460-4 - LOWER EXTREMITY ORTHOPEDIC INJURIES...

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LOWER EXTREMITY ORTHOPEDIC INJURIES MMMMMMMMMMMMMMMMMDCCCXXXII. ACHILLES TENDON RUPTURE – The achilles tendon complex is prone to injury under conditions in which there is a sudden and powerful eccentric contraction of the gastroc/soleus. This mechanism is best demonstrated in jumping and landing activities in which the knee is extending and the ankle being forced into dorsiflexion. The tendon usually ruptures at a point just proximal to the calcaneus. Vascular impairment, non-specific degeneration leading to tissue necrosis, and use of injectable corticosteroids may also weaken this area and predispose it to injury. A. SIGNS/SYMPTOMS : The athlete will report an audible snap and the sensation of being kicked in the leg. Immediate plantarflexion weakness with pain, swelling, and palpable defect are usually present. The diagnosis is confirmed with a positive Thompson test. Position the athlete prone with the knee bent and foot relaxed. A firm squeeze to the calf should produce calcaneal plantarflexion. A positive test is indicated if there is no movement of the foot. B. TREATMENT : Acute care consists of ice application and the foot immobilized in slight plantarflexion. A non-weight bearing crutch gait should be used until a definitive diagnosis regarding the severity of the injury is determined. The table included provides a treatment rationale for lesions of the tricep surae mechanism. Post-surgical or closed, non-surgical care of complete ruptures usually calls for 4- 8 weeks of cast immobilization. Protected arc, active plantarflexion range of motion activities may start as early as 4 weeks post injury. This allows collagen fibers to lay down along the line of stress. A one inch heel lift is used when weight bearing is allowed and is gradually decreased as dorsiflexion range of motion improves. MMMMMMMMMMMMMMMMMDCCCXXXIII. TENNIS LEG – Previously thought to be a tear of the plantaris muscle, “tennis leg” has now been proven through surgical exploration to be a musculotendinous lesion of the medial gastrocnemius head. PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP. ETIOLOGY/MECHANISM : The usual mechanism of injury is sudden extension of the knee with the foot in a dorsiflexed position. This places a tremendous tensile stress on the two-joint expansion of the gastroc. Middle-aged athletes or those with previous degenerative changes in this area may be predisposed to this type of trauma. QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ
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SIGNS/SYMPTOMS : The athlete will feel a sudden, sharp twinge in the upper medial
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460-4 - LOWER EXTREMITY ORTHOPEDIC INJURIES...

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