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Ankle & Subtalar Joint Motion Function Explained Biomechanic of the Foot - Pronation & Supination
 
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Biomechanic Reference: http://astore.amazon.com/nichogiovi-20 Popular Running Shoes: http://astore.amazon.com/nichogiovi-20?_encoding=UTF8&node=2 Dr. Glass DPM Podiatry Resource Network [email protected] www.drglass.org This video illustration depicts the ankle joint complex which includes the tibial talar and subtalar joint in human anatomy. Dr. Glass DPM - This is an illustration that depicts the cardinal plane movements of the lower extremity. This is a biomechanical demonstration of the functional orthopedic nature of podiatry
Views: 644510 DrGlassDPM
Ankle Fractures & X Rays - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes about fractures of the ankle X - rays, ankle fracture classification,ankle fracture dislocation, it also describes ankle fracture treatment and ankle fracture surgery and ankle fracture recovery. The Mortise view is about 15° of internal rotation. The medial clear space should be 4-5 mm or less, and it should be equal to the superior clear space which is between the talus and the distal tibia on the mortise view. If the medial clear space appears widened before surgery, then there is a deltoid injury. If the medial clear space does not appear widened, then make sure that you do not have a supination- external rotation type 4 injury. You may need to do stress view x-rays before surgery in order to prove that the deltoid ligament is or is not injured. The tiblofibular clear space should be less than 6 mm on the mortise view and it is the distance between the medial border of the fibula and the tibial Incisura notch. If the tiblofibular clear space is widened and the ankle mortise is unstable, this allows the talus to shift because the syndesmosis is unstable. 1 mm of talar shift will give a 42% decrease in tibiotalar contact area. This will cause future, accelerated arthritis. The tiblofibular overlap is about 10 mm in the AP view and you measure that from the medial border of the fibula. In the mortise view, the tibiofibular overlap should be more than 1 mm. Talo-Crural Angle I don’t use this and find not much value in this measurement except on exam questions! The lateral malleolus is longer than the medial malleolus, if the fibula is short, I can rely on two other x-ray measures that can help me: 1- Shenton’s Line: The subcondylar bone of the tibia and fibula should form a continuous line around the talus, so if the fibula is short then the spike of the fibula will too proximal. - If the fibula is long then the spike of the fibula will too distal. - Always look for the broken line from the lateral part of the articular surface of the talus to the distal fibula. 2- Dime Test - Look for the sprung mortise. - Look for the spike of the fibula to proximal. - Look for the broken Shenton’s Line. - Look for the Dime Test. - Look for medial clear space widening. - Get a lateral x-ray to see if there is a posterior malleolus fracture. - See if there is any talar subluxation. - See if there is any other associated Injuries from the talus and the calcaneous. The most important thing you will see on the lateral view x-ray of the ankle is the type of fracture: is it a Pronation - External rotation or Supination - External rotation Injury. - you will see that from the direction of the fracture. or Is the fracture comminuted? So you can say this is Pronation - Abduction Injury. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29
Views: 19420 nabil ebraheim
Common Foot And Ankle Injections - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes injection techniques for painful conditions of the foot and ankle. Conditions which cause pain and inflammation are treatable with the use of diagnostic and therapeutic injection. Ankle joint The ankle joint is formed by the articulation of the tibia and talus. Injection is done to alleviate pain occurring from trauma, arthritis, gout or other inflammatory conditions. Anterolateral ankle impingement •Can occur due to the build-up of scar tissue in the ankle joint or from the presence of bony spurs. •With the ankle in a neutral position, mark the injection site just above the talus and medial to the tibialis anterior tendon. •The injection site is disinfected with betadine. •The needle is inserted into the identified site and directed posterolaterally. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the foot to distract the ankle joint is helpful. First metatarsophalangeal joint •The MTP joint is a common injection site frequently affected by gout and osteoarthritis. •The injection site is disinfected with betadine. •The needle is inserted on the dorsomedial or dorsolateral surface. •The needle is angled to 60-70 degrees to the plane of the match the slope of the joint. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the big toe is sometimes helpful in distraction of the joint. Peroneal tendonitis •Peroneal tendonitis is an irritation to the tendons that run on the outside area of the ankle, the peroneus longus and peroneus brevis. •The injection site is disinfected with betadine. •Insert the needle carefully in a proximal direction when injecting the peroneus brevis and longus tendon sheath. •Advance the needle distally to inject the peroneus brevis alone at its bony insertion. Achilles tendonitis •Achilles tendonitis is irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that occurs in athletes. •Injection of steroid should be given around the tendon, not through the tendon. •Injections directly into the tendon is not recommended due to increased risk of tendon rupture. •Platelets injection can be done through the tendon with needling and fenestration. Tarsal tunnel syndrome •The condition of pain and paresthesia caused by irritation to the posterior tibial nerve. •Feel the pulse of the posterior tibial artery, the nerve is posterior, find the area of maximum tenderness, 1-2 cm above it will be the injection site that is marked on the medial side of the foot and disinfected with betadine. •The solution is injected at an angle of 30 degrees and directed distally. •Warn the patient that the foot may become numb. •Care should be taken In walking an driving. •Usually performed after a treatment program which can include rest, stretching and the use of shoe inserts. Plantar fasciitis •The plantar fascia is a band of connective tissue deep to the fat pad on the plantar aspect of the foot. •Patients with plantar fascia complain of chronic pain symptoms that are often worse in the morning with walking. •The injection site is identified and marked on the medial side of the foot and betadine used. •Avoid injecting through the fat pad at the bottom of the foot to avoid fat atrophy. •The needle is inserted in a medial to lateral direction one finger breathe above the sole of the foot in a line that corresponds to the posterior aspect of the tibia. •The solution is injected past the midline of the width of the foot.
Views: 109661 nabil ebraheim
Hemophilic Arthropathy
 
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This is a patient who presents with chronic ankle pain. Frontal and lateral radiographs of the ankle were obtained. The red arrows on the frontal radiograph demonstrate severe narrowing of the tibiotalar joint space. There is subchondral sclerosis, osteophyte formation, and large subchondral cyst formation indicative of advanced osteoarthritis. The lateral radiograph demonstrates similar findings. However, the ankle is a joint which is not typically associated with severe secondary osteoarthritis unless there is a predisposing disease condition or event. Differential considerations would include severe secondary osteoarthritis due to trauma, septic arthritis, neurogenic arthropathy, or hemophilia. The diagnosis in this case is hemophilic arthropathy. Hemophilia occurs in male patients who get recurrent hemarthroses which eventually leads to severe secondary osteoarthritis. PF242
Views: 568 CTisus
Ankle Ligament Injury Tests & Assessment - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes the ligaments of the Ankle. An ankle sprain is usually low ankle sprain, but occasionally high ankle sprain. Other conditions associated: •Osteochondral lesion •Peroneal tendon subluxation •Lateral process fracture of the talus •Anterior process fracture of the calcaneus •High syndesmotic injury Tests for injury of these ligaments: •Anterior drawer test •Squeeze test •External rotation stress test •Talar tilt test (inversion test). If the patient can’t bear weight on the ankle, the patient should get an x-ray. Injury to the deltoid ligament occurs on the medial side of the ankle joint and usually associated with fracture. Injury to the lateral side ligament is referred to as ankle sprain. The anterior tibiofibular ligament is the west on the lateral side. Anterior drawer test: is done to test the competency of the anterior tibiofibular ligament. The test is done in 20 degrees of plantar flexion and compares it to the other side. A shift of an absolute value of 9 mm on the lateral x-ray or 5mm compared to the other side is positive. The calcaneofibular ligament is usually injured after the anterior talofibular ligament. talar tilt test: less than 5 degrees of tilt is usually normal. A high ankle sprain may require surgery. Always track the fibula proximally to avoid missing a Maisonneuve fracture. Squeeze test is used to diagnose high ankle sprain. By squeezing the tibia and fibula at the mid-calf this causes pain at the syndesmosis if high ankle sprain is present. External rotation stress test: place the ankle in a neutral position, then apply external rotation stress and get a mortise view radiograph. The positive result if the tibiofibular clear space is more than 5 mm. there is also a positive result if the medial clear space is more than 4 mm. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 93868 nabil ebraheim
Inner Ankle Pain Instructional - Huntington Beach
 
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http://www.p2sportscare.com to learn prevention methods. We specialize in sports injuries and getting athletes back to their sports fast (running injuries, shoulder tendonitis, IT Band, Runners Knee, Hip Flexor tightness). We see athletes anywhere from baseball, triathletes, golfers, basketball, cyclist, runners and so on. We provide Active Release Techniques (ART), chiropractic care, strength training and corrective exercises. The Performance Place Sports Care is located in Huntington Beach, CA. 714-502-4243 Ankle impingement by an osseous growth, spur, can be the main source of pain with many biomechanical and functional movements. Anatomically the ankle is composed of three joints: talocrural joint, subtalar joint, and inferior tibiofibular joint. The ankle joint is special in that all surfaces of the joint are covered in articular cartilage, which can be a mechanical disadvantage if injured. Cartilage as a whole does not have neural or vascular supply, therefore any injury to the cartilage will not be able to heal properly. If enough cartilage damage is done to the level of the subchondral bone, an area of vascularity, it is possible that some of the articular cartilage may be healed with fibrocartilage. Although fibrocartilage indicates healing in the ankle joint, it has decreased biomechanical benefits and can lead to impingement. Typically articular cartialge will not induce pain, due to the lack of neural input. However, if pain is felt after the ankle swelling has reduced, it is likely the pain is referred from another source such as an osseous spur. The ankle joint is surrounded by many ligaments that hold all of the boney attachments together. Functionally speaking, the ankle is a joint of mobility and is the key player in determining the functionality for all the other major joints of the body. Athletes who have difficulty moving their ankle through ranges of motion or have pain upon movement can possibly have a restricted ankle joint, but the main cause is due to poor biomechanics from a previous overuse injury and fatiguing of the soft tissue. Among the ligaments found in the ankle, the strongest ligament of the ankle joint is the deltoid ligament, found on the inside. The other three ligaments, anterior and posterior talofibular ligaments, and calcaneofibular ligaments are found laterally and the area of insult with a classic inversion ankle sprain. Once the ankle is malpositioned, the ligaments become lax and unstable in efforts of preventing dysfunctional movement. Ankle sprains are usually caused by intense, repetitive movements applying too much pressure to the muscles and joints. The ankle is found to be most stable in the closed pack position, dorsiflexion, and most injuries are attained with plantar flexion. Running, ice skating, plyometric exercise are all activities with repetitive ankle motion and can lead to injury. When observing the ankle for motion, the patient may experience pain through the ranges of motion, which is a good indicator of an impingement and there is some sort of restriction in the soft tissue or in the joint. To fully diagnose a healed ankle with dyskinesis or pain imaging should also be considered in diagnosis to rule out any osseous fracture, joint degeneration, impingement from an osseous structure, or arthritis in the joint. The best source of imaging for the ankle joint is an arthroscopy. If a sprain is concluded another source of imaging would be a musculoskeletal ultrasound to further evaluate the scar tissue in the soft tissue preventing full range of motion in addition to pain upon exertion. Possible treatments for ankle impingement: - Active Release Technique - Graston - Eccentric rehabilitative exercises - Stretching - RICE (rest, ice, compress, elevate) - Surgery based on the severity of the tear to reattach the muscle tendon - Steroid injections - Non-Steroidal Anti-Inflammatory medications ankle impingement, impingement of ankle, impingement syndrome, ankle pain, pinch in ankle, ankle sprain, sprained ankle, rolled ankle, ankle therapy, ankle treatment, ankle physiotherapy, physiotherapy, chiropractic, sports chiropractor, huntington beach chiropractor, physiotherapist, peroneal tendonitis, atfl, ligament tear, tibialis positerior, tibialis anterior
Views: 40841 Sebastian Gonzales
KT Tape: Distal Posterior Tibial Tendonitis
 
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The posterior tibial tendon serves as one of the most important supporting structures for the foot. It runs behind the ankle bone on the inside of the foot, across the instep, and connects to the bottom of the foot. It is crucial in the function of walking and running and helps to build the arch of the foot. A condition called Posterior Tibial Tendon Dysfunction (PTTD) is a breakdown or change in this tendon that causes flat feet. Irritation and overuse can cause the area behind the ankle bone to become inflamed and painful. Other symptoms of tendonitis in this tendon are pain at the instep, swelling along the tendon, general weakness in the ankle, or flattened feet. Knots can form in the tendon due to scar tissue and have the possibility of eventually rupturing. This makes it very important to relieve the stress and cause of inflammation as soon as possible. Standing, walking, or running for long periods of time, degeneration of the tendon due to age, obesity, poor nutrition, traumatic injury, and severe overuse can all contribute to problems with this tendon. Rest, massage, anti-inflammatory medication, and arch supports are non-surgical treatments used to help relieve the stress and continued degradation of the tendon. KT Tape provides much needed support and relief for the tendon. Increased blood flow to the area will help to provide nutrients and healing agents to the inflamed areas, as well as help to "cool" them down. During the healing process KT Tape will relieve the inevitable stress most individuals continue to put on their feet. Recovery times can be dramatically reduced and compensation injuries can be avoided when the pain relief is combined with support.
Views: 504231 KT Tape