踝关节生物力学精选课件.ppt

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1、关于踝关节生物力学第一页，本课件共有55页AnkleAnatomical StructuresTibiaFibularTalus第二页，本课件共有55页Tibia胫骨This is the strongest largest bone of the lower leg.It bears weight and the bone creates the medial malleoli(the bump on the inside of your ankle)which is the medial aspect of the mortise or the(hole)that the talus li

2、es within.这是最强壮的小腿骨。它具有承重和形成了内侧支撑面(组成脚踝的凹面)，能与距骨相契合第三页，本课件共有55页The Tibia is the medial bone and largest bone of the lower leg.Tibia胫骨是小腿的最大和支撑骨的骨头。第四页，本课件共有55页Fibula腓骨This is a smaller lateral bone of the lower leg.It is not vital for weight bearing yet it comprises the lateral(outside)aspect of the

3、 malleoli and makes up the lateral aspect of the mortise.这是小腿的一根更小的外侧骨头。它不承重，它是踝关节的外侧支撑面。第五页，本课件共有55页Fibula-The fibula is longer and non weight bearing.It makes up the lateral aspect of the mortise.The lateral malleoli lies inferior(below)the medial malleoli它比较长和不承重。并组成踝关节外侧面。并低于内侧面_第六页，本课件共有55页Talu

4、s This bone transmits the forces from the calcaneus up into the tibia and also allows the articulations of Plantar Flexion(pointing the foot downward)Dorsiflexion or pulling the foot upward and Inversion(rolling the foot inward)and Eversion(rolling the foot outward)第七页，本课件共有55页-Talus第八页，本课件共有55页Talo

5、crural JointThe formation of the mortise(a hole)by the medial malleoli(Tibia)and lateral malleoli(fibula)with the talus lying in between them makes up the talocrural joint.This is a hinge joint and allows most of the motion with plantarflexion and dorsiflexion.第九页，本课件共有55页_Talocrural Jt.第十页，本课件共有55页

6、Subtalar JointThe articulation between the talus and the calcaneus is referred to as the subtalar joint.Motion allowed by this joint is inversion(roll inward)/eversion(roll outward)as well as rear foot pronation(inward tilt of the calcaneus)and supination(outward tilt of the calcaneus).第十一页，本课件共有55页

7、calcaneusTalus-Subtalar JointMedial aspect of foot第十二页，本课件共有55页Ankle LigamentsThere are three lateral ligaments predominantly responsible for the support and maintenance of bone apposition(best possible fit).These ligaments prevent inversion of the foot.These ligaments are:Anterior talofibular ligam

8、ent Calcaneofibular ligamentCalcaneofibular ligamentPosterior talofibular ligament第十三页，本课件共有55页TalusFibulaTibiaAnt.Talofibular LigamentAnt.Tibiofibular Lig.第十四页，本课件共有55页Post.Tibiofibular Lig.-Fibula-Ant.Talofibular Lig-TalusPeroneal TendonsCalcaneofibular LigamentCalcaneus Subtalar Joint SpaceCuboid

9、第十五页，本课件共有55页calcaneus-Fibular headPosterior tibiofibular LigamentAchilles TendonTalusPosterior talofibular lig.Peroneal tendons第十六页，本课件共有55页The deltoid ligamentThis is located on the medial aspect of the foot.It is the largest ligament but is actually comprised of several sections all fused togethe

10、r.This ligament prevents(eversion)of the ankle.The deltoid ligament is triangular in shape and has superficial and deep layers.It is the most difficult ligament in the foot to sprain.第十七页，本课件共有55页TibiaXXXNavicular-TalusTibialis Posterior TendonTibialis Ant.TendonDeltoid LigamentX第十八页，本课件共有55页Muscles

11、 of the lower leg/ankleThere are 4 compartments that make up the lower leg that operate the motions of the ankle.Injury can cause swelling inside these compartments that can lead to tissue death or nerve damage.第十九页，本课件共有55页第二十页，本课件共有55页Anterior CompartmentAnt.TibialisExt.Hallicus LongusExtensor Dig

12、itorum Extensor Digitorum LongusLongusContains Ant.Tibial Contains Ant.Tibial NerveNerveContains Anterior Tibial Contains Anterior Tibial ArteryArteryDorsiflexors of the foot Dorsiflexors of the foot(lifts foot up)(lifts foot up)-Ant.Comp第二十一页，本课件共有55页Lateral Compartment Everters of the foot(turns f

13、oot outward)Peroneus LongusPeroneus BrevisPeroneus BrevisPeroneus TertiusContains the superficial peroneal nerve-Lat.Comp.第二十二页，本课件共有55页Posterior Superficial GroupPlantar flexors(pushes foot downwards)Gastrocnemius Gastrocnemius SoleusSuperficialPosterior 第二十三页，本课件共有55页Posterior DeepAssists with Pla

14、ntarflexionTibialis PosteriorTibialis PosteriorFlexor Hallicus LongusFlexor Digitorum LongusPosterior tibial arteryPost.Deep-第二十四页，本课件共有55页Assessing the Lower Leg and AnkleHistoryPast history Mechanism of injuryMechanism of injuryWhen does it hurt?Type of,quality of,duration of pain?Type of,quality

15、of,duration of pain?Sounds or feelings?Sounds or feelings?How long were you disabled?How long were you disabled?Swelling?Swelling?Previous treatments?第二十五页，本课件共有55页Observations Postural deviations?Postural deviations?Is there difficulty with walking?Deformities,asymmetries or swelling?Deformities,as

16、ymmetries or swelling?Color and texture of skin,heat,redness?Patient in obvious pain?Is range of motion normal?第二十六页，本课件共有55页Percussion and compression testsUsed when fracture is suspectedUsed when fracture is suspectedPercussion test is a blow to the tibia,fibula or heel to create Percussion test i

17、s a blow to the tibia,fibula or heel to create vibratory force that resonates w/in fracture causing painvibratory force that resonates w/in fracture causing painCompression test involves compression of tibia and fibula Compression test involves compression of tibia and fibula either above or below s

18、ite of concerneither above or below site of concern Thompson testThompson testSqueeze calf muscle,while foot is extended off table to test Squeeze calf muscle,while foot is extended off table to test the integrity of the Achilles tendonthe integrity of the Achilles tendon Positive tests results in n

19、o movement in the footPositive tests results in no movement in the footHomans testHomans testTest for deep vein thrombophlebitisTest for deep vein thrombophlebitisWith knee extended and foot off table,ankle is moved into With knee extended and foot off table,ankle is moved into dorsiflexiondorsiflex

20、ionPain in calf is a positive sign and should be referred Pain in calf is a positive sign and should be referred 第二十七页，本课件共有55页Compression TestPercussion TestHomans TestThompson Test第二十八页，本课件共有55页Ankle Stability TestsAnterior drawer testAnterior drawer testUsed to determine damage to anterior talofi

21、bular Used to determine damage to anterior talofibular ligament primarily and other lateral ligament ligament primarily and other lateral ligament secondarilysecondarilyA positive test occurs when foot slides forward A positive test occurs when foot slides forward and/or makes a clunking sound as it

22、 reaches the end and/or makes a clunking sound as it reaches the end pointpointTalar tilt testTalar tilt testPerformed to determine extent of inversion or Performed to determine extent of inversion or eversion injurieseversion injuriesWith foot at 90 degrees calcaneus is inverted and With foot at 90

23、 degrees calcaneus is inverted and excessive motion indicates injury to calcaneofibular excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior ligament and possibly the anterior and posterior talofibular ligamentstalofibular ligamentsIf the calcaneus is

24、 everted,the deltoid ligament is If the calcaneus is everted,the deltoid ligament is testedtested第二十九页，本课件共有55页Anterior Drawer TestTalar Tilt Test第三十页，本课件共有55页 Kleigers testKleigers testUsed primarily to determine extent of damage to Used primarily to determine extent of damage to the deltoid ligame

25、nt and may be used to evaluate the deltoid ligament and may be used to evaluate distal ankle syndesmosis,anterior/posterior distal ankle syndesmosis,anterior/posterior tibiofibular ligaments and the interosseus tibiofibular ligaments and the interosseus membranemembraneWith lower leg stabilized,foot

26、 is rotated With lower leg stabilized,foot is rotated laterally to stress the deltoidlaterally to stress the deltoid Medial Subtalar Glide TestMedial Subtalar Glide TestPerformed to determine presence of excessive medial Performed to determine presence of excessive medial translation of the calcaneu

27、s on the talustranslation of the calcaneus on the talusTalus is stabilized in subtalar neutral,while other Talus is stabilized in subtalar neutral,while other hand glides the calcaneus,mediallyhand glides the calcaneus,mediallyA positive test presents with excessive movement,A positive test presents

28、 with excessive movement,indicating injury to the lateral ligamentsindicating injury to the lateral ligaments第三十一页，本课件共有55页Kleigers TestMedial Subtalar Glide Test第三十二页，本课件共有55页 Functional TestsWhile weight bearing the following should be performedWalk on toes(plantar flexion)Walk on toes(plantar fle

29、xion)Walk on heels(dorsiflexion)Walk on heels(dorsiflexion)Walk on lateral borders of feet(inversion)Walk on lateral borders of feet(inversion)Walk on medial borders of feet(eversion)Walk on medial borders of feet(eversion)Hops on injured ankleHops on injured anklePassive,active and resistive moveme

30、nts should Passive,active and resistive movements should be manually applied to determine joint integrity be manually applied to determine joint integrity and muscle functionand muscle function If any of these are painful they should be If any of these are painful they should be avoidedavoided第三十三页，

31、本课件共有55页Prevention of Injury to the AnkleStretching of the Achilles tendonStrengthening of the surrounding musclesProprioceptive training:balance exercises and agilityWearing proper footwear and or tape when appropriate第三十四页，本课件共有55页Specific InjuriesAnkle Injuries:SprainsSingle most common injury in

32、 athletics caused by sudden inversion or eversion momentsInversion Sprains Most common and result in injury to the lateral Most common and result in injury to the lateral ligamentsligamentsAnterior talofibular ligament is injured with Anterior talofibular ligament is injured with inversion,plantar f

33、lexion and internal rotationinversion,plantar flexion and internal rotationOccasionally the force is great enough for an avulsion fracture to occur w/the lateral malleolus第三十五页，本课件共有55页Severity of sprains is graded(1-3)With inversion sprains With inversion sprains the foot is forcefully the foot is

34、forcefully inverted or occurs inverted or occurs when the foot comes when the foot comes into contact w/uneven into contact w/uneven surfacessurfaces第三十六页，本课件共有55页第三十七页，本课件共有55页Grade 1 Inversion Ankle Sprain EtiologyEtiologyOccurs with inversion plantar flexion and adductionOccurs with inversion pla

35、ntar flexion and adductionCauses stretching of the anterior talofibular ligamentCauses stretching of the anterior talofibular ligamentSigns and SymptomsMild pain and disability;weight bearing is minimally impaired;Mild pain and disability;weight bearing is minimally impaired;point tenderness over li

36、gaments and no laxitypoint tenderness over ligaments and no laxityManagementRICE for 1-2 days;limited weight bearing initially and then RICE for 1-2 days;limited weight bearing initially and then aggressive rehabaggressive rehabTape may provide some additional supportTape may provide some additional

37、 supportReturn to activity in 7-10 daysReturn to activity in 7-10 days第三十八页，本课件共有55页Grade 2 Inversion Ankle SprainEtiologyEtiologyModerate inversion force causing great deal of Moderate inversion force causing great deal of disability with many days of lost timedisability with many days of lost time

38、Signs and SymptomsFeel or hear pop or snap;moderate pain w/Feel or hear pop or snap;moderate pain w/difficulty bearing weight;tenderness and edemadifficulty bearing weight;tenderness and edemaPositive talar tilt and anterior drawer testsPositive talar tilt and anterior drawer testsPossible tearing o

39、f the anterior talofibular and Possible tearing of the anterior talofibular and calcaneofibular ligamentscalcaneofibular ligamentsManagementRICE for at least first 72 hours;X-ray exam to rule RICE for at least first 72 hours;X-ray exam to rule out fx;crutches 5-10 days,progressing to weight out fx;c

40、rutches 5-10 days,progressing to weight bearingbearing第三十九页，本课件共有55页 Management(continued)Management(continued)Will require protective immobilization but begin Will require protective immobilization but begin ROM exercises early to aid in maintenance of ROM exercises early to aid in maintenance of m

41、otion and proprioceptionmotion and proprioceptionTaping will provide support during early stages of Taping will provide support during early stages of walking and runningwalking and runningLong term disability will include chronic instability Long term disability will include chronic instability wit

42、h injury recurrence potentially leading to joint with injury recurrence potentially leading to joint degenerationdegenerationMust continue to engage in rehab to prevent Must continue to engage in rehab to prevent against re-injury against re-injury 第四十页，本课件共有55页Grade 3 Inversion Ankle Sprain Etiolog

43、yEtiologyRelatively uncommon but is extremely disablingRelatively uncommon but is extremely disablingCaused by significant force(inversion)resulting in Caused by significant force(inversion)resulting in spontaneous subluxation and reductionspontaneous subluxation and reductionCauses damage to the an

44、terior/posterior Causes damage to the anterior/posterior talofibular and calcaneofibular ligaments as well talofibular and calcaneofibular ligaments as well as the capsuleas the capsuleSigns and SymptomsSevere pain,swelling,hemarthrosis,discolorationSevere pain,swelling,hemarthrosis,discolorationUna

45、ble to bear weightUnable to bear weightPositive talar tilt and anterior drawerPositive talar tilt and anterior drawer第四十一页，本课件共有55页 ManagementManagementRICE,X-ray(physician may apply dorsiflexion RICE,X-ray(physician may apply dorsiflexion splint for 3-6 weeks)splint for 3-6 weeks)Crutches are provi

46、ded after cast removalCrutches are provided after cast removalIsometrics in cast;ROM,PRE and balance Isometrics in cast;ROM,PRE and balance exercise once outexercise once outSurgery may be warranted to stabilize ankle due Surgery may be warranted to stabilize ankle due to increased laxity and instab

47、ilityto increased laxity and instability第四十二页，本课件共有55页Eversion Ankle Sprains-(Represent 5-10%of all ankle sprains)Etiology Etiology Bony protection and Bony protection and ligament strength ligament strength decreases likelihood of decreases likelihood of injuryinjury Eversion force results in Evers

48、ion force results in damage to deltoid damage to deltoid ligament and possibly fx ligament and possibly fx of the fibulaof the fibula Deltoid can also be Deltoid can also be impinged and contused impinged and contused with inversion sprainswith inversion sprains第四十三页，本课件共有55页第四十四页，本课件共有55页第四十五页，本课件共

49、有55页第四十六页，本课件共有55页Injury PreventionStrength training allows the supporting musculature to stabilize where ligaments may no longer be capable of holding the original tension between bones of the joint.This will also help prevent reinjury.第四十七页，本课件共有55页Chronic Ankle Injury“the vicious cycle”Why are so

50、me people prone to ankle re-injury over and over?Most commonly due to lack of rehabilitation,but more importantly lack of neuromuscular training.This means the person has not retrained the body to recognize where the ankle and foot are during motion.This sets up the body part to be re-injured due to