Leg Injuries

In the injuries of athletes the leg is the fourth most involved
1. It involves the calf musculature and achilles tendon
  1. Two acute injuries involve the same unit musculotendinous
  2. A tension of the gastrocnemius has few medical consequences
  3. Achilles tendon rupture is painless but involves 6 months of rehabilitation
Gastrocnemius Strain (Tennis Leg)
1. is a tension that involves the musculotendinous union
  1. medial head of the gastrocnemius and achilles tendon
  2. higher frequency in athletes over 30 years and women
    1. Not only in tennis is this problem but in a variety of activities
      1. includes walks, basketball and various forms of dance
      2. if it is not recognized or handled inappropriately it can cause disability months
        is mistakenly diagnosed as plantar rupture
2. History
  1. Mechanism Of Injury
    1. is generated by a powerful propulsion movement ankle plantar flexion
      1. associated with muscle fatigue
        the injury follows a bout of achilles tendinitis or an ankle injury or sprain
        the injury occurs in two parts
        a minor strain that is ignored, followed minutes later by complete rupture
  2. Symptoms
    1. The athlete feels or hears a pop in the medial appear of the calf
    2. feels like he has hit his calf with a tennis ball or racket
    3. a spasm of the calf musculature occurs rapidly
    4. swelling and ecchymosis not apparent the first hours of the injury
      1. ecchymosis may appear distally around the ankle and even on the foot
    5. 24 to 48 hours to induce the patient to seek medical attention
3. Physical Examination
  1. tenderness towards the medial side of the muscle-tendon calf junction
    1. Swelling and ecchymosis are present distal to the site of injury
      1. Motion is limited, and the foot is held in plantar flexion
        it possible to palpate a defect in the muscle , but the defect fills rapidly with blood
4. Radiographic Examination
  1. radiographic study is not required
5. Treatment
  1. Inicial Treatment
    1. The ankle should be placed at a neutral angle and should be maintained with a splint
      1. stay with repeated ice and focal compression
        the efforts to recover the movement of the ankle
    2. force the athlete to walk although gentle and active stretching is important
      1. Oral administration of anti-inflammatory medications should be started inmediately
  2. Definitive
    1. the objectives is the recovery of normal strength and flexibility of the musculature
      1. Three to five daily physiotherapy sessions to improve movement return
        high intensity galvanic stimulation ice, active and passive stretching
        Crutches without weight support and compression first 24 hours to calm bleeding
    2. strengthening with theraband 3 sets of 10 repetitions
      1. use a compression bandage
    3. It is employed after removal of the cast
6. Other Diagnostic Test
  1. It is nor necessary
Achilles Tendon Strain (Rupture)
1. Usually occurs in an abrupt, dramatic fashion
  1. orthopedic surgeon, and analyze the treatment of injury
2. Hystory
  1. Mechanism of Injury
    1. Push-off with the forefoot (Forceful plantar flexion of the ankle )
      1. Basketball, racquetball, softball, and tennis are sports most often associated with the injury
      2. The injury often occurs at a time of relative fatigue
        usually occur in athletes older than 30 years
        Is less common in women
  2. Symptoms
    1. sensation of being struck in the region of the tendon
    2. This usually accompanied by an audible pop or snap
3. Physical Examination
  1. lack of reflex plantar flexion when the calf is sharply squeezed
    1. A positive Thompson test
  2. Substantial loss of strength in plantar flexion
  3. Careful palpation usually reveals gap or loss of continuity in the tendon
  4. Bleending and swelling may be substantial in 24 to 48 hours
  5. Gait is antalgic and apropulsive
4. Radiographic Examination
  1. is not indicated
5. Other Diagnostic Test
  1. Magnetic resonance imaging may be useful to demonstrate the extent and exact location
6. Treatment
  1. Definitive
    1. Treatment should be left to the treating orthopedist
    2. the patient will be immobilized in a cast or orthopedic device for 2 to 3 months
  2. Initial
    1. should be placed in a compression wrap
    2. the ankle should be in a position of gravity- assisted plantar flexion
    3. a posterior plaster splint compression dressing helps maintain the plantarflexed
Acute Compartment Syndromes
1. condition in which inside a osteofascial compartment they are compromised by the pressure
  1. 4 compartements in the leg, the anterior is by far the most commonly involved
2. History
  1. Mechanism of Injury
    1. Any macrotrauma or microtrauma including
      1. fractures
      2. Tendon ruptures
      3. Muscle strains
      4. Contusions
      5. associated with bleeding or edema formation within
  2. Symptoms
    1. Severe pain
    2. Paresthesias
3. Physical Examination
  1. Swelling and tendernessover the compartment are early signs
  2. Paresis, pallor and pulselessness are late and ominous signs
4. Diagnostic Tests
  1. direct measurement of intracompartmental pressure
5. Treatment
  1. Initial
    1. mainly of rest and the application of ice
      1. Compression is contraindicated
        Elevation is also probably contraindicated
  2. Definitive
    1. Multiple compartment syndrome may be treated by proximal fibulectomy
Achilles Tendinitis
1. Inflammation of the Achilles tendon and even predispose to later rupture
  1. this condition is twofold
    1. The injury often seen only when it has become chronic
    2. The rehabilitation is a time-consuming and frustrating process
    3. The pathoanatomy includes of chronically inflamed partial rupture
      1. Stenosis and calcification within the tendon
2. History
  1. Mechanism of Injury
    1. Result of too much of an unaccustomed activity
      1. Hill running and changing of heel height
    2. Result of direct trauma such a pressure from the top of the heel counter of a shoe
    3. High-arched foot, a flat or pronated foot or a tight achilles tendon
  2. Symptoms
    1. Pain and stiffness are the usual initial complaints
    2. The athlete notices the presence of crepitation often of the squeaking or snowball type
3. Physical Examination
  1. Palpation or squeezing the tendon produces tenderness
  2. passively dorsiflexing the ankle with the knee extended often produces pain
  3. A diffusely, grossly enlarged, dense, tender tendon usually indicated the presence of peritendinous fibrosis and scarring
4. Radiographic Examination
  1. In chonic cases a lateral view of the leg
    1. May reveral the presence of calcification or ossification within the tendon
5. Other Diagnostic Tests
  1. A radionuclide bone scan reveals whether the process is still active
    1. MRI, and to a lesser degree sonography
6. Treatment
  1. Initial
    1. Total cessation of weight load
      1. heel elevation, non-steroidal anti-inflammatory drugs and repeated application of ice
        sleep at right angles
        high intensity galvanic stimulation, ultrasonography, cryotherapy and even cyriax massage
  2. Definitive
    1. Stretching exercises should be done repeatedly throughout the day and strengthening
      1. painless range of motion
Chronic Anterior Leg Pain (Shin Splints)
1. pain between knee and ankle
  1. not involving the calf/ achilles tendon
2. History
  1. Mechanism of Injury
    1. Result of unaccustomed activity or overuse
      1. Biomechanical abnormalities, such as hyperpronation of the foot
  2. Symptoms
    1. The primary symptom for all these conditions is pain
      1. Pain in the distal lateral aspect of the leg often indicates a fibular stress fracture
        Pain in the entire anterior lateral area of the leg may indicate presence of a chronic compartment syndrome
        Pain over the anterior surface of the tibia in the midleg indicated a tibial stress fracture
      2. Diffuse swelling, often described as a tense sensation
        Paresthesia or hypesthesia
3. Physical Examination
  1. tenderness over either the tibia or the fibula
    1. Muscle testing is helpful in some conditions
      1. Careful palpation of the anterior compartment may reveal incresed tightness
        The presence of a high-arched foot, or signficant pronation
4. Radiographic Examination
  1. Anteroposterior and lateral radiographs of the lef often reveal stress fractures
5. Other diagnostics tests
  1. Radionuclide bone scanning
6. Treatment
  1. Initial
    1. interruption of activities that produce pain
      1. wandering without crutches
        use modalities such as icing, ultrasonography and high intensity galvanic
  2. Definitive
    1. Stretching and strengthening exercises
      1. Arch Supports
        Band or counterforce bracing

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Leg Injuries

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