuse injury to distal patella (patella tendon origin)

-caused by kneeling, jumping, running, direct trauma

-usually occurs in girls 8-13 and boys 10-15

Actions of Hip

flex, extend, IR, ER, adduction, abduction

Iliopsoas Group

Action: flex hip causing True Groin Strain

Adductor Group

Action: adducts thigh causing Common Groin Strain

Test for Groin Strains

1) place band just above knee and have athlete lift up against resistance (iliopsoas-hip flex)

2) have athlete lie down, knees flexed at 90, then extend against resistance (rectus femoris-flex hip, extend knee)

3) athlete side lying, abduct thigh and hold, have athlete adduct lower leg against resistance (adductors-adduction)

Hip Dislocations

-femur dislocates Posteriorly from flexion, adduction, and IR (don’t reduce)

Legg (Calve) Perthe’s Disease

-condition where the femoral head degenerates

-caused by a vascular disturbance that diminishes blood flow to the head of the femur

Hip Pointer

-inflammation of the crest of the ilium resulting from trauma

-caused by direct compression to iliac crest (contusion)

Flexion of the Spine

disc pathology

Extension of the Spine

facet joint pathology

Spondylitis

inflammation

Spondylosis

degeneration

Spondylolysis

-stress fracture in the pars interarticularis

-hyperextension (begins with facet jt pathology)

Spondylolisthesis

-bilateral separation in pars that heads to anterior displacement

Lateral Compartment

-Peroneus Longus

-Peroneus Brevis

-Peroneus Tertius (superior and inferior peroneal retinaculum: at ankle, hold peroneal tendons behind lateral malleolus

Superficial Posterior Compartment

-Gastrocnemius

-Soleus

-Plantaris