Dr. Ebraheim animated educational video describing current concepts of foot and ankle injuries. I.Ankle fractures a.Supination-external rotation i.Vertical fractures of medial malleolus is bad ii.Differentiate between supination/external rotation and pronation/external rotation by lateral x-ray to see the direction of the fracture b.Isolated lateral malleolar fracture i.Nondisplaced with no talar shift can be treated conservatively. ii.Displaced fracture with talar shift will require surgery. c.Weber C fractures i.Syndesmotic injuries are common II.Ankle fractures & diabetes a.Surgery is better in diabetics III.Pilon fracture (tibial plafond) a.Axial load, high energy injury. Can occur due to a fall or from a car accident. i.medial malleolar fragment ii.Anterolateral fragment: chaput fracture iii.Posterolateral fragment: Volkman fracture (posterior inferior tibiofibular ligament is attached to this fragment) IV.Treatment of displaced fractures: a.Delay open reduction internal fixation until the skin condition improves. b.Soft tissue complications: you need to get skin wrinkles before you do internal fixation. c.Joint fusion surgery (arthrodesis) for arthritis: not commonly used or needed. V.Navicular fractures a.Stress fracture of the navicular is the important one and usually occurs in the central third. b.Treatment: Cast and non-weight bearing. Do ORIF in athletes, if there is a nonunion, or failure of conservative treatment and also in displaced fractures of the navicular. VI.5th metatarsal base fractures a.Zone I: proximal tubercle avulsion fracture. Treatment of zone I proximal tubercle fracture Is usually nonoperative (use a boot or a fracture shoe). b.Zone II (jones fracture) at the 4th and 5th metatarsal articulation which is the junction between the metaphysis and the diaphysis. c.Zone III proximal diaphysis fracture VII. Open calcaneal fractures a.Open fractures of the calcaneus may lead to amputation. There are two basic fragments: i.anteromedial (sustentacular) fragment ii.posterolateral (tuberosity) fragment VIII.Talus fractures (Hawkin’s classification) a.Type I: non-displaced. 10% AVN b.Type II: fracture with subtalar dislocation or subluxation. 50% AVN. c.Type III: fracture with subtalar and tibiotalar subluxation or dislocation. 90% AVN. d.Type IV: fracture with subtalar and tibiotalar dislocation and talonavicular subluxation. 90-100% AVN. 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: 60331 nabil ebraheim
Dr. Ebraheim’s educational animated video describes the ligaments of the ankle - injury and tests. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 5784 nabil ebraheim
Dr. Ebraheim’s educational animated video describes conditions and treatment methods associated with pain of the ankle. High ankle sprain •A high ankle sprain is a sprain of the syndesmotic ligaments that connect the tibia and fibula at the ankle. •Diagnosis of syndesmotic injury is usually done by the use of external rotation stress view examination or CT scan. This patient may require surgery. Anterolateral impingment •Painful limitation of full range of ankle motion due to soft tissue or osseous (bony) pathology. •Soft tissue thickeneing commonly seen in athletes with prior trauama that extends into the ankle jint. •Arthroscopy of the ankle may be helpful . •Tibisl bone spur impinging on the talus can become a source of chronic ankle pain and limitation of ankle motion in athletes. Osseous (bony) spur on the anterior lip of tibia contacting the talus during dorsiflexion. The patient may need debridment of the spur. Ankle sprain •Pain that is anterior and around the fibula can usually be attributed to a ligament sprain. •Sprains result from the stretching and tearing (partial or complete) of small ligaments that can become damaged when the ankle is forced into an unnatural position. •Treatment includes immobilization, ice therapy, physical therapy and rarely surgery. •With ankle sprain, the patient will be able to walk, but it will be painful. With a fracture, the patient will be unable to walk. Pain that is posterior to the fibula can usually be attributed to an injury of the peroneal tendons. Lateral ankle pain •Patients with peroneal tendon problemes usually describe pain in the outer part of the ankle or just behind the lateral malleolus. •Problems mainly occus in the area where the tendons of the two muscles glide within a fibrous tunnel . Peroneal inflammation/ tendonitis •Tendons are subject to excessive repetitive forces causing pain and swelling. •Peroneal tendon subluxation •Usually occurs secondary to an ankle sprain with retinaculum injury. •Occurs with dorsiflexion and usually eversion of the ankle. Posterior anle pain Achilles tendonitis •Irritation and inflammation due to overuse. •Pain, swelling and tears within the tendon. •Achilles tendon can become prone to injury or rupture with age, lack of use or by aggressive exercises. •The Thompson test is performed to determine the presence of an Achilles tendon rupture. A positive result for the thompson’s test is determined by no movement of the ankle while squeezing of the calf muscles. Posterior ankle impingment •Os trigonum or large posterior process of talus (stieda syndrome) •Common among athletes such as ballet dancers. •May be seen in association with flexor hallucis longus tenosynovitis. Tarsal tunnel syndrome •Compression or squeezing on the posterior tibial nerve that produces symptoms of pain and numbness on the medial area of the ankle. •When conservative treatment methods fail, surgical treatment or tarsal tunnel release surgery may be needed. Posterior tibial tendon tears are one of the leading causes of failing arches (flatfoot) in adults. •Too many toes sign •Loss of medial arch height •Pain on the medial ankle with weight bearing Arthritis of the ankle joint •Commonly the result of a prior injury or inflammation to the ankle joint. •Can usually be easily diagnosed with an examination and x-ray. Osteochondral lesion of the talus •Arthroscopic debridment may be necessary. Please go to the following link and support the artist Johnny Widmer in his art contest - Sign to Facebook and click LIKE https://www.facebook.com/marlinmag/photos/a.10153261748858040.1073741838.134227843039/10153261754338040/?type=3&theater Thank you! https://www.facebook.com/JohnnyWidmerArt?fref=ts http://www.johnnywidmer.com/
Views: 641693 nabil ebraheim
Dr. Ebraheim’s educational animated video describes the anatomy of the ankle ligaments. The ankle joint is made of three bones, the tibia, the fibula and the talus. The tibia is the major bone of the lower leg which bears the majority of the body weight. At the angle, the bump of the tibia forms the medial malleolus. The fibula is the smaller of the two bone of the leg. The lateral end of the fibula forms the lateral malleolus. In the ankle joint the talus articulates with the tibia. The talus is involved in multiple movements of the foot. There are ligaments in the ankle that provide connections between the bones. Injury to any of these ligaments may occur when the foot twists, rolls or turns beyond its normal motion. An ankle sprain is a common injury that occurs in sports as basketball and soccer. The deltoid ligament is on the medial side. It is formed of four parts: anterior tibiotalar part, tibionavicular part, tibiocalcaneal part and the posterior tibiotalar. The superficial deltoid arises from the anterior colliculus. The deep deltoid arises form the posterior colliculus and the intercollicular groove. The deltoid ligament is the main stabilizer of the ankle joint during the stance phase. The deltoid ligament is rarely injured by itself and it is usually associated with fractures. There are 3 lateral ligaments of the ankle joint: The anterior talofibular ligament (weakest): origin: 10 mm proximal to the tip of the fibula. Extends from the anterior inferior border of the fibula to the neck of the talus. The posterior talofibular ligament ( strongest): origin from the posterior border of the fibula. Inserts into posterolateral tubercle of the talus Calcaneofibular ligament: origin anterior border of the fibula 1 cm proximal to the distal tip. Inserts into the calcaneus distal to the subtalar joint and deep to the peroneal tendon sheath. The lateral ligaments are the most commonly injured ligaments in the ankle. The ligament of the syndesmosis •Anterior inferior tibiofibular ligament •Interosseous ligament •Posterior inferior tibiofibular ligament The connection of the tibia and fibula is called the syndesmosis. High ankle sprain = syndesmosis injury 5-10%. Injury of the ligaments above the ankle. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 74728 nabil ebraheim
Dr. Ebraheim’s educational animated video describing fractures of the ankle fractures - syndesmotic injury. how do we know if we have a syndesmotic injury? By getting the intra-operative stress exam, external rotation of the talus within the ankle mortise, this test determine if syndesmotic instability is present, you will do that test after fixation of the other fractures. The abduction external rotation of the talus will try to displace fibula from the incisura fibularis, the talus will move laterally and displaces the fibula. The ankle will show a valgus talar tilt or increase in the medial clear space. Before you do syndesmotic reduction and fixation, it is important to restore the length and rotation of the fibula. When instability is present, you have to do syndesmotic screw fixation. How do you know if there is instability? Always have a high index of suspicion. Syndesmotic fixation is more required when the fibular fracture is high and there is a deltoid ligament injury. Be skeptical about some of the statements such as fixation is not typically required when the fibular fracture is within 4.5 cm from the joint because that is not true. Just remember: Weber C is commonly associated with syndesmotic injury. So we get the stress views and look at certain measurements to determine if the syndesmosis is injured or not. At 1 cm above the joint we will measure the tibulofibular overlap which will be decreased if there is a syndesmotic injury. We also measure the tibiofibular clear space which will be more than 5 mm if there is a syndesmotic injury. Then we look at the medial clear space which will be increased, normally it should be less than 4 mm. Some people believe that the instability of the ankle appears more in the AP plain. The medial clear space can be increased preoperatively due to injury to the deltoid ligament. This is used to differentiate between supination – external rotation stage II and stage IV injuries. The medial clear space can be helpful intraoperatively after fixation of the fibula to diagnose syndesmotic injury on stress view radiographs. Syndesmosis fixation techniques: - You must restore the length and rotation of the fibula, which is not good enough by itself. - An Accurate reduction of the syndesmosis is required and direct inspection of the syndesmotic reduction is helpful, and this should be supported by x-rays. - Check for widening. - Check for the chenton’s line, dime sign, and that will be done after reduction and after using the reduction clamp. - This is the time to get an AP view and lateral view radiographs, and you assess before you place your screws. Try to use multiple techniques to check on the syndesmosis injury, one of them is the external rotation view the intraoperative one. The other one is the cotton test, get a hook and pull on the fibula and see the movement. The third one is direct inspection of the syndesmosis, make sure the crural fascia may be intact and covering a major syndesmotic injury. After that we go to the technique: 1- You dorsiflex the ankle. 2- Directly inspect and reduce the fibula. 3- Use reduction clamp. 4- Get x-rays to prove that the syndesmosis is reduced and then you put the screws, about 2-4 cm above the joint, with an angle of 20° to 30° posteriorly to anteriorly. Do not use lag screws and do not over compress the syndesmosis with the position of the talus in planter flexion, although a lot of people think it is not possible. Screws are really controversial ad no consensus about them. But there are a few important points about the screws: 1- The 4.5 mm are not used a lot nowadays. 2- When the widening is bad you are going to use more screws and more cortices, the more the better. 3- When you put the screws proximally and you don’t aim anteriorly you may miss the tibia. 4- Make sure when you go from cortex 1 to 2 and 3 in the tibia that you don’t miss cortex number 3 in the tibia. 5- Try to elevate the ankle a little bit so your hand will be allowed to do some anterior direction of the screws, so the screws will be angled a little bit. 6- Occasionally I cross the screws, so will be one direct straight forward and the other one will be oblique. 7- Screw removal: it’s controversial but you will not remove the screws before 3 months. What are the problems with the syndesmosis? • Missing the injury: Reading the x-ray, I use the 5 mm for reading the x-rays, whatever it is in the medial clear space or tibiofibular clear space as my mark, 5 mm is abnormal. • Malreduction of the syndesmosis: I want to make sure the fibula is anatomically reduced to the incisura before inserting the syndesmotic screws; I want to make sure and get an x-ray to check the talus both in the AP and lateral planes. Dr. Ebraheim is an orthopedic surgeon at the University of Toledo Medical Center.
Views: 28764 nabil ebraheim
Surgery to fuse (perform an arthrodesis) an ankle in a patient with posttraumatic arthritis of the left ankle joint.
Views: 33291 Gene Curry
Dr. Ebraheim’s educational animated video describes fractures of the ankle, classifications and ankle X - rays. It describes ankle fracture classification, ankle fracture dislocation. It also describes ankle fracture treatment and ankle fracture surgery and ankle fracture recovery and ankle fracture cast and brace. There is a lot of important topics in ankle fractures. Classifications of ankle fractures: • Weber classification: it classifies the ankle fracture according to the level of the fibular fracture: - Type A: the fracture is below the syndesmosis, this fracture is rarely unstable, but it could have syndesmotic injury. - Type B: its common, the fracture occurs at the level of the syndesmosis, the fracture could be unstable. - Type C: the fracture is above the syndesmosis, and is usually unstable, if you have a fracture weber c and you have a deltoid injury, you most likely need a syndesmotic screws, because the syndesmosis will be unstable. • Lauge Hansen classification: depends on the mechanism of the injury: depend on 2 things: position of the foot, and the force applied: 1- Supination- Adduction: there is a vertical fracture of the medial malleolus, movement of the talus medially, possible anteromedial tibial plafond impaction, transverse fracture of the distal fibula. How you fix it: screws parallel to the joint or anti-glide plate. With the injury having also the plafond impaction: you probably need to open the joint and elevate and restore the joint surface, and also this is the one that you may want to start medially, not laterally as we do routinely for other ankle fractures. 2- Supination- External rotation injury: the most common injury. Look at the lateral x-ray look at the fibula too, look on the AP and the lateral view radiograph. So if you find the fracture start from anterior inferior going posterior superior, that is supination external rotation injury, this is the one that can give you trouble if the fibula appear as the only bone that is fractured, you want to make sure that you are not missing type 4 fracture type. This injury has 4 stages, 4 will be on the medial side. 3- Pronation- External rotation: in this case the fracture goes from anterior superiorly to posterior inferior, and the fracture usually above the joint interval, it usually is weber C. 4- Pronation- Abduction injury: fracture of the fibula is usually transverse or comminuted; the fractured ankle may have only to the syndesmosis with nothing else appearing on x-ray. This fracture will start medially and will cause deltoid ligament injury, and then it probably moves to the syndesmosis at the following stage and ends by fibula, so it may come a little earlier so you don’t see a fibular fracture because it never happened, but you have syndesmotic injury. 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: 87950 nabil ebraheim
Dr. Ebraheim’s educational animated video describing fractures special situations, describing fractures of the ankle X – rays and ankle fracture classification, ankle fracture dislocation . It also describes ankle fracture treatment and ankle fracture surgery and ankle fracture recovery Ankle fractures and driving: Normal base line breaking time is about 9 weeks after surgery. For total hip is about 6 weeks. For long bone and periarticular fractures of the lower extremity, the breaking time is significantly reduced up to 6 weeks after initiation of weight bearing. Diabetes: in patients with diabetes, the first thing we have to check is if the patient have peripheral neuropathy, or Charcot- fracture. Diabetic patient has also high risk of infection, hardware failure, and delayed healing; the bone takes more time to heal. You have to do more percutaneous fixation, a lot of screws from the fibula to the tibia; it gives you more strength of the fixation because the screws are engaged into the tibia, so they are stronger than the small little screws in the fibula. Then delay weight bearing time and half more than the normal so usually you delay the weight bearing for about 3 months. Remember: surgery in displaced fracture in the ankle in diabetics is better than no surgery, but the complication rate is high. Ankle malunion: Usually the fibula is short and malreduced, and the syndesmosis is disrupted, usually you correct that by corrective osteotomy of the fibula to restore the fibular length, alignment, and rotation. You have to do anatomic reduction of the fibula and the Mortise, you have to do the plating of the fibula, and bone graft if needed, in addition to syndesmotic reconstruction. And you do ankle reconstruction to prevent arthritis by reducing the talus to the ankle mortise. Fibular fracture and unstable ankle mortise will allow the talar shift. 1mm shift of the talus will decrease the tibiotalar contact area by 42%. What are the fracture variants? - Maisonneuve fracture: it is a fracture of the proximal fibula with syndesmodic disruption, you can miss this fracture because you may think the patient has an ankle sprain, especially if the injury of the deltoid ligament is not apparent on the x-ray, you probably need to get long leg films to diagnose the fracture. So you need to fix the syndesmosis because in these patients the syndesmosis is disrupted, so you need to restore the fibular length and alignment before the insertion of the syndesmotic screws. Accurate reduction of the syndesmosis is needed. - Volkmann fracture: it is a fracture of the posterolateral aspect of the tibial attachment of the posterior inferior tibiofibular ligament. - Tillaux fracture: it is a salter type III fracture, it is a fracture of the tibial attachment of the anterior inferior tibiofibular ligament in the young. - Wagstaffe’s fracture: it is a fracture of the medial part of the fibula with that part being avulsed at the insertion of the anterior- inferior tibiofibular ligament. The anterior- inferior tibulofibular ligament remains intact. - Chaput’s Tubercle fracture: it is a fracture of the anterolateral part of the tibia in adults. It is similar to Tillaux fracture. Chaput’s tubercle fracture is different from Chaput’s fracture which is mid tarsal joint injury. So the ligament remains intact with: - Tillaux fracture - Wagstaffe’s fracture - Chaput’s Tubercle fracture The ligament is avulsed from the tibia in: - Tillaux fracture in the young - Chaput’s Tubercle fracture in adults The ligament is avulsed from the fibula in: - Wagstaffe’s fracture Bosworth fracture dislocation: rare fracture of the ankle, the fibula become trapped behind the tibia and become irreducible. The posterolateral ridge of the distal tibia will block reduction of the fibula. 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: 24930 nabil ebraheim
An AC Joint Sprain or Separation is often the result of falling with an outstretched arm. Movement of the joint will help increase the healing and decrease scarring. See Doctor Jo’s blog post about this at: http://www.askdoctorjo.com/ac-joint-sprain The AC (acromioclavicular) joint is where the acromion and the clavicle come together. The first stretches are called pendulums. Use a chair or counter top for balance, and lean over so your arm hangs down towards the ground. Move your body, not your arm in circles so your arm swings around like a pendulum. You can also rock front to back and side to side. Start off with 10 of each and work your way up to a minute of each. The next stretches you can use a Swiss/therapy ball, or if you don’t have one, you can use a table or counter top. This is an active assisted stretch, which means you are moving the arm now, but the ball will support the weight. You will slide your arm forward with your thumb facing upward towards the ceiling and lean your body forward until you feel a stretch. You can stabilize the ball with your other hand. Hold it for 3-5 seconds, and start off with 10-15. Next you will do isometric exercises for internal and external rotation of your shoulder. Isometrics are when you are activating the muscles, but not actually making the movement. You can use your other hand to push into, or you can do these exercises against a wall. You want to keep your elbow by your side. Bend your elbow with your fist out in front of you. Push your fist into your other hand gently towards your stomach and hold for 3-5 seconds. Then put your other hand on the outside of your fist, and push out gently for 3-5 seconds. You don’t have to push hard. You just want to feel a little pressure in your shoulder area. Do each of these 10-15 times. For the last exercise, you will do a shoulder external rotation with a resistive band. Try to keep your elbows by your sides through out the exercise. If you want to roll up a small towel and place it between your side and your elbow for each side, this will keep your arms close to your side through out the exercise. Keep your elbows at about a 90 degree angle and your thumbs up towards the ceiling. Also try to keep your wrists in a neutral position. You don’t want to over stress your wrists, and then have a wrist injury. Slowly pull both arms out away from each other keeping your elbows at your side, and then slowly come back in. Start off with 10 of these, and then work your way up to 20-25. If that becomes easy, then move up with resistive bands. Related Videos: Shoulder Pain Treatment & Rehab Stretches: https://youtu.be/DJvQ3ZGWUfQ?list=PLPS8D21t0eO_Ny9ors3aP4K1P_91a2-yw Shoulder Pain Top 3 Exercises: https://youtu.be/vbUm5rsPt5Y?list=PLPS8D21t0eO_Ny9ors3aP4K1P_91a2-yw =========================================== SUBSCRIBE for More Videos: http://www.youtube.com/subscription_center?add_user=askdoctorjo ======================================= Doctor Jo is a Doctor of Physical Therapy. http://www.AskDoctorJo.com http://www.facebook.com/AskDoctorJo http://www.pinterest.com/AskDoctorJo https://www.instagram.com/AskDoctorJo http://www.twitter.com/AskDoctorJo http://plus.google.com/+AskDoctorJo ======================================= AC Joint Sprain Stretches & Exercises: https://www.youtube.com/watch?v=hc4QDSqpw-k DISCLAIMER: This content (the video, description, links, and comments) is not medical advice or a treatment plan and is intended for general education and demonstration purposes only. This content should not be used to self-diagnose or self-treat any health, medical, or physical condition. Don’t use this content to avoid going to your own healthcare professional or to replace the advice they give you. Consult with your healthcare professional before doing anything contained in this content. You agree to indemnify and hold harmless Ask Doctor Jo, LLC and its officers for any and all losses, injuries, or damages resulting from any and all claims that arise from your use or misuse of this content. Ask Doctor Jo, LLC makes no representations about the accuracy or suitability of this content. Use of this content is at your sole risk.
Views: 82509 AskDoctorJo
Educational video describing the condition known as Maisonneuve Fracture. Maisonneuve Fracture involves fracture of the proximal fibula associated with an occult injury of the ankle. The patient could be mistakenly treated for having either: 1-Proximal fibular fracture alone: ankle injury is missed. 2-Sprain of the ankle joint : proximal fibular fracture is missed. High index of suspicion is necessary to diagnose and treat this injury. Long leg film that includes the ankle is mandatory in cases of •Patient with proximal fibular fracture to exclude the presence of ankle injury. •Unexplained increase in the medial clear space of the ankl joint to diagnose the presence of a high fibular fracture. Look for signs of syndesmotic injury: 1-Unexplained increase in medial clear space. 2-Tibiofibular clear space is widened (should be less than 5 mm). Treatment Fixation: syndesmotic screws. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 67959 nabil ebraheim
http://vivaint.biz/net/azol FO FREE! It seems you can hardly get through your day without something hurting. Finally, there's a natural solution to those annoying aches and pains with Eazol. Order your free trial today! Limited supp;y! Hurry up!
Views: 27 How to cure joints.
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: 23563 nabil ebraheim
Dr. John Dang, DC performing the edema protocol of Graston Technique for a grade 2 ankle sprain. Watch as the wave of edematous fluid is milked out of the traumatized and damaged tissue and back into the lymphatic vessels.
Views: 1516665 Columbia Integrated Health Centre
see my website: www.fibularpain.com for blog on Chronic Proximal Tibiofibular Posterior/Inferior Subluxation palpation by Dr. Scott Sheldon - Dwyer Chiropractic, Clarkston, WA describing pain symptoms, As an out of state patient, I made this video on 4/26/13 originally for Dr. D. Christopher Main, DO at Midwest Bone & Joint Center, Macon, MO a board certified Orthopedic Surgeon who then did an Arthrex TightRope Stabilization Surgery 5-14-13
Views: 8212 AHEHealth
"Each year over a million people have new ankle sprains, and these are just the people who came to seek medical help," says Dr. Glenn Shi, a Mayo Clinic orthopedic surgeon. "There are far more [sprains] that people are treating at home." The ankle is quite a well-engineered joint, actually. But, because it's a balancing act to carry the full weight of the body on three bones atop the foot, Dr. Shi says, "An injury can happen anytime an athlete gets on the field or to anyone just walking down the street. In fact, ankle sprains among high school athletes are the most common injury that they see." Still, there are ways to reduce the risk, particularly if you understand how the ankle is put together. More health and medical news on the Mayo Clinic News Network http://newsnetwork.mayoclinic.org/
Views: 410242 Mayo Clinic
Dr. Ebraheim’s educational animated video describes tibial pilon / plafond fracture, the etiology, diagnosis, imaging, and treatment options. A pilon fracture ( or tibial plafond fracture) is a fracture of the distal tibia involving the ankle joint and it typically fractures the fibula. Pilon is a French term of the injury mechanism meaning “hammer” or “pestle”. A pilon fracture is a high energy trauma with articular impaction and comminution. There will be significant associated soft tissue injury and metaphyseal bone loss with associated muscloskeletal injuries. Usually the fibula is fractured along with the pilon fracture but occasionally remains intact. Fracture usually occurs with an anterolateral fragment that subluxes or dislocates from the joint and remains attached to the fibula. The syndesmosis is injured. There will be talofibular joint incongruity due to disruption of the talofibular ligament. The fibula appears longer and moving laterally. Oblique views show the direction of the force. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step
Views: 13363 nabil ebraheim
http://www.michiganfootdoctors.com/twisted-ankle-recovery-time/ Curious to know what exactly you injured in your ankle? Well these are the types of injuries you can have and exactly what to do about them! http://www.michiganfootdoctors.com/
Views: 38124 Michigan Foot Doctors
http://drrobertlaprademd.com 1 (970) 479-5881 Dr. Robert LaPrade, an Orthopedic Surgeon at the Steadman Clinic in Vail, CO (Greater Denver) demonstrates a procedure that assesses the extent of a Tibiofibular Ligament Injury in the Clinical Knee Exam. Pain along the medial or lateral joint lines may be indicative of a joint capsule tear, joint capsule irritation, meniscus tear, among other possibilities. When applying a varus or valgus stress across the joint, one should place their fingers directly over the joint line to assess for joint line pain. It is important to discern from the patient if the pain is coming from directly below one's fingers of if it feels like it is deeper inside the joint to determine if it is a joint capsule injury, or if it is a meniscus or cartilage injury. Were you looking for Valgus Stress Test? http://youtu.be/a2YqD2MdGJc Valgus Stress Test for the MCL: http://youtu.be/xlD0tawW_uE Range of Motion after Knee Injury: http://youtu.be/FvQ9jn8NDek For additional information: http://drrobertlaprademd.com/clinical-exam http://thesteadmanclinic.com http://sprivail.org
Views: 5384 Robert LaPrade
Lateral ankle sprains can be very painful and cause your ankle to become unstable. These stretches and exercises should help the healing process. See Doctor Jo’s blog post about this at: http://www.askdoctorjo.com/lateral-sprained-ankle The first stretch will be a calf stretch. Start off with your legs out in front of you. You can bend up the leg you aren’t using towards you in a comfortable position. Keep the leg you want to stretch out in front of you. Take a stretch strap, dog leash, belt, or towel and wrap it around the ball of your foot. Relax your foot, and pull the strap towards you stretching your calf muscle. You should feel the stretch under your leg. Hold the stretch for 30 seconds, and do three of them. Now prop your ankle up on a roll or hang your foot off the bed or table so your heel doesn't touch the floor. Put the band around the ball of your foot for good resistance. First, push your foot down and up. This is called ankle plantarflexion. Next you are going to cross your foot over the foot with the band as seen in the video, and pull your foot inward. This is ankle inversion. Now you want to wrap the band around your other foot. This time you will have resistance pulling out. This is ankle eversion. The next exercise will be standing up. You want to lean against a wall or something sturdy. Place the foot you want to stretch behind you. Make sure to keep your heel down and your toes forward pointing towards the wall. With the other foot in front of you, like you are in a lunge position, bend your knee towards the wall until you feel a stretch through your back leg. Try to keep your back leg as straight as possible. Hold the stretch for 30 seconds, and do it three times. Now is a heel raise off the ground. Stand with your feet about shoulder width apart, come up on your toes as high as you can. Try not to lean forward, but bring your body straight up and slowly come back down. Push off as much as you can so your heel leaves the ground. Start off with ten and work your way up to 20-25. The last exercise will be a balance series. Stand on one foot, but hold onto something sturdy. Try to balance for 30 seconds to a minute. When that becomes easy, just use one finger one each side. Then just one finger for balance, and finally try balancing without holding on at all. Related Videos: Sprained Ankle Treatment with Ankle/Foot AROM: https://youtu.be/UYM-_k_dWZw?list=PLPS8D21t0eO9JGYS958XUh2mkV8Sa2sAq Sprained Ankle - How to Wrap an Ankle Sprain: https://youtu.be/BPbUH4rdKPo?list=PLPS8D21t0eO9JGYS958XUh2mkV8Sa2sAq =========================================== SUBSCRIBE for More Videos: http://www.youtube.com/subscription_center?add_user=askdoctorjo ======================================= Doctor Jo is a Doctor of Physical Therapy. http://www.AskDoctorJo.com http://www.facebook.com/AskDoctorJo http://www.pinterest.com/AskDoctorJo https://www.instagram.com/AskDoctorJo http://www.twitter.com/AskDoctorJo http://plus.google.com/+AskDoctorJo ======================================= Lateral Sprained Ankle Stretches & Exercises: https://www.youtube.com/watch?v=3JJayVC0-20 DISCLAIMER: This content (the video, description, links, and comments) is not medical advice or a treatment plan and is intended for general education and demonstration purposes only. This content should not be used to self-diagnose or self-treat any health, medical, or physical condition. Don’t use this content to avoid going to your own healthcare professional or to replace the advice they give you. Consult with your healthcare professional before doing anything contained in this content. You agree to indemnify and hold harmless Ask Doctor Jo, LLC and its officers for any and all losses, injuries, or damages resulting from any and all claims that arise from your use or misuse of this content. Ask Doctor Jo, LLC makes no representations about the accuracy or suitability of this content. Use of this content is at your sole risk.
Views: 126893 AskDoctorJo
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: 105124 nabil ebraheim
Dr. Ebraheim’s educational animated video describes tibial pilon fractures. High energy axial load injury. Soft tissue injury is bad. Closed or open fracture and ankle joint are usually involved. Metaphysis of the tibia is usually involved. No immediate open reduction and internal fixation because soft tissue is usually bad. Early ORIF is not recommended. Initially, the treatment is usually closed reduction and a splint followed by staged ORIF. In the operating room, start by applying external fixator. This decreases the incidence of wound complication and deep infection. When internal fixation is used, it is better to use minimally invasive fixation. Wait 1-3 weeks depending on the magnitude of the injury, the anticipated surgery and the presence of the wrinkle test. After application of the external fixator, get a CT scan to check the joint and the fragments. This will help you to select the best operative approach in the future after the soft tissue condition improves. The physician needs to be aware that the AP radiographs may look OK, however, it may be misleading. The joint usually has three fragments attached to ligaments. Because the ligaments are intact, the fragments can be pulled by the external fixator, which is called ligamentotaxis. The three fragments are: 1-Medial malleolus: attached to the deltoid ligament. 2-Anterolateral fragment: Chaput fragment (attached to the anterior inferior tibiofibular ligament). in children, this fragment is called Tillaux fracture. If the fracture involves avulsion of the fibula, it is called Wagstaffe fracture as rarely seen in some ankle fractures. 3-Volkmann fragment: posterolateral fragment attached to the posterior inferior tibiofibular ligament. In this CT scan, you can see the three fragments of the pilon fracture as well as the joint impaction. When the fibula is intact, the lateral collateral ligament of the ankle may rupture (fibula is intact in 20% of the cases). The break travel time in driving return to normal 6 weeks after initiation of weight bearing. In ankle fractures, it returns to normal 9 weeks after fixations (post-operatively). The goal of surgery is anatomic reduction and stabilization of the articular surface. May start with fixation of the fibula with a plate or with a screw ( in some cases the screw is better because it is minimally invasive). Fibular plate may add stability to the external fixator of the tibia, especially if there is a defect or comminution of the metaphysis of the tibia. Plating of the fibula adjunct to external fixation of the tibia. When there is a metaphyseal defect of the tibia, plating of the fibula can enhance the stiffness of the external fixator. Axial loading 2.2 times stiffer with plated fibula. Torsional force has no significant difference. Approaches are many and it varies between limited approach and extensile approach. Try to protect the superficial peroneal nerve. Dual incisions approach. Make sure that the distance between the incisions is no less than 7 cm. this is controversial. Everybody agrees that staged ORIF is the best. Significant disability in physical function was noted even with successful treatment in 36-item short form survey (SF-36). Improvement of function and pain may take up to 2 years and eventually, about 10-15% may need arthrodesis. Pilon fracture with a fracture of the tibial shaft: Do fixation of the articular surface (usually percutaneously) then do fixation of the tibial shaft, usually with IM rodding. Put external fixator calcaneal pins or talar pins. I usually put the calcaneal pin on the medial side of the ankle. Be aware of the location of the neurovascular structures, error in placement or the direction of the calcaneal pin can interfere with the neurovascular bundle. Avoid the bulge area. Application od the calcaneal traction pin is done at the posteromedial site. There is a ¾ distance between the palpable tip of the medial malleolus and the heel. The calcaneal transfixation pin is inserted in a transverse direction. It is better to keep the pin away from the area of future incisions. Talus pin insertion •Pin insertion should be medial to lateral. •Anterodistal to anterior colliculus. •Placement should be in 10 degrees anterocephalad direction. Three principles of pilon fracture: 1-Anatomical reduction 2-Stable internal fixation 3-Early range of motion. Achieving these three principles in every case of pilon fracture may not be possible. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 21814 nabil ebraheim
http://www.facebook.com/StefanDuellSportsPhysiotherapy Regarding my previous post about myofascial treatment of the inversion trauma, it is very important to correct the tibiotalar joint if it is still in the wrong position. Usually if you do a proper myofascial release treatment it will correct itself but sometimes it can still stay in the wrong place. If so, there is a high chance to suffer from an ankle dorsiflexion range of motion (DO ROM) deficit which can be reduced significantly through this kind of manipulation! ⚠️But watch out: never do this manipulation in the acute phase of an inversion trauma as it can lead to an internal bleeding and edema. To be on the secure side you can apply the HVLA thrust technique 4-5 days after the injury happened‼️ . The tibiotalar joint involves the talus moving in the ankle mortise, the major motions of this joint are dorsiflexion and plantarflexion. Dorsiflexion is more functional, more stable because the talus is wider anteriorly and fits securely into the ankle mortise. Reduction in dorsiflexion usually indicates that the tibia is anterior on the talus. The talus usually subluxates anteriorly, superiorly with medial rotation. To reduce the talus subluxation your contact will be on the anterior medial neck of the talus, the elbows will be parallel to each other, the therapist stands in a stable position and applies an high velocity low amplitude thrust technique.
Views: 656 Sports-Physiotherapy Stefan Duell
Anatomy of the subtalar and talocalcaneonavicular joints. in addition to brief idea about other joints of the foot as a part of the locomotor system.
Views: 645 Dr.Ahmed Farid
Ankle joint Imaging part 1 - by Prof. Dr. Mamdouh Mahfouz (2018) Discussed in Arabic
Views: 3586 Mamdouh Mahfouz
Dr. Ebraheim animated educational video describing the common tests used to diagnose injuries of the foot and ankle.ankle examination for ankle sprain ,ankle fracture and ankle injury.ankle examination orthopedic is explained and the ankle tests are shown.thompson test ,squeeze test and stress test of the ankle is shown .sprain ankle ,Achilles tendon rupture and fracture ankle are common .ligament ankle injury should be diagnosed .ankle pain from running ,ankle pain and swelling .diagnosis of ankle pain .ankle pain tests ankle pain examination . Ankle pain exercises and ankle pain treatment .ankle anatomy and Peroneal tendon subluxation, ankle instability .ankle fractures and ankle stress fractures. • The Anterior Drawer Test: This test is used to test the integrity of the anterior talofibular ligament, which is the weakest and the most commonly injured ligament in ankle sprains (lateral collateral ligament). • The Talar Tilt Test: Is used to test the calcaneofibular ligament, and is probably testing the anterior talofibular ligament and the calcaneofibular ligament. • The Squeeze Test: - High ankle sprain - At the calcaneus to check for stress fracture of the calcaneus. - At the metatarsals: to check for morton’s neuroma. In addition to the squeeze test, you can use the external rotation test or the gravity test to check for syndesmotic injury. • Thompson Test: will test tear of the Achilles tendon. • The best test of all is the ability to bear weight, if you cannot bear weight, then there probably is an ankle fracture. 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: 14403 nabil ebraheim
For more episodes and additional information about this post visit www.thewoddoc.com www.thewoddoc.com Subscribe Now.... New Episodes Daily Check WODdoc out on Facebook, Instagram, Twitter, & SnapChat: https://www.facebook.com/thewoddoc
Views: 55416 WOD doc
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: 124579 nabil ebraheim
Dr. Ebraheims animated educational video describing the condition of chronic lateral ankle instability Ankle sprain is a common injury that occurs with sports activities and the lateral ligaments are the most commonly injured ligaments in the ankle. Three ligaments on the ankle joint on the lateral side: 1- Anterior talofibular ligament: is the weakest ligament of all three of them, the integrity of this ligament is tested by preforming the anterior drawer test. 2- The posterior talofibular ligament: is the strongest of the three ligaments. 3- Calcaneofibular ligament: injury to this ligament usually occurs after injury to the anterior talofibular ligament, the integrity of this ligament is tested by preforming the talar tilt test. If the patient cannot bear weight after what is suspected ankle sprain, then you need to get an x-ray to check if the patient has a fracture. Acute ankle sprains are usually treated by: • Immobilization • Ice • Physical therapy • Surgery (rare) Sometimes these ligaments do not heal and become incompetent. Incompetence of these ligaments may create chronic lateral ankle instability. You may want to examine the hindfoot for varus malalignment. Occult varus may lead to treatment failure. Check for peroneal muscles and tendon weakness which is a frequent cause of lateral ankle instability. If you find that there is hindfoot varus, you may need to do the coleman block test to differentiate between fixed and flexible hindfoot varus. The treatment will be different. Treatment: The majority of ankle sprains will heal with time and are treated with: • Rest • Physical therapy - Peroneal muscle strengthening with proprioception and range of motion of the ankle. In some cases the patient may not get better and may have: • Mechanical instability or functional instability • Patient may not improve with conservative treatment - Patient may require surgery What type of surgery may be necessary? • Anatomic repair (Brostrom procedure). Direst repair of the attenuated ligament. OR • Anatomis repair (Modified Brostrom procedure). • Direct ligament repair with augmentation using the inferior extensor retinaculum. • A graft can be used if the Brostrom technique fails. For chronic lateral ankle instability, we also need to look for other conditions such as peroneal tendon pathology, fractures, joint lesions, or arthritis. There are a lot of differential diagnosis for this area that can create ankle instability. These are some of the other causes that can create the same symptoms of pain and instability of the lateral ankle. When pain is located posterior to the fibula, you can blame this on peroneal tendon pathology. The peroneal tendons are subjected to excessive repetitive forces causing pain, swelling, and instability of the lateral ankle. Treated by injection or possibly surgery (synovectomy). The superior peroneal retinaculum is usually holding two peroneal tendons behind the fibula. The inferior peroneal retinaculum is not as important as the superior peroneal retinaculum. Superior peroneal retinaculum tear: - Tear may lead to subluxation of the peroneal tendons. - Do physical therapy or reconstruction of the superior peroneal retinaculum. Peroneal tendon subluxation occurs with dorsiflexion and inversion; however it is tested with dorsiflexion and eversion against resistance. Peroneus longus or brevis tendon rupture or tear: - Tear of the peroneus longus tendon may occur at the peroneal tubercle with the Os Peroneum migrationg proximally. - Tears of the peroneus brevis may occur with peroneal tendon subluxation. - In these cases you will do repair or tenodesis of the torn tendon. Lesions inside the joint: - Osteochondral lesion of the talus (OCD): they are 2 types: • Posteromedial • Anterolateral Treatment: • NSAIDS • Physical therapy • Surgical treatment: ankle arthroscopy. - If the OCD lesion is less than 1 cm then you will do excision, curettage, or drilling of the lesion. - Anterolateral Impingement: painful limitation of full range of ankle motion due to asseous (bony) or soft tissue pathology. - Treatment: • physical Therapy • injection • arthroscopic debridement of the impingment - ankle synovitis: you do synovectomy. - Ankle arthritis: ankle arthritis of the ankle joint usually results from prior injury or inflammation to the ankle joint. - It can be diagnosed by an exam or by an x-ray. - We start with conservative treatment, brace, injection, if nothing works do arthrodesis or total ankle surgery if conservative treatment fails. - If there is loose bodies inside the ankle, remove it. - There may be some fractures that cause instability of the ankle, like lateral process fracture of the talus, anterior process fracture of the calcaneus. - Jones fracture or Pseudo- Jones fracture. - The treatment is specific for the type of fracture. - This needs to be diagnosed and treated accordingly. - Osteal coalition: may cause frequent ankle instability.
Views: 88680 nabil ebraheim
In my experience (comparative radiological studies), the most common fibular head dysfunctions are: 1) Antero-superior (even if for classical osteopathy it would be impossible!). 2) Postero-superior.After reduction of a subluxation of the ANTERO-SUPERIOR or POSTERO-SUPERIOR fibular head = apply a flexible adhesive tension (STRAPPING) maintains the upper Tibio-fibular joint, a few days: avoids early recurrences. This strapping of the two most frequent fibular malpositions: antero-superior and postero-inferior (80%) can then be relayed by a velcro neoprene strap, normally intended for patellar tendinopathies! As its common in gonalgia, it would be great for a manufacturer to produce a specific orthosis for the upper Tibio-fibular ... Sometimes, when I doubt about the direction of the subluxation, applying these tapes serves as a diagnostic test!!! 3) For the strapping of an inferior subluxation: it is the same idea, but by raising the fibular head. And here, I avoid the "velcro" contention which tends to go down. https://osteopathie-adhesiolyse.com/en/joints/knee-osteopathy/
Views: 7112 HO-PUN-CHEUNG Thierry
For the Ankle Joint Ligament Injury to heal completely and in the fastest possible time, it is imperative to do the following exercises, which is shown in the video diligently. In post ankle joint ligament injury, there is substantial swelling and reduced range of motion of the ankle. Learn about the exercises and recovery time for ankle joint ligament injury. Also Read: https://www.epainassist.com/sports-injuries/ankle-injuries/ankle-joint-ligament-injury Follow us: Facebook: https://www.facebook.com/Epainassistcom-370683123050810/?ref=hl Twitter: https://twitter.com/ePainAssist G+: https://plus.google.com/+Epainassist Linkedin: https://www.linkedin.com/in/epainassist
Views: 68447 ePainAssist
Dr.Mohamed Wahdan Lectures http://docdro.id/9wq1cgz
Views: 750 Dr.Wahdan Lectures
Dr.Mohamed Wahdan Lectures http://docdro.id/9wq1cgz
Views: 574 Dr.Wahdan Lectures
This video is an informative animated presentation that explains in detail about osteoarthritis. Arthritis is any disorder that affects joints, it can cause pain and inflammation. Osteoarthritis or degenerative arthritis is the most common type of joint disease. It’s usually seen in older people. The joints most commonly affected are in the hands, knees, hips and spine. Often the causes of osteoarthritis are unknown, but it may be due to a combination of the following risk factors; a family tendency for this condition, being overweight, a joint injury such as a fracture, repetitive strain from the activities such as sports, and problems with the bones in a joint not lining up properly. Over many years, these factors can wear away the articular cartilage. The exposed bony surfaces rub together, this along with the growth of bony projections, called bone spurs, causes swelling, pain and limited movements at the joints. Watch the video to know more in detail about the disease and Osteoarthritis treatment. To know more visit our website : https://www.manipalhospitals.com/ Get Connected Here: ================== Facebook: https://www.facebook.com/ManipalHospitalsIndia Google+: https://plus.google.com/111550660990613118698 Twitter: https://twitter.com/ManipalHealth Pinterest: https://in.pinterest.com/manipalhospital Linkedin: https://www.linkedin.com/company/manipal-hospital Instagram: https://www.instagram.com/manipalhospitals/ Foursquare: https://foursquare.com/manipalhealth Alexa: http://www.alexa.com/siteinfo/manipalhospitals.com Blog: https://www.manipalhospitals.com/blog/
Views: 217040 Manipal Hospitals
Ann Hoke, senior faculty member and senior examiner of NAIOMT, is shown here demonstrating a very thorough assessment and treatment of the superior tib-fib joint complex. This demonstration is part of a series of lectures and demonstrations aimed at the Level II NAIOMT curriculum. Full details can be found at www.naiomt.com
Views: 13900 NAIOMT1
Dr. Ebraheim’s educational animated video describes the structures that insert into the fibular head is a simple and easy way and explains the anatomy of the region with simple and clear images that provides you with all you need to know. 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: 10718 nabil ebraheim
Dr. Ebraheim’s educational animated video describes the anatomy of the lateral ankle, the bony structure, muscles, and nerves, and the injuries of the lateral ankle area. Ligaments around the ankle •Anterior talofibular ligament •Posterior talofibular ligament •Calcaneofibular ligament Peroneal tendons •Peroneus Brevis tendon •Superior & inferior peroneal retinacula •Peroneus longus tendon There are many structures present on the lateral side of the ankle. These structures are often susceptible to injury. Diagnosis of these injuries can be confusing and many of these injuries can be missed. Diagnosis of a sprained ankle may be the wrong diagnosis. Common injuries and conditions around the lateral ankle. 1-Ankle Sprain 2-High ankle sprain (syndesmotic injury). 3-Peroneal tendon subluxation. 4-Rupture of the peroneus longus tendon 5-Peroneal tendonitis 6-Anterior process of the calcaneus fracture. 7-Lateral process of the talus fracture 8-Achilles tendonitis
Views: 46911 nabil ebraheim
Dr Donald A Ozello DC of Championship Chiropractic in Las Vegas, NV is the author of "Running: Maximize Performance & Minimize Injuries." He can be found on the web at http://www.championshipchiropractic.com Dr Ozello's Sports Medicine Report is a weekly video that covers a different injury or body part each episode. Dr Ozello describes the anatomy and mechanism of injury in detail. He provides information on the intrinsic and extrinsic factors of the injury and discusses prevention and rehabilitation strategies to remove the sources of the condition. A playlist is available with videos demonstrating exercises & rehabilitation techniques. "Running: Maximize Performance & Minimize Injuries" is available in paperback & ebook. https://www.amazon.com/dp/1493618741/... Serious ankle sprains may possess long-term sequelae. If not healed properly, ankle sprains commonly recur. A serious ankle sprain can be worse than a broken bone because bones grow back stronger while an injured ligament may not heal completely. Ligaments are connective tissues made of tough collagen fibers that attach bones to other bones. Ligaments provide support & stabilize joints by preventing excessive motion. The most common location of ankle sprains is the outer or lateral region. Eighty percent of ankle sprains take place in the lateral area. Strong ligaments attach the bone of the lower leg to several bones in the foot. The ligaments of the lateral ankle function by preventing excessive inward turning of the ankle, or inversion. Three ligaments attach the lower aspect of the fibula to the foot. The anterior talofibular ligament, calcaneofibular ligament & posterior talofibular ligament. Most ankle sprains occur to the anterior talofibular ligament or calcaneofibular ligament. Sprains are injuries to ligaments. Sprains are classified according to severity. Mild (Grade 1) Stretching & microscopic tearing. Grade 2 (moderate) Partial tear. Grade 3 (Severe) Complete rupture. In most cases, a lateral ankle sprain occurs traumatically when the athlete’s ankle twists or turns to a larger degree than the ligaments would normally move. Traumatic ankle sprains usually occur when the runner is on uneven ground or an unsteady surface. Traumatic ankle sprains are one of the most common sports injuries. Lateral ankle sprains can occur or recur in a non-traumatic fashion. Non-traumatic ankle sprains develop from overuse, poor training technique, incorrect lower leg biomechanics, poor proprioception & incomplete healing of a prior ankle sprain. Correct these contributing factors to lessen & prevent the occurrence & recurrence of non-traumatic ankle sprains. Symptoms of traumatic ankle sprains begin immediately. Sharp pain is felt instantly. Followed by lack of motion, limited strength, inability to bear weight, swelling & bruising. Symptoms of a severe ankle sprain may persist for months. Symptoms of non-traumatic ankle sprains usually begin insidiously. Symptoms are described as a deep, dull ache that is tender to the touch & increases with walking, running & standing, or with foot & ankle motions. Localized ankle swelling may persist for months. If a lateral or medial ankle sprain occurred in the past, the ligaments might not have healed properly. Improper ligament healing leads to joint instability or a feeling of the ankle weakness or a sensation of “giving way.” A prior ankle sprain that did not heal properly or completely is the major intrinsic factor in the recurrence of the injury. Effective ankle rehabilitation may be long & tedious. Ligaments take time to heal completely & properly. Prevent recurrences by providing your ankle the tools & time it needs to heal properly. Your patience will pay off in the long run. Execute a comprehensive rehab program for optimal results. A detailed ankle rehabilitation program includes motion, strengthening, stabilizing & proprioception exercises. Pay close attention to your ankle before, during & after Training. Never attempt to push through pain when returning from an ankle sprain. Ankle injuries are common. Train smart & listen to your body to prevent & better rehab ankle sprains. Dr Donald A Ozello DC wishes you success in life and in your athletic endeavors. Train hard, train smart, stay injury free and accomplish your goals.
Views: 82 Dr Donald A Ozello DC
see my website: http://si-instability.com/fibularpain-com/ for blog regarding Pain and stability control for Chronic Proximal Tibiofibular Joint Posterior Subluxation/Instability with Knee immobilized and ankle tapped/wrapped for pain control and last effort to have some stability to joint, partial weight-bearing with crutches for a month while considering surgery to stabilize joint
Views: 2127 AHEHealth
https://www.p2sportscare.com/ankle-pain-runners/ Huntington Beach CA 714-502-4243 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: 46011 Sebastian Gonzales
http://vivaint.biz/net/azol FO FREE! It seems you can hardly get through your day without something hurting. Finally, there's a natural solution to those annoying aches and pains with Eazol. Order your free trial today! Limited supp;y! Hurry up!
Views: 154 How to cure joints.
PROXIMAL TIBIOFIBULAR JOINT The following lecture comprehensively presents information regarding Tibiofibular Joint. Section one of this lecture focuses on Proximal Tibiofibular Joint. The educator puts forth the Definition of Proximal Tibiofibular Joint in the beginning and then explains its Articulation. Later, the educator explains what Type of joint a Proximal Tibiofibular Joint is. In addition to this, light is shed on the Capsule and Ligaments of this joint. SYNOVIAL MEMBRANE AND MOVEMENTS The prime focus of section two is the elucidation of Synovial Membrane and Movements of Proximal Tibiofibular Joint. The educator begins by demonstrating the Synovial Membrane. After this, the Nerve Supply is discussed. At the end of this section, the educator extensively talks about the Movements of Proximal Tibiofibular Joint. DISTAL TIBIOFIBULAR JOINT Section three covers the topic of Distal Tibiofibular Joint. The educator begins by explaining Tibiofibular Syndesmosis. Afterwards, the educator gives comprehensive information about Inferior Tibiofibular Joint and highlights its Articulation. Moreover, light is shed on the Type of joint the Distal Tibiofibular Joint is. At the end of this section, the Ligaments of this joint are explained in detail. NERVE SUPPLY AND FUNCTIONS Section four is about Nerve Supply and Functions of Distal Tibiofibular Joint. The educator gives a comprehensive overview of the Nerve Supply and talks extensively about Distal Tibiofibular Joint’s Movements. Later, the discussion shifts towards Function which is followed by an elucidation of Motions Available. The educator concludes this section by shedding light on Syndesmosis Ligaments Attachment. CLINICAL SIGNIFICANCE In section five, the educator reports Clinical Significance of Tibiofibular Joint. First of all, the educator focuses on the injuries of Proximal Tibiofibular Joint and provides a thorough overview of various Types of Dislocation that can occur in this case. Moreover, an insight into the Pathology/Injury of Distal Tibiofibular Joint is also provided. Apart from this, the educator talks about Clinical Conditions and brings the topic of Ankle Fracture under consideration. ------------------------------------------------------------- Watch complete lecture on sqadia.com: https://www.sqadia.com/programs/tibiofibular-joint Lecture Duration: 00:48:51 Released: October 2018 Full List of Medical Anatomy Lectures: https://www.sqadia.com/categories/anatomy ------------------------------------------------------------- So, what is sqadia.com? sqadia.com is the best global V-Learning™ platform for all medical students and clinical professionals. Already hundreds of lectures are available and new additions every single day! Try for FREE! https://www.sqadia.com/pages/freebies ------------------------------------------------------------- MEDICAL LECTURES IN BASIC AND CLINICAL COURSES https://www.sqadia.com/pages/courses Anatomy - Anatomy (Embryology) - Anatomy (Histology) - Biochemistry - Cell Biology - Dermatology - Ear, Nose and Throat - Genetics - Immunology - Medical Statistics - Medicine - Medicine (Cardiology) - Medicine (Forensic) - Microbiology - Obstetrics and Gynaecology - Pathology - Pharmacology - Physiology - Psychology - Surgery (General) - Surgery (Orthopaedics) ------------------------------------------------------------- MEDICAL V-LEARNING™ ON SOCIAL MEDIA Facebook: https://www.facebook.com/sqadiacom Instagram: https://www.instagram.com/sqadiacom Vimeo: https://vimeo.com/sqadiacom Twitter: https://twitter.com/sqadiacom LinkedIN: https://www.linkedin.com/showcase/sqadia-com Pinterest: https://www.pinterest.com/sqadiacom TumblR: https://sqadiacom.tumblr.com ------------------------------------------------------------- Anatomy is a basic course in the Medical sciences concerned with the identification and description of the human body structures. sqadia.com provide you detailed medical video lectures covering all aspects of anatomical features and syllabus for medical students, as per ''Grant's Atlas of Anatomy'' by Anne M.R. Agur. Gross Anatomy is the study of macroscopic structures that are visible to the eye without the help of an instrument. sqadia.com V-Learning™ improves student’s learning and helps to identify macroscopic structures using high quality images in PowerPoint presentations (PPT). From Meninges to Ankle, Subtalar and Foot Joints, video presentations cover both, regional and systemic approach. Anatomical position is the description of any region or part of the human body in a specific stance. Our engaging and passionate educators illustrate relationship of structure by the help of anatomical positions. Watch sqadia120 at sqadia.com, 2-Minute clips through which medical students will learn the concepts in a more advanced way and in a shorter time as well as Medical professionals can get a glimpse into Anatomy. -------------------------------------------------------------
Views: 183 sqadia.com
Dr. Ebraheim’s educational animated video describing the anatomy the injury the diagnosis and treatment of ankle fracture. Surgical tactics and strategy. The goal of surgery is to reduce the talus in an anatomical position under the tibia. Once the fractures have been fixed then stress views can be used to rule out a syndesmotic injury. The most effective method utilized to rule out the presence of syndesmotic injury is the use of stress view examinations. Rule out syndesmotic injury using intraoperative stress views which is the most relieable method. Check medial clear space which is the distance between the lateral border of the medial malleolus and the medial border of the talus, measured at the level of the talar dome. Check tibiofibular clear space. Direct inspection of the syndesmosis: excessive movement of the fibula with the use of a bone hook is another diagnostic method for syndesmotic injury. Excessive movement is abnormal. How do you do the intraoperative stress views? •Place ankle into neutral position. •Apply external rotation stress. •Get mortise view radiograph. Syndesmotic injury fixation •Reduction •Screw fixation
Views: 428728 nabil ebraheim
Average Collateral Ligament Injury of the Knee (MCL Tear). What is an average insurance tendon (MCL) damage? The average security tendon (MCL) is situated on the internal viewpoint, or part, of your knee, however it's outside the joint itself. Tendons hold bones together and add security and quality to a joint. The MCL associates the highest point of the tibia, or shinbone, to the base of the femur, or thighbone. Damage to the MCL is frequently called a MCL sprain. Tendon wounds can either extend the tendon or tear it. MCL damage of the knee is normally caused by an immediate hit to the knee. This kind of damage is regular in contact sports. It's typically the consequence of a hit or hit to the external part of the knee, which extends or tears the MCL. Sorts of MCL wounds. MCL wounds can be grades 1, 2, or 3: A review 1 MCL damage is the minimum extreme. It implies that your tendon has been extended however not torn. A review 2 MCL damage implies that your tendon has been somewhat torn. This as a rule causes some shakiness in your knee joint. A review 3 MCL damage is the most serious kind of tendon damage. It happens when your tendon has been totally torn. Joint unsteadiness is basic in a review 3 MCL sprain. What are the side effects of a MCL damage? The manifestations of a MCL damage are like side effects of other knee issues. It's imperative for your specialist to look at your knee to decide the issue. The manifestations of a MCL damage may include: a popping sound upon damage. agony and delicacy along the inward piece of your knee. swelling of the knee joint. an inclination that your knee will give out when you put weight on it. securing or getting in the knee joint. How is a MCL damage analyzed?. Your specialist can frequently tell on the off chance that you have a MCL damage by inspecting your knee. Amid the examination, your specialist will twist your knee and put weight outwardly of it. They'll have the capacity to tell if your inward knee is free, which would demonstrate a MCL damage. It's imperative that you unwind your leg muscles amid the examination. This makes it less demanding for your specialist to test the solidness of your tendons. You may feel some torment and delicacy in your knee amid the examination. Your specialist may arrange imaging tests to help analyze your knee damage. A X-beam will give your specialist a picture of the bones in your knee. This can enable them to discount other knee issues. Amid a X-beam, a professional will position your knee with the goal that the machine can record pictures. This may cause some agony if your knee is delicate or swollen. Be that as it may, the procedure will just take a couple of minutes. The X-beam will tell your specialist if there's damage to the bones in your knee. Your specialist may likewise arrange a MRI check. This is a test that utilizations magnets and radio waves to deliver pictures of the body. For this test, you'll rests on a table and an expert will position your knee. The MRI machine regularly makes noisy commotions. You might be offered earplugs to ensure your ears. The table will slide into a scanner and pictures of your knee will be recorded. You'll have the capacity to speak with your professional through a receiver and speakers in the machine. The pictures from the MRI will tell your specialist on the off chance that you have an issue in the muscles or tendons of the knee. How is a MCL damage treated? Treatment choices shift contingent upon the seriousness of the MCL damage. Most MCL wounds will recuperate without anyone else following fourteen days of rest. Prompt treatment. Prompt treatment is important to ease agony and help balance out your knee. Quick treatment alternatives include: applying ice to lessen swelling lifting your knee over your heart to help with swelling. taking nonsteroidal calming drugs (NSAIDs) to ease torment and swelling compacting your knee utilizing a flexible gauze or prop. resting. utilizing braces to keep weight off of your harmed knee. All Photos Licensed Under CC Source : www.pexels.com www.pixabay.com www.commons.wikimedia.org
Views: 4530 Health Care
Test for presence of injury to the anterior talofibular ligament. The test is positive if inversion is painful with palpable tenderness over the ligament. A positive test indicates a sprained / lesion of the anterior talofibular ligament. To find out more about our work and the full range of our publications please visit our website: http://www.clinicalexams.co.uk/ The complete videos can be streamed or downloaded from our Vimeo site: https://vimeo.com/user21235595/vod_pages Excerpts and free video clips can be found on our YouTube channel: https://www.youtube.com/channel/UCyG7qeIHTBGlJqNrBi-_1NA/videos?view_as=public&shelf_id=1&view=0&sort=dd Bloomsbury Educational Limited 97 Judd Street, London, WC1H 9JB http://www.clinicalexams.co.uk/ Please subscribe to our channel to benefit from new additions. DISCLAIMER Bloomsbury Educational will not be held responsible or liable for any kind of loss or injury incurred as a result of the information conveyed in our videos. All procedures must be practiced in a supervised professional clinical setting. Andreas Syrimis, Bloomsbury Educational Limited.
Views: 7753 Clinical Examination Videos
Imaging of Ankle joint and foot (I) - Prof. Dr. Mamdouh Mahfouz DRE series Discussed in English
Views: 2396 Mamdouh Mahfouz