Anterior shin splintscareful with terminology etiology inflammation of ant' tib' muscle due to muscl - PowerPoint PPT Presentation

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Anterior shin splintscareful with terminology etiology inflammation of ant' tib' muscle due to muscl

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Sx pain along lateral border of the tibia associated with muscle stretch or contraction. ... some swelling, gradual onset, percussion, tuning fork or squeeze tests ... – PowerPoint PPT presentation

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Title: Anterior shin splintscareful with terminology etiology inflammation of ant' tib' muscle due to muscl


1
Shin Splints
Anterior shin splints-careful with terminology
etiology inflammation of ant. tib. muscle due to
muscle imbalance, overuse, altered activity, hill
work, or a varus foot. Sx pain along lateral
border of the tibia associated with muscle
stretch or contraction. Rx ice, stretch gastroc,
strengthen ant. tib., rest, alter training.
2
Posterior shin splints Etiology pain and swelling
in the post. tib.,flex. digitorum longus and
flexor hallucis longus due to overuse, pronation,
poor shock absorption. Sx pain at post. tib.
insertion (deep) and pain when structures are
stretched in inversion. Rx rest, ice, arch
supports/orthotics, strengthening these mm and
modify training.
3
Medial tibial stress syndrome
Etiology - pain and swelling at the origination
of the post. tib., flex. digitorum longus and
flex. hallucis longus. Mm are not painful or
sore, but the musculotendinous attachment to the
bone and periosteum are. Excessive mileage seems
to be the main culprit. Symptoms - pain on
distal 1/3 of tibia relived with non weight
bearing (NWB) and not related to muscle stresses.
There is increased bone uptake and involvement of
post. tibial cortex. Palpation is tender but not
localized.
4
Treatment - rest, ice, alter activity, gradual
return. Newest research shows tape and external
supports are unhelpful. If the patient pronates
the feet (turns in), orthotics with medial wedges
to straighten up the feet may be helpful.
However, care should be taken not to over correct
with the orthotics or to try to correct large
deviations all at one time. Be gradual, 1/16" to
1/8" at a time.
5
Compartment Syndromes - Anterior
Etiology is usually a trauma incident to any
compartment of the lower leg, usually the
anterior compartment. This leads to uncontrolled
swelling and hematoma in a closed area. Increases
in pressure collapse the vascular structures
which leads to hypoxia and throbbing
pain. Symptoms include a history of trauma,
throbbing/aching pain, red and distended skin,
tissue temp. elevation, "foot drop" due to
compression of neurological structures, tension
filled and hard, and a passive stretch will
induce pain. One of the most significant symptom
will be pain with passive motion.
6
Treatment consists of ice, elevation, rest, and
immediate referral to physician. In severe cases
the tendon sheathe is opened and pressure
released to avoid permanent damage.
7
Exertional Compartment Syndrome Etiology is
exercise induced and much more common in
athletics. The as circulation increases and
muscle volume expands which may limit venous
return leading to increased intra muscular
pressure and pain. Symptoms bilateral
involvement, muscle weakness, "foot drop",
paresthesias, onset at a consistent time during
the exercise regime, usually in ant. or lat.
compartments. Patients usually have pain relief
after exercise is stopped. Treatment can be
done with a fasciotomy. More conservative means
include rest, alter activities, ice.
8
Stress Fractures
Stress fractures are fractures which develop as
the result of abnormal or unusual repetitive
stress which is applied to the bone. The chain of
events is normally related to a change in shoes,
running surfaces, distance, or exercise regimen.
Surgery on another limb may also cause the
patient to place more stress on the non affected
limb and thus apply more pressure than normal.
Bone which is subjected to repetitive stress
remodels according to Wolff's law. ( bone
responds to physical stresses or to the lack of
them. Bone is deposited on areas subjected to
stress and reabsorbed from areas of little
stress. )
9
Trabeculae are resorbed by osteoclastic activity
and new cells are laid down by the osteoclasts
along the lines of stress. Approximately 10 days
after the process is initiated, the bone becomes
vulnerable to micro fracture because the
resorptive phase has weakened the bone and the
repair phase has not yet deposited sufficient new
bone.
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14
Etiology fx. may be more common in people with
high arches (tibial) or people who pronate
(fibular) when they run. Usually there is a
change in workout, surfaces or foot gear which
precipitates the increased stress. Symptoms pain
and point tenderness, some swelling, gradual
onset, percussion, tuning fork or squeeze tests
are positive, thickening or callus may be
palpable. Not associated with muscle tests,
resistance, or stretch.
15
Diagnosis early is very important, however, it
may be difficult to differentiate between "shin
splints" and stress fractures of the lower leg,
and many foot related stress frx's do no present
until the athlete or patient has become tired of
the pain which may have been present for 2-3
weeks. The physician may make use of regular
x-rays, or bone scans to aid in the diagnosis. (
bone scans use a radionuclide using 99m
technetium phosphates. These are 100 sensitive
to bony abnormality. ) MRI scans utilizing the T1
or T2 images may also be sensitive to bone stress
problems.
16
  • Stress Fractures
  • Mechanism of Injury
  • 1. prolonged, continuous stress on particular
    weight bearing bone
  • 2. history of particular trauma is lacking
  • 3. insidious onset of pain
  • B. Possible Responsible Factors
  • 1. Morton's foot-long 2nd metatarsal with short
    1st
  • 2. Hallux Valgus-weight transfer to 2nd
    metatarsal
  • 3. shoes - poor padding and overall support

17
Specific Structures Involved 1. 2nd metatarsal
- most common 2. 3rd 4th metatarsals - less
frequent 3. 1st 5th metatarsals rarely
affected D. Treatment 1. ice, elevation,
compression (flexible cast with post-op shoe) 2.
short leg walking boot (rarely is open reduction
necessary) X-rays taken shortly after onset of
symptoms may be negative. Re-x-ray in 2 - 3 weeks
will reveal fracture. If you suspect a stress
fracture treat as such until re-x-ray in 2 - 3
weeks, or bone scan.
18
Contusion with Staph Infection
19
Contusion with Staph Infection
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