BPK 241 UPDATED EXAM TEST PAPER QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔define Sprain; most common type with % and in what type of movement? also less
common type - ✔✔- Acute injury to ligament(s); Very common in ankle, undertreated
- Most common is inversion (85%)
Usually in plantarflexion
*anterior talofibular ligament*
- Less common in eversion (10%)
Usually in dorsiflexion- Deltoid ligament
Dorsiflexion sprains are rare
May destabilize mortice!
✔✔syndesmotic sprain (high ankle sprain): define, include what ligaments are involved,
3 SSx, and Tx - ✔✔injuries to the distal tibiofemoral joint; the Anterior and posterior
tibiofibular ligaments are b/w the distal tibia and fibula and extend up the leg at the
interosseous membrane
SSx
1. severe pain
2. loss of function of ankle region
3. pain when ankle is passively externally rotated or dorsiflexed
Tx: months to heal, otherwise same as other sprains
✔✔eversion sprains
3 predispositions
3 SSx
3 Tx - ✔✔predispositions:
a foot that excessively pronates, is hypermobile or has a depressed medial longitudinal
arch
but less common thanks to the thick deltiod ligament
SSx: usually unable to weightbear, severe pain, adduction and abduction cause pain
but pressing directly upward against the bottom of the foot is not painful
Tx: RICE, xray, NSAIDs
✔✔Sprain - 1st degree - ✔✔- most common; usually with running/jumping
- Partial tear of ligament(s)
- SSx; Mild tenderness, pain, swelling, *NO snap, no limp, no increased laxity*
- Tx= R.I.C.E., Reduce predisposing factors, use horseshoe pad, limit weightbearing ,
anterior and posterior mobilization of talus, ROM, isotonic and isometric strength
training exercises, later on proprioceptive training.
✔✔Sprain - 2nd degree - ✔✔- Tear of ligament(s) - incomplete (50% of sprains)
- SSx= *Snap*, Pain, tenderness, Swelling, bruising, *Limp*, Resists inversion (if
inversion sprain), *Increased laxity* (has end-point)
, - Tx= R.I.C.E for 72 hours- anterior and posterior mobilization of talus, 2 days of
absolute rest, Air cast, tape or plaster cast, NSAID, Physio, Rehab exercises
indefinitely, xray
✔✔Sprain - 3rd degree - ✔✔- Complete rupture of ligament(s)
inversion force to the ankle usually with plantar flexion and adduction; may involve tear
of ATFL, CFL, and PTFL
- SSx= As for 2nd degree but more severe, severe pain in the lateral malleolus,
weightbearing not possible
*Increased laxity no firm end point*; Positive anterior drawer test in inversion sprain;
Higher risk of fracture or dislocation
- Tx= RICE for 3 days, Stabilize (NPO); get medical attention, May need x-ray, surgery,
cast, Physio and rehab as for 2nd degree
✔✔what are the 5 Sprain Complications - ✔✔1. Recurrence (for all 3 degrees)
2. Chronic instability (1/3 of 2nd and 3rd degree sprains)
3. Fracture
Malleolus (tibia or fibula)
Fibular shaft (spiral)
Talus (cracked cartilage above it=osteochondrial)
4. Dislocation
5. Subtalar joint injury (in 2nd and 3rd degree)
✔✔ankle Fractures, assessment - ✔✔- Evidence= Hx of severe trauma, Deformity,
Bony tenderness, Crepitus (usually fibula or medial malleolus are fractured)
-Tx= Recognize likelihood, Stabilize & transport if suspicious, X-ray, Reduction (may
need surgery), Cast, Physio, rehab
✔✔Ottawa ankle rules, what they are and why we use them?
ex. when are ankle_____ needed?
when are foot ____ needed? - ✔✔to determine if x-ray is needed
-ankle x-rays needed if pain in malleolar area AND 1 of:
1. pain over distal 6cm inferior or posterior pole of medial or lateral malleolus
2. inability to weight-bear at all at time of injury
3. inability to weight- bear 4 steps at the time of exam
-foot x-rays needed if pain in midfoot area AND 1 of:
1. inability to weight bear at all at time of injury
2. inability to weight bear 4 steps at time of exam
3. tenderness along base of 5th metatarsal or navicular
✔✔ankle rehab; 6 steps - ✔✔1. activity modification/ controlled weight bearing
2. ROM
3. strengthening
4. test balance and proprioception
5. running progression
6. gradual return to sport
SOLUTIONS GUARANTEE A+
✔✔define Sprain; most common type with % and in what type of movement? also less
common type - ✔✔- Acute injury to ligament(s); Very common in ankle, undertreated
- Most common is inversion (85%)
Usually in plantarflexion
*anterior talofibular ligament*
- Less common in eversion (10%)
Usually in dorsiflexion- Deltoid ligament
Dorsiflexion sprains are rare
May destabilize mortice!
✔✔syndesmotic sprain (high ankle sprain): define, include what ligaments are involved,
3 SSx, and Tx - ✔✔injuries to the distal tibiofemoral joint; the Anterior and posterior
tibiofibular ligaments are b/w the distal tibia and fibula and extend up the leg at the
interosseous membrane
SSx
1. severe pain
2. loss of function of ankle region
3. pain when ankle is passively externally rotated or dorsiflexed
Tx: months to heal, otherwise same as other sprains
✔✔eversion sprains
3 predispositions
3 SSx
3 Tx - ✔✔predispositions:
a foot that excessively pronates, is hypermobile or has a depressed medial longitudinal
arch
but less common thanks to the thick deltiod ligament
SSx: usually unable to weightbear, severe pain, adduction and abduction cause pain
but pressing directly upward against the bottom of the foot is not painful
Tx: RICE, xray, NSAIDs
✔✔Sprain - 1st degree - ✔✔- most common; usually with running/jumping
- Partial tear of ligament(s)
- SSx; Mild tenderness, pain, swelling, *NO snap, no limp, no increased laxity*
- Tx= R.I.C.E., Reduce predisposing factors, use horseshoe pad, limit weightbearing ,
anterior and posterior mobilization of talus, ROM, isotonic and isometric strength
training exercises, later on proprioceptive training.
✔✔Sprain - 2nd degree - ✔✔- Tear of ligament(s) - incomplete (50% of sprains)
- SSx= *Snap*, Pain, tenderness, Swelling, bruising, *Limp*, Resists inversion (if
inversion sprain), *Increased laxity* (has end-point)
, - Tx= R.I.C.E for 72 hours- anterior and posterior mobilization of talus, 2 days of
absolute rest, Air cast, tape or plaster cast, NSAID, Physio, Rehab exercises
indefinitely, xray
✔✔Sprain - 3rd degree - ✔✔- Complete rupture of ligament(s)
inversion force to the ankle usually with plantar flexion and adduction; may involve tear
of ATFL, CFL, and PTFL
- SSx= As for 2nd degree but more severe, severe pain in the lateral malleolus,
weightbearing not possible
*Increased laxity no firm end point*; Positive anterior drawer test in inversion sprain;
Higher risk of fracture or dislocation
- Tx= RICE for 3 days, Stabilize (NPO); get medical attention, May need x-ray, surgery,
cast, Physio and rehab as for 2nd degree
✔✔what are the 5 Sprain Complications - ✔✔1. Recurrence (for all 3 degrees)
2. Chronic instability (1/3 of 2nd and 3rd degree sprains)
3. Fracture
Malleolus (tibia or fibula)
Fibular shaft (spiral)
Talus (cracked cartilage above it=osteochondrial)
4. Dislocation
5. Subtalar joint injury (in 2nd and 3rd degree)
✔✔ankle Fractures, assessment - ✔✔- Evidence= Hx of severe trauma, Deformity,
Bony tenderness, Crepitus (usually fibula or medial malleolus are fractured)
-Tx= Recognize likelihood, Stabilize & transport if suspicious, X-ray, Reduction (may
need surgery), Cast, Physio, rehab
✔✔Ottawa ankle rules, what they are and why we use them?
ex. when are ankle_____ needed?
when are foot ____ needed? - ✔✔to determine if x-ray is needed
-ankle x-rays needed if pain in malleolar area AND 1 of:
1. pain over distal 6cm inferior or posterior pole of medial or lateral malleolus
2. inability to weight-bear at all at time of injury
3. inability to weight- bear 4 steps at the time of exam
-foot x-rays needed if pain in midfoot area AND 1 of:
1. inability to weight bear at all at time of injury
2. inability to weight bear 4 steps at time of exam
3. tenderness along base of 5th metatarsal or navicular
✔✔ankle rehab; 6 steps - ✔✔1. activity modification/ controlled weight bearing
2. ROM
3. strengthening
4. test balance and proprioception
5. running progression
6. gradual return to sport
