踝关节生物力学课件.ppt

《踝关节生物力学课件.ppt》由会员分享，可在线阅读，更多相关《踝关节生物力学课件.ppt（55页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、关于踝关节生物力学现在学习的是第1页，共55页AnkleAnatomical StructuresTibiaFibularTalus现在学习的是第2页，共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 talu

2、s lies 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)，能与距骨相契合现在学习的是第3页，共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。现在学习的是第4页，共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)aspec

3、t of the 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。现在学习的是第5页，共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_现在学习的是

4、第6页，共55页Talus 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)现在学习的是第7页，共55页-Talus现在

5、学习的是第8页，共55页Talocrural 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.现在学习的是第9页，共55页_Talocrur

6、al Jt.现在学习的是第10页，共55页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 cal

7、caneus).现在学习的是第11页，共55页calcaneusTalus-Subtalar JointMedial aspect of foot现在学习的是第12页，共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:A

8、nterior talofibular ligament Calcaneofibular ligamentCalcaneofibular ligamentPosterior talofibular ligament现在学习的是第13页，共55页TalusFibulaTibiaAnt.Talofibular LigamentAnt.Tibiofibular Lig.现在学习的是第14页，共55页Post.Tibiofibular Lig.-Fibula-Ant.Talofibular Lig-TalusPeroneal TendonsCalcaneofibular LigamentCalcane

9、us Subtalar Joint SpaceCuboid现在学习的是第15页，共55页calcaneus-Fibular headPosterior tibiofibular LigamentAchilles TendonTalusPosterior talofibular lig.Peroneal tendons现在学习的是第16页，共55页The deltoid ligamentThis is located on the medial aspect of the foot.It is the largest ligament but is actually comprised of s

10、everal sections all fused together.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.现在学习的是第17页，共55页TibiaXXXNavicular-TalusTibialis Posterior TendonTibialis Ant.TendonDe

11、ltoid LigamentX现在学习的是第18页，共55页Muscles 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.现在学习的是第19页，共55页现在学习的是第20页，共55页Anterior CompartmentAn

12、t.TibialisAnt.TibialisExt.Hallicus LongusExtensor Digitorum Extensor Digitorum LongusLongusContains Ant.Tibial Contains Ant.Tibial NerveNerveContains Anterior Tibial Contains Anterior Tibial ArteryArteryDorsiflexors of the foot(lifts foot up)-Ant.Comp现在学习的是第21页，共55页Lateral Compartment Everters of th

13、e foot(turns foot outward)Peroneus LongusPeroneus BrevisPeroneus BrevisPeroneus TertiusContains the Contains the superficial peroneal superficial peroneal nervenerve-Lat.Comp.现在学习的是第22页，共55页Posterior Superficial GroupPlantar flexors(pushes Plantar flexors(pushes foot downwards)foot downwards)Gastroc

14、nemius Gastrocnemius SoleusSuperficialPosterior 现在学习的是第23页，共55页Posterior DeepAssists with PlantarflexionTibialis PosteriorTibialis PosteriorFlexor Hallicus LongusFlexor Hallicus LongusFlexor Digitorum LongusFlexor Digitorum LongusPosterior tibial arteryPosterior tibial arteryPost.Deep-现在学习的是第24页，共55

15、页Assessing the Lower Leg and AnkleHistory Past historyPast history Mechanism of injuryMechanism of injury When does it hurt?When does it hurt?Type of,quality of,duration of pain?Sounds or feelings?Sounds or feelings?How long were you disabled?Swelling?Swelling?Previous treatments?Previous treatments

16、?现在学习的是第25页，共55页ObservationsPostural deviations?Is there difficulty with walking?Is there difficulty with walking?Deformities,asymmetries or swelling?Deformities,asymmetries or swelling?Color and texture of skin,heat,redness?Color and texture of skin,heat,redness?Patient in obvious pain?Patient in o

17、bvious pain?Is range of motion normal?Is range of motion normal?现在学习的是第26页，共55页 Percussion and compression testsPercussion 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 is a blow to t

18、he 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 either Compression test involves compression of tibia and fibula either above or below site of

19、 concernabove or below site of concernThompson testSqueeze calf muscle,while foot is extended off table to test the Squeeze calf muscle,while foot is extended off table to test the integrity of the Achilles tendonintegrity of the Achilles tendon Positive tests results in no movement in the footPosit

20、ive tests results in no movement in the footHomans 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 dorsiflexiondorsiflexionPain in calf is a positive sign and

21、 should be referred Pain in calf is a positive sign and should be referred 现在学习的是第27页，共55页Compression TestPercussion TestHomans TestThompson Test现在学习的是第28页，共55页Ankle Stability Tests Anterior drawer testAnterior drawer testUsed to determine damage to anterior talofibular Used to determine damage to a

22、nterior 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 reaches the and/or makes a clunkin

23、g sound as it reaches the end pointend point Talar 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 degrees calcaneus is inverted and

24、 excessive motion indicates injury to calcaneofibular excessive motion indicates injury to calcaneofibular ligament and possibly the anterior and posterior talofibular ligament and possibly the anterior and posterior talofibular ligamentsligamentsIf the calcaneus is everted,the deltoid ligament is t

25、estedIf the calcaneus is everted,the deltoid ligament is tested现在学习的是第29页，共55页Anterior Drawer TestTalar Tilt Test现在学习的是第30页，共55页 Kleigers testKleigers testUsed primarily to determine extent of damage to the Used primarily to determine extent of damage to the deltoid ligament and may be used to evalu

26、ate distal deltoid ligament and may be used to evaluate distal ankle syndesmosis,anterior/posterior tibiofibular ankle syndesmosis,anterior/posterior tibiofibular ligaments and the interosseus membraneligaments and the interosseus membraneWith lower leg stabilized,foot is rotated laterally to With l

27、ower leg stabilized,foot is rotated laterally to stress the deltoidstress 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 calcaneus on the talustranslation of th

28、e 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 with excessive movement,indica

29、ting injury to the lateral ligamentsindicating injury to the lateral ligaments现在学习的是第31页，共55页Kleigers TestMedial Subtalar Glide Test现在学习的是第32页，共55页 Functional Tests While weight bearing the following should be While weight bearing the following should be performedperformedWalk on toes(plantar flexio

30、n)Walk on toes(plantar flexion)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,a

31、ctive and resistive movements should be Passive,active and resistive movements should be manually applied to determine joint integrity and manually applied to determine joint integrity and muscle functionmuscle function If any of these are painful they should be avoidedIf any of these are painful th

32、ey should be avoided现在学习的是第33页，共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现在学习的是第34页，共55页Specific InjuriesAnkle Injuries:Sprains

33、 Single most common injury in athletics caused by Single most common injury in athletics caused by sudden inversion or eversion momentssudden inversion or eversion momentsInversion Sprains Most common and result in injury to the lateral Most common and result in injury to the lateral ligamentsligame

34、nts Anterior talofibular ligament is injured with inversion,Anterior talofibular ligament is injured with inversion,plantar flexion and internal rotationplantar flexion and internal rotation Occasionally the force is great enough for an avulsion Occasionally the force is great enough for an avulsion

35、 fracture to occur w/the lateral malleolusfracture to occur w/the lateral malleolus现在学习的是第35页，共55页Severity of sprains is Severity of sprains is graded(1-3)graded(1-3)With inversion sprains With inversion sprains the foot is forcefully the foot is forcefully inverted or occurs inverted or occurs when

36、 the foot comes when the foot comes into contact w/uneven into contact w/uneven surfacessurfaces现在学习的是第36页，共55页现在学习的是第37页，共55页Grade 1 Inversion Ankle SprainEtiologyOccurs with inversion plantar flexion and adductionOccurs with inversion plantar flexion and adductionCauses stretching of the anterior

37、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 ligaments and no laxitypoint tenderness over ligaments and no

38、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 supportReturn to activity in 7-10 daysReturn to activity in

39、 7-10 days现在学习的是第38页，共55页Grade 2 Inversion Ankle Sprain EtiologyEtiologyModerate inversion force causing great deal of disability Moderate inversion force causing great deal of disability with many days of lost timewith many days of lost timeSigns and SymptomsFeel or hear pop or snap;moderate pain w

40、/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 of the anterior talofibular and Possible tearing of the ant

41、erior talofibular and calcaneofibular ligamentscalcaneofibular ligaments ManagementManagementRICE for at least first 72 hours;X-ray exam to RICE for at least first 72 hours;X-ray exam to rule out fx;crutches 5-10 days,progressing to rule out fx;crutches 5-10 days,progressing to weight bearingweight

42、bearing现在学习的是第39页，共55页Management(continued)Will require protective immobilization but begin ROM Will require protective immobilization but begin ROM exercises early to aid in maintenance of motion and exercises early to aid in maintenance of motion and proprioceptionproprioceptionTaping will provide

43、 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 with injury recurrence potentially leading to joint with injury recurre

44、nce potentially leading to joint degenerationdegenerationMust continue to engage in rehab to prevent against re-Must continue to engage in rehab to prevent against re-injury injury 现在学习的是第40页，共55页Grade 3 Inversion Ankle Sprain EtiologyEtiologyRelatively uncommon but is extremely disablingRelatively

45、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 anterior/posterior talofibular and Causes damage to the anterior/pos

46、terior talofibular and calcaneofibular ligaments as well as the capsulecalcaneofibular ligaments as well as the capsuleSigns and SymptomsSevere pain,swelling,hemarthrosis,discolorationSevere pain,swelling,hemarthrosis,discolorationUnable to bear weightUnable to bear weightPositive talar tilt and ant

47、erior drawerPositive talar tilt and anterior drawer现在学习的是第41页，共55页 ManagementManagementRICE,X-ray(physician may apply dorsiflexion splint for RICE,X-ray(physician may apply dorsiflexion splint for 3-6 weeks)3-6 weeks)Crutches are provided after cast removalCrutches are provided after cast removalIso

48、metrics 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 to Surgery may be warranted to stabilize ankle due to increased laxity and instabilityincreased laxity and instability现在学习的是第42页，共55页Eversion A

49、nkle Sprains-(Represent 5-10%of all 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 Eversion force results in damage

50、 to deltoid ligament damage to deltoid ligament and possibly fx of the and possibly fx of the fibulafibula Deltoid can also be Deltoid can also be impinged and contused with impinged and contused with inversion sprainsinversion sprains现在学习的是第43页，共55页现在学习的是第44页，共55页现在学习的是第45页，共55页现在学习的是第46页，共55页Injur